How pictorial warnings change parents' purchases of sugar-sweetened beverage for their children: mechanisms of impact

Marissa G Hall; Anna H Grummon; Tara Queen; Allison J Lazard; Isabella C A Higgins; Ana Paula C Richter; Lindsey Smith Taillie

doi:10.1186/s12966-023-01469-3

How pictorial warnings change parents' purchases of sugar-sweetened beverage for their children: mechanisms of impact

Int J Behav Nutr Phys Act. 2023 Jun 23;20(1):76. doi: 10.1186/s12966-023-01469-3.

Authors

Marissa G Hall^{1

2

3}, Anna H Grummon^{4

5

6}, Tara Queen⁷, Allison J Lazard^{8

9}, Isabella C A Higgins^{7

10}, Ana Paula C Richter^{7

10}, Lindsey Smith Taillie^{10

11}

Affiliations

¹ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. mghall@unc.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. mghall@unc.edu.
³ Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. mghall@unc.edu.
⁴ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁵ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
⁶ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
⁷ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹¹ Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Background: Pictorial health warnings on sugar-sweetened beverages (SSBs) are a promising policy for preventing diet-related disease in children. A recent study found that pictorial warnings reduced parents' purchases of SSBs for their children by 17%. However, the psychological mechanisms through which warnings affect parental behavior remain unknown. We aimed to identify the mechanisms that explain how pictorial warnings affect parents' SSB purchasing behavior for their children using secondary data from a randomized trial.

Methods: In 2020-2021, parents of children ages 2 to 12 years (n = 325) completed a shopping task in a convenience store laboratory in North Carolina, USA. Participants were randomly assigned to a pictorial warnings arm (SSBs displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (SSBs displayed a barcode label). Parents then bought a beverage for their child and took a survey measuring 11 potential psychological mediators, selected based on health behavior theories and a model explaining the impact of tobacco warnings. We conducted simple mediation analyses to identify which of the 11 mechanisms mediated the impact of exposure to pictorial warnings on purchasing any SSBs for their children.

Results: Two of the 11 constructs were statistically significant mediators. First, the impact of pictorial warnings on the likelihood of purchasing any SSB was mediated by parents' perceptions that SSBs were healthier for their child (mediated effect= -0.17; 95% CI = - 0.33, - 0.05). Second, parents' intentions to serve SSBs to their children also mediated the effect of warnings on likelihood of purchasing any SSB (mediated effect= -0.07, 95% CI=-0.21, - 0.003).

Conclusions: Pictorial warnings reduced parents' purchases of SSBs for their children by making parents think SSBs are less healthful for their children and reducing their intentions to serve SSBs to their children. Communication approaches that target healthfulness perceptions and intentions to serve SSBs may motivate parents to buy fewer SSBs for their children.

Keywords: Childhood obesity; Mediators; Pictorial warnings; Sugar-sweetened beverages; Warning labels.

Publication types

Randomized Controlled Trial

MeSH terms

Beverages
Child
Consumer Behavior
Diabetes Mellitus, Type 2*
Humans
Parents
Sugar-Sweetened Beverages*

Abstract

Publication types

MeSH terms

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