Perceptions of non-sugar sweeteners (NSS) and front-of-package NSS labels among parents of preschool and school-aged children in Brazil.

Objective: To describe Brazilian parents' perceptions of non-sugar sweeteners (NSS) in beverages consumed by children and their preferences for NSS front-of-package labels (FOPLs).

Design: A qualitative-driven mixed-methods embedded design was used. Seven focus groups with parents of children explored perceptions of NSS. Thematic analysis was conducted on transcripts. Participants also completed a closed-ended survey assessing familiarity with NSS-containing beverages, ability to identify NSS on labels, and perceptions of NSS FOPLs. Survey responses were summarized using descriptive statistics.

Setting: Public and private schools and early childhood education centers in urban areas of two municipalities in the State of São Paulo, Brazil.

Participants: Forty parents of children aged 2-5 and 6-11, across seven focus groups.

Results: About 35% of participants reported their children consumed at least one NSS-containing beverage weekly in the past month; 17% reported daily consumption. Parents expressed a preference for natural products and confusion over the term "edulcorantes" (Portuguese for NSS). They shared concerns about health effects of both sugar and NSS, particularly for children. NSS were seen as acceptable in specific cases, such as diabetes. Most parents supported FOPL like Mexico's, stating "not recommended for children." In the survey, 85% correctly identified beverages with NSS, but 82% misclassified non-NSS ingredients (e.g., sugar syrup, caramel) as NSS. The Mexico-style FOPL was preferred by 95%, who found it helpful and easy to understand.

Conclusions: An FOPL clearly indicating NSS presence, especially one recommending against consumption by children, may help parents make informed choices and reduce children's intake of NSS-containing beverages.