Perceptions of Nonsugar Sweeteners and Nonsugar Sweetener Front-of-Package Labels Among Parents in the United States: A Qualitative Study

Abstract

Background: In light of efforts to decrease added sugar, the use of nonsugar sweeteners (NSS) in the food supply is increasing. Although there is concern about the health effects of NSS, particularly among children, little is known about parents' perceptions of NSS as replacements for added sugar and whether NSS front-of-package labels (FOPLs) influence parents' perceptions and purchasing intentions surrounding products with NSS.

Objective: To examine parents' perceptions of sugar and NSS for their children and understand how parents perceive NSS FOPLs when making selections for their children.

Design: Focus group discussions were conducted using a semistructured guide, informed by the health belief model, which included questions about parents' perceptions of the healthfulness of NSS for children; parents' understanding and perceptions of NSS FOPLs; and how various NSS FOPL formats would potentially influence parents' perceptions of product healthfulness. Parents were also shown hypothetical NSS FOPLs and asked for feedback.

Participants/setting: Nine focus group discussions were conducted virtually with parents (n = 66) of children aged 2 to 12 years, in the United States (US), in April 2024.

Analyses performed: Focus group discussions were transcribed verbatim and coded independently by 2 coders, after which themes were identified using reflexive thematic analysis.

Results: Overarching themes were: parents try to limit their child's sugar intake and avoid providing products with artificial ingredients; parents had mixed views about the safety and healthfulness of NSS; parents perceived an NSS FOPL favorably, but they do not like the term diet sweeteners; and parents preferred an NSS FOPL that uses visual aids and communicates a recommendation.

Conclusions: Despite having mixed perceptions about the safety and healthfulness of NSS for children, parents perceived NSS FOPLs as helpful for making informed beverage choices for their children. Future research examining the effects of NSS FOPLs on parents' product selections is needed to inform FOPL policies and increase transparency regarding the presence of NSS in products consumed by children.

Keywords: Added sugars; Artificial sweeteners; Front-of-package labeling; Nutrition; Obesity.