Food Preferences
Conditions
Keywords
Food Labeling, Adolescents
Brief summary
Sugar-sweetened beverages are a significant contributor to adult and childhood obesity in Guatemala. Policies to place health warning labels on sugar-sweetened beverages are being pursued, but there is little empirical data on how such labels influence people. The primary aim of this study is to test the association between sugar-sweetened beverage (SSB) warning posters compared to control posters and change in SSBs purchased compared to baseline by adolescents shopping at school cafeterias in Guatemala City, Guatemala. The hypothesis is that posters with information warning people of the health harms associated with overconsuming SSBs and promoting low sugar beverages will be associated with greater reductions in SSB purchases compared to a control poster.
Interventions
BEHAVIORALExposure to beverage health information
Red stop sign and avoidance message for sugar-sweetened beverages and green check mark and promotion message for non-sugar-sweetened beverage nutrition information
BEHAVIORALExposure to beverage calorie information
Calories for sugar-sweetened and non-sugar-sweetened beverages
Sponsors
Fogarty International Center of the National Institute of Health
Universidad Rafael Landivar
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Masking description
Participants will be told the researchers are interested in cafeteria purchase preferences, but participants will not know which condition has been assigned to individual participants.
Intervention model description
Three private schools will be enrolled in the study (two larger, one smaller) that have students between the ages of 12 and 18. There will be no posters displayed at any of the schools during the baseline period. The two larger schools will be randomized to either an SSB warning/non-SSB promoting poster or a calorie/control poster that will be implemented in the school cafeterias during a four-week intervention period. To increase the sample size for the intervention condition, the intervention will also be implemented at a smaller school. For the primary analysis, data only from schools that were randomized to condition will be used. Data was collected from both a sample of participants & from the cash registers directly.
Eligibility
Sex/Gender
ALL
Age
12 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
* Between 12 and 18 years old * Made a food or beverage purchase * Has permission from parent or caregiver to participate * Has not yet completed the purchase assessment
Exclusion criteria
* Under 12 or over 18 years old * Did not make a food or beverage purchase * Parent or caregiver refused to give child permission to participate * Already participated in the purchase assessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Volume of SSBs Per Transaction | Through study period (either 4 weeks baseline, or 4 weeks intervention) | Total milliliters of SSBs per transaction from sales data |
| Beverage Calories Per Transaction | Through study period (either 4 weeks baseline or 4 weeks intervention) | Total number of calories for all beverages (SSBs and non-SSBs) per transaction from sales data |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Calories Per Transaction | Through time frame (either 4 weeks baseline, or 4 weeks intervention) | Total number of calories for all food and beverages (SSBs and non-SSBs) per transaction from purchase assessments (e.g., calories from Coke + bag of chips) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Healthy Perceptions of Non-SSBs | 4 weeks baseline, 4 weeks intervention | Average of perceptions of healthiness (measured on Likert scales) for two items (1=Extremely unhealthy; 7=Extremely healthy, higher values are more accurate) |
| Percentage of Participants With Transactions With SSBs Out of All Food and Beverage Transactions | 4-week baseline and 4-week intervention | Percentage of participants with transactions that have sugar sweetened beverages out of all participants who had food and beverage transactions |
| Poster Message Trust | During intervention, 4 weeks | How much do you trust the information on the poster? (1=Not at all; 5=Very much, higher values in the intervention condition indicate the intervention is perceived to be trustworthy) |
| Perceived Influence of Poster Among Those Who Saw it | During intervention, 4 weeks | Do you think the poster influenced what you purchased? (1=Not at all; 5=Very much, higher values in the intervention condition indicate the intervention is perceived to be effective) |
| Percentage of Participants With Transactions With SSBs Out of All Beverage Transactions | 4-week baseline and 4-week intervention | Percentage of participants with transactions that have sugar sweetened beverages out of all participants who had beverage transactions |
| Unhealthy Perceptions of SSBs | 4 weeks baseline, 4 weeks intervention | Average of perceptions of healthiness (measured on Likert scales) for two items (1=Extremely unhealthy; 7=Extremely healthy, lower values are more accurate) |
Countries
Guatemala
Participant flow
Pre-assignment details
We do not report data from 166 participants collected at a 3rd smaller school because that school was assigned (not randomized) to the SSB Warning and Non-SSB Promotion Poster because of its smaller size.
Participants by arm
| Arm | Count |
|---|---|
| Baseline for Calorie/Control Poster We will collect baseline data from a group of students before posting the Calorie/Control Poster in the control school. | 167 |
| Baseline for SSB Warning and Non-SSB Promotion Poster We will collect baseline data from a group of students before posting the SSB Warning and Non-SSB Promotion Poster in the treatment school. | 145 |
| Total | 312 |
Baseline characteristics
| Characteristic | Baseline for SSB Warning and Non-SSB Promotion Poster | Total | Baseline for Calorie/Control Poster |
|---|---|---|---|
| Age, Categorical <=18 years | 145 Participants | 312 Participants | 167 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 14.9 years STANDARD_DEVIATION 1.4 | 15.1 years STANDARD_DEVIATION 1.5 | 15.3 years STANDARD_DEVIATION 1.6 |
| Race and Ethnicity Not Collected | — | 0 Participants | — |
| Region of Enrollment Guatemala | 145 participants | 312 participants | 167 participants |
| Sex: Female, Male Female | 68 Participants | 126 Participants | 58 Participants |
| Sex: Female, Male Male | 77 Participants | 186 Participants | 109 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 167 | 0 / 145 | 0 / 143 | 0 / 173 |
| other Total, other adverse events | 0 / 167 | 0 / 145 | 0 / 143 | 0 / 173 |
| serious Total, serious adverse events | 0 / 167 | 0 / 145 | 0 / 143 | 0 / 173 |
Outcome results
Primary
Beverage Calories Per Transaction
Total number of calories for all beverages (SSBs and non-SSBs) per transaction from sales data
Time frame: Through study period (either 4 weeks baseline or 4 weeks intervention)
Population: In addition to the surveys with the participants (described in the participant flow), data on total sales were collected at the register. It is not possible to know if these sales data were associated with one or more than one participant because they are at the sales item level. For the purposes of this report, the number of participants are identical to the number of items sold.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Beverage Calories Per Transaction | 45.1 beverage calories sold | Standard Deviation 83.7 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Beverage Calories Per Transaction | 35.9 beverage calories sold | Standard Deviation 67.1 |
| Calorie/Control Poster | Beverage Calories Per Transaction | 41.2 beverage calories sold | Standard Deviation 75.9 |
| SSB Warning and Non-SSB Promotion Poster | Beverage Calories Per Transaction | 39.0 beverage calories sold | Standard Deviation 69 |
Primary
Volume of SSBs Per Transaction
Total milliliters of SSBs per transaction from sales data
Time frame: Through study period (either 4 weeks baseline, or 4 weeks intervention)
Population: In addition to the surveys with the participants (described in the participant flow), data on total sales were collected at the register. It is not possible to know if these sales data were associated with one or more than one participant because they are at the sales item level. For the purposes of this report, the number of participants are identical to the number of items sold.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Volume of SSBs Per Transaction | 116.2 mL of Sugar Sweetened Beverages purchase | Standard Deviation 212.5 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Volume of SSBs Per Transaction | 89.8 mL of Sugar Sweetened Beverages purchase | Standard Deviation 160.1 |
| Calorie/Control Poster | Volume of SSBs Per Transaction | 115.3 mL of Sugar Sweetened Beverages purchase | Standard Deviation 211.8 |
| SSB Warning and Non-SSB Promotion Poster | Volume of SSBs Per Transaction | 103.4 mL of Sugar Sweetened Beverages purchase | Standard Deviation 176.2 |
Secondary
Total Calories Per Transaction
Total number of calories for all food and beverages (SSBs and non-SSBs) per transaction from purchase assessments (e.g., calories from Coke + bag of chips)
Time frame: Through time frame (either 4 weeks baseline, or 4 weeks intervention)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Total Calories Per Transaction | 290.8 calories | Standard Deviation 224.2 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Total Calories Per Transaction | 338.5 calories | Standard Deviation 222.6 |
| Calorie/Control Poster | Total Calories Per Transaction | 287.5 calories | Standard Deviation 211.8 |
| SSB Warning and Non-SSB Promotion Poster | Total Calories Per Transaction | 332.0 calories | Standard Deviation 239.8 |
Other Pre-specified
Healthy Perceptions of Non-SSBs
Average of perceptions of healthiness (measured on Likert scales) for two items (1=Extremely unhealthy; 7=Extremely healthy, higher values are more accurate)
Time frame: 4 weeks baseline, 4 weeks intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Healthy Perceptions of Non-SSBs | 4.79 units on a scale | Standard Deviation 0.81 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Healthy Perceptions of Non-SSBs | 4.83 units on a scale | Standard Deviation 0.77 |
| Calorie/Control Poster | Healthy Perceptions of Non-SSBs | 5.01 units on a scale | Standard Deviation 0.87 |
| SSB Warning and Non-SSB Promotion Poster | Healthy Perceptions of Non-SSBs | 4.96 units on a scale | Standard Deviation 0.79 |
Other Pre-specified
Perceived Influence of Poster Among Those Who Saw it
Do you think the poster influenced what you purchased? (1=Not at all; 5=Very much, higher values in the intervention condition indicate the intervention is perceived to be effective)
Time frame: During intervention, 4 weeks
Population: Only asked in the treatment period of participants who reported seeing a poster.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Perceived Influence of Poster Among Those Who Saw it | 2.01 units on a scale | Standard Deviation 1.25 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Perceived Influence of Poster Among Those Who Saw it | 2.51 units on a scale | Standard Deviation 1.36 |
Other Pre-specified
Percentage of Participants With Transactions With SSBs Out of All Beverage Transactions
Percentage of participants with transactions that have sugar sweetened beverages out of all participants who had beverage transactions
Time frame: 4-week baseline and 4-week intervention
Population: This analysis was limited to people who bought a beverage. Students who only purchased food were not included.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Baseline for Calorie/Control Poster | Percentage of Participants With Transactions With SSBs Out of All Beverage Transactions | 57 Participants |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Percentage of Participants With Transactions With SSBs Out of All Beverage Transactions | 36 Participants |
| Calorie/Control Poster | Percentage of Participants With Transactions With SSBs Out of All Beverage Transactions | 40 Participants |
| SSB Warning and Non-SSB Promotion Poster | Percentage of Participants With Transactions With SSBs Out of All Beverage Transactions | 63 Participants |
Other Pre-specified
Percentage of Participants With Transactions With SSBs Out of All Food and Beverage Transactions
Percentage of participants with transactions that have sugar sweetened beverages out of all participants who had food and beverage transactions
Time frame: 4-week baseline and 4-week intervention
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Baseline for Calorie/Control Poster | Percentage of Participants With Transactions With SSBs Out of All Food and Beverage Transactions | 57 Participants |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Percentage of Participants With Transactions With SSBs Out of All Food and Beverage Transactions | 36 Participants |
| Calorie/Control Poster | Percentage of Participants With Transactions With SSBs Out of All Food and Beverage Transactions | 40 Participants |
| SSB Warning and Non-SSB Promotion Poster | Percentage of Participants With Transactions With SSBs Out of All Food and Beverage Transactions | 63 Participants |
Other Pre-specified
Poster Message Trust
How much do you trust the information on the poster? (1=Not at all; 5=Very much, higher values in the intervention condition indicate the intervention is perceived to be trustworthy)
Time frame: During intervention, 4 weeks
Population: Only asked during the intervention period.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Poster Message Trust | 3.55 units on a scale | Standard Deviation 1.16 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Poster Message Trust | 3.94 units on a scale | Standard Deviation 0.86 |
Other Pre-specified
Unhealthy Perceptions of SSBs
Average of perceptions of healthiness (measured on Likert scales) for two items (1=Extremely unhealthy; 7=Extremely healthy, lower values are more accurate)
Time frame: 4 weeks baseline, 4 weeks intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline for Calorie/Control Poster | Unhealthy Perceptions of SSBs | 3.05 units on a scale | Standard Deviation 1.07 |
| Baseline for SSB Warning and Non-SSB Promotion Poster | Unhealthy Perceptions of SSBs | 3.04 units on a scale | Standard Deviation 0.98 |
| Calorie/Control Poster | Unhealthy Perceptions of SSBs | 3.09 units on a scale | Standard Deviation 1.06 |
| SSB Warning and Non-SSB Promotion Poster | Unhealthy Perceptions of SSBs | 3.02 units on a scale | Standard Deviation 1 |