• Aviva A Musicus, Laura A Gibson, Scarlett L Bellamy, Jennifer A Orr, David Hammond, Karen Glanz, Kevin G Volpp, Marlene B Schwartz, Amy Bleakley, Andrew A Strasser, and Christina A Roberto.
• Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address: aam231@mail.harvard.edu.
• Am J Prev Med. 2023 May 1; 64 (5): 716727716-727.

IntroductionMultiple U.S. localities have introduced legislation requiring sugar-sweetened beverage (SSB) warnings. This study effects of different warning designs on beverage selections and perceptions.Study DesignThe study was an RCT.Setting/ParticipantsAn online virtual convenience store and survey were used with a nationally representative sample of primary caregivers of 6-11-year-olds (n=961). Data were collected in January 2020 and analyzed in May-July 2020.InterventionParticipants were randomized to view SSBs with 1 of 4 front-of-package label designs: (1) no-warning control, (2) health-related text warning, (3) sugar pictorial warning (image of beverage sugar content in cubes/teaspoons/packets with health-related warning text), or (4) health pictorial warning (image of possible health consequences of overconsuming SSBs with health-related warning text).Main Outcome MeasuresOutcomes included participants' beverage choice for their child and perceptions of beverages, their assigned labels, and warning policies.ResultsProportionally fewer participants chose a SSB in the sugar pictorial warning condition (-13.4 percentage points; 95% CI= -21.6 to -0.1 percentage points; p=0.007) and in the health pictorial warning condition (-14.7 percentage points; 95% CI= -22.8 to -0.1 percentage points; p=0.004) compared to the control. Sugar pictorial warnings led to more accurate added-sugar content estimates than all conditions and greater label trust and support for sugar-sweetened beverage warning policies than health pictorial warnings.ConclusionsSSB warning policies may be most effective if they mandate images of beverages' added sugar content accompanied by warning text.Trial RegistrationThis study is registered at www.Clinicaltrialsgov NCT03648138.Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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