ผลของกลยุทธ์การออกแบบทางเลือกต่อการเลือกเครื่องดื่มหวานน้อยในนักศึกษาคณะสาธารณสุขศาสตร์: การศึกษากึ่งทดลอง

Pornthip  Jaroenbunpol; Walaitip Songwaja; Subhawita  Phonwetamnuai; Suthasinee Teeweang; Adithep Sornplang; Wannachanok  Boonchoo

Authors

Pornthip Jaroenbunpol Department of Nutrition, Faculty of Public Health, Mahidol University, Ratchathewi District, Bangkok 10400. Thailand
Walaitip Songwaja Department of Nutrition, Faculty of Public Health, Mahidol University, Ratchathewi District, Bangkok 10400. Thailand
Subhawita Phonwetamnuai Department of Nutrition, Faculty of Public Health, Mahidol University, Ratchathewi District, Bangkok 10400. Thailand
Suthasinee Teeweang Department of Nutrition, Faculty of Public Health, Mahidol University, Ratchathewi District, Bangkok 10400. Thailand
Adithep Sornplang Department of Nutrition, Faculty of Public Health, Mahidol University, Ratchathewi District, Bangkok 10400. Thailand
Wannachanok Boonchoo Department of Nutrition, Faculty of Public Health, Mahidol University, Ratchathewi District, Bangkok 10400. Thailand

Keywords:

Default option, Choice architecture, Thai tea beverage, Sugar-sweetened beverages, Food choice behavior

Abstract

Consumption of sugar-sweetened beverages is a major contributor to excessive sugar intake and increases the risk of non-communicable diseases. This study aimed to evaluate the effectiveness of choice architecture strategies on beverage selection among students of the Faculty of Public Health, Mahidol University. A repeated-measures quasi-experimental study was conducted among 49 participants. Each participant selected Thai tea beverages under three experimental conditions: (1) a default low-sugar option, (2) sugar-content labels displayed in grams, and (3) sweetness-level labels displayed as percentages. The results showed that all three choice architecture strategies increased the proportion of lower-sugar beverage selections compared with participants’ usual choices. The default low-sugar option produced the highest proportion of lower-sugar selections (83.67%). Both the default low-sugar option and sugar-content labels significantly increased the selection of lower-sugar beverages compared with usual choices (p < 0.001 and p = 0.007, respectively). However, no statistically significant differences were observed among the three intervention strategies. These findings suggest that choice architecture strategies, particularly default options, may be a promising approach to promoting lower-sugar beverage choices among university students.

References

World Health Organization. Guideline: sugars intake for adults and children. Geneva: WHO; 2015.

Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89(4):1037–1042. doi:10.3945/ajcn.2008.27140.

Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes. Diabetes Care. 2010;33(11):2477–2483. doi:10.2337/dc10-1079.

Malik AH, Akram Y, Shetty S, Malik SS, Njike VY. Impact of sugar-sweetened beverages on blood pressure. Am J Cardiol. 2014;113(9):1574–1580. doi:10.1016/j.amjcard.2014.01.437.

Meng Y, Li S, Khan J, Dai Z, Li C, Hu X, et al. Sugar- and artificially sweetened beverages consumption linked to type 2 diabetes, cardiovascular diseases, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Nutrients. 2021;13(8):2636. doi:10.3390/nu13082636.

Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. Lancet Diabetes Endocrinol. 2016;4(2):174–186. doi:10.1016/S2213-8587(15)00419-2.

Institute for Population and Social Research, Mahidol University. Survey on sweetened beverage consumption behaviour in Thailand. Nakhon Pathom: Mahidol University; 2024. (in Thai).

Paopeng C, Limwattananon S, Chaisong S, Patcharanarumol W, Pongutta S, Limwattananon C, et al. Differences in food consumption behaviours among the Thai population: socio-economic and health determinants. J Health Syst Res. 2017. (in Thai).

Ministry of Finance. Excise tax rate regulation B.E. 2560. Bangkok: Ministry of Finance; 2017. (in Thai).

Phulkerd S, Thongcharoenchupong N, Chamratrithirong A, Gray RS, Prasertsom P. Changes in population-level consumption of taxed and non-taxed sugar-sweetened beverages after implementation of SSB excise tax in Thailand. Nutrients. 2020;12(11):3292. doi:10.3390/nu12113292.

Makjang K, Pongutta S. Monitoring price and sugar content of sugar-sweetened beverages before and after the Thai excise tax restructuring. J Health Syst Res. 2018;13(2):128–144. (in Thai).

Arno A, Thomas S. The efficacy of nudge theory strategies in influencing adult dietary behaviour: a systematic review and meta-analysis. BMC Public Health. 2016;16:676. doi:10.1186/s12889-016-3272-x.

Konig LM, Renner B. Boosting healthy food choices by meal colour variety: results from two experiments. BMC Public Health. 2019;19:975. doi:10.1186/s12889-019-7297-9.

Forsyth A, Lytle L, Riper DV. Finding food: issues and challenges in using geographic information systems to measure food access. J Transp Land Use. 2010;3(1):43–65. doi:10.5198/jtlu.v3i1.105.

Sridonpai P, Sridonpai P, Puwastien P, Nakngamanong Y, Sirichakwal P. Sugar content in sugar-sweetened beverages sold in and around Mahidol University: case study at Mahidol University Salaya Campus. J Public Health. 2019;49(1):33–43. (in Thai).

Ang FJL, Agrawal S, Finkelstein EA. Pilot randomized controlled trial testing the influence of front-of-pack sugar warning labels on food demand. BMC Public Health. 2019;19:164. doi:10.1186/s12889-019-6496-9.

Mahasuweerachai P, Mahasuweerachai P. All you have to do is ask: a nudge strategy for reducing sweetness in beverages. Int J Gastron Food Sci. 2023;34:100726. doi:10.1016/j.ijgfs.2023.100726.

Jhangiani RS, Chiang ICA, Cuttler C, Leighton DC. Experimental design. In: Research methods in psychology [Internet]. Available from: https://kpu.pressbooks.pub/psychmethods4e/chapter/experimental-design/

Bogliacino F, Charris R, Codagnone C, Folkvord F, Gaskell G, Gómez C, et al. Less is more: information overload in the labelling of fish and aquaculture products. Food Policy. 2023;116:102435. doi:10.1016/j.foodpol.2023.102435.

McCambridge J, de Bruin M, Witton J. The effects of demand characteristics on research participant behaviours in non-laboratory settings: a systematic review. PLoS One. 2012;7(6):e39116. doi:10.1371/journal.pone.0039116.

Jachimowicz JM, Duncan S, Weber EU, Johnson EJ. When and why defaults influence decisions: a meta-analysis of default effects. Behav Public Policy. 2019;3(2):159–186. doi:10.1017/bpp.2018.43.

Kahneman D. Thinking, fast and slow. New York: Farrar, Straus and Giroux; 2011.

Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: a systematic review. J Adolesc. 2018;62:116–127. doi:10.1016/j.adolescence.2017.11.010.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988.