Effects of Sugary Drinks Counter-marketing Messages

Effects of Anti-sugar-sweetened-beverage Counter-marketing on Behavioral Intentions and Perceived Weight Stigma

This study aims to examine consumer responses to traditional and counter-marketing messages discouraging sugary drink consumption, including effects on intentions to consume sugary drinks and perceived weight stigma. Because prior research has suggested that counter-marketing may be especially effective among younger populations, the investigators will examine effects overall and by age group (young adults [ages 18-29 years] vs. middle and older adults [ages 30+ years]).

Study Overview

• Status: Completed
• Conditions: Obesity; Dietary Habits; Weight Gain; Weight Prejudice
• Intervention / Treatment: Behavioral: Exposure to control (neutral) messages; Behavioral: Exposure to traditional health messages; Behavioral: Exposure to counter-marketing messages

Detailed Description

In this online randomized clinical trial, participants will be randomized to one of three arms: 1) Control (neutral) messages, 2) Traditional health messages, and 3) Counter-marketing messages. In each arm, participants will view four messages developed for their randomly assigned arm and answer questions about the messages and their behavioral intentions.

• Study Type: Interventional
• Enrollment (Actual): 2184
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Palo Alto, California, United States, 94304
      • Stanford School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 18 years old or older

Exclusion Criteria:

• Less than 18 years old

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Traditional health messages; Participants will view traditional health messages focused on the health consequences of sugar-sweetened beverage consumption, using text adapted from prior sugary drink campaigns. Participants will view a total of 4 messages developed for this arm.	Behavioral: Exposure to traditional health messages; Traditional health messages focused on the health consequences of sugar-sweetened beverage consumption, using text adapted from prior sugary drink campaigns. Participants will view a total of 4 messages developed for this arm.
Active Comparator: Control (neutral) messages; Participants will view control messages approximately matched to the intervention messages on length, but discussing a neutral topic unrelated to sugary drinks (safe driving). Participants will view a total of 4 messages developed for this arm.	Behavioral: Exposure to control (neutral) messages; Control messages approximately matched to the intervention messages on length, but discussing a neutral topic unrelated to sugary drinks (safe driving). Participants will view a total of 4 messages developed for this arm.
Experimental: Counter-marketing messages; Participants will view counter-marketing messages about sugary drinks that incorporate principles of effective counter-marketing campaigns, including describing industry manipulation of consumers, appealing to emotions (especially anger), describing health consequences, and criticizing the industry for demographic targeting. Messages include text adapted from prior counter-marketing campaigns. Participants will view a total of 4 messages developed for this arm.	Behavioral: Exposure to counter-marketing messages; Counter-marketing messages about sugary drinks that incorporate principles of effective counter-marketing campaigns, including describing industry manipulation of consumers, appealing to emotions (especially anger), describing health consequences, and criticizing the industry for demographic targeting. Messages include text adapted from prior counter-marketing campaigns. Participants will view a total of 4 messages developed for this arm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intentions to consume sugary drinks	We will assess intentions to consume sugary drinks using 2 items: "In the next week, I plan to drink sugary drinks like sodas, sports drinks, or fruit drinks," and "In the next week, I am likely to drink sugar-sweetened beverages like sodas, sports drinks, or fruit drinks". Response options to both items will use a 5-point Likert scale: the first item's response options will range from "definitely not" (1) to "definitely yes" (5), and the second item's response options will range from "not at all likely" (1) to "extremely likely" (5). We will average responses to the 2 items.	The survey will take up to 20 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived message effectiveness for discouraging sugary drink consumption	Item: "These messages discourage me from wanting to drink sugary drinks." This variable will be measured on a 5-point Likert scale ranging from "not at all" (1) to "a great deal" (5).	The survey will take up to 20 minutes
Negative feelings toward drinking sugary drinks	Item: "How do these messages make you feel about drinking sugary drinks?" This variable will be measured on a 5-point Likert scale ranging from "extremely positive" (1) to "extremely negative" (5).	The survey will take up to 20 minutes
Anticipated social interactions	We will examine anticipated social interactions by asking, "How likely are you to talk about these messages with others in the next week?" This item will be scored on a 5-pt Likert scale ranging from "not at all likely" (1) to "extremely likely" (5).	The survey will take up to 20 minutes
Attitudes toward sugary drink companies	We will examine attitudes toward sugary drink companies by asking, "How do you feel about companies that make sugary drinks?" This item will be scored on a 5-pt Likert scale ranging from "dislike them a lot" (1) to "like them a lot" (5).	The survey will take up to 20 minutes
Perceived obesity stigma	We will examine the extent to which participants perceive the messages as contributing to obesity stigma by asking 3 items: "These messages promote negative attitudes about people who have overweight or obesity," "These messages increase blame towards people for being overweight," and "These messages make obesity seem like a much simpler issue than it really is." Each item will be scored on a 5-point Likert scale from "not at all" (1) to "a great deal" (5). We will average responses to these items.	The survey will take up to 20 minutes
Message reactance	We will examine psychological reactance to the messages by asking 3 items: "These messages are trying to manipulate me," "These messages are overblown" and "How much do these messages make you feel angry?" Each item will be scored on a 5-point Likert scale from "not at all" (1) to "a great deal" (5). We will average responses to these items, assuming sufficient internal consistency (alpha>=.70).	The survey will take up to 20 minutes

Collaborators and Investigators

• Sponsor: Stanford University
• Collaborators: Harvard Pilgrim Health Care
• Investigators: Principal Investigator: Anna H Grummon, PhD, Stanford School of Medicine, Department of Pediatrics

Publications and helpful links

General Publications

• Bryan CJ, Yeager DS, Hinojosa CP. A values-alignment intervention protects adolescents from the effects of food marketing. Nat Hum Behav. 2019 Jun;3(6):596-603. doi: 10.1038/s41562-019-0586-6. Epub 2019 Apr 15.
• Kraak VI, Consavage Stanley K, Harrigan PB, Zhou M. How have media campaigns been used to promote and discourage healthy and unhealthy beverages in the United States? A systematic scoping review to inform future research to reduce sugary beverage health risks. Obes Rev. 2022 May;23(5):e13425. doi: 10.1111/obr.13425. Epub 2022 Feb 9.
• Boles M, Adams A, Gredler A, Manhas S. Ability of a mass media campaign to influence knowledge, attitudes, and behaviors about sugary drinks and obesity. Prev Med. 2014 Oct;67 Suppl 1:S40-5. doi: 10.1016/j.ypmed.2014.07.023. Epub 2014 Jul 24.
• Kite J, Grunseit A, Bohn-Goldbaum E, Bellew B, Carroll T, Bauman A. A Systematic Search and Review of Adult-Targeted Overweight and Obesity Prevention Mass Media Campaigns and Their Evaluation: 2000-2017. J Health Commun. 2018;23(2):207-232. doi: 10.1080/10810730.2018.1423651. Epub 2018 Jan 16.
• Te V, Ford P, Schubert L. Exploring social media campaigns against sugar-sweetened beverage consumption: A systematic search. Schumacher U, ed. Cogent Medicine. 2019;6(1):1607432. doi:10.1080/2331205X.2019.1607432
• Crandall CS, Reser AH. Attributions and Weight-Based Prejudice. In: Brownell K, Puhl R, Schwartz M, Rudd L, eds. Weight Bias: Nature, Consequences, and Remedies. Guilford Publications; 2005:83-96.
• Puhl RM, Schwartz MB, Brownell KD. Impact of perceived consensus on stereotypes about obese people: a new approach for reducing bias. Health Psychol. 2005 Sep;24(5):517-25. doi: 10.1037/0278-6133.24.5.517.
• Dixon H, Scully M, Gascoyne C, Wakefield M. Can counter-advertising diminish persuasive effects of conventional and pseudo-healthy unhealthy food product advertising on parents?: an experimental study. BMC Public Health. 2020 Nov 25;20(1):1781. doi: 10.1186/s12889-020-09881-1.
• Krieger J, Kwon T, Ruiz R, Walkinshaw LP, Yan J, Roberto CA. Countermarketing About Fruit Drinks, Alone or With Water Promotion: A 2019 Randomized Controlled Trial in Latinx Parents. Am J Public Health. 2021 Nov;111(11):1997-2007. doi: 10.2105/AJPH.2021.306488. Epub 2021 Oct 28.

Study record dates

Study Major Dates

• Study Start (Actual): August 7, 2023
• Primary Completion (Actual): August 7, 2023
• Study Completion (Actual): August 7, 2023

Study Registration Dates

• First Submitted: July 11, 2023
• First Submitted That Met QC Criteria: July 11, 2023
• First Posted (Actual): July 20, 2023

Study Record Updates

• Last Update Posted (Estimated): February 28, 2024
• Last Update Submitted That Met QC Criteria: February 26, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: health communication; sugar sweetened beverage; counter-marketing
• Additional Relevant MeSH Terms: Body Weight Changes; Body Weight; Weight Gain
• Other Study ID Numbers: 69580a

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The investigators will share statistical analysis plan and analytic code after publication. The investigators will post these items and de-identified data on ResearchBox, a publicly available platform.
• IPD Sharing Time Frame: Within 6 months of publication
• IPD Sharing Access Criteria: There will be no access criteria; information will be publicly available. We plan to make these resources available on ResearchBox.
• IPD Sharing Supporting Information Type: SAP; ANALYTIC_CODE

Drug and device information, study documents

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