Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis

Context: As a primary source of added sugars, sugar-sweetened beverage consumption contributes to obesity. This study systematically synthesizes the scientific evidence regarding the impact of sugar-sweetened beverage warning labels on consumer behaviors and intentions. Evidence acquisition: A keyword/reference search was performed in 2019 in Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, and Google Scholar. Meta-analysis was conducted in 2020 to estimate the effect of sugar-sweetened beverage warning labels on consumers' purchase decisions. Evidence synthesis: A total of 23 studies (13 RCTs, 9 nonrandomized experiments, and 1 computer simulation study) met the eligibility criteria and were included. Labels were classified into 6 categories: (1) symbol with nutrient profile, (2) symbol with health effect, (3) text of nutrient profile, (4) text of health effect, (5) graphic with health effect, and (6) graphic with nutrient profile. Compared with the no-label control group, sugar-sweetened beverage warning label use was associated with reduced odds of choosing sugar-sweetened beverages (OR=0.49, 95% CI=0.41, 0.56) and a reduced sugar-sweetened beverage purchase intention (Cohen's d= -0.18, 95% CI= -0.31, -0.06). Across alternative label categories, the graphic with health effect (OR=0.34, 95% CI=0.08, 0.61), text of health effect (OR=0.47, 95% CI=0.39, 0.55), graphic with nutrient profile (OR=0.58, 95% CI=0.36, 0.81), and symbol with health effect (OR=0.67, 95% CI=0.39, 0.95) were associated with reduced odds of choosing sugar-sweetened beverages. Conclusions: Sugar-sweetened beverage warning labels were effective in dissuading consumers from choosing them. Graphic with health effect labels showed the largest impact. Future studies should delineate the psychosocial pathways linking sugar-sweetened beverage warning labels to purchase decisions, recruit socioeconomically diverse participants, and design experiments in naturalistic settings. (C) 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.