Effects of front-of-package labels for added sugars and non-sugar sweeteners (NSS) on parents perceptions and selections of foods and beverages for their children: a randomized experiment

Abstract

Introduction: This study aimed to evaluate effects of front-of-package labels (FOPL) for added sugars and non-sugar sweeteners (NSS) on selection and perceptions of foods and beverages. Methods: Parents of children 2-12 years old (n= 2,896) completed an online survey and were randomized to: no-FOPL control (n = 990), added sugar FOPL (n = 949), or FOPLs for both added sugars and NSS (n = 957). Participants were shown four fruit drinks and four yogurts. For each set, one product was unsweetened, one was sweetened with added sugars, one with NSS, and one had added sugars and NSS. Products were shown in random order, with FOPLs per assigned treatment arm. Participants also viewed six NSS-containing products separately and reported their purchase intentions and product perceptions. Results: Participants exposed to the added sugar and NSS FOPLs were more likely to choose the unsweetened fruit drink (58% versus 39% for added sugar FOPL (p<0.001) and 32% for control (p<0.001)) and unsweetened yogurt (60% versus 29% for added sugar FOPL arm (p<0.001) and 14% for control (p<0.001)). Participants in the added sugar and NSS FOPL arm were also more likely to identify unsweetened products as the healthiest (70% for fruit drinks, 76% for yogurts), compared to the added sugar FOPL arm (46% for fruit drinks, 49% for yogurts) and control (37% for fruit drinks, 33% for yogurts) (all p<0.001). Those who viewed NSS FOPLs also had lower purchase intentions and perceptions of product healthfulness for NSS products, and higher perceptions of product sweetness compared to the added sugar FOPL or control arms. Conclusions: Viewing products with both added sugar and NSS FOPLs increased the likelihood of choosing the unsweetened option and lowered purchase intentions and healthfulness perceptions of NSS-containing products. FOPLs for both NSS and added sugar may support parents in making healthier choices for their children.

Competing Interest Statement

Allison C. Sylvetsky has engaged in consulting work for Spindrift Beverage Co. Inc. and is also engaged in consulting work on behalf of Abbott. The other authors do not have any conflicts of interest to disclose.

Clinical Trial

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Funding Statement

This study was funded by a grant from Healthy Eating Research (PI: Sylvetsky).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board (IRB) at the George Washington University gave ethical approval for this work.

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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