Policy makers are interested in beverage taxes to raise revenue and reduce sugar-sweetened beverage intake, given its strong connection to obesity and poor health.¹ Seven US cities have implemented beverage excise taxes, where the tax is levied on the distribution of beverages and may only be partially passed through to consumers. Philadelphia implemented an excise tax of 1.5 cents per ounce on the distribution of sugar-sweetened and artificially sweetened drinks on January 1, 2017.² This tax is unique because it includes diet drinks and affects a large, racially/ethnically diverse, and low-income population (Philadelphia is the poorest of the 10 largest US cities).³

Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of ( a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and ( b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improvepopulation health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits.

BACKGROUND AND OBJECTIVES: US states have introduced bills requiring sugar-sweetened beverages (SSBs) to display health warning labels. This study examined how such labels may influence parents and which labels are most impactful. METHODS: In this study, 2381 demographically and educationally diverse parents participated in an online survey. Parents were randomly assigned to 1 of 6 conditions: (1) no warning label (control); (2) calorie label; or (3–6) 1 of 4 text versions of a warning label (eg, Safety Warning: Drinking beverages with added sugar[s] contributes to obesity, diabetes, and tooth decay). Parents chose a beverage for their child in a vending machine choice task, rated perceptions of different beverages, and indicated interest in receiving beverage coupons. RESULTS: Regression analyses controlling for frequency of beverage purchases were used to compare the no warning label group, calorie label group, and all warning label groups combined. Significantly fewer parents chose an SSB for their child in the warning label condition (40%) versus the no label (60%) and calorie label conditions (53%). Parents in the warning label condition also chose significantly fewer SSB coupons, believed that SSBs were less healthy for their child, and were less likely to intend to purchase SSBs. All P values <.05 after correcting for multiple comparisons. There were no consistent differences among different versions of the warning labels. CONCLUSIONS: Health warning labels on SSBs improved parents’ understanding of health harms associated with overconsumption of such beverages and may reduce parents’ purchase of SSBs for their children.