Pictorial warnings pack a punch: Study finds decrease in parents' purchases of sugary drinks for kids

By Bhavana KunkalikarJun 27 2023Reviewed by Benedette Cuffari, M.Sc.

In a recent study published in the International Journal of Behavioral Nutrition and Physical Activity, researchers examine the impact of pictorial warnings on parents' decisions to purchase sugar-sweetened beverages (SSBs) for their children.

Study: How pictorial warnings change parents' purchases of sugar-sweetened beverage for their children: mechanisms of impact. Image Credit: Vintage Tone / Shutterstock.com

Warning labels to deter SSB consumption

The use of pictorial health warnings on SSBs is a potential policy to prevent diet-related illnesses in children. According to a recent study, pictorial warnings resulted in a 17% decrease in parents' purchases of SSBs for their children.

Nevertheless, the impact of these warnings on parental behavior's psychological mechanisms remains unclear. The present study aimed to determine the mechanisms responsible for how pictorial warnings impact parents' purchasing behavior of SSBs for their children.

About the study

The current study analyzed data obtained from a randomized trial involving 326 parents of children aged between two and 12 years. Trial participants were recruited from Central North Carolina between January and March 2020 using various methods such as in-person recruitment, email listservs, flyers, social media advertisements, and word of mouth.

The study required participants to be 18 years or older and have at least one child between the ages of two and 12 years who consumed a minimum of one SSB in the previous week. Participants were required to be proficient in English or Spanish, possess the ability to answer a survey using a computer or tablet and attend an in-person study visit.

The research was conducted at the UNC Mini Mart, a research-oriented convenience store spanning 245 square feet located in Chapel Hill, North Carolina. A parallel arm study design was employed, wherein participants were randomly assigned to either control labels or pictorial warnings by the staff.

Two pictorial warnings accompanied by relevant photographs were displayed to warn against the harmful effects of excessive consumption of sugary drinks, such as type 2 diabetes and cardiovascular disease. Several potentially confounding factors were also identified, including message reactions, beliefs and attitudes, and beliefs and intentions.

Mediators that influenced the effect of pictorial warnings on the purchase of SSBs in the Mini Mart were also determined.

Study findings

The average age of the parents was 38 years, 77% of whom were women. The group consisted of less than 50% non-Hispanic White individuals, 25% non-Hispanic Black individuals, and 20% Hispanics.

Approximately 50% of the participants reported an annual household income below $50,000, whereas 42% possessed a high school diploma or lower level of education. Almost 62% of participants shopped for children between the ages of six and 12 years, while 38% shopped for children between two and five years old.

The implementation of pictorial warnings resulted in three significant responses, including increased attention, negative emotional responses, and contemplation of the adverse effects of consuming SSBs.

The warnings resulted in decreased perceptions that SSBs are healthy for children and a greater likelihood of limiting SSBs to children. Pictorial warnings also reduced the intentions of adults to serve SSBs to their children and increased expected social interactions.

Nevertheless, the use of pictorial warnings did not result in any changes in the perceived quantity of added sugar in SSBs, the appeal of SSBs for children, the perceived tastiness of SSBs for children, or the perceived risks of children having health problems because of SSB intake.

Assessing the relationship between mediators and purchasing behaviors of SSBs while controlling for the trial arm showed that parents' belief that SSBs were healthier for their children was associated with a higher probability of purchasing SSBs. Comparatively, individuals who believed that consuming SSBs could lead to health issues in children were less likely to buy SSBs.

Pictorial warnings also had a mediated effect of -0.07 on the likelihood of SSB purchase, as warnings resulted in lower intents to serve SSBs to their child, thereby leading to a reduced chance of purchasing SSBs.

The impact of warnings on calories purchased was partially influenced by the perceived health quality of SSBs, which accounted for 22% of the total effect. Intentions to serve SSBs partially mediated the total effect and accounted for 9%.

Conclusions

The present randomized trial showed that the use of pictorial warnings on SSBs led to a decrease in parents' SSB purchases for their children by altering parents' perceptions of the health benefits of SSBs for their children and changing their intentions to serve SSBs. Communicating the health quality of beverages and issuing warnings could effectively reduce parents' SSB purchases for their children.