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Pictorial warning labels on sugary drinks may help curb sales, a new study found.

In a randomized trial of parents with young children (ages 2 to 12), shopping in a "store" that displayed health-related warning labels on sugary drinks led to a 17% reduction (95% CI 7-27%) in sales for these beverages, reported Lindsey Smith Taillie, PhD, of the University of North Carolina at Chapel Hill, and colleagues in .

Among 325 parents included in the trial, which was conducted in a naturalistic store set in a North Carolina laboratory, 45% of those in the control arm -- for whom sugary drinks were only labeled with a traditional barcode -- bought their young child one of these drinks versus 28% of the parents who saw health warnings on these drinks (P=0.002).

Of note, the warning labels were effective across the board, as there were no differences between parent demographics, such as race/ethnicity, income, education level, or the age of their child.

These pictorial warning labels included a stock image and text highlighting two possible health outcomes that are associated with drinking sugar-sweetened beverages: type 2 diabetes and heart damage. The heart damage label featured an image of an unhealthy heart with the following text below: "WARNING: Excess consumption of drinks with added sugar contributes to heart damage." The other label featured a foot with necrotic skin reading: "WARNING: Excess consumption of drinks with added sugar contributes to type 2 diabetes."

"We know from tobacco control research that warnings that include images are effective for reducing consumption," Taillie explained in a statement. "Our study is one of the first to show that this type of policy works for sugary drinks, too."

"This data provides evidence to support policies to require strong front-of-package warnings as a strategy to reduce children's intake of sugary drinks," she added.

Not only did these warning labels make parents think twice about buying these drinks, but there was also a significant reduction in total calories purchased: parents that shopped in stores with the warning labels purchased on average 52 calories versus 82 calories for parents shopping in a store that only displayed traditional barcodes on the drinks (P=0.003).

As for their reactions to the warning labels, parents generally felt they were quite effective (all P<0.05 vs no warning label):

• Felt more in control of healthy eating decisions
• Greater thinking about the harms of sugary drinks
• Stronger negative emotional reactions
• Lower perceived healthfulness of sugary drinks for their child

All in all, parents concluded that these graphic warning labels did in fact lead to lower intentions to serve their child sugary drinks.

However, some things that the warning labels didn't change was the perceived tastiness of sugary drinks, perceived amount of added sugar in sugary drinks, and general appeal of sugary drinks.

For the study, Taillie and colleagues recruited parents from Central North Carolina in January to March 2020. Of the parents included, 77% were women, with an average age of 38. The participants entered the UNC Mini Mart, which is a 245-square-foot naturalistic store laboratory. Over 33 types of single-serve beverages were on display, along with over 130 types of food items, and 31 household items. For every sugary drink on sale, there was a comparable non-sugar option (for example, Ocean Spray Cranberry Juice Cocktail and Ocean Spray 100% Cranberry Juice). There were also unflavored waters available.

The participants were instructed to purchase one snack and one beverage for their child, along with one household item. The researchers told the parents that just one of their items would be randomly selected for them to take home, and the cost of it would be deducted from their $40 incentive.

"We think the paper could be useful for policymakers in the U.S. and globally," said co-author Marissa G. Hall, PhD, also of the University of North Carolina at Chapel Hill, in a statement. "This evidence supports strong, front-of-package warnings to reduce sugary drink consumption in children."

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