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What is the impact of increasing the prominence of calorie labelling? A stepped wedge randomised controlled pilot trial in worksite cafeterias
Background: Calorie labelling may help to reduce energy consumption, but few well-controlled experimental studies have been conducted in real world settings. In a previous randomised controlled pilot trial we did not observe an effect of calorie labelling on energy purchased in worksite cafeterias. In the present study we sought to enhance the effect by making the labels more prominent, and to address the operational challenges reported previously by worksites. Methods: Three worksite cafeterias were randomised in a stepped wedge design to start the intervention at one of three fortnightly periods between March and July 2018. The intervention comprised introducing prominent calorie labelling for all cafeteria products for which calorie information was available (on average 87% of products offered across the three sites were labelled). Calorie content was displayed in bold capitalised Verdana typeface with a minimum font size of 14 e.g. 120 CALORIES. Feasibility and acceptability were assessed using post-intervention surveys with cafeteria patrons and semi-structured interviews with managers. Effectiveness was assessed using total daily energy (kcal) purchased from intervention items across the three sites, analysed using semi-parametric GAMLSS models. Results: Recruitment and retention of worksite cafeterias proved feasible: all three randomised sites successfully completed the study. Post-intervention feedback suggested high levels of intervention acceptability: 87% of responding patrons wanted calorie labelling to remain in place. No effect of the intervention on daily energy purchased was observed: −0.6% (95%CI -2.5 to 1.2, p = .487). By-site analyses showed similar null effects at each of the three sites, all ps > .110. Conclusions: There was no evidence that prominent calorie labelling changed daily energy purchased across three English-based worksite cafeterias. The intervention was feasible to implement and acceptable to patrons and managers.
Impact of increasing the proportion of healthier foods available on energy purchased in worksite cafeterias: A stepped wedge randomized controlled pilot trial
Increasing the proportion of healthier foods available could encourage healthier consumption, but evidence to date is limited in scope and quality. The current study aimed to: (a) examine the feasibility and acceptability of intervening to change product availability in worksite cafeterias; and (b) estimate the impact on energy purchased of increasing the proportion of healthier (i.e. lower energy) cooked meals, snacks, cold drinks and sandwiches. Six English worksite cafeterias increased the proportion of healthier foods available, aiming to keep the total number of options constant, in a stepped wedge randomized controlled pilot trial conducted between January and May 2017. The intervention was generally successfully implemented and acceptable to clientele. Generalized linear mixed models showed a reduction of 6.9% (95%CI: -11.7%, −1.7%, p = 0.044) in energy (kcal) purchased from targeted food categories across all sites. However, impact varied across sites, with energy purchased from targeted categories significantly reduced in two sites (−10.7% (95%CI: -18.1% to −2.6%, p = 0.046); −18.4% (95%CI: -26.9% to −8.8%, p = 0.013)), while no significant differences were seen in the other four sites. Overall, increasing the proportion of healthier options available in worksite cafeterias seems a promising intervention to reduce energy purchased but contextual effects merit further study.
Impact of reducing portion sizes in worksite cafeterias: A stepped wedge randomised controlled pilot trial
Background: Reducing the portion sizes of foods available in restaurants and cafeterias is one promising approach to reducing energy intake, but there is little evidence of its impact from randomised studies in field settings. This study aims to i. examine the feasibility and acceptability, and ii. estimate the impact on energy purchased, of reducing portion sizes in worksite cafeterias. Methods: Nine worksites in England were recruited to reduce by at least 10% the portion sizes of foods available in their cafeterias from targeted categories (main meals, sides, desserts, cakes). In a stepped wedge randomised controlled pilot trial, each site was randomised to a date of implementation, staggered fortnightly, following a baseline period of four weeks. Impact on energy purchased was analysed using generalised linear mixed modelling. We also assessed feasibility, acceptability, and fidelity of intervention implementation. Results: Data from six of the nine randomised sites were analysed, with three sites excluded for not providing sufficient data and/or not implementing the intervention. The extent to which the intervention was implemented varied by site, with between 6 and 49% of products altered within targeted categories. Feedback following the intervention suggested it was broadly acceptable to customers and cafeteria staff. For the primary outcome of daily energy (kcal) purchased from intervention categories, there was no statistically significant change when data from all six sites were pooled: percentage change -8.9% (95% CI: -16.7, -0.4; p=0.081). Each of these six sites showed reductions in energy purchased, ranging from -15.6 to -0.3%, which were borderline statistically significant at two sites (respective percentage changes (95% CIs): -15.6% (-26.7, -2.8); -14.0% (-25.0, -1.2)). Secondary outcome data are suggestive of a compensatory increase in energy purchased from food categories not targeted by the intervention, with no overall effect observed on energy purchased across all categories. Conclusions: The results of this pilot trial suggest that reducing portion sizes could be effective in reducing energy purchased and consumed from targeted food categories, and merits investigation in a larger trial. Future studies will need to address factors that prevented optimal implementation including site dropout and application across a limited range of products.
Impact of calorie labelling in worksite cafeterias: A stepped wedge randomised controlled pilot trial
Background: For working adults, about one-third of energy is consumed in the workplace making this an important context in which to reduce energy intake to tackle obesity. The aims of the current study were first, to identify barriers to the feasibility and acceptability of implementing calorie labelling in preparation for a larger trial, and second, to estimate the potential impact of calorie labelling on energy purchased in worksite cafeterias. Methods: Six worksite cafeterias were randomised to the intervention starting at one of six fortnightly periods, using a stepped wedge design. The trial was conducted between August and December 2016, across 17 study weeks. The intervention comprised labelling all cafeteria products for which such information was available with their calorie content (e.g. "250 Calories") displayed in the same font style and size as for price. A post-intervention survey with cafeteria patrons and interviews with managers and caterers were used to assess the feasibility and acceptability of the intervention. Intervention impact was assessed using generalised linear mixed modelling. The primary outcome was the total energy (kcal) purchased from intervention items in each cafeteria each day. Results: Recruitment and retention of worksite cafeterias proved feasible, with post-intervention feedback suggesting high levels of intervention acceptability. Several barriers to intervention implementation were identified, including chefs' discretion at implementing recipes and the manual recording of sales data. There was no overall effect of the intervention: -0.4% (95%CI -3.8 to 2.9, p = .803). One site showed a statistically significant effect of the intervention, with an estimated 6.6% reduction (95%CI -12.9 to - 0.3, p = .044) in energy purchased in the day following the introduction of calorie labelling, an effect that diminished over time. The remaining five sites did not show robust changes in energy purchased when calorie labelling was introduced. Conclusions: A calorie labelling intervention was acceptable to both cafeteria operators and customers. The predicted effect of labelling to reduce energy purchased was only evident at one out of six sites studied. Before progressing to a full trial, the calorie labelling intervention needs to be optimised, and a number of operational issues resolved.
Perceived impact of smaller compared with larger-sized bottles of sugar-sweetened beverages on consumption: A qualitative analysis
Sugar-sweetened beverage (SSB) consumption increases obesity risk and is linked to adverse health consequences. Large packages increase food consumption, but most evidence comes from studies comparing larger with standard packages, resulting in uncertainty regarding the impact of smaller packages. There is also little research on beverages. This qualitative study explores the experiences of consuming cola from smaller compared with larger bottles, to inform intervention strategies. Sixteen households in Cambridge, England, participating in a feasibility study assessing the impact of bottle size on in-home SSB consumption, received a set amount of cola each week for four weeks in one of four bottle sizes: 1500 ml, 1000 ml, 500 ml, or 250 ml, in random order. At the study end, household representatives were interviewed about their experiences of using each bottle, including perceptions of i) consumption level; ii) consumption-related behaviours; and iii) factors affecting consumption. Interviews were semi-structured and data analysed using the Framework approach. The present analysis focuses specifically on experiences relating to use of the smaller bottles. The smallest bottles were described as increasing drinking occasion frequency and encouraging consumption of numerous bottles in succession. Factors described as facilitating their consumption were: i) convenience and portability; ii) greater numbers of bottles available, which hindered consumption monitoring and control; iii) perceived insufficient quantity per bottle; and iv) positive attitudes. In a minority of cases the smallest bottles were perceived to have reduced consumption, but this was related to practical issues with the bottles that resulted in dislike. The perception of greater consumption and qualitative reports of drinking habits associated with the smallest bottles raise the possibility that the ‘portion size effect’ has a lower threshold, beyond which smaller portions and packages may increase consumption. This reinforces the need for empirical evidence to assess the in-home impact of smaller bottles on SSB consumption.
Physical micro-environment interventions for healthier eating in the workplace: Protocol for a stepped wedge randomised controlled pilot trial
Background: An estimated one third of energy is consumed in the workplace. The workplace is therefore an important context in which to reduce energy consumption to tackle the high rates of overweight and obesity in the general population. Altering environmental cues for food selection and consumption-physical micro-environment or 'choice architecture' interventions-has the potential to reduce energy intake. The first aim of this pilot trial is to estimate the potential impact upon energy purchased of three such environmental cues (size of portions, packages and tableware; availability of healthier vs. less healthy options; and energy labelling) in workplace cafeterias. A second aim of this pilot trial is to examine the feasibility of recruiting eligible worksites, and identify barriers to the feasibility and acceptability of implementing the interventions in preparation for a larger trial. Methods: Eighteen worksite cafeterias in England will be assigned to one of three intervention groups to assess the impact on energy purchased of altering (a) portion, package and tableware size (n = 6); (b) availability of healthier options (n = 6); and (c) energy (calorie) labelling (n = 6). Using a stepped wedge design, sites will implement allocated interventions at different time periods, as randomised. Discussion: This pilot trial will examine the feasibility of recruiting eligible worksites, and the feasibility and acceptability of implementing the interventions in preparation for a larger trial. In addition, a series of linear mixed models will be used to estimate the impact of each intervention on total energy (calories) purchased per time frame of analysis (daily or weekly) controlling for the total sales/transactions adjusted for calendar time and with random effects for worksite. These analyses will allow an estimate of an effect size of each of the three proposed interventions, which will form the basis of the sample size calculations necessary for a larger trial.
Impact of bottle size on in-home consumption of sugar-sweetened beverages: A feasibility and acceptability study
Background: Consumption of sugars-sweetened beverages (SSB) increases energy intake and the risk of obesity. Large packages increase consumption of food, implying that smaller bottle sizes may help curb SSB consumption, but there is a lack of relevant evidence relating to these products. This study explores the feasibility and acceptability of conducting a randomised controlled trial to assess the impact of different bottle sizes on SSB consumption at home. Methods: Households in Cambridge, England, which purchased at least 2 l of regular cola drinks per week, received a set amount of cola each week for four weeks, in bottles of one of four sizes (1500 ml, 1000 ml, 500 ml, or 250 ml) in random order. The total volume received consisted of a modest excess of households' typical weekly purchasing, but was further increased for half the study households to avoid ceiling effects. Consumption was measured by recording the number of empty bottles at the end of each week. Eligible households were invited to complete a run-in period to assess levels of active participation. Results: Thirty-seven of 111 eligible households with an interest in the study completed the run-in period. The study procedures proved feasible. The target for recruitment (n = 16 households) was exceeded. Measuring consumption was feasible: over three quarters (n = 30/37) of households returned all bottles on the majority (n = 88/101) of the study weeks completed across households. The validity of this measure was compromised by guests from outside the household who drank the study cola (n = 18/37 households on 48/101 study weeks) and consumption of the study cola outside the home. Supplying enhanced volumes of cola to nine households was associated with higher consumption (11,592 ml vs 7869 ml). The intervention and study procedures were considered acceptable. Thirteen households correctly identified the study aims. Conclusion: The findings support the feasibility and acceptability of running a randomised controlled trial to assess the impact of presenting a fixed volume of SSB in different bottle sizes on in-home consumption. However, methods that avoid consumption being influenced by the amount of cola supplied weekly by the study and that capture out of home consumption are needed before conducting a randomised controlled trial. Trial registration: ISRCTN14964130; Registered on 18th May, 2015.
Price promotions on healthier compared with less healthy foods: A hierarchical regression analysis of the impact on sales and social patterning of responses to promotions in Great Britain
Background: There is a growing concern, but limited evidence, that price promotions contribute to a poor diet and the social patterning of diet-related disease. Objective: We examined the following questions: 1) Are lesshealthy foods more likely to be promoted than healthier foods? 2) Are consumers more responsive to promotions on less-healthy products? 3) Are there socioeconomic differences in food purchases in response to price promotions? Design: With the use of hierarchical regression, we analyzed data on purchases of 11,323 products within 135 food and beverage categories from 26,986 households in Great Britain during 2010. Major supermarkets operated the same price promotions in all branches. The number of stores that offered price promotions on each product for each week was used to measure the frequency of price promotions. We assessed the healthiness of each product by using a nutrient profiling (NP) model. Results: A total of 6788 products (60%) were in healthier categories and 4535 products (40%) were in less-healthy categories. There was no significant gap in the frequency of promotion by the healthiness of products neither within nor between categories. However, after we controlled for the reference price, price discount rate, and brand-specific effects, the sales uplift arising from price promotions was larger in less-healthy than in healthier categories; a 1-SD point increase in the category mean NP score, implying the category becomes less healthy, was associated with an additional 7.7-percentage point increase in sales (from 27.3% to 35.0%; P < 0.01). The magnitude of the sales uplift from promotions was larger for higher-socioeconomic status (SES) groups than for lower ones (34.6% for the high-SES group, 28.1% for the middle-SES group, and 23.1% for the low-SES group). Finally, there was no significant SES gap in the absolute volume of purchases of less-healthy foods made on promotion. Conclusion: Attempts to limit promotions on less-healthy foods could improve the population diet but would be unlikely to reduce health inequalities arising from poorer diets in low-socioeconomic groups.
Impact of bottle size on in-home consumption of sugar-sweetened beverages: Protocol for a feasibility and acceptability study
Background: Intake of free sugars in the population exceeds recommendations, with the largest source in the diet being sugar-sweetened beverages (SSBs). SSB consumption is linked to adverse health consequences and contributes to health inequalities, given greater consumption amongst the most deprived. One possible intervention is to reduce the available sizes of SSB packaging but there is an absence of evidence that this would reduce consumption. Based on evidence from studies targeting food consumption that people consume less when exposed to smaller package sizes, we hypothesise that presenting SSBs in smaller containers reduces consumption. We are planning a crossover randomised controlled trial to assess the impact of presenting a fixed volume of SSB in different bottle sizes on consumption at home. To reduce the uncertainties related to this trial, we propose a preliminary study to assess the feasibility and acceptability of the recruitment, allocation, measurement, retention and intervention procedures. Methods/design: Households which purchase at least 2l of regular cola drinks per week and live in Cambridgeshire, UK will have a set amount of a cola SSB (based on their typical weekly purchasing of cola) delivered to their homes each week by the research team. This total amount of cola will be packaged into bottles of one of four sizes: (i) 1500ml, (ii) 1000ml, (iii) 500ml or (iv) 250ml. A crossover design will be used in which households will each receive all four of the week-long interventions (the four different bottle sizes) over time, randomised in their order of presentation. Approximately 100 eligible households will be approached to assess the proportion interested in actively participating in the study. Of those interested, 16 will be invited to continue participation. Discussion: The findings will inform the procedures for a crossover randomised controlled trial assessing the impact of presenting a fixed volume of SSB in different bottle sizes on consumption at home. The findings from such a trial are expected to provide the best estimate to date of the effect of container size on beverage consumption and inform ongoing scientific and policy discussions about the effectiveness of this intervention at reducing population intake of free sugars in beverages.
Sales impact of displaying alcoholic and non-alcoholic beverages in end-of-aisle locations: An observational study
In-store product placement is perceived to be a factor underpinning impulsive food purchasing but empirical evidence is limited. In this study we present the first in-depth estimate of the effect of end-of-aisle display on sales, focussing on alcohol. Data on store layout and product-level sales during 2010-11 were obtained for one UK grocery store, comprising detailed information on shelf space, price, price promotion and weekly sales volume in three alcohol categories (beer, wine, spirits) and three non-alcohol categories (carbonated drinks, coffee, tea). Multiple regression techniques were used to estimate the effect of end-of-aisle display on sales, controlling for price, price promotion, and the number of display locations for each product. End-of-aisle display increased sales volumes in all three alcohol categories: by 23.2% (p=0.005) for beer, 33.6% (p<0.001) for wine, and 46.1% (p<0.001) for spirits, and for three non-alcohol beverage categories: by 51.7% (p<0.001) for carbonated drinks, 73.5% (p<0.001) for coffee, and 113.8% (p<0.001) for tea. The effect size was equivalent to a decrease in price of between 4% and 9% per volume for alcohol categories, and a decrease in price of between 22% and 62% per volume for non-alcohol categories. End-of-aisle displays appear to have a large impact on sales of alcohol and non-alcoholic beverages. Restricting the use of aisle ends for alcohol and other less healthy products might be a promising option to encourage healthier in-store purchases, without affecting availability or cost of products. © 2014 The Authors.
Socioeconomic differences in purchases of more vs. less healthy foods and beverages: Analysis of over 25,000 British households in 2010
Socioeconomic inequalities in diet-related health outcomes are well-recognised, but are not fully explained by observational studies of consumption. We provide a novel analysis to identify purchasing patterns more precisely, based on data for take-home food and beverage purchases from 25,674 British households in 2010. To examine socioeconomic differences (measured by occupation), we conducted regression analyses on the proportion of energy purchased from (a) each of 43 food or beverage categories and (b) major nutrients. Results showed numerous small category-level socioeconomic differences. Aggregation of the categories showed lower SES groups generally purchased a greater proportion of energy from less healthy foods and beverages than those in higher SES groups (65% and 60%, respectively), while higher SES groups purchased a greater proportion of energy from healthier food and beverages (28% vs. 24%). At the nutrient-level, socioeconomic differences were less marked, although higher SES was associated with purchasing greater proportions of fibre, protein and total sugars, and smaller proportions of sodium. The observed pattern of purchasing across SES groups contributes to the explanation of observed health differences between groups and highlights targets for interventions to reduce health inequalities. © 2013 The Authors.
Impact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial
Background Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. Methods and findings This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of −4.8% (95% CI −7.0% to −2.7%), p < 0.001 during the availability intervention period and a reduction of −11.5% (95% CI −13.7% to −9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of −6.6% (95% CI −7.9% to −5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). Conclusions Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings.
Straight-sided beer and cider glasses to reduce alcohol sales for on-site consumption: A randomised crossover trial in bars
Background: Straight-sided glasses can slow the rate of lager consumption in a laboratory setting compared with curved glasses. Slower drinking rates may lower overall alcohol consumption. Glass shape is therefore a potential target for intervention. The aim of this randomised crossover trial was to estimate the impact of serving draught beer and cider in straight-sided glasses, compared with usual, predominantly curved glasses, on alcohol sales for on-site consumption in bars. Methods: Twenty-four bars in England completed two intervention periods (A) and two control periods (B) in a randomised order: 1) BABA; 2) BAAB; 3) ABBA; or 4) ABAB. Each period lasted two weeks and involved serving draught beer and cider in either straight-sided glasses (A) or the venue's usual glasses (≥75% curved; B). The primary outcome was the mean volume (in litres) of draught beer and cider sold weekly, compared between A and B periods using a paired-samples t-test on aggregate data. A regression model adjusted for season, order, special events, and busyness. Findings: Mean weekly volume sales of draught beer and cider was 690·9 L (SD 491·3 L) across A periods and 732·5 L (SD 501·0 L) across B periods. The adjusted mean difference (A minus B) was 8·9 L per week (95% CI -45·5 to 63·3; p = 0·737). Interpretation: This study provides no clear evidence that using straight-sided glasses, compared with usual, predominantly curved glasses, reduces the volume of draught beer and cider sold for on-site consumption in bars.
Altering choice architecture to alter drinking behaviour: Evidence from research on lower strength alcohol labelling and glass design
This chapter brings together recent work investigating the impact of the physical micro-environment on alcohol-related perceptions and behaviour, taking examples of how altering the ways in which alcoholic drinks (in particular wine and beer) are presented can impact on perceptions of these drinks, as well as on purchasing and consumption. In particular, this chapter outlines research relating to the use of (a) labels indicating lower alcohol strength, and (b) glasses of different sizes and shapes. The existing evidence base is small, and highlights that robust investigation of both mechanisms and intervention efficacy are needed. Future studies designed to examine choice architecture interventions should take a whole systems approach, exploring how the alcohol industry and retailers respond to interventions, for example, through branding and marketing.
Impact of bottle size on in-home consumption of wine: a randomized controlled cross-over trial
Aim: To assess the impact of purchasing wine in 50 cl bottles compared with 75 cl bottles on the amount of wine consumed at home. Design: Cross-over randomized controlled trial with a ‘usual behaviour’ period of a maximum of 3 weeks between conditions. Setting: Households in the United Kingdom. Participants: One hundred and eighty-six households that consumed between two and eight 75 cl bottles of wine each week. Intervention: Households were randomized to the order in which they purchased wine in two bottle sizes. During two 14-day intervention periods, households purchased a pre-set volume of wine—based on their baseline self-reported weekly consumption—in either 75 cl bottles or 50 cl bottles. On days 7 and 14 of each study period, participating households sent photographs of each purchased wine bottle. Measurements: The primary outcome was the volume of study wine in millilitres (ml) consumed during each study period estimated through returned photographs. The secondary outcome was the rate of consumption measured by the mean number of days taken to drink 1.5 litres from each bottle size. Findings: One hundred and sixty-six of 186 enrolled households satisfactorily completed the study. After accounting for pre-specified covariates, 191.1 ml [95% confidence interval (CI) = 42.03–339.2] or 4.5% (95% CI = 1.0–7.9%) more wine was consumed per 14-day period from 75-cl bottles than from 50-cl bottles. Consumption was 5.8% faster (95% CI = –10.9 to –0.4%) from 75 cl bottles than from 50 cl bottles. Conclusions: Consuming wine at home from 50 cl bottles, compared with 75 cl bottles, may reduce both amount consumed and rate of consumption.
Glass shape influences drinking behaviours in three laboratory experiments
Reducing consumption of drinks which contain high levels of sugar and/or alcohol may improve population health. There is increasing interest in health behaviour change approaches which work by changing cues in physical environments (“nudges”). Glassware represents a modifiable cue in the drinking environment that may influence how much we drink. Here, we report three laboratory experiments measuring consumption of soft drinks served in different glasses (straight-sided vs. outward-sloped), using distinct paradigms to measure drinking. In Study 1 (N = 200), though total drinking time was equivalent, participants consumed a soft drink with a more ‘decelerated’ trajectory from outward-sloped tumblers, characterised by a greater amount consumed in the first half of the drinking episode. In Study 2 (N = 72), during a bogus taste test, participants consumed less from straight-sided wine flutes than outward-sloped martini coupes. In Study 3 (N = 40), using facial electromyography to explore a potential mechanism for decreased consumption, straight-sided glasses elicited more ‘pursed’ lip embouchures, which may partly explain reduced consumption from these glasses. Using a combination of methods, including objective measures of volume drunk and physiological measures, these findings suggest that switching to straight-sided glasses may be one intervention contributing to the many needed to reduce consumption of health-harming drinks.