Researchers at UNC-Chapel Hill have found that combining taxes on sugary drinks with added messaging on price tags further discourages parents from wanting to buy sugary drinks for their children. 

Currently, over 60 countries and smaller jurisdictions around the world have levied taxes on sugary drinks in an effort to curb their consumption, yet these beverages typically appear with a standard price tag displaying a tax-inclusive price and no additional messages or label requirements.

Researchers wondered how communicating either the price increase from the tax or the high sugar content on price tags might further empower healthy decision-making. 

The study found that all types of enhanced price tags discouraged parents from wanting to buy sugary drinks for their children compared to the standard price tags. Messages about taxes on price tags could reduce purchases of unhealthy products, enabling more health benefits. 

“Even though this policy hasn’t been implemented yet, public health lawyers think it should be legally feasible for policymakers to enact price tag requirements in conjunction with an excise tax on sugary drinks,” said Marissa Hall, PhD, assistant professor in Gillings School of Global Health’s Department of Health Behavior, Global Food Research Program faculty member, and study’s first author.

Read more about this research by Rachel Morrow at the Gillings School of Global Public Health news page.

Read the full article in the American Journal of Preventive Medicine online.

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AUTHORS

Marissa Hall
Phoebe Ruggles
Katherine McNeel
Carmen Prestemon
Cristina Lee
Caitlin Lowery
Aline D’Angelo Campos
Lindsey Smith Taillie

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Learn more about sugary drink taxes around the world.

Findings from a new study in PLOS Medicine conducted by researchers from UNC-Chapel Hill, Stanford University, and the University of Edinburgh indicate that warning label and tax policies effectively reduce purchases of red meat-containing items, such as burger patties, pepperoni pizza, and ham luncheon meat.

Consumption of red meat has gained attention as a nutrition and environmental concern, given its link to harmful climate and health impacts, including high greenhouse gas emissions and increased risk of noncommunicable diseases. The landmark 2019 EAT-Lancet Commission encourages consumers to decrease red meat consumption to improve health and consume a more environmentally friendly diet. Yet, there is limited research assessing how food policies could encourage this decrease in red meat consumption. Warning labels and taxes on processed foods and sugar-sweetened beverages have been found to effectively reduce their purchase and consumption, but this study is the first to assess the impact of warning labels and tax policies specifically on red meat-containing products.

Online shopping for red meat

Researchers randomly assigned participants to a control group or to one of three intervention groups: warning labels, tax, or combined (warning labels + tax). A total of 3,518 participants completed an online shopping task where they were instructed to purchase items from a predetermined 9-item shopping list with a $40 budget: 1 pizza, 1 burrito, burger patties (meat or vegetarian), breakfast sausages (meat or vegetarian), 1 frozen individual meal, 1 loaf of bread, 1 sandwich filling (for example, ham, turkey, or peanut butter), 1 pack of tortillas, and 1 taco filling (for example, steak, chicken, or beans). Researchers counted the number of products that contained red meat and proportion of red meat products in the shopping haul.

They found that warning label, tax, and a combination of both interventions all led to reductions in purchases of red meat-containing items: 39% of control group participants purchased red meat items compared to 36% of those who saw warning labels, 34% of those in the tax group, and 31% of those exposed to a combination of the two interventions.

Exposure to the combined intervention of warnings and the tax also resulted in less calories (-312 kcal) and saturated fat (-12.8 g) in participants’ shopping baskets, but not sodium, when compared to the control group.

“These results show that taxes and warning labels on red meat work similarly to sugary drinks and tobacco, helping consumers reduce their purchases of these products,” said first author Lindsey Smith Taillie, PhD, associate professor and associate chair of academics in the Department of Nutrition at UNC-Chapel Hill’s Gillings Global School of Public Health. “Policies like taxes and warning labels to reduce red meat purchases could yield both public health and environmental benefits.”

Key findings:

“Moving forward, it is also important to determine how to encourage a shift away from red meat purchases to more healthy and environmentally friendly products,” said Taillie. “While reducing red meat is important, we also need to understand the environmental and health impacts of the substitutes that consumers are choosing to ensure the shift does indeed lead to improved outcomes.”

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This research was funded by Wellcome Trust and support from the National Heart, Lung, and Blood Institute of the NIH and the NICHD-NRSA Population Research Training grant.

AUTHORS

Lindsey Smith Taillie
Maxime Bercholz
Carmen E. Prestemon
Isabella C. A. Higgins
Anna H. Grummon
Marissa G. Hall
Lindsay M. Jaacks

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MORE RESEARCH ON RED AND PROCESSED MEATS:

Americans consume red meat from a variety of foods, creating opportunities to introduce meat-free substitutions Read more…

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Health, environmental messages boost Meatless Monday campaign Read more…

Chilean policies aimed at reining in unhealthy food marketing are succeeding in protecting children from the onslaught of television advertisements (TV ads) for these products, according to new research. The country’s multi-phased regulations, which began in 2016, have led to a 73% drop in children’s exposure to TV ads for regulated foods and drinks (those that exceed legal thresholds for calories, sugar, salt or saturated fat) by 2019. During this time, the number of ads for unhealthy foods dropped 64% on all TV programs and 77% during children’s programming. Researchers also found that 67% fewer unhealthy food ads used child-directed creative content such as cartoons, characters, toys or contests, which are also prohibited under the country’s laws.

These and other findings from researchers at the University of Chile, Diego Portales University and the University of North Carolina at Chapel Hill underscore both the potential and need for strict rules around marketing to build healthier eating habits. The study also highlights the importance of a key policy addition contributing to the regulations’ success: The initial Law of Food Labeling and Advertising in 2016 limited child-directed creative content in any marketing and prohibited companies from placing TV ads for regulated products during programs attracting a child audience. In 2018, Chile extended this prohibition to a full “daytime” ban across all TV from 6 a.m. to 10 p.m. While researchers saw a decline in advertising for unhealthy foods during earlier phases of the law (in 2017 and early 2018), the significantly greater drop following the full daytime ban is noteworthy.

Key findings:

• Total TV advertising dropped 64% for unhealthy foods and drinks (i.e., those high in calories, sugar, salt and/or saturated fat) from 2016 (pre-regulation) to 2019, after the full 6 a.m. to 10 p.m. ban began.

• TV advertising for unhealthy products during children’s programming dropped 77%
  from 2016 to 2019.

• Children viewed 73% fewer TV ads for regulated products in 2019 compared to 2016.

• The number of TV ads for unhealthy foods and drinks that used prohibited child-directed content (e.g., cartoon characters, prizes, games) dropped 67% from 2016 to 2019.

• For all outcomes, impacts were significantly greater after the full 6 a.m. to 10 p.m. daytime advertising ban began in 2018 compared to earlier restrictions during children’s programming, only (in 2017 and early 2018).

“Focusing on child-directed ad content and child-directed programming to reduce children’s exposure to unhealthy food advertising does work to an extent, based on what we’ve seen in Chile, but children are simply exposed to much more than this,” said Francesca Dillman Carpentier, PhD, W. Horace Carter Distinguished Professor at the UNC Hussman School of Journalism and Media and the study’s first author. “To markedly reduce the amount of unhealthy food promotions children view, we see that it takes a bold move like Chile’s 6 a.m. to 10 p.m. ban to be effective. The number of unhealthy food ads on TV, as well as kids’ exposure to them, was greatly reduced after Chile added the daytime ban on these ads.”

This study’s findings underscores a weakness of nearly all governmental restrictions on TV advertising for unhealthy foods worldwide: Most focus on very narrow windows of time or programming, leaving children exposed most of the day and night to targeted ads for unhealthy foods and drinks. (See below.) This study provides evidence that countries could significantly strengthen existing policies by expanding TV restrictions to complete bans. Countries considering introducing policies to regulate food marketing can also learn from the Chilean experience to protect children more effectively from ad exposure.

Chile enacted marketing controls in 2016 as part of an ambitious, comprehensive policy package aimed at reducing childhood obesity and other health risks by creating a healthier food environment. The Law of Food Labeling and Advertising also mandated “stop sign” warning labels on packages for unhealthy foods and banned their sale or promotion in schools. This remains one of the most ambitious regulatory frameworks in the world aimed at tackling rising nutrition-related diseases and soaring health care costs, and many policymakers and public health advocates worldwide have been watching to gauge the policy package’s effectiveness.

Other studies evaluating the combined effects of Chile’s marketing restrictions, warning labels and school ban have yielded similarly promising results: A study of household grocery purchases found a 24% drop in calories purchased in the first year (during the most lax period of the law’s three-phased nutritional criteria) and a 37% reduction in sodium purchased. Focus groups indicate that parents are being encouraged by their children to avoid buying foods with warning labels. Students reduced their sugar, saturated fat and sodium intake in schools — albeit with some evidence of compensation outside of school settings. And marketing restrictions also led to the removal of child-directed marketing strategies from nearly half of all “high-in” breakfast cereals to just 15% in the first year of the law.

“The Chilean experience has shown us that rigorous food marketing regulations work to reduce kids’ exposure to TV food advertising,” said co-author Lindsey Smith Taillie, PhD, associate professor and associate chair of academics in the Department of Nutrition at UNC-Chapel Hill’s Gillings Global School of Public Health.

“Looking to the future, we need to figure out how to monitor and regulate the digital food marketing environment, as kids increasingly shift their attention to smartphones and other online content.”

Key messages:

This research was supported primarily by Bloomberg Philanthropies at part of the Food Policy Program, with additional support from INTA-UNC, INFORMAS, and CONICYT Fondecyt.

AUTHORS

Francesca R. Dillman Carpentier
Fernanda Mediano Stoltze
Marcela Reyes
Lindsey Smith Taillie
Camila Corvalán
Teresa Correa

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Read the study in the International Journal of Behavioral Nutrition and Physical Activity

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RESOURCES

Read more about the evidence for restricting marketing for non-essential foods and drinks high in sugar, salt, saturated or trans fats, or calorie density.

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Compare existing policies around the world aimed at restricting unhealthy food marketing to children.

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MORE RESEARCH FROM CHILE:

After Chile’s labeling and marketing law, drink purchases contained less sugar and more non-nutritive sweeteners, but overall sweetness stayed the same Read more…

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Study shows Chilean policy package led to declines in purchased calories, sugar, fat, and sodium Read more…

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Study finds no negative economic impact from Chilean food labeling and advertising law Read more…

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Sugary Drink purchases plunge following Chile’s new food law Read more…

A new study from South Africa comparing three different front-of-package (FOP) labeling schemes found that a nutrient warning label helped more participants correctly identify unhealthy products and more strongly reduced their intention to purchase those products, compared to a “multiple traffic light” label and a Guideline Daily Amounts label.

These findings, published in Appetite, come at an important time as South African policymakers consider draft regulation for the country’s first mandatory front-of-package label. While research from other countries has found that nutrient warning labels are the stronger FOP label option for identifying and discouraging consumption of unhealthy foods, some studies find that other labels, such as the traffic light, can also be effective. This suggests that context plays an important role and underscores the importance of testing a label designed specifically for South Africa.

“It was important to create a warning label for South Africa that can help people from different language backgrounds and literacy levels make informed decisions on what to buy and eat,” said Makoma Bopape (left), first author and Senior Lecturer in Human Nutrition and Dietetics at the University of Limpopo. “We achieved this using a triangle shape and exclamation mark that are associated with ‘warning’ in South Africa and by including icons for each nutrient, for example a saltshaker for sodium.”

In a randomized controlled trial, researchers from the University Limpopo, the University of the Western Cape, the University of Antwerp, and the University of North Carolina at Chapel Hill compared how well the different label types helped South African consumers:

• Identify products high in sugar, salt, or saturated fat;
• Identify unhealthy products; and
• Reduce intention to purchase unhealthy products.

Participants were randomly selected from the general South African population, which resulted in a representative sample of nearly 2,000 households. They first answered questions about a set of fictional products with no FOP labels, as a control condition. Next, they were randomly assigned to one of the three FOP label conditions and shown another set of products featuring that label. They then answered the same questions about the labeled products.

Researchers measured how many participants in each group correctly identified products high in nutrients of concern (sugar, salt, and saturated fat), how many correctly identified products as unhealthy, and whether participants’ intention to purchase the unhealthy products changed after seeing them with a specific FOP label.

“These findings are consistent with a rapidly growing body of evidence from around the world showing that warning labels are the most effective label type for helping consumers rapidly identify unhealthy foods — and perhaps more importantly, discouraging consumers from buying them,” said Lindsey Smith Taillie (right), co-author and Associate Professor of Nutrition at the University of North Carolina at Chapel Hill.

This research comes on the heels of another study by Bopape, Taillie, and Rina Swart, senior author and professor in Dietetics and Nutrition at the University of the Western Cape, in which they examined how the same warning labels impacted parents’ food purchasing decisions and perceptions of unhealthy foods. When shown images of products with warning labels, parents said they would buy less of the foods with warning labels and switch to non-labeled, healthier options. Parents in the study also expressed that their children’s health was their top priority. Warning labels made them think about future health impacts if their children continued eating ultra-processed foods high in sodium, sugar, and saturated fat.

Like many countries worldwide, South Africa faces high rates of obesity and other diet-related diseases including type 2 diabetes, hypertension, and heart disease — all exacerbated by consuming a diet high in sugar, sodium, or saturated fat. In addition to helping consumers easily and more accurately identify foods high in nutrients of concern and discourage purchases of those products, requiring FOP warning labels on the least-healthy foods and drinks could incentivize industry to offer healthier product choices.

Policies using similar FOP nutrient warning labels have already been implemented or passed in ten other countries — most in the last three years. Evidence of their impact in Chile, where FOP warning labels have been required on unhealthy packaged foods and drinks since 2016, suggests that findings from experiments like this one in South Africa can translate into real, population-level changes in shopping behavior once a policy is implemented. In its first year, Chile’s FOP warning label policy was associated with a 24% drop in sugary drink purchases and declines in sodium (–37%), total calories (–24%), calories from sugar (–27%), and calories from saturated fat (–16%) purchased from all foods and beverages.

“If South Africa adopts the labels used in this study into the current draft regulations, ours will be the first African country and second country in the world after Israel to use a mandatory warning label with icons for different nutrients,” said Swart (left). “In addition to helping guide South African consumers toward healthier choices on what to buy, eat, and feed their families, this could provide important evidence for other countries that have diverse languages and literacy levels.”

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This research was funded by Bloomberg Philanthropies.

For inquiries, contact Emily Busey.

Read the full paper in Appetite:

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AUTHORS

Makoma Bopape
University of Limpopo,
University of the Wester Cape

Jeroen De Man
University of Antwerp

Lindsey Smith Taillie
UNC-Chapel Hill

Shu Wen Ng
UNC-Chapel Hill

Nandita Murukutla
Vital Strategies, New York

Rina Swart
University of the Western Cape

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RESOURCES

Read more about the evidence for front-of-package labels.

View different front-of-package labeling policies around the world.