Background

Sugar-sweetened beverage (SSB) consumption contributes to the risk of cardiometabolic disease and mortality. There has been growing interest in policies mandating SSB health warning labels at the point of purchase, but little is known about which label design would maximize impact.

Methods

Based on formative focus groups, we selected design elements for testing in a factorial experiment: loss- vs. gain-frame, text-only vs. text + icon, and no attribution vs. attribution to an authority. The base label color was bright yellow and text was: “Drinking beverages with added sugar(s) contributes to obesity, type 2 diabetes, and tooth decay.” We recruited 1,142 young adults from three diverse public universities. In an online experiment, participants were randomized to see beverage dispensers with no label (control) or with a label containing a combination of the elements above. We examined two outcome variables: 1) selecting an SSB in a hypothetical cafeteria with a one-drink limit and 2) the number of SSBs selected in a cafeteria with unlimited drinks. We used Poisson and log-linear regression with robust standard errors to compare levels of each factor and to compare each combination to the control. We also compared seeing any warning label to the control condition.

Results

No level out-performed the other, but compared to the controls, those viewing the loss-frame, icon, no attribution label were 41% less likely to select an SSB (P=0.01) when there was a one-drink limit and selected 23% fewer SSBs (P=0.05) with no limit. Those in the loss-frame, text-only, no attribution condition selected 26% fewer SSBs than controls (P=0.02) when there was no drink limit. Those who saw any warning were 15% less likely than controls to select an SSB (P=0.05) with a one-drink limit and selected 14% fewer SSBs (P=0.02) with no limit.

Conclusions

Two SSB warning designs outperformed the control condition in reducing SSB selection, and seeing any warning label in front of beverage dispensers decreased SSB selection.