In 2015, San Francisco became the first US jurisdiction to adopt a sugary drink warning label. In 2020, the city revised the label in response to court challenges. The new warning label reads, “SAN FRANCISCO GOVERNMENT WARNING: Drinking beverages with added sugar(s) can cause weight gain, which increases the risk of obesity and type 2 diabetes.” The purpose of this study was to measure consumers’ reactions to the label, specifically the extent to which it made them think about health problems caused by sugary drinks and discouraged sugary drink consumption.  Participants (n=2,164) were part of a larger, multipart study recruited by a survey technology company.  To be eligible, they must have identified themselves as a parent or caregiver to at least one child aged 6 months to 5 years.  Participants were randomly assigned to view the San Francisco warning label noted above or the following control message,  “Always read the Nutrition Facts Panel.” Next, they were asked to answer two questions about the message via an online survey.  Statistical analysis included ordinary least square regression.  Results showed that the San Francisco warning label elicited significantly more thinking about health harms of sugary drinks and was rated more effective in discouraging sugary drink consumption compared to the control message (p<0.001).  Although these differences were statistically significant, the effect size was small. The influence on health harms did not differ significantly among demographic characteristics examined (age, gender, race, education, income or survey language).

Study Strengths: This is the first study to evaluate the San Francisco’s 2020 warning label.  Results suggest that warning labels may be an effective public policy tool for encouraging healthy beverages. Additionally, this is the first US study to examine reactions to warning labels that have been translated to another language besides English.  Lastly, this study utilized a diverse sample of US adults with 49% Hispanic and 34% African American.

Study limitations: This study utilized a convenience sample, results are not generalizable to the U.S. population. These outcomes were also self-reported using an online survey.  The degree to which social desirability may have influenced responses is unknown.  In addition, behavioral outcomes were not assessed.

What this means for your practice: This study’s results suggest that a warning label could be an effective way to discourage sugary drink consumption across diverse populations. As a trusted healthcare provider, you can continue to promote healthy beverage choices and encourage parents/guardians to limit serving sugary drinks to their children. You can refer parents to for more information about healthy beverage choices for their family.

Original citation: Grummon, A. H., Reimold, A. E., & Hall, M. G. (2022). Influence of the San Francisco, CA, Sugar-Sweetened Beverage Health Warning on Consumer Reactions: Implications for Equity from a Randomized Experiment. Journal of the Academy of Nutrition and Dietetics, 122(2), 363-370.

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