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Mumena WA, Kutbi HA. Sources of free sugar in the diet of Saudi children. Front Public Health 2024; 12:1305364. [PMID: 38660353 PMCID: PMC11041394 DOI: 10.3389/fpubh.2024.1305364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Data concerning sources of free sugar (FS) in the diet of Saudi children are limited. Identification of the top sources of FS would permit to develop tailored interventions that aid in meeting the recommendations of the World Health Organization for FS (≤ 25 g/day). This study aimed to investigate sources of FS in children's diet. Methods A cross-sectional data of healthy children ages between 6 and 12 years who reside in Saudi Arabia were gathered from their mothers using online platforms (WhatsApp, Facebook, and X) (n = 424; 210 boys and 214 girls). An interview was conducted through the phone with the mother and her child to collect data pertaining FS intake using a validated food frequency questionnaire. Results The primary sources of FS were Sweetened Beverages, followed by Sugars, Sweet Bakery Products, Other Desserts, and Candies, of which the added sugar consisted mostly of its total sugar. The consumption of FS coming from solid food sources for the highest quartile of children almost doubled the amount of FS coming from liquid food sources. Compared to boys, girls in the top quartile of FS intake consumed significantly higher amounts of solid sugars (p = 0.030). Only the intake of FS coming from Sweetened Beverages was associated negatively with age of children (p = 0.032). Discussion Public health interventions should emphasize the necessity of reducing the consumption of the top sources of FS to practically achieve the recommendations of FS intake.
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Affiliation(s)
- Walaa Abdullah Mumena
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Hebah Alawi Kutbi
- , Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Lee J, Lee H, Lee H. Navigating healthier beverage consumption in adolescents using the "R-Ma Bot" chatbot: A usability and evaluation study. Digit Health 2024; 10:20552076241283243. [PMID: 39323432 PMCID: PMC11423371 DOI: 10.1177/20552076241283243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/28/2024] [Indexed: 09/27/2024] Open
Abstract
Objective This pilot study aimed to evaluate the usability and effectiveness of a behavior change technique (BCT)-based chatbot developed to promote healthier beverage consumption among adolescents. Methods The Read and Manage your health roBot ("R-Ma Bot"), designed with 13 BCTs, was tested with 42 adolescents (13 men, 29 women, mean age 15.0 ± 0.7) for 2 weeks. Usability was assessed after the 2-week intervention using a chatbot usability questionnaire, recruitment, retention, participation, and engagement. Scores above 70 out of 100 were considered high usability. Qualitative data from open-ended questions were collected for evaluation. Effectiveness was measured by changes in knowledge, use and impact of nutrition labels, and weekly consumption of sugar, sodium, and caffeine from carbonated and/or energy drinks before and after the 2-week intervention. Results The score of R-Ma Bot's usability averaged 74.7, with participants addressing it useful, friendly, and easy to use, though they suggested improving unnatural conversation flow. All participants engaged with the chatbot for at least 13 out of 14 days, with over half using it daily for the entire period. After intervention, awareness of nutrition labels increased from 64.3% to 92.9%, and nonreaders decreased from 42.9% to 16.7%. Weekly sugar intake from beverages significantly decreased by 60%, from 13.1 ± 20.1 mg to 7.9 ± 12.8 mg. Conclusions R-Ma Bot's high usability contributed to high retention and behavioral changes, significantly reduced sugar consumption from beverages and improved awareness of nutrition labels. We suggest integrating strategies that enhance knowledge, motivation, and opportunities through BCTs with youth-friendly design elements in the development of interventions for adolescents.
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Affiliation(s)
- Jisu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
| | - Hyeyeon Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
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Börnhorst C, Ahrens W, De Henauw S, Hunsberger M, Molnár D, Moreno LA, Russo P, Schreuder A, Sina E, Tornaritis M, Vandevijvere S, Veidebaum T, Vrijkotte T, Wijnant K, Wolters M. Age-Specific Quantification of Overweight/Obesity Risk Factors From Infancy to Adolescence and Differences by Educational Level of Parents. Int J Public Health 2023; 68:1605798. [PMID: 38033763 PMCID: PMC10684735 DOI: 10.3389/ijph.2023.1605798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives: To explore the age-dependent associations between 26 risk factors and BMI in early life, and differences by parental educational level. Methods: Data of 10,310 children (24,155 measurements) aged 2-16 years participating in a multi-centre European cohort from 2007 to 2014 were utilized. Trajectories of overweight/obesity risk factors and their age-specific associations with BMI were estimated using polynomial mixed-effects models. Results: Exposure to most unfavourable factors was higher in the low/medium compared to the high education group, e.g., for PC/TV time (12.6 vs. 10.6 h/week). Trajectories of various risk factors markedly changed at an age of 9-11 years. Having a family history of obesity, maternal BMI, pregnancy weight gain and birth weight were positively associated with BMI trajectories throughout childhood/adolescence in both education groups; associations of behavioural factors with BMI were small. Parental unemployment and migrant background were positively associated with BMI in the low/medium education group. Conclusion: Associations of risk factors with BMI trajectories did not essentially differ by parental education except for social vulnerabilities. The age period of 9-11 years may be a sensitive period for adopting unfavourable behaviours.
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Affiliation(s)
- Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Monica Hunsberger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Denéz Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Luis A. Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Anton Schreuder
- Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Social Medicine Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Elida Sina
- Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
| | | | | | - Thomas Veidebaum
- Estonian Centre of Behavioral and Health Sciences, National Institute for Health Development, Tallinn, Estonia
| | | | - Kathleen Wijnant
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
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Mackey AW, Ralston PA, Young-Clark I, Coccia CC. Life Satisfaction and Emerging Health Behaviors in Underserved Adolescents: A Narrative Review. Am J Health Behav 2023; 47:479-488. [PMID: 37596754 DOI: 10.5993/ajhb.47.3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objectives: Obesity rates continue to rise in underserved adolescents. Obesity is linked to poor mental health outcomes. The purpose of this narrative review is to examine existing literature on life satisfaction and obesity-related emerging health behaviors (sugar-sweetened beverage consumption, sleeping patterns, and screen time) in underserved adolescents. Methods: We conducted a review of articles published in English between January 1995 and November 2021 to develop a narrative summary. Results: In general, few studies have been conducted investigating life satisfaction and the emerging behaviors of sugar-sweetened beverage consumption, sleeping patterns, and screen time use with adolescents, especially underserved adolescents. In the studies reviewed, we noted links between lower life satisfaction and more than once-a-day sugar consumption, including sugar-sweetened beverages, lower life satisfaction and lower sleep duration, and life satisfaction and screen-time, with both positive and negative relationships shown. Conclusions: Given the limitations in the number of studies, recommendations are provided for future research.
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Affiliation(s)
- Alexandria W Mackey
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Penny A Ralston
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, FL, United States
| | - Iris Young-Clark
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, FL, United States
| | - Catherine C Coccia
- Department of Dietetics & Nutrition, Florida International University, Miami, FL, United States
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Hennessy M, Bleakley A, Ellithorpe ME, Maloney E, Jordan AB, Stevens R. Reducing Unhealthy Normative Behavior: The Case of Sports and Energy Drinks. HEALTH EDUCATION & BEHAVIOR 2023; 50:394-405. [PMID: 34772291 PMCID: PMC10205043 DOI: 10.1177/10901981211055468] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their "healthiness" and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents' avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.
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Affiliation(s)
| | | | | | | | | | - Robin Stevens
- University of Southern California, Los Angeles, CA, USA
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Ferguson K, Gunthert K, Kaidbey JH, Parr M, Visek AJ, Sacheck JM, Sylvetsky AC. Behavioral Patterns of Sugary Drink Consumption among African American Adolescents: A Pilot and Feasibility Study Using Ecological Momentary Assessment. Nutrients 2023; 15:2171. [PMID: 37432343 DOI: 10.3390/nu15092171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Sugary drinks (SDs) are the predominant contributors to added sugar intake among adolescents, with the highest intakes reported among African American adolescents. The objective of this pilot study was to examine the feasibility of using mobile phone-based ecological momentary assessment (EMA) to investigate, in real time, behavioral patterns of SD consumption among African American adolescents from low-income households. METHODS Adolescents (n = 39, ages 12-17) attended a virtual meeting with a trained research assistant, which involved completion of surveys and training on responding to EMA prompts using a mobile phone application. On the seven subsequent days, adolescents were instructed to respond to researcher-initiated prompts three times daily, which queried their SD intake, location, social context, activities, stress, and mood. They were also asked to complete an analogous self-initiated survey each time they consumed SDs. RESULTS SD consumption was reported on 219 of 582 (38%) researcher-initiated surveys and on 135 self-initiated SD consumption surveys, for a total of 354 instances of SD intake over the 7-day assessment period. The majority (69%) of the surveys were completed while at home. SD consumption was reported on 37%, 35%, and 41% of researcher-initiated surveys completed at their home, at the home of a friend or family member, or while in transit, respectively. CONCLUSIONS These preliminary data indicate that mobile phone-based EMA is feasible for investigating SD intake behaviors among African American youth from low-income households and support the promise of EMA for investigating SD consumption in this population in larger samples of youth.
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Affiliation(s)
- Kacey Ferguson
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Kathleen Gunthert
- Department of Psychology, American University, Washington, DC 20016, USA
| | - Jasmine H Kaidbey
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Meredith Parr
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Amanda J Visek
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Jennifer M Sacheck
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
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Lin P, Hillstrom K, Gottesman K, Jia Y, Kuo T, Robles B. Financial and Other Life Stressors, Psychological Distress, and Food and Beverage Consumption among Students Attending a Large California State University during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3668. [PMID: 36834363 PMCID: PMC9965632 DOI: 10.3390/ijerph20043668] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted the daily lives and health of college students across the United States. This study investigated several stressors (e.g., financial strain/uncertainty), psychological distress, and dietary behaviors among college students attending a large state university during the pandemic. A cross-sectional online survey was administered to students from the California State University, Los Angeles between April and May 2021 (final analytic sample n = 736). Differences in gender and race/ethnicity were examined using chi-square, t-test, and one-way ANOVA tests. Paired t-tests were performed to compare variables before and during the pandemic. Negative binomial regression models examined the associations between various stressors, psychological distress, and three key dietary outcomes. Descriptive results showed that the consumption of fruits and vegetables, fast food, and sugary beverages, along with psychological distress, all increased during the pandemic. Significant differences in fruit and vegetable and fast food consumption by gender and race/ethnicity were also observed. In the regression models, several stressors, including financial strain and psychological distress, were associated with unfavorable food and beverage consumption, thereby suggesting that college students may need more support in mitigating these stressors so they do not manifest as poor dietary behaviors. Poor diet quality is associated with poor physical health outcomes such as premature development of type 2 diabetes or hypertension.
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Affiliation(s)
- Paulina Lin
- Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951722, Los Angeles, CA 90095, USA
| | - Kathryn Hillstrom
- Department of Nutrition and Food Science, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | - Kimberly Gottesman
- Department of Nutrition and Food Science, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | - Yuane Jia
- School of Health Professions, Rutgers Biomedical and Health Sciences, 65 Bergen St., Newark, NJ 07101, USA
| | - Tony Kuo
- Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951722, Los Angeles, CA 90095, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024, USA
- Population Health Program, UCLA Clinical and Translational Science Institute, 10833 Le Conte Ave., BE-144 CHS, Los Angeles, CA 90095, USA
| | - Brenda Robles
- Research Group on Statistics, Econometrics, and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003 Girona, Spain
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Yu Z, Qin W, Li J. Intergenerational transmission of parental risky health behaviors in Chinese children: Are there socioeconomic status differences? Front Med (Lausanne) 2023; 9:842817. [PMID: 36698800 PMCID: PMC9870313 DOI: 10.3389/fmed.2022.842817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Risky health behaviors in childhood, including smoking, alcohol consumption, and having a poor diet, are the major sources of non-communicable diseases in adulthood. This study aimed to examine how parents affect children's risky health behaviors and whether intergenerational transmission differs based on socioeconomic status (SES). Methods Data were extracted from the 1991-2015 China Health and Nutrition Survey (CHNS). Smoking (n = 5,946), alcohol consumption (n = 7,821), and sugar-sweetened beverages (SSBs) consumption (n = 3,537) were used as proxies for risky health behaviors in children. A binary choice model for panel data with a random-effect specification was employed to examine whether risky health behaviors can be transmitted from parents to their children. Subsequently, we conducted a seemingly unrelated estimation test (SUEST) to explore the differences in parental transmission between the different SES groups. Results We found strong intergenerational persistence of smoking, alcohol drinking, and SSBs drinking behaviors, except for the mothers' smoking behavior. Mothers had a greater influence on children's alcohol drinking and SSBs drinking behaviors than fathers both in urban and rural areas and in different SES groups. The intergenerational transmission of SSBs drinking behavior exhibited a decreasing trend with increasing SES for both urban and rural families. In urban areas, mothers' alcohol drinking behavior has a decreasing trend with increasing education level, occupation, and income; however, in rural areas, the influence of mothers' alcohol drinking behavior occurred in the same direction with increasing education level and occupation type. In rural areas, the influence of fathers' drinking and smoking behaviors on children appears to mostly increase with increasing SES. Meanwhile, the influence of such behaviors among urban fathers would decrease with increasing SES. Conclusion Parents' behaviors and SES can influence the initiation of risky health behaviors in their offspring. Thus, to promote healthy behaviors, policymakers can introduce health education programs for parents, particularly for those living in rural areas and with a low SES.
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Affiliation(s)
- Zexuan Yu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Wen Qin
- Infirmary of Shandong University, Jinan, China
| | - Jiajia Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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9
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Wang Y, Bi C, Liu H, Lin H, Cai R, Zhang J. Association of sugar-sweetened beverage consumption with psychological symptoms among Chinese university students during the COVID-19 pandemic. Front Psychol 2022; 13:1024946. [PMID: 36312111 PMCID: PMC9608563 DOI: 10.3389/fpsyg.2022.1024946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/26/2022] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Mental health of college students has become a public health issue of common concern worldwide. Especially during the COVID-19 pandemic, the problem has become even more acute. The aim of this study was to assess the association between sugar-sweetened beverages (SSB) consumption and psychological symptoms among Chinese college students in order to promote their mental health. METHODS The study population was 6,120 college students aged 19-22 years from Anhui, Henan and Xinjiang, China. Basic demographic information, covariates and SSB Consumption data were collected through a self-assessment questionnaire. The "Multidimensional Sub-health Questionnaire of Adolescents" was used to assess the psychological symptoms of college students. The Chi-square test, one-way ANOVA and logistic regression analysis were used to investigate the differences and associations between SSB consumption and psychological symptoms among Chinese college students. RESULTS The detection rate of psychological symptoms among Chinese college students was 8.1%. The detection rate of boys students was 9.4% and that of girls students was 7.1%, and the difference was statistically significant in comparison (χ 2-value was 11.08, p < 0.001). After controlling for covariates, Model 2 analysis showed that compared to SSB consumption <2 time/week, college students with SSB consumption ≥2 time/week (OR = 2.96, 95% CI: 2.36, 3.70) had a higher risk of psychological symptoms (p < 0.001). The same trend was found for emotional symptoms, behavioral symptoms, and social adaptation difficulties dimensions. CONCLUSION There is an association between SSB consumption and the occurrence of psychological symptoms among Chinese college students. Future measures should be taken to reduce both SSB consumption and the incidence of psychological symptoms.
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Affiliation(s)
- Yujie Wang
- Public Teaching Department, Zhumadian Vocational and Technical College, Zhumadian, China
| | - Cunjian Bi
- School of Physical Education, Chizhou University, Chizhou, China
- Sports Health Promotion Center, Chizhou University, Chizhou, China
| | - He Liu
- Research Department of Physical Education, Xinjiang University, Urumqi, China
| | - Hongniu Lin
- School of Physical Education, Chizhou University, Chizhou, China
- Sports Health Promotion Center, Chizhou University, Chizhou, China
| | - Ruibao Cai
- School of Physical Education, Chizhou University, Chizhou, China
- Sports Health Promotion Center, Chizhou University, Chizhou, China
| | - Jie Zhang
- School of Physical Education, Chizhou University, Chizhou, China
- Sports Health Promotion Center, Chizhou University, Chizhou, China
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Musicus AA, Roberto CA, Moran AJ, Sorscher S, Greenthal E, Rimm EB. Effect of Front-of-Package Information, Fruit Imagery, and High-Added Sugar Warning Labels on Parent Beverage Choices for Children: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2236384. [PMID: 36227595 PMCID: PMC9561948 DOI: 10.1001/jamanetworkopen.2022.36384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Fruit drinks are widely consumed by young children, and many parents mistakenly believe that these drinks are healthy, potentially due to front-of-package claims and imagery. Research is needed on the influence of this marketing and how labeling regulations could change behavior. OBJECTIVE To assess the effects of a front-of-package 100% vitamin C claim, fruit imagery, percentage juice and teaspoons of added sugar disclosures, and high-added sugar warnings on parents' choices, knowledge, and perceptions of beverages. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted May to July 2021 as a single-exposure (no follow-up) online survey of primary caregivers of children ages 0 to 5 years throughout the US. INTERVENTIONS Participants were shown no-, low-, and high-added sugar beverages and asked to choose 1 for their child. Participants were randomized to see high-added sugar beverages with 1 of 7 front-of-package conditions: (1) claim and imagery (control); (2) no claim; (3) no imagery; (4) no claim or imagery; (5) claim, imagery, and percentage juice disclosure; (6) claim, imagery, and warning; or (7) claim, imagery, warning, and teaspoons of added sugar disclosure. MAIN OUTCOMES AND MEASURES Primary outcomes were type of beverage chosen (eg, high-added sugar beverage) and resulting calories and added sugar (in grams). Secondary outcomes were fruit drink knowledge (added sugar and percent juice) and perceptions. RESULTS There were 5005 participants included in the final analysis (mean [SD] age, 31.5 [8.3] years; 3587 female participants [71.7%]), including 714 participants in group 1, 717 participants in group 2, 710 participants in group 3, 717 participants in group 4, 708 participants in group 5, 729 participants in group 6, and 710 participants in group 7. Compared with participants in the control group, who had a mean (standard error [SE]) of 9.4 (0.5) g of added sugar and 81.9 (1.6) kcal in chosen beverages, only participants who saw warnings with teaspoons of added sugar disclosures had significantly reduced added sugar (-1.3 g; 95% CI, -2.6 to -0.1 g [-14.2%; 95% CI, -26.7% to -1.8%]; P = .04) and calories (-5.3 kcal; 95% CI, -9.8 to -0.9 kcal [-6.5%; 95% CI, -11.8% to -1.3%]; P = .02) in selected beverages. In warning conditions (ie, 6 and 7) compared with the control group (mean [SE] 41.0% [1.8%]), the proportion of participants choosing high-added sugar beverages was significantly reduced, by 5.5 percentage points (95% CI, 0.5 to 10.5 percentage points [13.4%; 95% CI, 1.2% to 25.6%]; P = .03) and 6.4 percentage points (95% CI, 1.4 to 11.4 percentage points [15.6%; 95% CI, 3.3% to 27.8%]; P = .01), respectively. The no claim or imagery condition (4) significantly reduced the proportion of parents choosing high-added sugar beverages (-7.6 percentage points; 95% CI, -12.6 to -2.6 percentage points [-18.4%; 95% CI, -30.6% to -6.3%]; P = .003). Percentage juice disclosures did not affect beverage choice. CONCLUSIONS AND RELEVANCE These findings suggest that added sugar warnings and prohibitions of front-of-package claims and imagery may reduce parents' purchases of high-added sugar beverages for their young children but that percentage juice disclosures may not change behavior. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04811690.
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Affiliation(s)
- Aviva A. Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Sorscher
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Eva Greenthal
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Eric B. Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Rodriguez LA, Gopalan A, Darbinian JA, Chandra M, Greenspan LC, Howell A, Lo JC. Identifying modifiable obesogenic behaviors among Latino adolescents in primary pediatric care. Prev Med Rep 2022; 29:101939. [PMID: 35942298 PMCID: PMC9356151 DOI: 10.1016/j.pmedr.2022.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Latino adolescents engage in more obesogenic behaviors, including sedentary behaviors and sugary drink consumption, than White adolescents. However, it is unclear whether engagement in obesogenic behaviors differs within the Latino population. Cross-sectional data were examined from Latino adolescents ages 13–17 with a well-child visit (2016–2019) in an integrated healthcare system. Adolescents self-reported on four daily obesogenic behaviors: 1) consuming < 5 servings of fruits/vegetables; 2) drinking > 1 juice/soda; 3) exercising/playing sports < 60 min; and 4) > 2 h screen time. A composite variable of ≥ 3 self-reported behaviors was constructed. Multivariable logistic regression was used to examine associations between obesogenic behaviors with age category (13–15 or 16–17 years), sex, household language preference (English/Spanish), neighborhood deprivation index (NDI quartiles), and body mass index (BMI). Among 77,514 Latino adolescents (mean age 14.7 ± 1.4; 50 % female), 23 % lived in Spanish-speaking households, 43 % resided in census tracts with the highest (most deprived) NDI quartile, and 45 % had an overweight or obese BMI. Older (vs younger) adolescents had higher odds of insufficient fruit/vegetable intake (OR 1.20; CI 1.17–1.24), greater sedentary behavior (OR 1.51; 1.46–1.56), and reporting > 2 h screen time (OR 1.07; 1.03–1.11). Adolescents in the 4th (vs 1st) NDI quartile (OR 1.34; 1.26–1.42) and those with obesity (vs healthy weight) (OR 1.55; 1.42–1.70 for class 3 obesity) had higher odds of ≥ 3 obesogenic behaviors. In conclusion, among Latino adolescents, older age, obesity, and living in more deprived neighborhoods were associated with greater obesogenic behaviors. Identifying adolescents more likely to engage in obesogenic behaviors can inform targeted lifestyle interventions.
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Affiliation(s)
- Luis A. Rodriguez
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- Corresponding author at: Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
| | - Anjali Gopalan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- The Permanente Medical Group, Oakland, CA, United States
| | - Jeanne A. Darbinian
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Malini Chandra
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Louise C. Greenspan
- The Permanente Medical Group, Oakland, CA, United States
- Kaiser Permanente San Francisco, Department of Pediatrics, San Francisco, CA, United States
| | - Amanda Howell
- Health Engagement Consulting Services, The Permanente Medical Group, Oakland, CA, United States
| | - Joan C. Lo
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- The Permanente Medical Group, Oakland, CA, United States
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Vitamin D Levels in Ethnic Minority Adolescents in Primary Care. J Pediatr Health Care 2022; 36:443-448. [PMID: 35654708 DOI: 10.1016/j.pedhc.2022.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This pilot study examined the distribution of low vitamin D levels among ethnic minority adolescents in primary care to elucidate the clinical needs of this diverse population. METHOD A cross-sectional study was conducted using a retrospective patient chart review. Participants were a consecutive sample of 119 ethnically diverse adolescents aged 12-18 years, attending a primary care clinic, who had a wellness examination in 2018 and documented vitamin D levels on the basis of previously collected blood work. RESULTS Sixty-one percent of adolescents had low vitamin D levels. Vitamin D deficiency increased with age, independently of ethnicity or gender. DISCUSSION A significant number of ethnically diverse adolescents presented with low vitamin D levels. A need exists to raise awareness among clinicians regarding social determinants of health and culturally sensitive dietary practices to improve vitamin D levels and prevent long-term complications, focusing on adolescent at-risk ethnic groups.
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Edmondson EK, Roberto CA, Gregory EF, Mitra N, Virudachalam S. Association of a Sweetened Beverage Tax With Soda Consumption in High School Students. JAMA Pediatr 2021; 175:1261-1268. [PMID: 34661612 PMCID: PMC8524354 DOI: 10.1001/jamapediatrics.2021.3991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022]
Abstract
Importance Sweetened beverage taxes are one policy approach to reduce intake of added sugars. Soda is the leading source of added sugars in the US diet, but few studies have examined how such taxes influence sweetened beverage intake in youth. Objective To estimate the association between the Philadelphia, Pennsylvania, beverage tax and adolescent soda intake. Design, Setting, and Participants This economic evaluation of school district-level Youth Risk Behavior Surveillance System data from September 2013 to December 2019 compared weekly soda intake in high school students in Philadelphia, a city with a sweetened beverage tax, with that in 7 comparison cities without beverage taxes. Difference-in-differences regression modeling was used to estimate change in soda intake in Philadelphia compared with control cities. Secondary analyses compared 100% juice and milk intake to explore potential substitution associations. Subgroup analyses evaluated differences by race and ethnicity and weight status (obesity and overweight or obesity). Analyses were performed between August 20 and October 20, 2020. School districts that had weighted data and a survey question on weekly soda intake from 2013 to 2019 were included. The study included high school students, grades 9 to 12, in school districts participating in the Youth Risk Behavior Surveillance System from 2013 to 2019. Exposures Implementation of a sweetened beverage tax in Philadelphia, Pennsylvania, in January 2017. Main Outcomes and Measures Reported weekly servings of soda, 100% juice, and milk. Results A total of 86 928 participants (weighted mean [SD] age, 15.8 [1.3] years; 49% female) from 8 US cities (including Philadelphia) were included. Before the tax, adolescents in the 7 comparison cities had a mean intake of 4 servings of soda per week compared with 5.4 servings per week in Philadelphia. Philadelphia's tax was associated with a reduction of 0.81 servings of soda per week (95% CI, -1.48 to -0.14 servings; P = .02) 2 years after tax implementation. There was no significant difference in 100% juice or milk intake, although Philadelphia adolescents consumed more juice than those in nontaxed cities. In subgroup analyses, the tax was associated with a reduction of 1.13 servings per week in Hispanic/Latinx adolescents (95% CI, -2.04 to -0.23 servings; P = .01) and 1.2 servings per week in adolescents with obesity (95% CI, -2.33 to -0.13 servings; P = .03). Conclusions and Relevance This economic evaluation found that a sweetened beverage tax was associated with a reduction in soda intake among adolescents, providing evidence that such taxes can improve dietary behaviors.
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Affiliation(s)
- Emma K. Edmondson
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily F. Gregory
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Senbagam Virudachalam
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Parker MK, Davy BM, Hedrick VE. Current Knowledge Base of Beverage Health Impacts, Trends, and Intake Recommendations for Children and Adolescents: Implications for Public Health. Curr Nutr Rep 2021; 10:427-434. [PMID: 34797556 DOI: 10.1007/s13668-021-00376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Improving beverage patterns is important for promoting the health of children and adolescents. Food preferences can begin developing at a young age; thus, children and adolescents should be provided healthy beverages in accordance with current recommendations. The purpose of this review is to identify and summarize existing beverage recommendations for children and adolescents. This review also discusses the health impacts of beverages and how beverage consumption has changed among children and adolescents over time. RECENT FINDINGS The mean number of calories that children and adolescents are consuming from beverages on a given day has declined in recent years. However, sugar-sweetened beverages (SSB) are the primary source of added sugars in this population. Therefore, SSB consumption remains a concern, and reducing the intake of SSB is still considered a top priority for helping to improve dietary quality. This review uniquely compiles recommendations into one convenient table for the entire age range of 0-19 years and includes recommendations that can be more adequately individualized. Beverage categories where beverage recommendations from authoritative sources are lacking have also been identified. Potential methods that can be implemented to improve beverage patterns and current public policy recommendations have been discussed to provide actionable steps that public health professionals can utilize in practice. The comprehensive table of beverage recommendations could be useful for professionals promoting the health of children and adolescents in research, clinical, and public health settings.
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Affiliation(s)
- Molly K Parker
- Virginia Tech, 295 West Campus Drive, 337 Wallace Hall, Blacksburg, VA, 24061, USA
| | - Brenda M Davy
- Virginia Tech, 295 West Campus Drive, 266B Wallace Hall, Blacksburg, VA, 24061, USA
| | - Valisa E Hedrick
- Virginia Tech, 295 West Campus Drive, 335A Wallace Hall, Blacksburg, VA, 24061, USA.
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15
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Parker MK, Davy BM, Hedrick VE. Preliminary assessment of the Healthy Beverage Index for U.S. Children and Adolescents: a tool to quantify the overall beverage intake quality of 2- to 19-year-olds. J Acad Nutr Diet 2021; 122:371-383.e6. [PMID: 34371228 DOI: 10.1016/j.jand.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Improving beverage patterns of children and adolescents is recommended for combatting obesity and reducing disease risk. Therefore, it is important to assess beverage intake quality in this population. For adults, the Healthy Beverage Index (HBI) was created to assess beverage intake quality, but a similar tool did not exist for children and adolescents. OBJECTIVE The objective was to develop an HBI for U.S. Children and Adolescents (HBI-CA), and then assess the validity and reliability of this tool. DESIGN Modeled after the adult HBI, age-specific, evidence-based beverage recommendations were compiled. Ten components were included to assess beverage intake quality. Validity and reliability were assessed using cross-sectional data and methods similar to those used for the evaluation of the Healthy Eating Index. PARTICIPANTS The 2015-2016 National Health and Nutrition Examination Survey provided 24-hour dietary recall data for 2,874 children and adolescents aged 2-19 years. MAIN OUTCOME MEASURES HBI-CA scores were the main outcome measure. STATISTICAL ANALYSES PERFORMED To assess validity, independent t-tests were used to determine differences in HBI-CA component and total scores among groups, and principal component analysis (PCA) was completed to examine multidimensionality of the HBI-CA. Pearson's bivariate correlations were used to assess reliability. RESULTS The HBI-CA produced a (mean±standard error) total score of 69.2±0.8, which is similar to the adult HBI mean total score of 63. PCA identified six factors, indicating the multidimensionality of the HBI-CA, with more than one combination of components contributing to variation in total scores. Most HBI-CA components were significantly correlated to the total score, with met fluid requirements, total beverage energy, sugar-sweetened beverage, and water components demonstrating the strongest correlations (r ranged 0.335-0.735, P-value ≤0.01). CONCLUSIONS The results provide preliminary evidence to support the validity and reliability of the HBI-CA. If future research establishes the predictive validity and sensitivity of the HBI-CA, this tool could be useful to quantify the beverage intake quality of children and adolescents.
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Affiliation(s)
- Molly K Parker
- Doctoral Student, Virginia Tech, 295 West Campus Drive, 337 Wallace Hall, Blacksburg, VA 24061
| | - Brenda M Davy
- Professor, Virginia Tech, 295 West Campus Drive, 266B Wallace Hall, Blacksburg, VA 24061
| | - Valisa E Hedrick
- Assistant Professor, Virginia Tech, 295 West Campus Drive, 335A Wallace Hall, Blacksburg, VA 24061.
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16
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Finn EB, Beck A, Sharifi M. Equitable approaches to reducing the prevalence of pediatric obesity: school nutrition policies and beyond. Int J Obes (Lond) 2021; 45:2289-2290. [PMID: 34331000 PMCID: PMC8322633 DOI: 10.1038/s41366-021-00924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Emily B Finn
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | - Amy Beck
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Bleich SN, Dunn CG, Soto MJ, Yan J, Gibson LA, Lawman HG, Mitra N, Lowery CM, Peterhans A, Hua SV, Roberto CA. Association of a Sweetened Beverage Tax With Purchases of Beverages and High-Sugar Foods at Independent Stores in Philadelphia. JAMA Netw Open 2021; 4:e2113527. [PMID: 34129022 PMCID: PMC8207239 DOI: 10.1001/jamanetworkopen.2021.13527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 01/06/2023] Open
Abstract
Importance The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items. Objective To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores. Design, Setting, and Participants This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties. Main Outcomes and Measures Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods. Results Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001). Conclusions and Relevance This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.
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Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Caroline G. Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark J. Soto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Laura A. Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hannah G. Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Caitlin M. Lowery
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ana Peterhans
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Trends and patterns in sugar-sweetened beverage consumption among children and adults by race and/or ethnicity, 2003-2018. Public Health Nutr 2021; 24:2405-2410. [PMID: 33843567 DOI: 10.1017/s1368980021001580] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sugar-sweetened beverage (SSB) consumption has declined steadily. This study uses the latest national data to examine trends in SSB consumption among children and adults by race and/or ethnicity and to document whether long-standing disparities in intake remain. DESIGN Trend analyses of demographic and dietary data measured by 24-h dietary recall from the National Health and Nutrition Examination Survey (NHANES). SETTING Data from the 2003-2004 through 2017-2018 NHANES survey cycles were analysed in 2020. PARTICIPANTS The study sample included 21 156 children aged 2-19 years and 32 631 adults aged 20+ years. RESULTS From 2003-2004 to 2017-2018, the prevalence of drinking any amount of SSB on a given day declined significantly among all race and/or ethnicity groups for children (non-Hispanic (NH) White: 81·6 % to 72·7 %; NH Black: 83·2 % to 74·8 %, Hispanic: 86·9 % to 77·2 %) and most race and/or ethnicity groups for adults (NH White: 72·3 % to 65·3 %; Hispanic: 84·6 % to 77·8 %). Consumption declined at a higher rate among NH Black and Hispanic children aged 12-19 years compared with their NH White peers; among NH Black children aged 6-11 years, the rate of decline was lower. Despite significant declines in per capita SSB energy consumption from soda and fruit drinks, consumption of sweetened coffee/tea beverages increased among older children and nearly all adults and consumption of sweetened milk beverages increased among NH White and Hispanic children. CONCLUSIONS SSB consumption has declined steadily for children and adults of all race and/or ethnicity groups, but disparities persist, and overall intake remains high.
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Carl AE, Taillie LS, Grummon AH, Lazard AJ, Higgins ICA, Sheldon JM, Hall MG. Awareness of and reactions to the health harms of sugary drinks: An online study of U.S. parents. Appetite 2021; 164:105234. [PMID: 33823230 DOI: 10.1016/j.appet.2021.105234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/12/2021] [Accepted: 03/23/2021] [Indexed: 01/10/2023]
Abstract
Evidence about the health problems associated with sugary drink consumption is well-established. However, little is known about which sugary drink health harms are most effective at changing consumers' behavior. We aimed to identify which harms people were aware of and most discouraged them from wanting to buy sugary drinks. Participants were a national convenience sample of diverse parents (n = 1,058), oversampled for Latino parents (48%). Participants rated a list of sugary drink-related health harms occurring in children (7 harms) and in adults (15 harms). Outcomes were awareness of each harm and how much each harm discouraged parents from wanting to purchase sugary drinks. Most participants were aware that sugary drinks contribute to tooth decay in children (75%) and weight gain in both children (73%) and adults (69%). Few participants were aware that sugary drinks contribute to adult infertility (16%), arthritis (18%), and gout (18%). All health harms were rated highly in terms of discouraging parents from wanting to buy sugary drinks (range: 3.59-4.11 on a 1-5 scale), with obesity, pre-diabetes, and tooth decay eliciting the highest discouragement ratings. Harm-induced discouragement was higher for participants who were aware of more health harms (B = 0.05, p < 0.0001), identified as female (B = 0.15 compared to male, p = 0.02), or had an annual household income of $50,000 or more (B = 0.16 compared to less than $50,000, p = 0.03). These findings suggest health messages focused on a variety of health harms could raise awareness and discourage sugary drink purchases.
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Affiliation(s)
- Alexandra E Carl
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr., Chapel Hill, NC, 27599, United States.
| | - Lindsey Smith Taillie
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Nutrition, 135 Dauer Dr., Chapel Hill, NC, 27599, United States; University of North Carolina at Chapel Hill, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC, 27516, United States.
| | - Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, 9 Bow Street, Cambridge, MA 02138, United States.
| | - Allison J Lazard
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 101 Manning Dr., Chapel Hill, NC, 27514, United States; University of North Carolina at Chapel Hill, Hussman School of Journalism and Media, Carroll Hall, CB 3365, Chapel Hill, NC, 27599, United States.
| | - Isabella C A Higgins
- University of North Carolina at Chapel Hill, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC, 27516, United States.
| | - Jennifer Mendel Sheldon
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 101 Manning Dr., Chapel Hill, NC, 27514, United States.
| | - Marissa G Hall
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr., Chapel Hill, NC, 27599, United States; University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 101 Manning Dr., Chapel Hill, NC, 27514, United States.
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McGurk MD, Cacal SL, Vu U, Sentell T, Beckelman T, Lee J, Yang A, Pirkle CM. Baseline Assessment of Children's Meals and Healthy Beverage Options Prior to a State-Level Healthy Default Beverage (HDB) Law. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2021; 1:63-73. [PMID: 37789908 PMCID: PMC10544922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
In January 2020, Hawai'i became the second state with a healthy default beverage (HDB) law, requiring restaurants to offer HDBs with their children's meals. This observational study presents baseline characteristics of restaurants with a children's menu and meal. The study describes pre-law beverage options to inform future HDB policy language, implementation, and evaluation. Between November and December 2019, data were collected from a statewide sample of unique restaurants (N = 383) with health inspection permits. Restaurants were assessed separately for a children's menu and meal using website reviews, telephone calls, and in-person visits. Meals were evaluated for pre-law beverage type and compliance. Logistic regression was used to estimate the likelihood of having a children's menu and meal. Most of the restaurants were full-service (70.2%) and non-chains (67.9%). While 49.3% of restaurants had a children's menu, only 16.7% had a children's meal. Significant predictors of having a children's menu were being full-service, national/international or local chains, neighbor island (non-Honolulu) locations, and hotel locations. Only being a national/international chain significantly predicted having a children's meal. Although 35.9% of children's meals offered a non-sugar-sweetened beverage (SSB) option, only 3.1% offered law-compliant beverages. Inclusion of an SSB default option (60.9%) and not specifying the type of default beverage were the predominant factors for pre-law non-compliance. Results support the need for HDB regulations, especially for national/international chains, which were most likely to have children's meals, and provide data to inform policies in other jurisdictions.
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Affiliation(s)
| | | | - Uyen Vu
- University of Hawai‘i at Mānoa, Honolulu, Hawai‘i
| | | | | | - Jessica Lee
- Hawai‘i State Department of Health, Honolulu, Hawai‘i
| | - Alyssa Yang
- Hawai‘i State Department of Health, Honolulu, Hawai‘i
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