Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2022 Oct 3;5(10):e2236384. doi: 10.1001/jamanetworkopen.2022.36384.
Fruit drinks are widely consumed by young children, and many parents mistakenly believe that these drinks are healthy, potentially due to front-of-package claims and imagery. Research is needed on the influence of this marketing and how labeling regulations could change behavior.
To assess the effects of a front-of-package 100% vitamin C claim, fruit imagery, percentage juice and teaspoons of added sugar disclosures, and high-added sugar warnings on parents' choices, knowledge, and perceptions of beverages.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted May to July 2021 as a single-exposure (no follow-up) online survey of primary caregivers of children ages 0 to 5 years throughout the US.
Participants were shown no-, low-, and high-added sugar beverages and asked to choose 1 for their child. Participants were randomized to see high-added sugar beverages with 1 of 7 front-of-package conditions: (1) claim and imagery (control); (2) no claim; (3) no imagery; (4) no claim or imagery; (5) claim, imagery, and percentage juice disclosure; (6) claim, imagery, and warning; or (7) claim, imagery, warning, and teaspoons of added sugar disclosure.
Primary outcomes were type of beverage chosen (eg, high-added sugar beverage) and resulting calories and added sugar (in grams). Secondary outcomes were fruit drink knowledge (added sugar and percent juice) and perceptions.
There were 5005 participants included in the final analysis (mean [SD] age, 31.5 [8.3] years; 3587 female participants [71.7%]), including 714 participants in group 1, 717 participants in group 2, 710 participants in group 3, 717 participants in group 4, 708 participants in group 5, 729 participants in group 6, and 710 participants in group 7. Compared with participants in the control group, who had a mean (standard error [SE]) of 9.4 (0.5) g of added sugar and 81.9 (1.6) kcal in chosen beverages, only participants who saw warnings with teaspoons of added sugar disclosures had significantly reduced added sugar (-1.3 g; 95% CI, -2.6 to -0.1 g [-14.2%; 95% CI, -26.7% to -1.8%]; P = .04) and calories (-5.3 kcal; 95% CI, -9.8 to -0.9 kcal [-6.5%; 95% CI, -11.8% to -1.3%]; P = .02) in selected beverages. In warning conditions (ie, 6 and 7) compared with the control group (mean [SE] 41.0% [1.8%]), the proportion of participants choosing high-added sugar beverages was significantly reduced, by 5.5 percentage points (95% CI, 0.5 to 10.5 percentage points [13.4%; 95% CI, 1.2% to 25.6%]; P = .03) and 6.4 percentage points (95% CI, 1.4 to 11.4 percentage points [15.6%; 95% CI, 3.3% to 27.8%]; P = .01), respectively. The no claim or imagery condition (4) significantly reduced the proportion of parents choosing high-added sugar beverages (-7.6 percentage points; 95% CI, -12.6 to -2.6 percentage points [-18.4%; 95% CI, -30.6% to -6.3%]; P = .003). Percentage juice disclosures did not affect beverage choice.
These findings suggest that added sugar warnings and prohibitions of front-of-package claims and imagery may reduce parents' purchases of high-added sugar beverages for their young children but that percentage juice disclosures may not change behavior.
ClinicalTrials.gov Identifier: NCT04811690.
果汁饮料深受幼儿喜爱，许多家长误以为这些饮料是健康的，这可能是由于包装正面的声称和图像的影响。需要研究这种营销的影响以及标签法规如何改变行为。
评估 100%维生素 C 声称、水果图像、果汁百分比和添加糖量披露以及高添加糖警告对父母选择、知识和对饮料的看法的影响。
设计、设置和参与者：这是一项 2021 年 5 月至 7 月进行的随机临床试验，作为一项针对美国各地 0 至 5 岁儿童主要照顾者的单次暴露（无随访）在线调查。
参与者被展示了低添加糖和高添加糖饮料，并被要求为孩子选择 1 种。参与者被随机分配到高添加糖饮料，有 7 种包装正面条件之一：（1）声称和图像（对照组）；（2）无声称；（3）无图像；（4）无声称或图像；（5）声称、图像和果汁百分比披露；（6）声称、图像和警告；或（7）声称、图像、警告和添加糖量披露。
主要结果是选择的饮料类型（例如，高添加糖饮料）以及由此产生的卡路里和添加糖量（以克为单位）。次要结果是对果汁饮料的知识（添加糖和果汁百分比）和看法。
共有 5005 名参与者进入最终分析（平均[标准差]年龄，31.5[8.3]岁；女性参与者 3587 名[71.7%]），包括对照组 1 组 714 名参与者，对照组 2 组 717 名参与者，对照组 3 组 710 名参与者，对照组 4 组 717 名参与者，对照组 5 组 708 名参与者，对照组 6 组 729 名参与者，对照组 7 组 710 名参与者。与对照组相比，参与者选择的饮料中添加糖的平均（标准误差[SE]）为 9.4（0.5）g，卡路里为 81.9（1.6）kcal，只有看到添加糖量披露警告的参与者添加糖量显著减少（-1.3 g；95%置信区间，-2.6 至-0.1 g [-14.2%]；95%置信区间，-26.7%至-1.8%]；P = 0.04）和卡路里（-5.3 kcal；95%置信区间，-9.8 至-0.9 kcal [-6.5%]；95%置信区间，-11.8%至-1.3%]；P = 0.02）。在警告条件（即 6 和 7）与对照组（平均[SE]41.0%[1.8%]）相比，选择高添加糖饮料的参与者比例显著降低，降低了 5.5 个百分点（95%置信区间，0.5 至 10.5 个百分点[13.4%]；95%置信区间，1.2%至 25.6%]；P = 0.03）和 6.4 个百分点（95%置信区间，1.4 至 11.4 个百分点[15.6%]；95%置信区间，3.3%至 27.8%]；P = 0.01）。无声称或图像条件（4）显著降低了父母选择高添加糖饮料的比例（-7.6 个百分点；95%置信区间，-12.6 至-2.6 个百分点[18.4%]；95%置信区间，-30.6%至-6.3%]；P = 0.003）。果汁百分比披露不会影响饮料选择。
这些发现表明，添加糖警告和禁止包装正面声称和图像可能会减少父母为年幼子女购买高添加糖饮料的行为，但果汁百分比披露可能不会改变行为。
ClinicalTrials.gov 标识符：NCT04811690。
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