Governments have proposed text warning labels to decrease consumption of sugary drinks—a contributor to chronic diseases such as diabetes. However, they may be less effective than more evocative, graphic warning labels. We field-tested the effectiveness of graphic warning labels (vs. text warning labels, calorie labels, and no labels), provided insight into psychological mechanisms driving effectiveness, and assessed consumer sentiment. Study 1 indicated that graphic warning labels reduced the share of sugary drinks purchased in a cafeteria from 21.4% at baseline to 18.2%—an effect driven by substitution of water for sugary drinks. Study 2 showed that graphic warning labels heighten negative affect and prompt consideration of health consequences. Study 3 indicated that public support for graphic warning labels can be increased by conveying effectiveness information. These findings could spur more effective labeling policies that facilitate healthier choices, do not decrease overall beverage purchases, and are publicly accepted.

References

Bleich, S. N., Barry, C. L., Gary-Webb, T. L., Herring, B. J. ( 2014 ). Reducing sugar-sweetened beverage consumption by providing caloric information: How Black adolescents alter their purchases and whether the effects persist . American Journal of Public Health, 104, 2417 – 2424 . doi:10.2105/ajph.2014.302150

Google Scholar Crossref | Medline | ISI

Bleich, S. N., Economos, C. D., Spiker, M. L., Vercammen, K. A., VanEpps, E. M., Block, J. P., . . . Roberto, C. A. ( 2017 ). A systematic review of calorie labeling and modified calorie labeling interventions: Impact on consumer and restaurant behavior . Obesity, 25, 2018 – 2044 . doi:10.1002/oby.21940

Google Scholar Crossref | Medline

Bleich, S. N., Herring, B. J., Flagg, D. D., Gary-Webb, T. L. ( 2012 ). Reduction in purchases of sugar-sweetened beverages among low-income Black adolescents after exposure to caloric information . American Journal of Public Health, 102, 329 – 335 . doi:10.2105/ajph.2011.300350

Google Scholar Crossref | Medline | ISI

Block, J. P., Roberto, C. A. ( 2014 ). Potential benefits of calorie labeling in restaurants . Journal of the American Medical Association, 312, 887 – 888 . doi:10.1001/jama.2014.9239

Google Scholar Crossref

Bollard, T., Maubach, N., Walker, N., Ni Mhurchu, C. ( 2016 ). Effects of plain packaging, warning labels, and taxes on young people’s predicted sugar-sweetened beverage preferences: An experimental study . International Journal of Behavioral Nutrition and Physical Activity, 13, Article 95. doi:10.1186/s12966-016-0421-7

Google Scholar Crossref | Medline

Borland, R., Wilson, N., Fong, G. T., Hammond, D., Cummings, K. M., Yong, H.-H., . . . McNeill, A. ( 2009 ). Impact of graphic and text warnings on cigarette packs: Findings from four countries over five years . Tobacco Control, 18, 358 – 364 . doi:10.1136/tc.2008.028043

Google Scholar Crossref | Medline | ISI

Burstein, P. ( 2003 ). The impact of public opinion on public policy: A review and an agenda . Political Research Quarterly, 56, 29 – 40 . doi:10.1177/106591290305600103

Google Scholar SAGE Journals | ISI

Coady, M. H., Chan, C. A., Auer, K., Farley, S. M., Kilgore, E. A., Kansagra, S. M. ( 2012 ). Awareness and impact of New York City’s graphic point-of-sale tobacco health warning signs . Tobacco Control, 22, e51 – e56 . doi:10.1136/tobaccocontrol-2011-050261

Google Scholar Crossref | Medline

Colchero, M. A., Rivera-Dommarco, J., Popkin, B. M., Ng, S. W. ( 2017 ). In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax . Health Affairs, 36, 564 – 571 . doi:10.1377/hlthaff.2016.1231

Google Scholar Crossref | Medline

Downs, J. S., Loewenstein, G., Wisdom, J. ( 2009 ). Strategies for promoting healthier food choices . American Economic Review, 99, 159 – 164 . doi:10.1257/aer.99.2.159

Google Scholar Crossref | Medline | ISI

Downs, J. S., Wisdom, J., Wansink, B., Loewenstein, G. ( 2013 ). Supplementing menu labeling with calorie recommendations to test for facilitation effects . American Journal of Public Health, 103, 1604 – 1609 . doi:10.2105/ajph.2013.301218

Google Scholar Crossref | Medline | ISI

Emery, L. F., Romer, D., Sheerin, K. M., Jamieson, K. H., Peters, E. ( 2014 ). Affective and cognitive mediators of the impact of cigarette warning labels . Nicotine & Tobacco Research, 16, 263 – 269 . doi:10.1093/ntr/ntt124

Google Scholar Crossref | Medline | ISI

Evans, A. T., Peters, E., Strasser, A. A., Emery, L. F., Sheerin, K. M., Romer, D. ( 2015 ). Graphic warning labels elicit affective and thoughtful responses from smokers: Results of a randomized clinical trial . PLOS ONE, 10(12), Article e0142879. doi:10.1371/journal.pone.0142879

Google Scholar Crossref

Fagerlin, A., Zikmund-Fisher, B. J., Ubel, P. A. ( 2011 ). Helping patients decide: Ten steps to better risk communication . Journal of the National Cancer Institute, 103, 1436 – 1443 . doi:10.1093/jnci/djr318

Google Scholar Crossref | Medline

Fung, T. T., Malik, V., Rexrode, K. M., Manson, J. E., Willett, W. C., Hu, F. B. ( 2009 ). Sweetened beverage consumption and risk of coronary heart disease in women . The American Journal of Clinical Nutrition, 89, 1037 – 1042 . doi:10.3945/ajcn.2008.27140

Google Scholar Crossref | Medline | ISI

Hayes, A. F., Preacher, K. J. ( 2014 ). Statistical mediation analysis with a multicategorical independent variable . British Journal of Mathematical and Statistical Psychology, 67, 451 – 470 . doi:10.1111/bmsp.12028

Google Scholar Crossref | Medline | ISI

Hollands, G. J., Shemilt, I., Marteau, T. M., Jebb, S. A., Lewis, H. B., Wei, Y., . . . Ogilvie, D. ( 2015 ). Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco . The Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD011045.pub2

Google Scholar Crossref

John, L. K., Donnelly, G. E., Roberto, C. A. ( 2017 ). Psychologically informed implementations of sugary-drink portion limits . Psychological Science, 28, 620 – 629 . doi:10.1177/0956797617692041

Google Scholar SAGE Journals | ISI

Kim, A. E., Nonnemaker, J. M., Loomis, B. R., Shafer, P. R., Shaikh, A., Hill, E., . . . Farrelly, M. C. ( 2014 ). Influence of point-of-sale tobacco displays and graphic health warning signs on adults: Evidence from a virtual store experimental study . American Journal of Public Health, 104, 888 – 895 .

Google Scholar Crossref | Medline

Korfage, I. J., Fuhrel-Forbis, A., Ubel, P. A., Zikmund-Fisher, B. J., Greene, S. M., McClure, J. B., . . . Fagerlin, A. ( 2013 ). Informed choice about breast cancer prevention: Randomized controlled trial of an online decision aid intervention . Breast Cancer Research, 15, Article R74. doi:10.1186/bcr3468

Google Scholar Crossref | Medline

Loewenstein, G. ( 1996 ). Out of control: Visceral influences on behavior . Organizational Behavior and Human Decision Processes, 65, 272 – 292 . doi:10.1006/obhd.1996.0028

Google Scholar Crossref | ISI

Loewenstein, G., Read, D., Baumeister, R. F. ( 2003 ). Time and decision: Economic and psychological perspectives of intertemporal choice. New York, NY : Russell Sage Foundation .

Google Scholar

Loewenstein, G. F., Weber, E. U., Hsee, C. K., Welch, N. ( 2001 ). Risk as feelings . Psychological Bulletin, 127, 267 – 286 . doi:10.1037/0033-2909.127.2.267

Google Scholar Crossref | Medline | ISI

Ludwig, D. S., Peterson, K. E., Gortmaker, S. L. ( 2001 ). Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis . The Lancet, 357, 505 – 508 . doi:10.1016/S0140-6736(00)04041-1

Google Scholar Crossref | Medline | ISI

Noar, S. M., Francis, D. B., Bridges, C., Sontag, J. M., Brewer, N. T., Ribisl, K. M. ( 2017 ). Effects of strengthening cigarette pack warnings on attention and message processing: A systematic review . Journalism & Mass Communication Quarterly, 94, 416 – 442 . doi:10.1177/1077699016674188

Google Scholar SAGE Journals | ISI

Noar, S. M., Francis, D. B., Bridges, C., Sontag, J. M., Ribisl, K. M., Brewer, N. T. ( 2016 ). The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies . Social Science & Medicine, 164, 118 – 129 . doi:10.1016/j.socscimed.2016.06.011

Google Scholar Crossref | Medline | ISI

Noar, S. M., Hall, M. G., Francis, D. B., Ribisl, K. M., Pepper, J. K., Brewer, N. T. ( 2016 ). Pictorial cigarette pack warnings: A meta-analysis of experimental studies . Tobacco Control, 25, 341 – 354 . doi:10.1136/tobaccocontrol-2014-051978

Google Scholar Crossref | Medline | ISI

Peters, E. ( 2006 ). The functions of affect in the construction of preferences . In Lichtenstein, S., Slovic, P. (Eds.), The construction of preference (pp. 454 – 463 ). New York, NY : Cambridge University Press .

Google Scholar Crossref

Peters, E., Lipkus, I., Diefenbach, M. A. ( 2006 ). The functions of affect in health communications and in the construction of health preferences . Journal of Communication, 56, S140–S162. doi:10.1111/j.1460-2466.2006.00287.x

Google Scholar Crossref

Peters, E., Romer, D., Slovic, P., Jamieson, K. H., Wharfield, L., Mertz, C. K., Carpenter, S. M. ( 2007 ). The impact and acceptability of Canadian-style cigarette warning labels among U.S. smokers and nonsmokers . Nicotine & Tobacco Research, 9, 473 – 481 . doi:10.1080/14622200701239639

Google Scholar Crossref | Medline | ISI

Purmehdi, M., Legoux, R., Carrillat, F., Senecal, S. ( 2017 ). The effectiveness of warning labels for consumers: A meta-analytic investigation into their underlying process and contingencies . Journal of Public Policy & Marketing, 36, 36 – 53 . doi:10.1509/jppm.14.047

Google Scholar SAGE Journals | ISI

R. J. Reynolds Tobacco Co. v. U.S. Food & Drug Administration, 696 F.3d 1205 (D.C. Cir. 2012).

Google Scholar

Roberto, C. A., Wong, D., Musicus, A., Hammond, D. ( 2016 ). The influence of sugar-sweetened beverage health warning labels on parents’ choices . Pediatrics, 137, Article e20153185. doi:10.1542/peds.2015-3185

Google Scholar Crossref | Medline

Rolls, B. J., Morris, E. L., Roe, L. S. ( 2002 ). Portion size of food affects energy intake in normal-weight and overweight men and women . The American Journal of Clinical Nutrition, 76, 1207 – 1213 .

Google Scholar Crossref | Medline | ISI

Schulze, M. B., Manson, J. E., Ludwig, D. S., Graham, A. C., Meir, J. S., Walter, C. W., Frank, B. H. ( 2004 ). Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women . Journal of the American Medical Association, 292, 927 – 934 . doi:10.1001/jama.292.8.927

Google Scholar Crossref | Medline | ISI

Silver, L. D., Ng, S. W., Ryan-Ibarra, S., Taillie, L. S., Induni, M., Miles, D. R., . . . Popkin, B. M. ( 2017 ). Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study . PLOS Medicine, 14, Article e1002283. doi:10.1371/journal.pmed.1002283

Google Scholar Crossref | Medline

Simmons, J. ( 2014 , April 4 ). MTurk vs. the lab: Either way we need big samples. Retrieved from http://datacolada.org/18

Google Scholar

Simmons, J. P., Nelson, L. D., Simonsohn, U. ( 2011 ). False-positive psychology: Undisclosed flexibility in data collection and analysis allows presenting anything as significant . Psychological Science, 22, 1359 – 1366 . doi:10.1177/0956797611417632

Google Scholar SAGE Journals | ISI

Slovic, P., Finucane, M. L., Peters, E., MacGregor, D. G. ( 2002 ). The affect heuristic . In Gilovich, T., Griffin, D., Kahneman, D. (Eds.), Heuristics and biases: The psychology of intuitive judgment (pp. 397 – 421 ). New York, NY : Cambridge University Press .

Google Scholar Crossref

Stroebe, W., van Koningsbruggen, G. M., Papies, E. K., Aarts, H. ( 2013 ). Why most dieters fail but some succeed: A goal conflict model of eating behavior . Psychological Review, 120, 110 – 138 . doi:10.1037/a0030849

Google Scholar Crossref | Medline | ISI

Sunstein, C. R. ( 2016 ). People prefer System 2 nudges (kind of) . Duke Law Journal, 66(121), 122 – 168 .

Google Scholar

U.S. Food & Drug Administration . ( 2014 ). Food labeling: Nutrition labeling of standard menu items in restaurants and similar retail food establishments . Final regulatory impact analysis. Retrieved from https://www.fda.gov/downloads/Food/IngredientsPackagingLabeling/LabelingNutrition/UCM423985.pdf

Google Scholar

U.S. Food & Drug Administration . ( 2016 ). A labeling guide for restaurants and retail establishments selling away-from-home foods—Part II (menu labeling requirements in accordance with 21 CFR 101.11): Guidance for industry . Retrieved from https://www.fda.gov/downloads/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/UCM461963.pdf

Google Scholar

VanEpps, E. M., Roberto, C. A. ( 2016 ). The influence of sugar-sweetened beverage warnings: A randomized trial of adolescents’ choices and beliefs . American Journal of Preventive Medicine, 51, 664 – 672 . doi:10.1016/j.amepre.2016.07.010

Google Scholar Crossref | Medline

Wiener, S., Mar, E., Cohen, M., Avalos, J. ( 2015 ). Sugar-sweetened beverage warning for advertisements. Retrieved from http://www.sfbos.org/ftp/uploadedfiles/bdsupvrs/ordinances15/o0100-15.pdf

Google Scholar