UW News

October 28, 2021

Countermarketing based on anti-smoking campaigns reduces buying of sugary ‘fruit’ drinks for children

UW News

Public health messages such as in the image below — designed to reduce parents’ purchases of sugar-sweetened beverages marketed as fruit drinks for children — convinced a significant percentage of parents to avoid those drinks, according to a study by researchers at the University of Washington and the University of Pennsylvania.

image of a child with rotted teeth with text "Sugary fruit drinks are 'naturally' rotting your kid's teeth"

This is an example of a message designed to reduce parents’ spending on sugary beverages. Go to Truth About Fruit Drinks for more countermarketing images and content to share on social media or anywhere.

The UW-led study set out to assess the effect of culturally tailored countermarketing messages on drink choices, similar to stark anti-smoking campaigns, and involved more than 1,600 Latinx parents who participated by joining Facebook groups. Study authors focused on this demographic because Latinx children have a high rate of sugary drink consumption, and the beverage industry intentionally targets the Latinx community, said Dr. James Krieger, lead author and clinical professor of health systems and population health in the UW School of Public Health.

“The negative health effects associated with the consumption of sugary drinks — such as tooth decay or, later in life, diabetes — are disproportionately affecting this community,” Krieger said. “We want these and other kids to be able to avoid developing strong taste preferences for a product that’s ultimately going to harm them.”

To design their study, published Thursday in the American Journal of Public Health, researchers consulted focus groups involving dozens of Latinx parents from across the country to get their perceptions of how marketing works, how they think about what they are buying for their children, as well as how to culturally tailor messages that would resonate in their community.

“They know that targeted marketing happens all the time in the digital era, but what really got them was the fact that they were given deceptive information that they felt was leading them to make unhealthy choices on behalf of their kids,” Krieger said.

That industry marketing, Krieger added, led parents to believe fruit drinks are healthy beverages by creating a “halo of health” around the product. Ads, labels, and even online games and cartoons often contain claims about nutrients such as vitamin C and images of healthy kids drinking their products while participating in sports.

With information from those focus groups and the aid of a Latinx marketing firm, the researchers created countermarketing graphics and messages in Spanish and English designed to elicit outrage, fear of the harmful effects on children and other negative emotions. The messages called out specific brands and images, along with describing the adverse effects of these products.

“We looked at anti-tobacco messages and the words and types of images they used,” Krieger said. “We wanted messages that would appeal to folks on an emotional level as well as a cognitive one, because that’s what research shows drives people to make choices.”

The researchers then enrolled 1,628 Latinx parents — predominantly female and from lower-income households — to participate in Facebook groups for six weeks to study the impact of countermessages on those parents’ beverage choices and fruit drink perceptions.

Sample messages

child drinking a juice drink with text "THink again, it's not fruit in this drink, it's fat!"

Message text: Your body turns sugar you drink into fat which can result in diabetes.

image of a juice drink with text "The 'all natural fruit drink?'"

Message text: WARNING: Calling it natural does not make it good for your kids.

Child with a bike helmet drinking water with text "parents! the choice is clear, H2O is the way to go!"

Message text: Activate your kid’s health by giving them thirst quenching water instead of sugary fruit drinks. The choice is clear.

The study divided parents into three groups. The two “intervention” groups were those who received fruit drink countermessages only, and those receiving a combination of countermessages plus water promotion messages. The third group, the control group, saw safety messages about car seats. Using a simulated online store that offered fruit drinks, soda, water, milk or 100% fruit juice, parents from all three groups chose a drink for their kids and received money they could use to buy the drink in a real store.

The researchers found that parents who saw countermarketing messages alone or combined with pro-water messages were less likely to buy a fruit drink and more likely to buy water. Specifically, parents in the fruit-drink countermarketing group decreased their virtual purchases of these drinks by 31% compared to the control group, and by 43% by the group receiving the combined messages. Parents in the combination group did choose water more often than the first group.

Based on those choices, the authors estimated that children in the combination group consumed 22% less added sugar than the average for children two- to five-years-old. In exit surveys, the authors wrote, the parents in both intervention groups were also “significantly” less likely to trust fruit drink brands.

The researchers said the study is the first to “demonstrate the efficacy of countermessages delivered solely via social media as well as the first to specifically target sweetened beverage consumption among young children.” As a result of this study, the researchers have also created a social media countermarketing toolkit for use by anyone to campaign against fruit drink purchases for children.

As executive director of Healthy Food America and with an extensive background in the development and evaluation of community-based chronic disease prevention programs, including a stint with Public Health-Seattle & King County, Krieger hopes the study will be used widely to curb consumption of sugary fruit drinks.

“For me, there’s no point in doing a study if it is not going to be applied to changing things in the world, so we’ve formed an advisory group and created the toolkit and a plan to reach out to national organizations and encourage them to use the messages,” Krieger said.

Co-authors include Taehoon Kwon, who worked on the study while a UW graduate student in economics; Rudy Ruiz, of Interlex, a multicultural advocacy marketing agency in San Antonio; Lina Pinero Walkinshaw, a clinical instructor in the UW School of Public Health; and Jiali Yan and Christina Roberto at the University of Pennsylvania. This research was funded by the Healthy Eating Research Program of the Robert Wood Johnson Foundation; and the Arcora Foundation, the foundation of Delta Dental of Washington.


For more information, contact Dr. Krieger at jwkrieg@uw.edu.