Widespread use of face coverings is a key public health strategy to prevent the spread of COVID-19. However, few studies have examined why Americans use or do not use face coverings, and little is known about the most effective messaging strategies. This study explored perceptions of face coverings, including motivations and barriers for use, and examined reactions to messaging promoting the use of face coverings. Six virtual focus groups were conducted with 34 North Carolina residents in July 2020. Participants reported high compliance with face covering recommendations but often did not wear them around family, friends, and colleagues. The most prevalent motivation for the use of face coverings was to protect or respect other people, including high-risk populations and individuals. Other motivators were self-protection, responsibility, desire for control, requirements, and expert advice. Barriers included physical and social discomfort, confusion or misinformation, low perceived susceptibility to COVID-19, and perceptions of identity and autonomy. Even among individuals who frequently wear face coverings, there are opportunities to improve compliance. Messaging should highlight how face coverings protect the wearer and others around them, normalize the use of face coverings in social settings, and emphasize requirements. Positive messages that focus on unity, personal experiences and the rationale for face coverings are recommended.

Background: Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents’ purchases of sugary drinks for their children in a naturalistic store laboratory. Methods and findings: Parents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05). Conclusions: Pictorial warnings reduced parents’ purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US. Trial registration: The trial design, measures, power calculation, and analytic plan were registered before data collection at www.clinicaltrials.gov NCT04223687.

Policies to require warnings on the front of food and drinks high in nutrients of concern (e.g., added sugar, sodium, or saturated fat) are becoming increasingly common as an obesity prevention strategy. Colombia, a country with growing prevalence of obesity, is considering implementing a similar policy. The objective of this study was to assess perceptions and reactions to different warning designs. We conducted a randomized experiment in an online panel of adults age > 18y (n = 1997). Participants were randomized to view one of four labels: a control label (barcode), an octagon warning, a circle warning, and a triangle warning. Participants viewed their randomly assigned label on a series of products and answered questions (continuous outcomes ranged from 1–4). Compared to the control, all warnings led to higher perceived message effectiveness (increase in mean from 1.79 in the control to 2.59–2.65 in the warning conditions, p < 0.001), a higher percentage of participants who correctly identified products high in nutrients of concern (from 48% in the control condition to 84–89% in the warning conditions, p < 0.001), and reduced intentions to purchases these products (decrease in mean from 2.59 to 1.99–2.01 in the warning conditions, p < 0.001). Relative to the control, warnings performed similarly across education levels, suggesting this policy would be equitable in Colombia. Looking at differences by warning type, the pattern of results suggested that the octagon warnings performed best. After viewing all label types, 49% of participants selected the octagon warning as the one that most discouraged them from consuming products high in nutrients of concern, while 21% and 27% selected the circle and triangle warning. Colombian policymakers should consider the octagon warning as part of a front-of-package labeling policy to help consumers identify and reduce consumption of foods and drinks high in nutrients of concern.

Background: Policies to reduce red meat intake are important for mitigating climate change and improving public health. We tested the impact of taxes and warning labels on red meat purchases in the United States. The main study question was, will taxes and warning labels reduce red meat purchases? Methods and findings: We recruited 3,518 US adults to participate in a shopping task in a naturalistic online grocery store from October 18, 2021 to October 28, 2021. Participants were randomized to one of 4 conditions: control (no tax or warning labels, n = 887), warning labels (health and environmental warning labels appeared next to products containing red meat, n = 891), tax (products containing red meat were subject to a 30% price increase, n = 874), or combined warning labels + tax (n = 866). We used fractional probit and Poisson regression models to assess the co-primary outcomes, percent, and count of red meat purchases, and linear regression to assess the secondary outcomes of nutrients purchased. Most participants identified as women, consumed red meat 2 or more times per week, and reported doing all of their household’s grocery shopping. The warning, tax, and combined conditions led to lower percent of red meat–containing items purchased, with 39% (95% confidence interval (CI) [38%, 40%]) of control participants’ purchases containing red meat, compared to 36% (95% CI [35%, 37%], p = 0.001) of warning participants, 34% (95% CI [33%, 35%], p < 0.001) of tax participants, and 31% (95% CI [30%, 32%], p < 0.001) of combined participants. A similar pattern was observed for count of red meat items. Compared to the control, the combined condition reduced calories purchased (−311.9 kcals, 95% CI [−589.1 kcals, −34.7 kcals], p = 0.027), while the tax (−10.3 g, 95% CI [−18.1 g, −2.5 g], p = 0.01) and combined (−12.7 g, 95% CI [−20.6 g, −4.9 g], p = 0.001) conditions reduced saturated fat purchases; no condition affected sodium purchases. Warning labels decreased the perceived healthfulness and environmental sustainability of red meat, while taxes increased perceived cost. The main limitations were that the study differed in sociodemographic characteristics from the US population, and only about 30% to 40% of the US population shops for groceries online. Conclusions: Warning labels and taxes reduced red meat purchases in a naturalistic online grocery store. Trial Registration: http://www.clinicaltrials.gov/ NCT04716010.

Rejection from parents can lead transgender (trans) youth and young adults to experience poor health outcomes, while parental and sibling acceptance and support can be protective against poor health outcomes. The role of family in adult trans women's lives has been minimally investigated. This study aimed to explore experiences of familial rejection, acceptance, and support in the lives of trans women sex workers living with HIV in the Dominican Republic. In-depth interviews were conducted with 21 trans women ages 23 to 49 in Santo Domingo in 2019. We conducted a qualitative analysis of the interviews. We developed narrative summaries and a case-based matrix to analyze data within and across participants and confirm patterns and themes in the data. Familial rejection and acceptance were processes with most participants receiving acceptance from at least one family member over time as well as receiving emotional and instrumental support. Poor health outcomes influenced by rejection and lack of support included suicide attempts, depression, and substance use. Conversely, acceptance and support bolstered well-being and provided housing stability and assistance with HIV treatment. Family rejection and acceptance play an important role throughout the life course. Working with families to become accepting of their trans family members could improve trans women's health outcomes.

Objective: This study assessed nutrient warnings’ impact on product selection and identification of food products high in nutrients of concern in Colombia.Methods: In an online experiment (October 2020), 8,061 Colombians were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition. They viewed two fruit drinks labeled according to their condition, one high in sugar and one not, and completed selection tasks. Next, they assessed four products high in sugar, sodium, and/or saturated fat (“high in” product). Finally, they selected which label would most discourage them from consuming a “high in” product.Results: The nutrient warning performed better on most outcomes. Twenty percent of participants exposed to the nutrient warning would purchase the high-sugar fruit drink compared to GDA (24%, p<0.01), Nutri-Score (33%, p<0.001), and no label (29%, p<0.001). GDA performed slightly better than the nutrient warning in identifying the high-sugar fruit drink (91% vs 88%, p<0.001). The nutrient warning best helped participants correctly identify other “high in” products (75% vs. 23% no-label, 26% Nutri-Score, and 43% GDA, all p<0.001) and had the highest perceived message effectiveness (3.86 on 5-point scale vs. 2.97 GDA and 2.70 Nutri-Score, both p<0.001) and lowest likelihood of purchasing “high in” products (2.58 on 5-point scale vs. 3.23 GDA, 3.49 Nutri-Score, and 3.51 no label, all p<0.001). The nutrient warning most discouraged participants from wanting to consume “high in” products.Conclusions: Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern.Trial registration: Trial Registration:NCT04567004.