Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task.

Effective strategies to reduce free sugar intake are needed. This study examined exposure to a warning label, independently and in conjunction with a Health Star Rating (HSR) label, on the selection of commercially available cold beverages with real decision-making stakes. Participants (N = 511, 47.9% female, mean = 21.7 (SD = 6.1) years) accessed an online convenience store app via an on-campus laptop to select one of 10 beverages (5 sugar-sweetened beverages [SSBs], 1100% fruit juice, 2 artificially sweetened beverages [ASBs] and 2 waters). The task was repeated with the addition of a warning label on high-sugar drinks in Round 2, and the addition of an HSR label on all drinks in Round 3. Participants were informed that they would receive a complementary drink (valued at <$5AUD) based on their selections following the completion of a brief questionnaire. Baseline results indicated that SSBs and waters were the most and least popular choices, respectively. For both males and females, there was a significant decrease in SSB selection (p < 0.001) and significant increase in ASB and water selection (p < 0.001) following the addition of warning labels to high-sugar drinks. The decreased selection of SSBs and increased selection of waters was maintained in Round 3 when HSR labels were added to all drinks. 100% fruit juice selection decreased with the addition of a warning label for females only (p < 0.01), but increased following the addition of a 4-star HSR label, for both males (p < 0.05) and females (p < 0.001). Warning labels reduced young adults' selection of SSBs and promoted substitution to water. The HSR reinforced this effect for the least healthy drinks. Increased water selection may be further enhanced by ensuring that warning label thresholds and HSR algorithms align to present consistent messaging.

Selling function: the advertising of sugar-containing beverages on Australian television.

Reducing population consumption of sugar-containing beverages has become a public health priority in many countries due to causal evidence between high consumption, weight gain and non-communicable diseases. This study aims to explore how sugar-containing beverages are associated with health and wellness in television advertisements. Our sample consisted of all televised advertisements from sugar-containing beverage manufacturers aired on free-to-air television from one Australian network (four channels) in 2016 (n = 30 unique advertisements). We transcribed advertisements for audio and visual information. We analysed data inductively using methods from thematic, discourse and multi-modal analysis. Advertisements for sugar-containing beverages reflected both traditional (physical health and reduced risk of disease) and broader (wellbeing) conceptualizations of health. Beverages were positioned in advertisements as contributing a functional role to promote and enhance health and wellbeing within the physical, mental and social domains. Beverages were advertised as correcting suboptimal states of being to achieve desirable outcomes, including relaxation, increased resistance to disease, enhanced performance, better cognitive functioning and improved social connections. Positioning beverages within a wider conceptualization of health and wellbeing aligns with how health and nutrition are increasingly being understood and sought out by consumers, creating increased opportunities for the marketing of sugar-containing beverages as 'healthy'.

What makes a beverage healthy? A qualitative study of young adults' conceptualisation of sugar-containing beverage healthfulness.

Sugar-containing beverages are the leading source of added sugar consumption among young adults. The aim of this study was to explore how young adults conceptualise what influences the healthfulness of sugar-containing beverages. Seven focus groups stratified by gender and educational institute were conducted with South Australians aged 18-25 years (n = 32). Focus groups were semi-structured and included a ranking activity where participants individually ranked eight beverages from least to most healthy. Focus groups were recorded, transcribed verbatim and thematically analysed. Participants commonly selected soda (soft drink) and energy drink as the least healthy beverage and water as the healthiest, but those between varied in rankings. Four themes were identified relating to how participants conceptualise beverage healthfulness in the thematic analysis: ingredients harmful to health, properties beneficial to health, functionality, and packaging. While participants were aware that beverages can contain high amounts of sugar, and that this can be harmful to health, many other factors influence the perceptions of beverage healthfulness and these can outweigh the perceived harms of consumption. Public health interventions and policies are needed to address misperceptions about the healthfulness of sugar-containing beverages to better put the harms of high sugar consumption in perspective for consumers.

Health Star Ratings: What's on the labels of Australian beverages?

ISSUE ADDRESSED: The Health Star Rating (HSR) System provides a useful tool to communicate health and nutrition messages to consumers. Given the large contribution from sugar-containing beverages to sugar intake in the Australian diet and the adverse health outcomes associated with frequent consumption, it is important to investigate how the HSR System is displayed on beverages. Our research measured and compared the presence of the HSR System on the labels of sugar-containing and sugar-free beverages in Australia. METHODS: We conducted a survey of the labels on 762 ready-to-drink (≤600 mL) nondairy/nonalcoholic beverages, sampled from 17 South Australian supermarkets in late 2016. We measured the presence of a star rating icon or an energy-only icon (which is an option of the HSR System for beverages). RESULTS: The HSR System was observed on 35.3% of beverages, with only 6.8% displaying a star rating icon and 28.5% displaying an energy-only icon. When present (n = 52), star rating icons were almost universally 5 stars (94.2%), and of these, they were predominantly displayed on 100% juices (85.7%). Almost all beverages with a star rating contained high amounts of sugar; only three sugar-free beverages displayed a star rating. CONCLUSION: We found that there are low uptake and limited use of the HSR System on beverages. SO WHAT?: The HSR System on beverages could better achieve its objectives if the energy-only icon were removed from the graphic options, the algorithm were adjusted so that 100% juices cannot display a 5-star rating, and the System were made mandatory.

Industry use of 'better-for-you' features on labels of sugar-containing beverages.

OBJECTIVE: To examine the ways in which sugar-containing beverages are being portrayed as 'better-for-you' (BFY) via features on product labels. DESIGN: Cross-sectional audit of beverage labels. SETTING: Adelaide, Australia. Data on beverage labels were collected from seventeen grocery stores during September to November 2016. SUBJECTS: The content of 945 sugar-containing beverages labels were analysed for explicit and implicit features positioning them as healthy or BFY. RESULTS: The mean sugar content of beverages was high at 8·3 g/100 ml and most sugar-containing beverages (87·7 %) displayed features that position them as BFY. This was most commonly achieved by indicating the beverages are natural (76·8 %), or contain reduced or natural energy/sugar content (48·4 %), or through suggesting that they contribute to meeting bodily needs for nutrition (28·9 %) or health (15·1 %). Features positioning beverages as BFY were more common among certain categories of beverages, namely coconut waters, iced teas, sports drinks and juices. CONCLUSIONS: A large proportion of sugar-containing beverages use features on labels that position them as healthy or BFY despite containing high amounts of sugar.

Sugar-sweetened beverage (SSB) consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review.

OBJECTIVES: Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. METHODS: PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. DESIGN: Systematic scoping review. RESULTS: 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). CONCLUSIONS: There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from an existing nationally representative survey of Aboriginal and Torres Strait Islander people could provide detailed information for demographic subgroups and benchmarks for future interventions. It is recommended that a consistent, culturally appropriate, set of consumption measures be developed.

The marketing of sugar-sweetened beverages to young people on Facebook.

OBJECTIVE: We explored how sugar-sweetened beverages are marketed to Australian young people through sugar-sweetened beverage brand Facebook pages. METHODS: We undertook a content analysis of Facebook posts made by six of the most popular sugar-sweetened beverage Facebook pages in Australia. Data were collected for a six-month period and were quantitatively analysed for descriptive data and explicit marketing techniques and then thematically analysed for implicit marketing messages. RESULTS: There were almost 1.9 million engagements across the six pages over the six-month period. Most posts (70%) included one or more calls to action through which followers were encouraged to do something. Content by sports and energy drink brands were heavily dominated by 'sporting prowess' and 'masculinity' themes while content by Coca-Cola shared the message of 'having fun with friends' and 'happiness'. All pages used outdoor setting scenes. CONCLUSIONS: Sugar-sweetened beverage brands use Facebook to align their marketing with the socio-cultural values and practices likely to be regarded as important by young people. Implications for public health: Our findings provide challenges and opportunities for those in public health advocacy and policy to consider for future obesity-reduction strategies.

Presenting a strong and united front to tobacco industry interference : a content analysis of Australian newspaper coverage of tobacco plain packaging 2008-2014.

OBJECTIVES: In 2012, Australia was the first country in the world to introduce plain or standardised tobacco packaging, coupled with larger graphic health warnings. This policy was fiercely opposed by industry. Media coverage can be an influential contributor to public debate, and both public health advocates and industry sought media coverage for their positions. The aim of this study was to measure the print media coverage of Australian's plain packaging laws, from inception to roll-out, in major Australian newspapers. METHODS: This study monitored mainstream Australian print media (17 newspapers) coverage of the plain packaging policy debate and implementation, over a 7-year period from January 2008 to December 2014. Articles (n=701) were coded for article type, opinion slant and topic(s). DESIGN: Content analysis. RESULTS: Coverage of plain packaging was low during preimplementation phase (2008-2009), increasing sharply in the lead into legislative processes and diminished substantially after implementation. Articles covered policy rationale, policy progress and industry arguments. Of the news articles, 96% were neutrally framed. Of the editorials, 55% were supportive, 28% were opposing, 12% were neutral and 5% were mixed. CONCLUSIONS: Protracted political debate, reflected in the media, led to an implementation delay of plain packaging. While Australian media provided comprehensive coverage of industry arguments, news coverage was largely neutral, whereas editorials were mostly supportive or neutral of the policy. Countries seeking to implement plain packaging of tobacco should not be deterred by the volume of news coverage, but should actively promote the evidence for plain packaging in the media to counteract the arguments of the tobacco industry.

The Australian NHMRC guidelines for alcohol consumption and their portrayal in the print media: a content analysis of Australian newspapers.

OBJECTIVE: To measure and characterise unpaid coverage in the Australian print media of the 2001, 2007 and 2009 National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol. METHODS: A total of 172 articles published in Australian newspapers between 1999 and 2014 were content analysed using a coding framework aimed to define the article descriptors, article prominence, content, slant and guidelines. RESULTS: The majority (62.2%) of articles were published between 2007 and 2009, the predominant topic being 'the National Health and Medical Research Council guidelines" with less than two-thirds (59.2%) of the articles mentioning the specific guidelines for reducing alcohol-related harm. CONCLUSIONS: There was low unpaid print newspaper coverage of the guidelines, which may contribute to low community knowledge of the guidelines. Implications for public health: This study provides a foundation for developing further studies and highlights the need to improve awareness of the guidelines.

Sugar-sweetened beverage consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review protocol.

INTRODUCTION: Aboriginal and Torres Strait Islander communities of Australia experience poorer health outcomes in the areas of overweight and obesity, diabetes and cardiovascular disease. Contributing to this burden of disease in the Australian community generally and in Aboriginal and Torres Strait Islander communities, is the consumption of sugar-sweetened beverages (SSBs). We have described a protocol for a review to systematically scope articles that document use of SSBs and interventions to reduce their consumption with Aboriginal and Torres Strait Islander people. These results will inform future work that investigates interventions aimed at reducing harm associated with SSB consumption. METHODS AND ANALYSIS: This scoping review draws on a methodology that uses a six-step approach to search databases including PubMed, SCOPUS, CINAHL, Informit (including Informit: Indigenous Peoples), Joanna Briggs Institute EBP Database and Mura, between January 1980 and February 2017. Two reviewers will be engaged to search for and screen studies independently, using formulated selection criteria, for inclusion in our review. We will include primary research studies, systematic reviews including meta-analysis or meta-synthesis, reports and unpublished grey literature. Results will be entered into a table identifying study details and characteristics, summarised using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis chart and then critically analysed. ETHICS AND DISSEMINATION: This review will not require ethics committee review. Results will be disseminated at appropriate scientific meetings, as well as through the Aboriginal and Torres Strait Islander community.