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Sugary drink warnings are a promising policy for reducing sugary drink consumption, but it remains unknown how to design warnings to maximize their impact overall and among diverse population groups, including parents of Latino ethnicity and parents with low English use. In 2019, we randomized US parents of children ages 2-12 (n = 1078, 48% Latino ethnicity, 13% low English use) to one topic (one of four warnings, or a neutral control), which they viewed on three designs (text-only, icon, and graphic) to assess reactions to the various warnings on sugary drinks. All warning topics were perceived as more effective than the control (average differential effect [ADE] ranged from 1.77 to 1.84 [5-point Likert scale], all p .001). All warning topics also led to greater thinking about harms of sugary drinks (all p .001) and lower purchase intentions (all p .01). Compared to text-only warnings, icon (ADE = 0.18) and graphic warnings (ADE = 0.30) elicited higher perceived message effectiveness, as well as greater thinking about the harms of sugary drinks, lower perceived healthfulness, and lower purchase intentions (all p .001). The impact of icon warnings (vs. text warnings) was stronger for parents with low English use, compared to those with high English use (p = .024). Similarly, the impact of icon (vs. text warnings) was stronger for Latino parents than non-Latino parents (p = .034). This experimental study indicates that many warning topics hold promise for behavior change and that including images with warnings could increase warning efficacy, particularly among Latino parents and parents with low English use. Clinical Trial Registration: NCT04382599.

BackgroundFront-of-package nutrient warning labels are one promising policy to inform healthier food choices and purchasing decisions. This study aimed to identify the impact of nutrient warning labels on product selection and the ability to correctly identify products with an excess of critical nutrients, among other outcomes in Colombia.MethodsWe conducted an online randomized experiment among 8,061 Colombian adults in October 2020. Participants were randomly assigned to a front-of-package label condition: nutrient warning, guideline daily amounts (GDA), Nutri-Score, or a no-label condition. First, they viewed a fruit drink with added sugar that was labeled per their assigned condition and one without added sugar, which was only labeled in the GDA and Nutri-Score conditions, and completed selection tasks. The primary outcomes were 1) selection of the fruit drink with added sugar as the fruit drink they would rather buy and 2) correctly identifying which fruit drink was higher in sugar. Next, they viewed four food products (cookies, yogurt, sliced bread, and breakfast cereal) with their assigned condition and answered a series of questions. Finally, they selected which of the three label types would most discourage them from consuming a specified ultra-processed food.ResultsFewer participants in the nutrient warning condition (20%) selected the added sugar fruit drink as the product they would rather buy compared to 24% in the GDA condition (pConclusionsNutrient warning labels are a promising policy strategy to prevent obesity and diet-related non-communicable diseases in Colombia. Future research is needed to understand the impact of nutrient warning labels on actual ultra-processed food purchases in Colombia. Trial Registration: NCT04567004

Objectives:Toddler milk (i.e. a nutrient-fortified milk-based drink marketed for children 12–36 months old) is increasingly being marketed in the USA despite not being recommended for young children. There is evidence of targeted toddler milk marketing to Latinos in the USA. This study aimed to explore toddler milk perceptions and behaviours among Latino and non-Latino parents.Design:An online survey assessed toddler milk perceptions, behaviours and interpretations of nutrition-related claims. Multivariable logistic and linear regression explored socio-demographic correlates of parent reported past purchases and perceived healthfulness.Setting:Online.Participants:National convenience sample of 1078 US parents of children aged 2–12 years (48 % Latino).Results:About half of parents (51 %) had previously purchased toddler milk and few (11 %) perceived toddler milk as unhealthy. Latino parents were more likely to have purchased toddler milk than non-Latino parents (P< 0·001), but there were no differences in perceived product healthfulness (P= 0·47). Compared to parents born in the USA, parents living in the USA 10 years or less were more likely to have purchased toddler milk (P< 0·001) and perceive toddler milk as healthier (P= 0·002). Open-ended interpretations of claims were primarily positive, suggesting ‘health halo’ effects.Conclusions:Common misperceptions about toddler milk healthfulness suggest stronger labelling regulations are needed. Greater reported purchases by Latino parents and recent immigrants warrant further investigation.

State and local health departments have been tasked with promoting the use of face coverings to decrease the spread of COVID-19 in their respective communities. However, little is known about motivations and barriers to wearing face coverings in the context of COVID-19 prevention, particularly among communities of color who are at an increased risk of serious illness from the disease. The purpose of this study was to identify common motivations and barriers to face covering use, as well as explore perceptions of messages encouraging the use of face coverings among a racially and ethnically diverse sample. A survey was distributed electronically to North Carolina (NC) residents through NC Department of Health and Human Services listservs in July 2020. Participants self-categorized as Latino/a (33.5%), Black (39.1%), or white or another race (27.5%). The most commonly endorsed motivations for wearing face coverings were to avoid spreading COVID-19 (77%), as well as to protect people who are vulnerable (76%) and one’s community (72%). Being uncomfortable (40%) was the most commonly endorsed barrier. Messages that included a clear request (ex. please wear a face covering) and a direct benefit (ex. keep community safe) were more commonly endorsed than those that did not. Commonly endorsed motivations, behaviors, and messages differed by race and ethnicity. Increased attention to message content, message structure, and access to information and resources may aid local officials in increasing consistent use of face coverings.

Widespread use of face coverings is a key public health strategy to prevent the spread of COVID-19. However, few studies have examined why Americans use or do not use face coverings, and little is known about the most effective messaging strategies. This study explored perceptions of face coverings, including motivations and barriers for use, and examined reactions to messaging promoting the use of face coverings. Six virtual focus groups were conducted with 34 North Carolina residents in July 2020. Participants reported high compliance with face covering recommendations but often did not wear them around family, friends, and colleagues. The most prevalent motivation for the use of face coverings was to protect or respect other people, including high-risk populations and individuals. Other motivators were self-protection, responsibility, desire for control, requirements, and expert advice. Barriers included physical and social discomfort, confusion or misinformation, low perceived susceptibility to COVID-19, and perceptions of identity and autonomy. Even among individuals who frequently wear face coverings, there are opportunities to improve compliance. Messaging should highlight how face coverings protect the wearer and others around them, normalize the use of face coverings in social settings, and emphasize requirements. Positive messages that focus on unity, personal experiences and the rationale for face coverings are recommended.

Evidence about the health problems associated with sugary drink consumption is well-established. However, little is known about which sugary drink health harms are most effective at changing consumers' behavior. We aimed to identify which harms people were aware of and most discouraged them from wanting to buy sugary drinks. Participants were a national convenience sample of diverse parents (n = 1,058), oversampled for Latino parents (48%). Participants rated a list of sugary drink-related health harms occurring in children (7 harms) and in adults (15 harms). Outcomes were awareness of each harm and how much each harm discouraged parents from wanting to purchase sugary drinks. Most participants were aware that sugary drinks contribute to tooth decay in children (75%) and weight gain in both children (73%) and adults (69%). Few participants were aware that sugary drinks contribute to adult infertility (16%), arthritis (18%), and gout (18%). All health harms were rated highly in terms of discouraging parents from wanting to buy sugary drinks (range: 3.59-4.11 on a 1-5 scale), with obesity, pre-diabetes, and tooth decay eliciting the highest discouragement ratings. Harm-induced discouragement was higher for participants who were aware of more health harms (B = 0.05, p 0.0001), identified as female (B = 0.15 compared to male, p = 0.02), or had an annual household income of $50,000 or more (B = 0.16 compared to less than $50,000, p = 0.03). These findings suggest health messages focused on a variety of health harms could raise awareness and discourage sugary drink purchases.

Simulated online grocery store platforms are innovative tools for studying nutrition-related policies and point-of-selection/point-of-purchase interventions in online retail settings, yet there is no clear guidance on how to develop these platforms for experimental research. Thus, we created a standardized guide for the development of an online grocery store, including a detailed description of (1) methods for acquiring and cleaning online grocery store data, and (2) how to design a two-dimensional online grocery store experimental platform. We provide guidance on how to address product categorization, product order/sorting and product details, including how to identify outliers and conflicting nutritional information and methods for standardizing prices. We also provide details regarding our process of “tagging” food items that can be leveraged by future studies examining policies and point-of-selection/point-of-purchase interventions targeting red and processed meat and fruits and vegetables. We experienced several challenges, including obtaining accurate and up-to-date product information and images, and accounting for the presence of store-brand products. Regardless, the methodology described herein will enable researchers to examine the effects of a wide array of nutrition-related policies and interventions on food purchasing behaviors in online retail settings, and can be used as a template for reporting procedures in future research.

Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12–36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents’ experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential “health halo” effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.

Policies to require warnings on the front of food and drinks high in nutrients of concern (e.g., added sugar, sodium, or saturated fat) are becoming increasingly common as an obesity prevention strategy. Colombia, a country with growing prevalence of obesity, is considering implementing a similar policy. The objective of this study was to assess perceptions and reactions to different warning designs. We conducted a randomized experiment in an online panel of adults age &gt, 18y (n = 1997). Participants were randomized to view one of four labels: a control label (barcode), an octagon warning, a circle warning, and a triangle warning. Participants viewed their randomly assigned label on a series of products and answered questions (continuous outcomes ranged from 1&ndash, 4). Compared to the control, all warnings led to higher perceived message effectiveness (increase in mean from 1.79 in the control to 2.59&ndash, 2.65 in the warning conditions, p &lt, 0.001), a higher percentage of participants who correctly identified products high in nutrients of concern (from 48% in the control condition to 84&ndash, 89% in the warning conditions, p &lt, 0.001), and reduced intentions to purchases these products (decrease in mean from 2.59 to 1.99&ndash, 2.01 in the warning conditions, p &lt, 0.001). Relative to the control, warnings performed similarly across education levels, suggesting this policy would be equitable in Colombia. Looking at differences by warning type, the pattern of results suggested that the octagon warnings performed best. After viewing all label types, 49% of participants selected the octagon warning as the one that most discouraged them from consuming products high in nutrients of concern, while 21% and 27% selected the circle and triangle warning. Colombian policymakers should consider the octagon warning as part of a front-of-package labeling policy to help consumers identify and reduce consumption of foods and drinks high in nutrients of concern.