Effectiveness of a multi-component intervention including pictorial warnings to reduce sugar-sweetened beverage consumption - a randomized controlled trial

Abstract

Introduction: Sugar-sweetened beverages (SSBs) are a significant source of added sugars in the Indian diet, contributing to adverse health outcomes such as obesity, type 2 diabetes, and dental caries. Multi-component interventions (MCIs) have shown promise in reducing the consumption of harmful products like tobacco. This study assessed the effectiveness of a multi-component intervention—comprising Pictorial Health Warnings (PHWs), educational pamphlets, and targeted counseling—in reducing parental purchases of SSBs for children. Methods: A randomized stepped-wedge controlled trial was conducted across three urban slum sectors in Hyderabad. A total of 60 parents were recruited, with data collected over ten weeks. MCIs were implemented on SSBs at general stores, and outcomes were measured by comparing SSB purchase frequency, risk perception, and parental attitudes before and after the intervention. Results: The implementation of MCIs led to a significant reduction in SSB purchases, with 25% of parents buying SSBs post-intervention compared to 55% pre-intervention (p = 0.002). Parents also purchased SSBs with fewer calories post-intervention (45 kcal vs. 92 kcal, p < 0.001). Additionally, MCIs increased awareness of SSB-related harms (d = 2.19, p < 0.001) and strengthened negative emotional responses (d = 2.08, p < 0.001). No significant differences were observed in the appeal or perceived tastiness of SSBs (p > 0.05). Conclusion: MCIs on SSBs effectively reduced purchase frequency and calorie intake among parents in urban slum settings. The findings support the potential for MCIs to be a feasible public health intervention to reduce SSB consumption in similar socio-economic contexts. Trial registration: CTRI/2024/08/072220 dated 09/08/2024.