The Relationship Between Fruit Drink Front-of-Package Claims, Fruit Imagery, and Ingredient Disclosures and Consumer Perceptions, Intentions, and Behavior: A Systematic Review.

Abstract

Background: Fruit drinks are the top source of added sugar in young children's diets, increasing their risk of chronic disease. It is unclear to what extent front-of-package marketing and disclosures influence parents' perceptions of fruit drinks and their intentions and decisions to purchase them. These data are needed to inform regulatory and legal action to reduce potentially misleading marketing and help parents make healthier choices for their children.

Objective: This systematic review investigated the relationship between fruit drink front-of-package claims (nutrient, natural/implied-natural, or health-related), fruit imagery, and ingredient disclosures (sugar, nonnutritive sweeteners, and juice content) and consumer perceptions, intentions, and behavior.

Methods: A comprehensive search was used to identify peer-reviewed, original quantitative, and/or qualitative research published any time using the following databases: PubMed, Embase, PsycInfo, CAB Abstracts, Web of Science Core Collection, and Business Source Complete. Searches were conducted during May 2022 and January 2023. Risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Programme checklist for qualitative studies. Articles were grouped by exposure and narratively synthesized.

Results: Sixteen articles met inclusion criteria. Reviewed studies found that natural claims-and, to some extent, nutrient claims and fruit imagery-are associated with increased selection, purchase intentions, perceived healthfulness, and appeal of fruit drinks; as well as increased misunderstandings of fruit drink juice content (overestimation) and added sugars content (underestimation). Ingredient disclosures-including percent-juice content and presence of added sweeteners-may help correct misperceptions about product healthfulness.

Conclusions: Front-of-package claims and imagery can increase healthfulness misperceptions and selection of fruit drinks, and ingredient disclosures could partially correct those misperceptions. The US Food and Drug Administration should consider updating fruit drink front-of-package marketing regulations. More high-quality randomized experiments would be useful to inform federal and legal action to support parents in selecting healthier beverages for their children.