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Zoellner JM, You W, Porter K, Kirkpatrick B, Reid A, Brock D, Chow P, Ritterband L. Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2024; 21:46. [PMID: 38664715 PMCID: PMC11046896 DOI: 10.1186/s12966-024-01594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND High consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students' SSB consumption. Secondary objectives focus on caregivers' SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)]. METHODS This Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors. RESULTS Of the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001). CONCLUSIONS Kids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline. TRIAL REGISTRATION Clincialtrials.gov: NCT03740113. Registered 14 November 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113 .
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA.
| | - Wen You
- Department of Public Health Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
| | - Kathleen Porter
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Brittany Kirkpatrick
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Annie Reid
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Donna Brock
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Phillip Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
| | - Lee Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
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Wang C, Chen Y, Xu H, Wang W, Zhou H, Sun Q, Hong X, Zhao J. Sustaining Healthy Habits: The Enduring Impact of Combined School-Family Interventions on Consuming Sugar-Sweetened Beverages among Pilot Chinese Schoolchildren. Nutrients 2024; 16:953. [PMID: 38612987 PMCID: PMC11013720 DOI: 10.3390/nu16070953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024] Open
Abstract
This study assesses the enduring impact of combined school- and family-based interventions on reducing the consumption of sugar-sweetened beverages (SSBs) among schoolchildren in China. Two primary schools were assigned at random to either the Intervention Group or the Control Group, in Nanjing, eastern China. All students were in grade three and received an invitation to participate. In the first year, students in the Intervention Group received one-year intervention measures, including monthly monitoring, aiming to decrease the consumption of SSBs. Students in the Control Group only received regular monitoring without interventions. In the second year, both groups received only regular monitoring, without active interventions. A generalized estimating equations model (GEE) was used to assess the intervention effects. After two years, relative to the Control Group, the Intervention Group had a significantly improved knowledge of SSBs and an improved family environment with parents. In the Intervention Group, 477 students (97.3%) had adequate knowledge about SSBs, compared to 302 students (83.2%) in the Control Group (X2 = 52.708, p < 0.001). Two years later, the number of students who stated 'my home always has SSBs' in the Intervention Group (7.8%) was fewer than that in the Control Group (12.4%), which was a statistically significant finding (p < 0.05). One year later, both the frequency and the quantity of SSB consumption in the Intervention Group were less than those in the Control Group; such differences between the groups remained statistically significant for the quantity but not for the frequency of SSB consumption two years later. In the Intervention Group, the frequency of SSB consumption was significantly reduced by 1.0 times per week, compared to a reduction of 0.1 times per week in the Control Group in the first year (p < 0.05). In the second year, the frequency of SSB consumption was reduced by 0.8 times per week in the Intervention Group, compared to 0.5 times per week in the Control Group (p > 0.05). In the first year, the volume of SSB consumption was significantly reduced by 233 mL per week in the Intervention Group, compared to an increase of 107 mL per week in the Control Group (p < 0.05). In the second year, the volume of SSB consumption was reduced by 122 mL per week in the Intervention Group compared to an increase of 31 mL per week in the Control Group (p > 0.05). The combined school-based and family-based interventions had a positive effect on the students' knowledge of SSBs and their family dynamics during the first and second year. Relative to the Control Group, the Intervention Group had a statistically significant reduction in SSB consumption after 1 year, but not after 2 years.
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Affiliation(s)
- Chenchen Wang
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Yijia Chen
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Hao Xu
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Weiwei Wang
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Hairong Zhou
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Qiannan Sun
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Xin Hong
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (Y.C.); (H.X.); (W.W.); (H.Z.); (Q.S.)
| | - Jinkou Zhao
- Department of Non-Communicable Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
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Ghazaryan A, Park S, Onufrak SJ, Carlson AC, Rhone A, Roy K. Characteristics Associated With Purchasing Sugar-Sweetened Beverages and Bottled Water Among US Households, 2015. J Acad Nutr Diet 2024; 124:28-41. [PMID: 37648023 PMCID: PMC10840658 DOI: 10.1016/j.jand.2023.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/18/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Frequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. OBJECTIVE This study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. DESIGN This study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. PARTICIPANTS/SETTINGS A total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. EXPLANATORY VARIABLES The included demographic and socioeconomic variables were household head's age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households' residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. MAIN OUTCOME MEASURES Annual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. STATISTICAL ANALYSIS Unadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana's household projection factors. RESULTS Nearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. CONCLUSIONS These findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status.
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Affiliation(s)
- Armen Ghazaryan
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sohyun Park
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen J Onufrak
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea C Carlson
- Food Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC
| | - Alana Rhone
- Food Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC
| | - Kakoli Roy
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Vonk L, Eekhout I, Huijts T, Levels M, Jansen MWJ. School health promotion and the consumption of water and sugar-sweetened beverages in secondary schools: a cross-sectional multilevel study. BMC Public Health 2023; 23:1296. [PMID: 37407939 DOI: 10.1186/s12889-023-16123-7] [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: 01/13/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Overweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students' health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. METHODS We performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics. RESULTS The school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption). CONCLUSIONS The low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions.
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Affiliation(s)
- Lisanne Vonk
- Academic Collaborative Center for Public Health Limburg, Public Health Service South Limburg, P.O. Box 33, 6400 AA, Heerlen, The Netherlands.
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Iris Eekhout
- Expertise Center Child Health, Netherlands Organisation for Applied Scientific Research (TNO), P.O. Box 3005, 2301 DA, Leiden, The Netherlands
| | - Tim Huijts
- Research Centre for Education and the Labour Market (ROA), School of Business and Economics, Maastricht University, Postbus 616, 6200 MD, Maastricht, The Netherlands
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), P.O. Box 8900, NO-7491, Trondheim, Norway
| | - Mark Levels
- Research Centre for Education and the Labour Market (ROA), School of Business and Economics, Maastricht University, Postbus 616, 6200 MD, Maastricht, The Netherlands
| | - Maria W J Jansen
- Academic Collaborative Center for Public Health Limburg, Public Health Service South Limburg, P.O. Box 33, 6400 AA, Heerlen, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Park S, Lee SH, Merlo C, Blanck HM. Associations between Knowledge of Health Risks and Sugar-Sweetened Beverage Intake among US Adolescents. Nutrients 2023; 15:nu15102408. [PMID: 37242294 DOI: 10.3390/nu15102408] [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: 04/27/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) intake is associated with adverse health outcomes. OBJECTIVE We examined associations between the knowledge of health risks related to SSB and SSB intake among adolescents. DESIGN A cross-sectional study using 2021 YouthStyles survey data. PARTICIPANTS/SETTINGS 831 US adolescents (12-17 years old). MAIN OUTCOME MEASURES The outcome variable was SSB intake (none, 1-6 times/week, and ≥1 time/day). Exposure variables were knowledge of seven SSB-related health risks. STATISTICAL ANALYSES PERFORMED Seven multinomial regressions were used to estimate adjusted odds ratios (AOR) for drinking SSB, according to knowledge of SSB-related health risks and after controlling for sociodemographics. RESULTS Overall, 29% of adolescents consumed SSB ≥1 time/day. Although most adolescents identified cavities (75.4%), weight gain (74.6%), and diabetes (69.7%) as being related to drinking SSB, fewer adolescents identified related conditions such as high blood pressure (31.7%), high cholesterol (25.8%), heart disease (24.6%), and some cancers (18.0%). Compared to non-SSB consumers, drinking SSB ≥1 time/day was significantly higher among adolescents who lacked knowledge of associations between SSB intake and weight gain (AOR = 2.0), heart disease (AOR = 1.9), or some cancers (AOR = 2.3) after controlling for covariates. CONCLUSIONS Among US adolescents, knowledge of SSB-related health risks varied by condition, ranging from 18% (some cancers) to 75% (cavities and weight gain). There were increased odds of drinking SSB among those unaware that weight gain, heart disease, and some cancers are associated with SSB intake. Intervention could evaluate whether increasing certain types of knowledge may influence youth SSB intake.
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Affiliation(s)
- Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Seung Hee Lee
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Caitlin Merlo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Heidi M Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Limbachia J, Desai D, Abdalla N, de Souza RJ, Teo K, Morrison KM, Punthakee Z, Gupta M, Lear SA, Anand SS. The association of maternal sugary beverage consumption during pregnancy and the early years with childhood sugary beverage consumption. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:231-240. [PMID: 36175645 PMCID: PMC10036700 DOI: 10.17269/s41997-022-00681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A woman's food choices during pregnancy may be associated with her offspring's food choices. Several studies support an association between childhood sugary beverage (SB) consumption and poor cardiometabolic health. This study aimed to assess the association of maternal SB consumption during pregnancy and later, with her offspring's SB consumption in early infancy and childhood. METHODS A total of 1945 women and 1595 children participating in 3 Canadian studies reported SB consumption during pregnancy, at 2 years of age, and/or at school age (5 to 8 years old). Mother and offspring SB intakes were self-reported by mothers. Multivariable linear regression analyses were conducted within each cohort and cohort data were combined using fixed effect meta-analyses. RESULTS Maternal SB consumption during pregnancy was associated with higher offspring SB consumption at 2 years of age (standardized β = 0.19 predicted change in the number of standard deviations of offspring SB intake for an increase of 1 standard deviation in maternal serving [95% CI: 0.16 to 0.22]). Concurrent maternal SB consumption was associated with higher offspring SB intake when children were aged 5 to 8 years (standardized β= 0.25 [95% CI: 0.10 to 0.40]). CONCLUSION Maternal SB consumption during pregnancy is associated with a marginally higher SB intake among their offspring at age 2, and concurrent maternal consumption is associated with a higher SB intake among school-aged offspring (5 to 8 years old). Future interventions tailored for pregnancy and early childrearing years to reduce SB intakes of mothers may reduce young children's SB intake.
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Affiliation(s)
- Jayneel Limbachia
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
| | - Dipika Desai
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
| | - Nora Abdalla
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Katherine M Morrison
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Milan Gupta
- Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Scott A Lear
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada.
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
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Prospective association of family members' sugar-sweetened beverages intake with children's sugar-sweetened beverages consumption in China. Eur J Nutr 2023; 62:175-184. [PMID: 35931834 PMCID: PMC9899727 DOI: 10.1007/s00394-022-02971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE We aimed to investigate whether parental and siblings' sugar-sweetened beverage (SSB) intake had prospective impact on children's SSB consumption, and the potential sex difference in these associations. METHODS This study included a total of 904 children and their parents enrolled from 2004 to 2011 China Health and Nutrition Survey (CHNS) cohort study. SSB consumption information was estimated using a short dietary questionnaire and total energy intake was assessed with three-day 24-h dietary assessments at recruitment and follow-up surveys. Multivariate logistic or linear regression analyses were used to assess the association for SSB consumption between parents, siblings and children after adjusting for age, body mass index (BMI) z-score, household income and parental educational level. RESULTS In this study, a majority (87.6%) of children consumed SSB. Among them, the median consumption of SSB was 70.3 ml/day per capita and 205.4 ml/day per consumer. Parental SSB consumption was relevant to children's SSB consumption, and this association was more pronounced in boys than in girls. Meanwhile, fathers seemed to have a stronger impact on whether children consume SSB than mothers which was reflected by lower P and higher OR. Additionally, children's SSB intake was prospectively associated with their older siblings' SSB consumption (P for trend < 0.03). CONCLUSIONS Parental and older siblings' SSB consumption was relevant to children's SSB intake. Particularly, boys were more susceptible to parental impact than girls, and fathers seemed to have a greater influence on children than mothers.
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Zhang R, Yang Q, Tang Q, Xi Y, Lin Q, Yang L. Is Adolescents' Free Sugar Intake Associated with the Free Sugar Intake of Their Parents? Nutrients 2022; 14:nu14224741. [PMID: 36432428 PMCID: PMC9693973 DOI: 10.3390/nu14224741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
High free sugar intake can lead to increased dental caries, obesity, and other health risks among adolescents. Studies have shown that family factors, especially parents, are one of the primary factors influencing adolescents' sugar intake. This study aims to investigate the influence of adolescent parents' free sugar intake, knowledge, attitude, and practice (KAP) on adolescents' free sugar intake. A total of 1090 pairs of adolescents and their parents from 10 secondary schools in Changsha were enrolled in a cross-sectional study. Free sugar intakes of parents and adolescents were measured using the food frequency questionnaire (FFQ). The current status of parents' knowledge, attitude, and practice in consuming free sugar was investigated using online and offline questionnaires. Parental free sugar intake was 11.55 (5.08, 21.95) g/d, and that of adolescents was 41.13 (19.06, 80.58) g/d. Parental free sugar intake, free sugar knowledge level, intake behavior, and guidance behavior were associated with adolescent free sugar intake. A superior level of parental free sugar knowledge (adjusted OR = 0.726, 95% CI: 0.557~0.946) was a protective factor for adolescent free sugar intake. Moderate and high levels of parental free sugar intake (adjusted OR = 1.706, 95% CI: 1.212~2.401; adjusted OR = 2.372, 95% CI: 1.492~3.773, respectively) were risk factors for free sugar intake in adolescents. Given the importance of parental influence on the adolescent free sugar intake, further limiting parental intake and increasing awareness of free sugars could play an active role in future interventions for adolescents' free sugar intake.
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Affiliation(s)
| | | | | | | | - Qian Lin
- Correspondence: (Q.L.); (L.Y.); Tel.: +86-0731-84805464 (L.Y.)
| | - Lina Yang
- Correspondence: (Q.L.); (L.Y.); Tel.: +86-0731-84805464 (L.Y.)
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Reduced Consumption of Sugar-Sweetened Beverages Is Associated with Lower Body Mass Index Z-Score Gain among Chinese Schoolchildren. Nutrients 2022; 14:nu14194088. [PMID: 36235739 PMCID: PMC9571809 DOI: 10.3390/nu14194088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
To examine whether reducing sugar-sweetened beverage (SSB) consumption is associated with reduced body mass index z-score gain among Chinese schoolchildren in Nanjing, China, a randomized controlled trial (RCT) was conducted in four selected primary schools from September 2019 to September 2020. Students in the third grade in the Intervention Group received school-based and home-based interventions for two consecutive semesters to reduce SSB consumption, while two schools in the Control Group did not receive any interventions. Weight changes were expressed as body mass index (BMI) z-scores as standard deviations of the BMI distribution per age and sex group. Changes in SSB consumption before and after the interventions were categorized into Level-Up if it increased, Level-Same if it was maintained and Level-Down if it decreased. Multivariable linear regression models were used to explore the association of different levels of changes in SSB consumption pre- and post-intervention with the BMI z-score. Among 1633 participants who completed the trial, the mean age at baseline was 9.36 years (±0.48 SD).The median baseline BMI z-score was −0.24 (25th percentile −0.72; 75th percentile 0.58). After the intervention, the median BMI z-score increased by 0.06 (−0.17~0.37) in the Intervention Group and by 0.14 (−0.08~0.41) in the Control Group (p < 0.001). A higher increase in BMI was found in the Control Group than in the Intervention Group (1.20 vs. 0.94) during the 12-month period. Among participants whose parents’ educational attainment was above 9 years, the median BMI z-score increased by 0.07 (−0.17~0.37) in the Intervention Group and by 0.16 (−0.06~0.41) in the Control Group (p < 0.001). In a linear regression analysis adjusted for potential confounders, the BMI z-score decreased by 0.057 more in Level-Down than in Level-Up (95% CI: −0.103 to −0.012, p = 0.014). These results indicate that the decreased consumption of SSBs might have reduced the prevalence of overweight in schoolchildren in China, especially in students whose parents had high educational levels.
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'I Knew I Should Stop, but I Couldn't Control Myself': a qualitative study to explore the factors influencing adolescents' consumption of sugar-sweetened beverages and sugary snacks from a socio-ecological perspective. Public Health Nutr 2022; 25:2465-2474. [PMID: 35582995 PMCID: PMC9991719 DOI: 10.1017/s1368980022001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the factors influencing Taiwanese adolescents' consumption of sugar-sweetened beverages (SSB) and sugary snacks from a socio-ecological perspective. DESIGN This study adopted a qualitative design by using face-to-face, in-depth interviews guided by a semistructured questionnaire. SETTING Eight junior high schools in New Taipei City and Changhua County, Taiwan, September to November 2018. PARTICIPANTS Fifty-nine participants aged 12-14 years participated in this study. RESULTS Reflexive thematic analysis was used to analyse the data. This study identified four themes to address the multifaceted factors that influence adolescents' consumption of SSB and sugary snacks. At the intrapersonal level, physiological factors, psychological factors, individual economic factors and taste preferences were mentioned in connection with people's consumption of SSB and sugary snacks. Positive or negative influences of parents, siblings, peers and teachers on SSB and sugary snack intake were identified at the interpersonal level. The availability of SSB and sugary snacks at home, their availability in vending machines or in school stores in the school environment and participants' access to convenience stores and hand-shaken drink shops in the broader community influenced SSB and sugary snack consumption. Additionally, food culture and food advertising were identified as influencing societal factors. CONCLUSIONS Overall, this qualitative study determined not only that the consumption of SSB and sugary snacks is influenced by intrapersonal factors but also that interpersonal, environmental and societal factors affect adolescents' increased sugar intake. The findings are helpful to broaden the options for designing and developing interventions to decrease SSB and sugary snack consumption by adolescents.
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Porter KJ, You W, Kirkpatrick BM, Thatcher EJ, Reid AL, Yuhas M, Zoellner JM. Factors Influencing the Sugar-Sweetened Beverage Intake of Caregivers of Adolescents in Appalachia. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:230-238. [PMID: 34953641 PMCID: PMC8920759 DOI: 10.1016/j.jneb.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To identify factors that influence the sugar-sweetened beverage (SSB) intake of caregivers of middle school-aged adolescents. DESIGN Cross-sectional. SETTING Southwestern Virginia, US, part of Central Appalachia. PARTICIPANTS Caregivers (n = 362) of adolescents enrolled in the Kids SIPsmartER trial. Participants were mostly female (91%) and non-Hispanic White (96%), and 21% received Supplemental Nutrition Assistance Program (SNAP) benefits. MAIN OUTCOME MEASURES Caregiver daily SSB intake and demographics, personal-level, interpersonal-level, and environmental-level determinants. ANALYSIS Descriptive statistics, 1-way ANOVA, and stepwise regression. RESULTS On average, caregivers consumed 25.7 (SD, 33.2) fluid ounces of SSB per day. In the final model, which included all variables, age (β = -0.41; P < 0.05), receiving SNAP benefits (β = 14.19; P ≤ 0.01), behavioral intentions (β = -5.48; P ≤ 0.001), affective attitudes (β = -2.15, P < 0.05), perceptions of whether their adolescent frequently consumes high amounts of SSB (β = 1.92; P ≤ 0.001), and home availability (β = 7.43; P ≤ 0.01) were significantly associated with SSB intake. CONCLUSIONS AND IMPLICATIONS Caregivers of Appalachian middle school students are high SSB consumers. Findings highlight the importance of implementing behavioral interventions for caregivers of adolescents that target multiple levels of influence, including demographic, personal-level, interpersonal-level, and environmental-level factors. Interventions may be particularly important for communities and groups with higher SSB intakes, such as those in Appalachia and who receive SNAP benefits.
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Affiliation(s)
- Kathleen J Porter
- Department of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA.
| | - Wen You
- Department of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA
| | - Brittany M Kirkpatrick
- Department of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA
| | - Esther J Thatcher
- Department of Population Health, University Hospitals, Cleveland, OH
| | - Annie L Reid
- Department of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA
| | - Maryam Yuhas
- Department of Nutrition and Food Studies, Falk College, Syracuse University, Syracuse, NY
| | - Jamie M Zoellner
- Department of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA
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Dietary Intake and Sources of Added Sugars in Various Food Environments in Costa Rican Adolescents. Nutrients 2022; 14:nu14050959. [PMID: 35267934 PMCID: PMC8912352 DOI: 10.3390/nu14050959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all food environments where they socialize. However, it is relevant for public health to consider the home and school environments as fundamental units of interventions aimed at reducing added sugars in the adolescent diet. Frescos prepared at home and school and fruit-flavored still drinks must be the focus of these interventions.
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Wang C, Hong X, Wang W, Zhou H, Wu J, Xu H, Zhou N, Zhao J. The Combination of School-Based and Family-Based Interventions Appears Effective in Reducing the Consumption of Sugar-Sweetened Beverages, a Randomized Controlled Trial among Chinese Schoolchildren. Nutrients 2022; 14:nu14040833. [PMID: 35215483 PMCID: PMC8875123 DOI: 10.3390/nu14040833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/23/2022] Open
Abstract
To examine whether environmental interventions, student awareness and parents’ model roles are associated with the consumption of sugar-sweetened beverages (SSBs), a randomized controlled trial was conducted among Chinese schoolchildren. A multi-stage cluster random sampling method was applied to select four primary schools, two in urban areas and two in rural areas, in Nanjing, eastern China. Classes of the third grade in the selected four schools were randomly assigned to the intervention group and control group. Among selected students in those classes, aged 9–10 years, those in the intervention group received intervention measures comprising school-based and family-based measures and accepted monthly monitoring along with interventions, for two consecutive semesters, while those in the control group did not receive any specific interventions. After intervention, there was a significant increase in SSB knowledge and an improvement in the family environment with parents in the intervention group. The proportion of frequent consumption (≥4 times/week) of any SSBs in the intervention group was lower than that in the control group (31.5% vs. 56.2%, p < 0.01). Multivariate analysis indicated that parental education level is positively associated with reduced SSB consumption. Interventions showed an average decrease in SSBs consumption by 1.77 units, those living in urban areas decreased by 2.05 units. The combination of school-based and family-based interventions appears effective in reducing SSB consumption among Chinese schoolchildren, especially in urban areas and for those with parents with lower educational levels.
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Affiliation(s)
- Chenchen Wang
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
| | - Xin Hong
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
| | - Weiwei Wang
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
| | - Hairong Zhou
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
| | - Jie Wu
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
| | - Hao Xu
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
| | - Nan Zhou
- Department of Non-Communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China; (C.W.); (X.H.); (W.W.); (H.Z.); (J.W.); (H.X.)
- Correspondence: (N.Z.); (J.Z.); Tel.: +86-25-5701-0699 (N.Z.)
| | - Jinkou Zhao
- Department of Non-Communicable Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
- Correspondence: (N.Z.); (J.Z.); Tel.: +86-25-5701-0699 (N.Z.)
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Schneider S, Schilling L, Osenbrügge N. Determinants of soft drink consumption among children and adolescents in developed countries - a systematic review. Cent Eur J Public Health 2022; 29:290-300. [PMID: 35026068 DOI: 10.21101/cejph.a6755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Soft drinks are a major component of daily caloric and sugar intake. This is especially true for children and adolescents. The WHO as well as many other institutions currently recommend to increase research on the determinants of soft drink consumption. We submit a current systematic review on this topic. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we included all quantitative observational studies that comprise samples from developed countries in the age range 0-18 years and are listed in PubMed, Sociological Abstracts and the Social Sciences Citation Index. Publication period was not limited. The second and the last author screened all 10,392 hits independently with both reviewers being blinded. Interrater reliability (agreement and Cohen's kappa) was 97%/0.73 for the selection of titles, 91%/0.83 for abstracts and 91%/0.80 for full texts. RESULTS Results of 43 included studies, published between 2001 and 2017, show that children and adolescents consuming soft drinks tend to be older, male and of lower social status. Important contextual factors promoting consumption include constant availability at home, at schools or elsewhere as well as restrictions by parents and rules concerning drinks during meals or generally at home. The association between media consumption and soft drink consumption is particularly striking. Other factors in the food environment (choice of food and alternative drinks at home, having meals together, motivation, knowledge about nutrition and healthy eating) are of minor importance. CONCLUSIONS When introducing interventions parents should play a major role because they serve as physical and social gatekeepers for this early risk factor of juvenile obesity.
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Affiliation(s)
- Sven Schneider
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Schilling
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina Osenbrügge
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Smirk E, Mazahery H, Conlon CA, Beck KL, Gammon C, Mugridge O, von Hurst PR. Sugar-sweetened beverages consumption among New Zealand children aged 8-12 years: a cross sectional study of sources and associates/correlates of consumption. BMC Public Health 2021; 21:2277. [PMID: 34903202 PMCID: PMC8670206 DOI: 10.1186/s12889-021-12345-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background The benefit of reducing sugar-sweetened beverage (SSB) consumption is widely accepted, but updated and in-depth data on New Zealand (NZ) children’s SSB consumption is lacking. The aims of this study were to describe beverage consumption, focusing on SSBs in primary school age children living in Auckland; to examine the association of selected socio-demographic, home, community and school factors and children’s beverage knowledge/attitudes with regards to beverage consumption; to explore the relationship between SSBs consumption and adiposity in children. Methods A cross-sectional, Auckland-wide survey of 578 school age children (8-12 years) was conducted using questionnaires to collect data on beverage consumption, beverage knowledge/attitudes, and selected socio-demographic and home, community, school factors. Body fat percentage (BF%) was assessed using bioelectrical impedance (BIA). Results Ninety-six percent of children consumed ≥1 serving of SSBs a week; with ≥5 servings reported by 62% of children. Of all SSBs assessed, consumption of ≥1 serving of sugar sweetened milk-based beverages (85%, mainly milk drinks made from powder) was most prevalent, followed by fruit juice (46%) and sugar-containing carbonated drinks (39%, mainly soft/fizzy drinks). Among unsweetened beverages, plain water was reported to be consumed < 2 times a day by 22% of children, and plain milk < 1 serving a day by 53%. Higher consumption of SSBs was associated with socio-economic disadvantage, non-NZ European ethnicities (Māori, Pacific, Asian, others), availability of SSBs in the home, frequent takeaway/convenience shop visits, children’s incorrect perception of adequate SSBs consumption frequency, and higher BF% (females only). School health policy and encouragement of children to consume un-sweetened beverages was not associated with SSBs consumption. Conclusions The consumption of SSBs is prevalent in NZ school age children, with higher consumption rates observed among those from socially disadvantaged areas. This high consumption is associated with higher BF% in females. Multi-contextual interventions to decrease SSBs should target children, and their families/environment, particularly those from socially disadvantaged areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12345-9.
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Affiliation(s)
- Emma Smirk
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, 0745, New Zealand
| | - Hajar Mazahery
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, 0745, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, 0745, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, 0745, New Zealand
| | - Cheryl Gammon
- School of Health Sciences, College of Health, Massey University, Auckland, 0745, New Zealand
| | - Owen Mugridge
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, 0745, New Zealand
| | - Pamela R von Hurst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, 0745, New Zealand.
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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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Qiu N, Moore JB, Wang Y, Fu J, Ding K, Li R. Perceived Parental Attitudes Are Indirectly Associated with Consumption of Junk Foods and Sugar-Sweetened Beverages among Chinese Adolescents through Home Food Environment and Autonomous Motivation: A Path Analysis. Nutrients 2021; 13:nu13103403. [PMID: 34684401 PMCID: PMC8541436 DOI: 10.3390/nu13103403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to use path analysis to determine the association between perceived parental attitudes toward restricting junk food (JF)/sugar-sweetened beverage (SSB) intake and JF/SSB consumption among Chinese adolescents, and whether JF/SSB availability in the home environment and autonomous motivation of adolescents mediated the association. A cross-sectional survey was conducted using questionnaires adapted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to collect data on 3819 participants with an average age of 14.7 years (SD = 1.7). Spearman correlations and path analysis were performed. It was found that perceived parental attitudes were not directly associated with adolescents’ JF/SSB consumption frequency, but indirectly related to them through JF/SSB availability in the home environment and autonomous motivation of adolescents. When parents held a less positive attitude toward JF/SSB consumption and kept less JFs/SSBs at home, youth displayed more autonomous motivation for restricting JF/SSB intake and consumed fewer JFs/SSBs.
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Affiliation(s)
- Nan Qiu
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan 430071, China; (N.Q.); (Y.W.); (J.F.); (K.D.)
| | - Justin B. Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Yechuang Wang
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan 430071, China; (N.Q.); (Y.W.); (J.F.); (K.D.)
| | - Jialin Fu
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan 430071, China; (N.Q.); (Y.W.); (J.F.); (K.D.)
| | - Kai Ding
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan 430071, China; (N.Q.); (Y.W.); (J.F.); (K.D.)
| | - Rui Li
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan 430071, China; (N.Q.); (Y.W.); (J.F.); (K.D.)
- Correspondence: ; Tel.: +86-27-68759901; Fax: +86-27-68758648
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McCormick BA, Porter KJ, You W, Yuhas M, Reid AL, Thatcher EJ, Zoellner JM. Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents. Public Health Nutr 2021; 24:3242-3252. [PMID: 33427154 PMCID: PMC8272722 DOI: 10.1017/s1368980021000069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents' sugar-sweetened beverage (SSB) intake. DESIGN This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake - step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver's SSB behaviours, caregiver's SSB rules) and step 4: environmental (i.e., home SSB availability) level variables. SETTING Eight middle schools across four rural southwest Virginia counties in Appalachia. PARTICIPANTS Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years). RESULTS Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent's SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001). CONCLUSIONS SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.
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Affiliation(s)
- Brittany A McCormick
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia, 16 East Main Street, Christiansburg, VA24073, USA
| | - Kathleen J Porter
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia, 16 East Main Street, Christiansburg, VA24073, USA
| | - Wen You
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA22903, USA
| | - Maryam Yuhas
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY13244, USA
| | - Annie L Reid
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia, 16 East Main Street, Christiansburg, VA24073, USA
| | - Esther J Thatcher
- Department of Population Health, University Hospitals, Cleveland, OH44106, USA
| | - Jamie M Zoellner
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia, 16 East Main Street, Christiansburg, VA24073, USA
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Zhuang X, Liu Y, Gittelsohn J, Lewis E, Song S, Ma Y, Wen D. Sugar-Sweetened Beverages Consumption and Associated Factors among Northeastern Chinese Children. Nutrients 2021; 13:2233. [PMID: 34209665 PMCID: PMC8308402 DOI: 10.3390/nu13072233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 01/04/2023] Open
Abstract
(1) Background: The present study aimed to investigate the association between home-related factors, community environmental factors, and sugar-sweetened beverages (SSBs) intake among Northeastern Chinese children. (2) Methods: Cross-sectional. Children with complete data were included in the analysis (n = 901). A questionnaire modified according to BEVQ-15 measured the intake of SSBs. Logistic regression was applied to determine the factors associated with the consumption of SSBs. IBM SPSS Statistics 23.0 was applied to perform all statistical analyses. (3) Results: The mean total amount of SSBs consumed on a weekly basis was 2214.04 ± 2188.62 mL. Children's weekly pocket money, frequency of SSBs purchase, SSBs availability at home, the number of accessible supermarkets, and frequency of weekly visits to convenience stores were all found to be associated with a high intake of SSBs among all children. Among children of normal weight, the findings indicated that weekly pocket money, SSBs availability at home, and number of accessible supermarkets were associated with a high SSBs intake. At the same time, frequency of SSBs purchase, mother's SSBs intake, and frequency of weekly visits to convenience stores were associated with a high SSBs intake among children with obesity. (4) Conclusions: Given the potential negative health effects of high SSBs intake, it is crucial to pay attention to home-related factors and community environment.
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Affiliation(s)
- Xuxiu Zhuang
- Institute of Health Science, China Medical University, Shenyang 110000, China; (X.Z.); (Y.L.); (S.S.); (Y.M.)
| | - Yang Liu
- Institute of Health Science, China Medical University, Shenyang 110000, China; (X.Z.); (Y.L.); (S.S.); (Y.M.)
| | - Joel Gittelsohn
- Human Nutrition Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.G.); (E.L.)
| | - Emma Lewis
- Human Nutrition Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.G.); (E.L.)
| | - Shenzhi Song
- Institute of Health Science, China Medical University, Shenyang 110000, China; (X.Z.); (Y.L.); (S.S.); (Y.M.)
| | - Yanan Ma
- Institute of Health Science, China Medical University, Shenyang 110000, China; (X.Z.); (Y.L.); (S.S.); (Y.M.)
| | - Deliang Wen
- Institute of Health Science, China Medical University, Shenyang 110000, China; (X.Z.); (Y.L.); (S.S.); (Y.M.)
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Papies EK. The Psychology of Desire and Implications for Healthy Hydration. ANNALS OF NUTRITION AND METABOLISM 2021; 76 Suppl 1:31-36. [PMID: 33774627 DOI: 10.1159/000515025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022]
Abstract
This article discusses the cognitive mechanisms underlying the motivation to consume sugar-sweetened beverages (SSBs) and outlines implications for developing healthy hydration habits. While the detrimental health consequences of consuming SSBs are well understood, the psychological processes underlying the motivation to consume them are understudied. To address this gap, the current article applies a grounded cognition theory of desire and motivated behaviour, which can be used as a framework to understand and potentially change the motivation for SSBs and healthier alternatives, such as water. The grounded cognition theory of desire argues that people represent foods and drinks through potentially rewarding simulations, or re-experiences, of consuming them. These simulations, in turn, can increase desire and motivated behaviour. In line with this theory, research on eating behaviour shows that people think about attractive food in terms of what it feels like to eat it and in terms of relevant eating situations and that these simulations predict the desire to eat. Similarly, emerging research on SSBs shows that people represent these beverages in terms of the sensory and rewarding experiences of drinking them, more so than water, and especially if they consume them often. These simulations, in turn, predict the desire for sugary drinks and actual consumption. This has implications for attempts to increase healthy hydration: in order to facilitate healthy choices, the immediate pleasure to be gained from consuming a healthy beverage should be emphasized, rather than its long-term benefits. Repeatedly facilitating healthy drink choices in similar situations can ultimately contribute to the development of healthy hydration habits.
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Free Sugars Intake among Chinese Adolescents and Its Association with Dental Caries: A Cross-Sectional Study. Nutrients 2021; 13:nu13030765. [PMID: 33652968 PMCID: PMC7996778 DOI: 10.3390/nu13030765] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
This study aims to estimate the free sugars intake, identify the primary food sources of free sugars, and explore the relationship between free sugars intake and dental caries among Chinese adolescents. This cross-sectional study included 1517 middle-school students aged 12–14 years in Changsha city, China. Adolescents completed a 12-item Food Frequency Questionnaire (FFQ) and oral health assessment. The students’ dental caries experience was available as DMFT score (number of decayed, missing, and filled permanent teeth). Statistical analyses included the Mann–Whitney test, Kruskal–Wallis test, Chi-square test, and binary logistic regression model. The average intake of free sugars was 53.1 g/d in adolescents, and 43.2% of the students consumed more than 50 g of free sugars daily. The primary contributor to free sugars was sugar-sweetened beverages (SSBs). Age, boarders, and high family income were risk factors for excessive free sugars intake (p < 0.05), and increased free sugars intake was a risk factor for dental caries (odds ratio, OR = 1.446, 95% confidence interval: 1.138–1.839). Both the free sugars intake and dental caries prevalence in Chinese adolescents were high. Targeted interventions are urgently needed to address the excessive consumption of free sugars and improve Chinese adolescents’ oral health.
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Chau S, Oldman S, Smith SR, Lin CA, Ali S, Duffy VB. Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting. Nutrients 2021; 13:223. [PMID: 33466705 PMCID: PMC7828782 DOI: 10.3390/nu13010223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child's activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child's behaviors. The child's PALS responses appeared reasonable (fair-to-good child-parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child's weight or family's food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.
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Affiliation(s)
- Sarah Chau
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Samantha Oldman
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Sharon R. Smith
- CT Children’s Medical Center, University of CT School of Medicine, Hartford, CT 06269-1101, USA;
| | - Carolyn A. Lin
- Communications Department, University of CT, Storrs, CT 06269-1101, USA;
| | - Saba Ali
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
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Wang Z, Jansen EC, Miller AL, Peterson KE, Téllez-Rojo MM, Watkins D, Schnaas L, Chavez MDCH, Cantoral A. Childhood emotional and behavioral characteristics are associated with soda intake: A prospective study in Mexico City. Pediatr Obes 2020; 15:e12682. [PMID: 32558284 PMCID: PMC8570088 DOI: 10.1111/ijpo.12682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 04/18/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate whether childhood emotional and behavioral characteristics are associated with soda intake. METHODS The study population included 391 Mexico City adolescents enrolled in a birth cohort study. When children were between 6 and 12 years of age, the Behavioral Assessment System for Children (BASC)-2 was administered. Nondiet soda intake was measured concurrently and again when participants were of peripubertal ages via food frequency questionnaire. Linear regression models were run with soda mL/day (cross-sectional and change in soda over time) as the outcome and BASC composite scores as predictors (in separate models), adjusting for confounders. RESULTS At baseline, children were 8.3 (SD 1.3) years (49% males). Three scales out of 18 examined had statistically significant associations. Parent-reported adaptive skills were inversely associated with concurrent soda intake (β = -2.29 with 95% CI -4.27 to -0.31). Parent-reported internalizing problems (higher = more problems) were related to higher change in soda intake from childhood to adolescence (β = 5.83 with 95% CI 0.98-10.68; N = 191). Self-reported school problems were associated with a higher change in soda intake over time (β = 9.46 with 95% CI 2.10-16.82; N = 122). CONCLUSIONS Parent- and self-reported emotional and behavioral difficulties in childhood were associated with soda consumption and changes in soda consumption over time.
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Affiliation(s)
- Zeyuan Wang
- Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA,Contributed equally to this work
| | - Erica C. Jansen
- Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA,Contributed equally to this work
| | - Alison L. Miller
- Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Karen E. Peterson
- Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Deborah Watkins
- Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lourdes Schnaas
- Institute of Perinatology, ABC Hospital, Mexico City, Mexico
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Jústiz AM, Landry MJ, Asigbee FM, Ghaddar R, Jeans MR, Davis JN. Associations between Child and Parent Knowledge of Added Sugar Recommendations and Added Sugar Intake in Multiethnic Elementary-Aged Children. Curr Dev Nutr 2020; 4:nzaa140. [PMID: 32923924 PMCID: PMC7475003 DOI: 10.1093/cdn/nzaa140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A key goal of the Dietary Guidelines for Americans 2015-2020 is to reduce added sugar intake by increasing public knowledge about added sugars. However, research has not shown if knowledge of added sugar recommendations is associated with intake. OBJECTIVES To determine the relation between parent and child knowledge of added sugar recommendations with added sugar intake in primarily low-income and Hispanic third- to fifth-grade students. METHODS Analysis examined baseline, cross-sectional data from TX Sprouts, a 1-y cooking, gardening, and nutrition clustered randomized controlled trial. Participants were 685 parent-child dyads from 16 elementary schools in the greater Austin area. Parents and children completed a survey to assess knowledge of added sugar recommendations. Children completed two 24-h dietary recalls to assess average intake of added sugars. Mixed effects linear regression models were used to estimate associations between child and parent knowledge of added sugar recommendations and average total added sugar intake. RESULTS Children who correctly identified the added sugar recommendation consumed lower amounts of added sugar compared with children who did not correctly identify the recommendation (34.8 ± 2.7 compared with 41.0 ± 2.5 g; P = 0.003), after adjusting for sociodemographic characteristics. Parent knowledge of added sugar recommendations was not associated with child intake. CONCLUSIONS Child knowledge of added sugar recommendations was associated with lower intake of added sugars. Findings suggest that child nutrition education should focus on increasing knowledge of national recommendations. Future research should investigate a causal relation between added sugar knowledge and intake in elementary-aged children.
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Affiliation(s)
- Amanda M Jústiz
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Matthew J Landry
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Fiona M Asigbee
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Matthew R Jeans
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Jaimie N Davis
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
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Schneider S, Mata J, Kadel P. Relations between sweetened beverage consumption and individual, interpersonal, and environmental factors: a 6-year longitudinal study in German children and adolescents. Int J Public Health 2020; 65:559-570. [PMID: 32561963 PMCID: PMC7360664 DOI: 10.1007/s00038-020-01397-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 05/20/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aims to characterize the consumption of sweetened beverages (SB) among young people in Germany in terms of individual and interpersonal-environmental correlates. METHODS A representative sample of children and adolescents from Germany was assessed twice, 6 years apart (total longitudinal sample n = 11,691 children and adolescents aged between 0 and 17 years old; weighted). The relations between individual and interpersonal-environmental factors at baseline with SB intake 6 years later were analysed using bivariate and multivariate methods. RESULTS The majority of children and adolescents in Germany consume sweetened beverages weekly, 23% daily. SB consumption is particularly high in boys and often accompanied by other unhealthy lifestyle behaviours including a high level of tobacco and media consumption with a concurrent deficiency in fruit and vegetable consumption. Interpersonal factors associated with higher sweetened beverage consumption include low socio-economic status, tobacco consumption of parents, and older maternal age. CONCLUSIONS Research on factors that correlate with sweetened beverage consumption is crucial to design effective interventions. Our findings underline the importance of complex, multi-level interventions to target sweetened beverage intake and obesity.
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Affiliation(s)
- Sven Schneider
- Division Head Child and Health, Medical Faculty Mannheim, Mannheim Institute for Public Health, Social and Preventive Medicine, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
| | - Jutta Mata
- Health Psychology, University of Mannheim, 68161 Mannheim, Germany
| | - Philipp Kadel
- Division Head Child and Health, Medical Faculty Mannheim, Mannheim Institute for Public Health, Social and Preventive Medicine, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
- Health Psychology, University of Mannheim, 68161 Mannheim, Germany
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Abstract
AbstractObjective:To identify correlates and underlying beliefs regarding the adolescents’ intention to abstain from consuming sugar-sweetened beverages (SSB) and the consumption of ≤1 daily portion of SSB.Design:Correlational study.Setting:Region of Chaudière-Appalaches in the province of Quebec, Canada.Participants:311 adolescents aged 13–18 years completed a self-administrated online questionnaire based on the Reasoned Action Approach. Frequency and quantity of different types of SSB within the past month were measured.Results:Total mean SSB intake was 882·6 ml/d (654·0 kJ/d ). Only 11·3 % abstained from SSB within the last month. Intention to abstain from SSB was explained by identification as SSB abstainers (β = 0·47), perceived norm (β = 0·32), attitude (β = 0·30), age 13–14 years (β = –0·27) and perception of the school environment (β = 0·14), which explained 66 % of the variance. Consumption of ≤1 daily portion of SSB was explained by the intention to abstain (OR = 1·55; 95 % CI 1·14, 2·11), perceived behavioural control to abstain (OR = 1·80; 95 % CI 1·29, 2·52), sex (girls v. boys: OR = 2·34; 95 % CI 1·37, 3·98) and socio-economic status (advantaged v. disadvantaged school: OR = 2·08; 95 % CI 1·21, 3·56). Underlying beliefs (i.e. more energy, decreased risk of addiction and friends’ approval) associated with intention as well as perceived barriers (e.g. access to SSB, after an activity that makes you thirsty), and facilitating factors (e.g. access to water) linked to SSB consumption were identified.Conclusions:The results can inform public health interventions to decrease SSB consumption and their associated health problems among adolescents.
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Cohen DA, Bogart LM, Han B, Williamson S, Castro G. High consumption of energy-dense nutrient-poor foods among low-income groups in the Mississippi Delta and Alabama. Public Health Nutr 2020; 23:1067-1075. [PMID: 31566159 PMCID: PMC10200526 DOI: 10.1017/s1368980019002817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years. DESIGN We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10-17 years with parental consent. SETTING Retail food outlets in Mississippi and Alabama, USA. PARTICIPANTS Adults (n 11 311) and adolescents (n 3460). RESULTS The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male - female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings. CONCLUSIONS SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.
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Affiliation(s)
- Deborah A Cohen
- RAND Corporation, 1776 Main Street, Santa Monica, CA90407, USA
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA90407, USA
| | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA90407, USA
| | | | - Gabriela Castro
- RAND Corporation, 1776 Main Street, Santa Monica, CA90407, USA
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Affiliation(s)
- Elena V Kuklina
- Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta GA
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta GA
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Eck KM, Delaney CL, Shelnutt KP, Olfert MD, Byrd-Bredbenner C. Parenting Advice School-Age Kids Offer to Parents to Promote Healthier Child Weight-Related Behaviors. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:290-298. [PMID: 31607432 DOI: 10.1016/j.jneb.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore parenting advice children would provide to help parents encourage positive health-related behaviors by children. DESIGN Focus group discussions were conducted, and children shared the advice they would provide parents to help them encourage healthy weight-related behaviors (ie, diet, physical activity, and sleep) for children. SETTING Focus groups (n = 65) were conducted in 3 states (Florida, New Jersey, and West Virginia). PARTICIPANTS School-age children (n = 194) between the ages of 6 and 11 years old. PHENOMENON OF INTEREST What parenting practices are recommended by children, and are they in line with best-practice guidelines? ANALYSIS Focus group data were analyzed to identify themes and trends. RESULTS Children's recommendations were congruent with authoritative parenting styles (ie, high levels of warmth and control). Most of the advice shared by children aligned with recommended parent practices (ie, responsive feeding, facilitation, environmental restructuring, parent modeling, and encouragement). However, not all of the children's advice aligned with best practices guidelines (ie, use of food rewards and deception). CONCLUSIONS AND IMPLICATIONS Future nutrition education programs may be strengthened by helping parents adopt best practices for promoting healthy child behaviors. Furthermore, teaching children about recommended child feeding parenting practices may help protect future generations by preparing children to care for younger siblings or raise their children using best parenting practices.
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Affiliation(s)
- Kaitlyn M Eck
- Nutritional Sciences Department, Rutgers University, New Brunswick, NJ.
| | - Colleen L Delaney
- Nutritional Sciences Department, Rutgers University, New Brunswick, NJ
| | - Karla P Shelnutt
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, West Virginia University, Morgantown, WV
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Association of sugar-sweetened beverage intake with risk of metabolic syndrome among children and adolescents in urban China. Public Health Nutr 2020; 23:2770-2780. [PMID: 31915093 DOI: 10.1017/s1368980019003653] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE High sugar-sweetened beverage (SSB) intake has been shown to correlate with a higher risk for CVD and metabolic disorders, while the association between SSB intake and the risk of metabolic syndrome (MetS) remains unclear. The present study aimed to explore the association between SSB intake and MetS among children and adolescents in urban China. DESIGN A cross-sectional study involving 7143 children and adolescents was conducted in urban China. MetS definition proposed by the International Diabetes Federation was adopted. Data on SSB intake, diet, physical activity and family environment factors were obtained through questionnaires. Logistic regression models with multivariable adjustment were adopted to analyse the association between SSB intake and the risk of MetS and its components. SETTING Primary and secondary schools in three urban cities of China. PARTICIPANTS Children and adolescents (n 5258) aged 7-18 years. RESULTS Among the participants, 29·9 % of them had high SSB intake (at least 0·3 servings/d) and the overall MetS prevalence was 2·7 %. Participants with high SSB intake were at higher risk for MetS (OR = 1·60; 95 % CI 1·03, 2·54) and abdominal obesity (OR = 1·55; 95 % CI 1·28, 1·83) compared with their counterparts with no SSB intake (0 servings/d). CONCLUSIONS High SSB intake is significantly associated with increased MetS and abdominal obesity risk among children and adolescents in urban China. These results suggest that strong policies focusing on controlling SSB intake might be effective in preventing MetS and abdominal obesity.
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Imoisili OE, Park S, Lundeen EA, Yaroch AL, Blanck HM. Daily Adolescent Sugar-Sweetened Beverage Intake Is Associated With Select Adolescent, Not Parent, Attitudes About Limiting Sugary Drink and Junk Food Intake. Am J Health Promot 2020; 34:76-82. [PMID: 31409090 PMCID: PMC10863727 DOI: 10.1177/0890117119868382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent attitudes about limiting SSB and junk food (SSB/JF) intake. DESIGN Quantitative, cross-sectional study. SETTING The 2014 Family Life, Activity, Sun, Health, and Eating study. SAMPLE Parent-adolescent dyads (N = 1555). MEASURES The outcome was adolescent SSB intake. Exposure variables were parent SSB intake, sociodemographics, and parent and adolescent attitudes about SSB/JF intake (responses: agree, neither, or disagree). ANALYSIS Multinomial logistic regressions estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs). RESULTS Half (49.5%) of adolescents and 33.7% of parents consumed SSB ≥1 time/day. Parent daily SSB intake was associated with adolescent daily SSB intake (aOR = 8.9; CI = 4.6-17.3) [referent: no consumption]. Adolescents who disagreed on having confidence to limit SSB/JF intake had higher odds of daily SSB intake (aOR = 3.5; CI = 1.8-6.8), as did those who disagreed they felt bad about themselves if they did not limit SSB/JF intake (aOR = 1.9; CI=1.1-3.3), compared to adolescents who agreed with these attitudes. No parental attitudes were significant. CONCLUSION Higher odds of daily SSB intake among adolescents was associated with parent SSB intake and adolescent attitudes about confidence in, and feeling bad about, limiting SSB/JF intake. Parent attitudes were not associated with daily adolescent SSB intake. Efforts to reduce adolescent SSB intake could consider strategies geared toward improving adolescent attitudes and dietary behaviors and parental SSB intake.
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Affiliation(s)
- Omoye E. Imoisili
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A. Lundeen
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy L. Yaroch
- The Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rillamas-Sun E, Bishop S, Cisneros O, Mendoza JA, Kratz M, Ko LK. Psychosocial Factors of Diet and Physical Activity among Rural, Hispanic Children: Findings from a Multilevel Health Intervention Study. J Racial Ethn Health Disparities 2019; 6:1218-1227. [PMID: 31385261 PMCID: PMC6832826 DOI: 10.1007/s40615-019-00623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the relationship of psychosocial factors, such as self-efficacy, family role modeling, and perceptions of the environment, on diet, physical activity, and sedentary behavior in Hispanic children living in rural Washington State. METHODS Gender, heights, and weights were obtained from Hispanic 8-12 year olds (n = 553) from two rural communities in Lower Yakima, Washington. A subsample of 179 children provided psychosocial measures, diet, and screen time via questionnaire and physical activity via accelerometer. Body mass index percentiles were used to calculate the prevalence of obesity. The association of demographic and psychosocial measures on the mean difference (95% confidence interval (CI)) of fruit, vegetable, and sugar consumption and minutes spent active was estimated using linear regression models. RESULTS Prevalence of obesity was 35%. Children with obesity consumed one-fifth (- 0.3, - 0.02) fewer cups of fruits, 2.2 (0.1, 4.2) more teaspoons of total added sugars, and spent 16.1 (- 22.0, - 10.2) fewer minutes in moderate-to-vigorous physical activity per day compared with children with healthy weights. Males consumed more added sugars and reported more screen time than females, but spent more daily minutes in moderate-to-vigorous physical activity. Higher fruit and vegetable self-efficacy scores were associated with more consumption of fruits and vegetables, more engagement in light physical activity, and less time spent sedentary per day. CONCLUSION Male gender and some psychosocial measures were associated with obesogenic behaviors. Insight about factors associated with obesity-related behaviors in rural, Hispanic children may help the development of successful and effective behavioral health interventions for this understudied population.
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Affiliation(s)
- Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sonia Bishop
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Jason A. Mendoza
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Mario Kratz
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Linda K. Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA
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Zhang CQ, Wong MCY, Zhang R, Hamilton K, Hagger MS. Adolescent sugar-sweetened beverage consumption: An extended Health Action Process Approach. Appetite 2019; 141:104332. [DOI: 10.1016/j.appet.2019.104332] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
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Gustafson A, Ng SW, Jilcott Pitts S. The association between the “Plate it Up Kentucky” supermarket intervention and changes in grocery shopping practices among rural residents. Transl Behav Med 2019; 9:865-874. [DOI: 10.1093/tbm/ibz064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
Rural communities experience higher rates of obesity, and residents have a lower intake of fruits and vegetables. Innovative healthy food promotions in supermarkets may improve healthy food access and dietary intake among residents, yet few supermarket interventions have been translated to the rural context. The aim of this project was to determine whether a supermarket-based intervention “Plate it Up Kentucky” was associated with change in fruit, vegetable, and sugar-sweetened beverage (SSB) purchases among rural supermarket customers. Ten Kentucky supermarkets participated in an intervention titled “Plate It Up” to provide in-store promotions, including recipe cards, samples, price reductions for specific fruits and vegetables, and marketing on shopping carts. Six stores in rural Kentucky and North Carolina were controls. Two cross-sectional customer intercept surveys were conducted among grocery store customers in Spring of 2016 (baseline, n = 131 control and n = 181 intervention store customers) and Spring–Summer of 2017 (post-intervention, n = 100 control and n = 83 intervention store customers). Customers were asked to provide store receipts and participate in a survey assessing grocery shopping practices and dietary intake. The primary outcome was purchases in fruit and vegetable (obtained from receipt data). The secondary outcome was dietary intake (captured with the National Cancer Institute's Fruit and Vegetable Screener and BRFSS questionnaire). An adjusted, difference-in-difference model was used to assess the differences between control and intervention store customers at baseline, post-intervention, and then between the two time points. Post-intervention, there was a greater increase in customers stating that they “liked the food” as one main reason for shopping in the store where surveyed among intervention versus control store customers. The adjusted difference-in-difference model indicated that intervention store customers spent on average 8% more on fruits and vegetables from baseline to post-intervention (p = .001) when compared with customers from control stores. Among controls, spending on SSB decreased from $3.61 at baseline to $3.25 at post-intervention, whereas among intervention customers, spending on SSB decreased from $2.75 at baseline to $1.81 at post-intervention (p = .02). In-store promotions that provide recipe cards, samples, price reductions for specific fruits and vegetables, and marketing on shopping carts hold promise as a method to promote healthy food purchases among rural supermarket customers at two time points.
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Affiliation(s)
- Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, USA
| | - Shu Wen Ng
- Department of Nutrition, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Zoellner JM, Porter KJ, You W, Chow PI, Ritterband LM, Yuhas M, Loyd A, McCormick BA, Brock DJP. Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods. Contemp Clin Trials 2019; 83:64-80. [PMID: 31233859 PMCID: PMC6713199 DOI: 10.1016/j.cct.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
Abstract
The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. Unfortunately, there is insufficient evidence for effective strategies targeting SSB behaviors among Appalachian youth in real-world settings, including rural schools. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy program aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short message service (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior and health literacy, media literacy, numeracy, and public health literacy concepts. Guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. Secondary outcomes include other changes in students (e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed, along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine how teachers implement Kids SIPsmartER and the potential for institutionalization within schools. This paper discusses the rationale for implementing and evaluating a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors in Appalachia. Clincialtrials.gov: NCT03740113.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Kathleen J Porter
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 321A Hutcheson Hall, 24060, USA
| | - Phillip I Chow
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Lee M Ritterband
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Maryam Yuhas
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Annie Loyd
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Brittany A McCormick
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Donna-Jean P Brock
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
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Yuhas M, Porter KJ, Brock DJP, Loyd A, McCormick BA, Zoellner JM. Development and Pilot Testing of Text Messages to Help Reduce Sugar-Sweetened Beverage Intake Among Rural Caregivers and Adolescents: Mixed Methods Study. JMIR Mhealth Uhealth 2019; 7:e14785. [PMID: 31364600 PMCID: PMC6691674 DOI: 10.2196/14785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 01/30/2023] Open
Abstract
Background A high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. Objective By targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. Methods A convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. Results In phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). Conclusions Spending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors.
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Affiliation(s)
- Maryam Yuhas
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Donna-Jean P Brock
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Annie Loyd
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Brittany A McCormick
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
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Gustafson A, Jilcott Pitts SB, McQuerry K, Babtunde O, Mullins J. A Mentor-Led Text-Messaging Intervention Increases Intake of Fruits and Vegetables and Goal Setting for Healthier Dietary Consumption among Rural Adolescents in Kentucky and North Carolina, 2017. Nutrients 2019; 11:nu11030593. [PMID: 30862118 PMCID: PMC6471255 DOI: 10.3390/nu11030593] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction—Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home” Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control schools). Adolescents were recruited to participate in the eight-week text-messaging intervention. The text messages were primarily affective messages, and included a weekly challenge related to consuming fruits, vegetables, or healthy/low-calorie beverages. Undergraduate nutrition students sent text messages on Tuesday and Saturday every week over the eight-week period via the “Group Me” mobile application. Delayed controls received no information or text messages during the eight-week intervention. Fruit and vegetable intake was measured with the National Cancer Institute Fruit and Vegetable screener and beverage intake was assessed using the Beverage Questionnaire-10 (BEVQ-10). Intention-to-treat analyses were conducted among all those that completed the baseline and post-intervention survey (n = 277 intervention students and n = 134 delayed control students). All linear regression models were adjusted for race and were clustered on school to control for intraclass correlation. Results—In adjusted analyses, there was a statistically significant positive intervention effect on the primary outcome of fruit and vegetable servings/day with a mean difference between intervention and control participants of 1.28 servings/day (95% Confidence Interval 1.11, 1.48). There was no intervention effect on beverage intake. There was a statistically significant increase in the odds of goal setting for healthier dietary behaviors among intervention participants relative to controls. Conclusion—An eight-week text-messaging intervention led to increases in self-reported fruit and vegetable intake and improvements in goal setting for healthier dietary behaviors. Due to the use of undergraduate students to deliver the messages, and use of an existing web application, this text-messaging intervention can be sustained in underserved, rural environments. Thus there is potential for significant reach and public health impact to improve dietary patterns.
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Affiliation(s)
- Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, 206G Funkhouser Building, Lexington, KY 40506, USA.
| | - Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Drive, Mailstop 660, Room 2239, Greenville, NC 27834, USA.
| | - Kristen McQuerry
- Applied Statistics Lab, University of Kentucky, 305B MDS Building, Lexington, KY 40506, USA.
| | - Oyinlola Babtunde
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Health Sciences Bldg. Rm. 2437, MailStop #668, 600 Moye Blvd., Greenville, NC 27834, USA.
| | - Janet Mullins
- Department of Dietetics and Human Nutrition, University of Kentucky, 206J Funkhouser Building, Lexington, KY 40506, USA.
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Boles RE, Johnson SL, Burdell A, Davies PL, Gavin WJ, Bellows LL. Home food availability and child intake among rural families identified to be at-risk for health disparities. Appetite 2019; 134:135-141. [DOI: 10.1016/j.appet.2018.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/28/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023]
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Autonomous motivation, sugar-sweetened beverage consumption and healthy beverage intake in US families: differences between mother-adolescent and father-adolescent dyads. Public Health Nutr 2019; 22:1010-1018. [PMID: 30741132 DOI: 10.1017/s136898001800383x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess interdependent effects of autonomous motivation to limit sugar-sweetened beverage (SSB) consumption in relation to SSB and healthy beverage (HB) intake in mother-adolescent and father-adolescent dyads. DESIGN Adopting a dyadic cross-sectional design, the actor-partner interdependence modelling (APIM) approach was used to construct and analyse two APIM for mother-adolescent and father-adolescent dyads. The first model assessed actor effects (individual's autonomous motivation associated with his/her own beverage intake) and partner effects (individual's autonomous motivation associated with another family member's beverage consumption) of autonomous motivation on SSB consumption. The second model assessed actor and partner effects of autonomous motivation on HB intake. SETTING Two Internet-based surveys were completed in participant households.ParticipantsData from a demographically representative US sample of parent-adolescent dyads (1225 mother-adolescent dyads, 424 father-adolescent dyads) were used. RESULTS In the first model (autonomous motivation on SSB consumption), actor effects were significant for adolescents, but not for parents. Partner effects were significant for mother-adolescent, but not father-adolescent dyads. In the second model (autonomous motivation on HB intake), actor effects were significant for adolescents and parents in all dyadic combinations. Regarding partner effects, adolescent autonomous motivation had a significant effect on HB intake for mothers and fathers. In addition, maternal autonomous motivation had a significant effect on adolescent HB intake. No partner effects for HB were identified for fathers. CONCLUSIONS We found significant interdependent effects of autonomous motivation in relation to SSB and HB intake in mother-adolescent and father-adolescent dyads for eleven out of sixteen pathways modelled.
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Kim KW, Wallander JL, Felt JM, Elliott MN, Schuster MA. Associations of Parental General Monitoring with Adolescent Weight-Related Behaviors and Weight Status. Obesity (Silver Spring) 2019; 27:280-287. [PMID: 30597754 DOI: 10.1002/oby.22372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/25/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined how parental general monitoring (PGM), which refers to parental awareness of adolescents' activities in various domains, is associated with adolescents' weight status and related behaviors and whether these relationships differ among racial/ethnic groups. METHODS Data are from 4,088 Black, Latino, and White youth assessed in seventh grade (mean age = 13.06). BMI percentile based on measured height and weight indicated weight status. PGM was assessed by adolescent report of parents' awareness of money spending, friends, and whereabouts. Adolescents reported both healthy and unhealthy dietary intake (DI), physical activity, and screen time over the past 7 days. Total sample and multigroup structural models were estimated. RESULTS PGM was associated with lower weight status for the total sample, as well as being positively associated with healthy DI and physical activity and inversely associated with screen time across racial/ethnic groups. PGM was also inversely associated with unhealthy DI, except for in Black adolescents. There was an indirect effect from PGM to lower weight status via reduced screen time among Latino and White adolescents. CONCLUSIONS Positive outcomes associated with PGM are extended to weight status and related behaviors. Efforts at improving weight status and related behaviors could benefit from addressing general parenting practices with their children.
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Affiliation(s)
- Kay W Kim
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, California, USA
| | - Jan L Wallander
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, California, USA
| | - John M Felt
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, California, USA
| | | | - Mark A Schuster
- Kaiser Permanente School of Medicine, Pasadena, California, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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The role of the home environment in sugar-sweetened beverage intake among northern Mexican adolescents: a qualitative study. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Eck KM, Dinesen A, Garcia E, Delaney CL, Famodu OA, Olfert MD, Byrd-Bredbenner C, Shelnutt KP. "Your Body Feels Better When You Drink Water": Parent and School-Age Children's Sugar-Sweetened Beverage Cognitions. Nutrients 2018; 10:E1232. [PMID: 30189588 PMCID: PMC6165219 DOI: 10.3390/nu10091232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 12/21/2022] Open
Abstract
Sugar-sweetened beverages (SSBs) are a leading source of added sugar in the American diet. Further, ingestion of added sugars from SSBs exceeds recommendations. Thus, interventions that effectively reduce SSB consumption are needed. Focus group discussions with parents (n = 37) and school-aged children between the ages of 6 and 11 years (n = 41) from Florida, New Jersey, and West Virginia were led by trained moderators using Social Cognitive Theory as a guide. Trends and themes that emerged from the content analysis of the focus group data indicated that both parents and children felt that limiting SSBs was important to health and weight control. However, parents and children reported consuming an average of 1.85 ± 2.38 SD and 2.13 ± 2.52 SD SSB servings/week, respectively. Parents and children were aware that parent behaviors influenced kids, but parents reported modeling healthy SSB behaviors was difficult. Busy schedules, including more frequent parties and events as children get older, were another barrier to limiting SSBs. Parents were most successful at limiting SSBs when they were not in the house. This qualitative research provides novel insights into parents' and children's cognitions (e.g., beliefs, attitudes), barriers, and facilitators related to SSB ingestion. Consideration of these insights during nutrition intervention development has the potential to improve intervention effectiveness in reducing SSB intake.
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Affiliation(s)
- Kaitlyn M Eck
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Aleksandr Dinesen
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Elder Garcia
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL 32611, USA.
| | - Colleen L Delaney
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Oluremi A Famodu
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL 32611, USA.
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, West Virginia University, 1194 Evansdale Dr. G28, West Virginia University, Morgantown, WV 26506, USA.
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Karla P Shelnutt
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL 32611, USA.
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Exploring perceptions of the Mexican sugar-sweetened beverage tax among adolescents in north-west Mexico: a qualitative study. Public Health Nutr 2017; 21:618-626. [DOI: 10.1017/s1368980017002695] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo explore awareness and perceptions of the sugar-sweetened beverage (SSB) tax implemented in Mexico in 2014 among a sample of Mexican adolescents, and to investigate how the tax has affected their purchases and intake of SSB.DesignQualitative.SettingSemi-structured interviews were conducted in April–May 2016. The data were analysed using thematic analysis.SubjectsAdolescents residing in north-west Mexico (n29, 55·2 % females), aged 15–19 years.ResultsFour main themes emerged: awareness of taxation; perceptions of how the tax has affected SSB intake; reasons why the tax was not perceived to have affected SSB intake; and preferences for substitution of the taxed SSB. Participants were mostly unaware of the tax and perceived that it would not cause reductions in their intake of SSB; they felt that the price increase was low and insufficient to affect intake. Taste preferences and ‘addiction’ to SSB were highlighted as the main reasons why participants perceived taxation would not affect intake. If SSB prices were to increase further via a higher tax, participants would consider substituting SSB with other beverages, namely home-made drinks (e.g. 100 % fruit juices), non-caloric, instant-flavoured drinks and water.ConclusionsThese findings provide important insights into the views of this sample of Mexican adolescents regarding the taxation of SSB, by pointing out several possible limitations of the tax policy in Mexico. These results could inform the design of future interventions directed at Mexican youth that would complement and strengthen the current SSB taxation.
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Gustafson A, Jilcott Pitts S, McDonald J, Ford H, Connelly P, Gillespie R, Liu E, Bush H, Brancato C, Babatande T, Mullins J. Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101255. [PMID: 29065444 PMCID: PMC5664756 DOI: 10.3390/ijerph14101255] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022]
Abstract
Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.
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Affiliation(s)
- Alison Gustafson
- Department of Dietetics and Human Nutrition, 206J Funkhouser Building, University of Kentucky, Lexington, KY 40546, USA.
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, ECU 600 Moye Blvd., Mailstop 660, Lakeside Annex Modular Unit 8 Room 126, Greenville, NC 27834, USA.
| | - Jordan McDonald
- Department of Dietetics and Human Nutrition, 206J Funkhouser Building, University of Kentucky, Lexington, KY 40546, USA.
| | - Hannah Ford
- Department of Dietetics and Human Nutrition, 206J Funkhouser Building, University of Kentucky, Lexington, KY 40546, USA.
| | - Paige Connelly
- Department of Dietetics and Human Nutrition, 206J Funkhouser Building, University of Kentucky, Lexington, KY 40546, USA.
| | - Rachel Gillespie
- Department of Dietetics and Human Nutrition, 206J Funkhouser Building, University of Kentucky, Lexington, KY 40546, USA.
| | - Emily Liu
- Department of Nutrition, University of Pennsylvania, College Station, PA 20067, USA.
| | - Heather Bush
- College of Public Health, University of Kentucky, 725 Rose Street Room 301, Lexington, KY 40536, USA.
| | - Candace Brancato
- College of Public Health, University of Kentucky, 725 Rose Street Room 301, Lexington, KY 40536, USA.
| | - Toyin Babatande
- Health Sciences Bldg, 3310J MailStop #668, College of Allied Health Sciences, East Carolina University, Greenville, NC 27834, USA.
| | - Janet Mullins
- Department of Dietetics and Human Nutrition, 206J Funkhouser Building, University of Kentucky, Lexington, KY 40546, USA.
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