Preventing Non-communicable Diseases in Guatemala Through Sugary Drink Reduction

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.

Study Overview

• Status: Completed
• Conditions: Food Preferences
• Intervention / Treatment: Behavioral: Exposure to beverage calorie information; Behavioral: Exposure to beverage health information

• Study Type: Interventional
• Enrollment (Actual): 628
• Phase: Phase 3

Contacts and Locations

Study Locations

• Guatemala
  • Guatemala City, Guatemala
    • Universidad Rafael Landivar

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 18 years (ADULT, CHILD)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: PREVENTION
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Calorie/Control Poster; This poster will display images of both SSBs and low or no sugar beverages with calories listed below the beverages. It will simply state that those beverages are sold in the school store.	Behavioral: Exposure to beverage calorie information; Calories for sugar-sweetened and non-sugar-sweetened beverages
EXPERIMENTAL: SSB Warning and Non-SSB Promotion Poster; This poster will display images of both SSBs and low or no sugar beverages with calories listed below the beverages. In addition, the message will state that SSBs are high in sugar and should be avoided, while low or no sugar beverages are healthier options and should be chosen.	Behavioral: Exposure to beverage calorie information; Calories for sugar-sweetened and non-sugar-sweetened beverages; Behavioral: Exposure 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
NO_INTERVENTION: 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.
NO_INTERVENTION: 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 intervention school.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Volume of SSBs Per Transaction	Total milliliters of SSBs per transaction from sales data	Through study period (either 4 weeks baseline, or 4 weeks intervention)
Beverage Calories Per Transaction	Total number of calories for all beverages (SSBs and non-SSBs) per transaction from sales data	Through study period (either 4 weeks baseline or 4 weeks intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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)	Through time frame (either 4 weeks baseline, or 4 weeks intervention)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
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	4-week baseline and 4-week intervention
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	4-week baseline and 4-week intervention
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)	4 weeks baseline, 4 weeks intervention
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)	4 weeks baseline, 4 weeks intervention
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)	During intervention, 4 weeks
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)	During intervention, 4 weeks

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Collaborators: Fogarty International Center of the National Institute of Health; Universidad Rafael Landivar

Study record dates

Study Major Dates

• Study Start (ACTUAL): July 8, 2019
• Primary Completion (ACTUAL): August 30, 2019
• Study Completion (ACTUAL): August 30, 2019

Study Registration Dates

• First Submitted: July 9, 2019
• First Submitted That Met QC Criteria: July 16, 2019
• First Posted (ACTUAL): July 17, 2019

Study Record Updates

• Last Update Posted (ACTUAL): March 25, 2021
• Last Update Submitted That Met QC Criteria: March 1, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Adolescents; Food Labeling
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Noncommunicable Diseases
• Other Study ID Numbers: R21TW010837 (NIH)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No