What makes a beverage healthy? A qualitative study of young adults’ conceptualisation of sugar-containing beverage healthfulness

"They start on the zero-alcohol and they wanna try the real thing": Parents' views on zero-alcohol beverages and their use by adolescents

OBJECTIVE

Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents.

METHODS

We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data.

RESULTS

Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported.

CONCLUSIONS

Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents.

IMPLICATIONS FOR PUBLIC HEALTH

As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

Do Mindful Eating and Intuitive Eating Affect Beverage Preferences? A Cross-Sectional Survey

Intuitive eating involves following body signals to guide eating decisions and avoiding restrictive diets. Mindful eating is paying full attention to sensory experiences and fostering nonjudgmental awareness. We aimed to elucidate potential relationships between beverage intake and intuitive and mindful eating scores. This cross-sectional exploratory study (October 2021-December 2022) enrolled adult male and female participants who provided sociodemographic and health-related information and subsequently completed the Beverage Intake Questionnaire, the Mindful Eating Questionnaire (MEQ-30), and the Intuitive Eating Scale (IES-2). Bidirectional relationships were observed between beverage intake and intuitive and mindful eating scores. The total beverage intake of males was double compared with that of females, with the intake being mainly derived from sugar-sweetened beverages (p = 0.000). Increased total water intake was positively correlated with IES-2 and its subscale scores and was negatively correlated with MEQ-30 scores in both sexes (p < 0.05). Alcoholic beverage intake was associated with reductions in IES-2 and MEQ-30 scores, whereas unconditional permission to eat increased by 18.3% in males. In females, the consumption of milk-based beverages decreased the IES-2 scores. Understanding the complex relationships between beverage intake and intuitive and mindful eating may deepen our understanding of individual dietary behaviors and inform dietary interventions.

Sugar labeling information and online marketing strategies for hand-shaken tea drinks in northern Taiwan

Background

Sugar-sweetened beverages (SSBs) are the main cause of excessive sugar intake and increased health risks. Food companies usually use social media to market SSBs in order to increase consumers' purchase intentions. To reduce excessive added sugar consumption from hand-shaken tea drinks, Taiwan has implemented a mandatory policy requiring clear sugar content labeling. This study aimed to investigate the sugar label information and online marketing strategies for hand-shaken tea drinks in northern Taiwan.

Methods

In this cross-sectional study, content analysis was employed to investigate the sugar labeling information and the current situation of online marketing in hand-shaken tea drink brands based in northern Taiwan. Seventy-two hand-shaken tea drink brands' stores were visited to record their sugar labeling presentation methods, with brands lacking labeling, presenting incomplete labeling, or not offering customized sugar levels being excluded, resulting in 60 brands being chosen for the subsequent data collection process. The sugar and energy contents in 1,581 hand-shaken tea drinks were recorded and calculated. Subsequently, the sugar contents were assessed in accordance with World Health Organization (WHO) sugar recommendations (25 g/day), warning label criteria, and Taiwan's regulations for low-sugar packaged beverages. Seven brands that had high online impressions were further selected and their marketing strategies in 560 Facebook posts were analyzed.

Results

The presentation methods of labeling varied among the 60 brands, and only 42 brands had obvious and easily accessible labeling. The most common labeling presentation method was posters (n = 28). After converting the sugar content of half-sugar and low-sugar hand-shaken tea drinks, it was found that 60.2% of half-sugar beverages and 13.0% of low-sugar beverages exceeded 25 g of sugar per cup. Over 90% of brands had Facebook and Instagram accounts. The top marketing strategies for tea drink brands on Facebook were specific beverage information, brand information, and nutrition and health marketing. Most posts promoted sugar-sweetened beverages.

Conclusion

Not all hand-shaken tea drink brands in this study followed Taiwan's labeling regulations. Moreover, high sugar contents in hand-shaken tea drinks labeled as half-sugar and low-sugar could potentially lead people to unconsciously consume excessive amounts of sugar. Future research should explore the impact of online marketing strategies on SSBs consumption behavior and ways to mitigate it among the Taiwanese public.

Tooth loss severity and core and non-core food consumption among older Brazilian adults

OBJECTIVE

To investigate the association between tooth loss severity and core and non-core food consumption in the older Brazilian population.

METHODS

We analysed data from 20 756 people aged 60 years or older who participated in the 2019 Brazilian National Health Survey. The average consumption days a week of core (8-item) and non-core (4-item) foods were the outcomes, measured using a Food Frequency Questionnaire. Tooth loss severity was the main exposure, using a four-category ordinal variable: mild (1-12 teeth missing), moderate (13-22), severe (23-31) and edentulous (all 32). Sociodemographic, tobacco smoking, use of dental prosthesis, difficulty in chewing and systemic conditions were among the covariates. Linear regression models estimated the association between tooth loss and food consumption.

RESULTS

Almost two-thirds of participants had moderate or worse levels of tooth loss. Older adults with more severe tooth loss reported an overall lower consumption of core and higher non-core foods than those with mild tooth loss. Worse tooth loss severity was associated with lower consumption of vegetables and/or legumes and fruits, and higher consumption of beans, artificial fruit juices and confectionery.

CONCLUSIONS

Older Brazilian adults with more severe tooth loss are consuming lower core and higher non-core foods. Our findings reinforce the importance of the common risk factor approach to tackle the adverse effects of tooth loss on diet.

The Association between Sugar-Sweetened Beverages and Male Pattern Hair Loss in Young Men

We performed this study to investigate the association between sugar-sweetened beverage (SSB) consumption and male pattern hair loss (MPHL) in young men. We conducted this cross-sectional study from January to April 2022 in mainland China. Young people aged 18-45 years (n = 1951) were recruited from 31 provinces in China. We used a self-reported online survey for data collection. We explored the associations between the amount/frequency of SSB consumption and MPHL by using a binary logistic regression model, with adjustments for sociodemographic, hair status, dietary intake, lifestyle, and psychological factors. Among the 1028 participants (27.8 ± 7.2 years) in the final analysis, we found that high SSB consumption is associated with a higher risk of MPHL. We recommend more support to decrease SSB consumption among young people to minimize negative health outcomes.

Paper-Based Enzymatic Electrochemical Sensors for Glucose Determination

The general objective of Analytical Chemistry, nowadays, is to obtain best-quality information in the shortest time to contribute to the resolution of real problems. In this regard, electrochemical biosensors are interesting alternatives to conventional methods thanks to their great characteristics, both those intrinsically analytical (precision, sensitivity, selectivity, etc.) and those more related to productivity (simplicity, low costs, and fast response, among others). For many years, the scientific community has made continuous progress in improving glucose biosensors, being this analyte the most important in the biosensor market, due to the large amount of people who suffer from diabetes mellitus. The sensitivity of the electrochemical techniques combined with the selectivity of the enzymatic methodologies have positioned electrochemical enzymatic sensors as the first option. This review, focusing on the electrochemical determination of glucose using paper-based analytical devices, shows recent approaches in the use of paper as a substrate for low-cost biosensing. General considerations on the principles of enzymatic detection and the design of paper-based analytical devices are given. Finally, the use of paper in enzymatic electrochemical biosensors for glucose detection, including analytical characteristics of the methodologies reported in relevant articles over the last years, is also covered.

The Healthy Eater’s Idea and Related Behavior of a Healthy Diet—A Case Study with Kombucha Drinkers

Consumers’ demand for ‘healthy’ food is growing at a fast pace. Beverages are one of the fastest-growing segments in the healthy food market. Kombucha is a product with a rapid market growth and is considered a ‘healthy beverage’. Kombucha drinkers (n = 296) in the contiguous United States (U.S.) were targeted to investigate differences in the various consumer segments regarding the healthy eater’s behavior, namely—(1) healthy diet stage-of-change attitudes, (2) healthy eating criteria, and (3) label information usage. An online survey questionnaire was used as a data collection tool. The data were analyzed via chi-square tests and multiple correspondence analysis (MCA). The majority of kombucha consumers were health-conscious and kombucha fitted into their view of a healthy diet. The female, older, western U.S. residents, and higher-educated consumers were more likely to take action and maintain a healthier diet. Healthy eaters’ idea of a healthy diet was very similar to that of the general population. Kombucha consumers focused mainly on sugar/calories and natural/organic ingredients. Additional investigations to expand the understanding of the healthy eater’s behavior with actual kombucha samples are needed in the future.

Perceived Associations between Excessive Sugar Intake and Health Conditions

Excessive sugar intake represents an increased risk of developing non-communicable diseases (e.g., obesity, cardiometabolic diseases, and dental diseases). Still, it is unclear whether people are aware of these adverse health outcomes. The current study systematically examined the extent to which people associate health conditions with excessive sugar intake. Participants (N = 1010 Portuguese volunteers) freely reported all health conditions they associated with excessive sugar consumption and rated the strength of these associations for eight specific health conditions. All participants reported health conditions associated with excessive sugar intake, with the most frequent being risk factors for cardiometabolic diseases (e.g., diabetes), cardiovascular diseases, oral problems, oncological and mental health conditions. Moreover, participants considered diabetes, overweight/obesity, and oral problems as being the conditions most related to excessive sugar intake. Women, participants with children in the household, and experts in health/nutrition rated excessive sugar intake as being more strongly linked to some of the health conditions. The identification of the health conditions that people associate with excessive sugar consumption may inform policymakers, educators, and health professionals and support interventions targeting the general public or specific groups (e.g., overweight people) in raising awareness of potential adverse health outcomes and, ultimately, contribute to reducing sugar intake.

Experimental study of front-of-package nutrition labels' efficacy on perceived healthfulness of sugar-sweetened beverages among youth in six countries

Front-of-package (FOP) nutrition labels have been proposed as a strategy to help limit sugar-sweetened beverage (SSB) consumption among youth. However, few studies have examined the efficacy of FOP labels in youth across different countries. A between-group experiment was conducted to examine the impact of FOP labels (no-label control, Health Star Rating, 'High in' Octagon, Guideline Daily Amount (GDA), Traffic Light, or Nutri-Score) on perceived healthfulness of an SSB. The study was conducted online in November-December 2019 with 10,762 children aged 10-17 from six countries: Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. A binary logistic regression model tested the impacts of FOP label condition, country, and sociodemographic characteristics on participants' likelihood of perceiving the SSB to be Unhealthy. Compared to the control condition, participants in each of the five FOP label conditions were significantly more likely to perceive the SSB as Unhealthy (p < 0.002). The 'High in' Octagon label had the greatest impact on perceived healthfulness across five out of six countries, whereas the GDA and Nutri-Score labels demonstrated the lowest impact across all six countries. The impact of FOP labels was consistent across sex, age, race/ethnicity, and perceived income adequacy. FOP labels can significantly reduce the perceived healthfulness of SSBs among youth across multiple countries. The current study adds to the evidence that 'high in' labels, which use intuitive symbols such as the octagon 'stop sign', are the most efficacious labels for helping consumers identify foods high in nutrients of concern, including SSBs.

Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task

Effective strategies to reduce free sugar intake are needed. This study examined exposure to a warning label, independently and in conjunction with a Health Star Rating (HSR) label, on the selection of commercially available cold beverages with real decision-making stakes. Participants (N = 511, 47.9% female, mean = 21.7 (SD = 6.1) years) accessed an online convenience store app via an on-campus laptop to select one of 10 beverages (5 sugar-sweetened beverages [SSBs], 1100% fruit juice, 2 artificially sweetened beverages [ASBs] and 2 waters). The task was repeated with the addition of a warning label on high-sugar drinks in Round 2, and the addition of an HSR label on all drinks in Round 3. Participants were informed that they would receive a complementary drink (valued at <$5AUD) based on their selections following the completion of a brief questionnaire. Baseline results indicated that SSBs and waters were the most and least popular choices, respectively. For both males and females, there was a significant decrease in SSB selection (p < 0.001) and significant increase in ASB and water selection (p < 0.001) following the addition of warning labels to high-sugar drinks. The decreased selection of SSBs and increased selection of waters was maintained in Round 3 when HSR labels were added to all drinks. 100% fruit juice selection decreased with the addition of a warning label for females only (p < 0.01), but increased following the addition of a 4-star HSR label, for both males (p < 0.05) and females (p < 0.001). Warning labels reduced young adults' selection of SSBs and promoted substitution to water. The HSR reinforced this effect for the least healthy drinks. Increased water selection may be further enhanced by ensuring that warning label thresholds and HSR algorithms align to present consistent messaging.

Health Star Ratings and Beverage Purchase Intentions: A Study of Australian and New Zealand Hospitality Consumers

This study examines the effects of a health star rating system on the attitudes of consumers and their purchase intentions towards beverage products sold in hospitality venues. Previous studies linking health ratings to the food and beverages of consumers mainly focus on fast-moving consumer goods and retail purchasing. However, purchasing patterns in hospitality and foodservice environments are distinct as consumers may be less concerned about health and more interested in the dining experience. Thus, this research focuses on: (1) whether the presence of health star ratings on beverage products influences the willingness of consumers to purchase in the context of the hospitality industry, and (2) identifying the demographic and psychographic factors influencing these behavioural intentions. Using Ordinary Least Squares regression to analyse data from an e-survey of 1021 consumers in Australia and New Zealand, the study found that health star ratings do have an impact on the willingness of consumers to purchase healthy beverages. Specifically, psychographic segmentation around ‘health goals’ is far more pertinent to understanding purchase behaviour in a hospitality setting than age, gender, income, or country. The findings present new insights into the importance of health star labelling on beverages and the purchase intentions of consumers.

Selling function: the advertising of sugar-containing beverages on Australian television

Reducing population consumption of sugar-containing beverages has become a public health priority in many countries due to causal evidence between high consumption, weight gain and non-communicable diseases. This study aims to explore how sugar-containing beverages are associated with health and wellness in television advertisements. Our sample consisted of all televised advertisements from sugar-containing beverage manufacturers aired on free-to-air television from one Australian network (four channels) in 2016 (n = 30 unique advertisements). We transcribed advertisements for audio and visual information. We analysed data inductively using methods from thematic, discourse and multi-modal analysis. Advertisements for sugar-containing beverages reflected both traditional (physical health and reduced risk of disease) and broader (wellbeing) conceptualizations of health. Beverages were positioned in advertisements as contributing a functional role to promote and enhance health and wellbeing within the physical, mental and social domains. Beverages were advertised as correcting suboptimal states of being to achieve desirable outcomes, including relaxation, increased resistance to disease, enhanced performance, better cognitive functioning and improved social connections. Positioning beverages within a wider conceptualization of health and wellbeing aligns with how health and nutrition are increasingly being understood and sought out by consumers, creating increased opportunities for the marketing of sugar-containing beverages as 'healthy'.

A mixed-methods study of American Millennials' views about celebrity endorsement of foods and beverages

More than one-third of American Millennial adults have obesity, and a significant amount of their household budget is spent on purchasing energy-dense and nutrient-poor food and beverage products. Consumers' brand awareness and purchasing behaviors are influenced by celebrity credibility measured by trustworthiness, expertise and attractiveness; and celebrity 'fit' between products, brands and consumer' self-image. This empirical mixed-methods study combined Q methodology with questionnaires to explore the shared and distinct viewpoints of demographically diverse Millennial adults about celebrity endorsement of food and beverage products or marketing campaigns in the United States (USA). Millennials (n = 40; aged 26-39 years) sorted photo images (n = 48) of US celebrities associated with branded food and beverage product endorsements on a 9-point normal distribution scale from 'most trusted' (+4) to 'most distrusted' (-4). Participants also completed a 4-item post Q-sort questionnaire to interpret their thoughts during the card sorting process, and a 3-item questionnaire to examine their views about celebrity credibility, 'fit' and multiple brand and product endorsements. Three distinct viewpoints were identified that included: (i) healthy lifestyle champions who trusted celebrities associated with healthy products or campaigns; (ii) female role-model admirers who trusted female celebrities associated with positive social impacts and (ii) African-American celebrity fans who trusted African-American celebrities who endorsed any brand or products. Qualitative analysis of the questionnaire identified the potential negative influence of celebrity endorsement for unhealthy products on Millennials' dietary behaviors. Businesses and organizations should carefully select credible celebrities trusted by Millennials to encourage food and beverage products associated with a healthy diet.

"I know it's just pouring it from the tap, but it's not easy": Motivational processes that underlie water drinking

Water drinking behaviour is under-researched despite the prevalence and adverse health consequences of underhydration. We conducted a qualitative exploration into the motivational processes underlying water drinking, informed by a grounded cognition perspective on desire and motivated behaviour. We interviewed and analysed data from 60 participants stratified by age, gender, and education level using thematic analysis, to generate three key themes. "Water as situated habits," suggests that participants form and maintain situated water drinking habits, so that within certain situations they regularly drink water. However, participants who situated their water intake only in one key situation (e.g., work routine), had low and inconsistent intake when they left this situation. Some situations happened so infrequently during the day (e.g., before bed) that participants' daily water intake was low. Many participants reported drinking water in reaction to thirst cues, but these were easily suppressed or ignored, so that water drinking was inconsistent. Participants who saw drinking water as part of their self-identity had consistent and high water intake across a variety of situations. "Knowledge and attitudes," suggests that few participants had knowledge or attitudes that promoted water intake (e.g., perceived water as positive or understood the importance of hydration). "Strategies underlying attempts to increase intake" suggests that many participants lacked insight into strategies to increase water intake, although they spontaneously discussed attempts to drink more. This lead to ineffective attempts at behaviour change. Participants' mentions of dehydration and their responses to a urine colour chart suggested that many participants were possibly underhydrated. Our findings suggest that interventions and practitioners attempting to increase water intake need to increase knowledge about the importance of hydration, and encourage individuals to develop effective situated water drinking habits.

A qualitative study about college students' attitudes, knowledge and perceptions regarding sugar intake

Excessive sugar intake has been associated with multiple health conditions (e.g., higher risk for non-communicable diseases). Hence, health organizations have issued guidelines defining the maximum daily intake of free or added sugars. However, data from several countries suggests that these guidelines are rarely met, particularly by young adults. For example, almost half of Portuguese adolescents and young adults exceed the recommended sugar intake. In this work, we aim to further explore college students' attitudes, knowledge, and perceptions about sugar intake, as well as about sugar intake guidelines. A thematic analysis on data from five focus groups (N = 40) indicated that participants reported difficulty in the comprehension of added/free sugars definition and sugar intake recommendations. Overall, attitudes toward sugar were ambivalent. Sugar was simultaneously perceived as pleasurable and needed, but also as addictive and harmful. Although aware of the potential negative health outcomes associated with excessive sugar intake, most participants did not perceive being at risk due to their youth, exercise habits, or type of diet. The few concerns expressed were mostly associated with the negative impact of high sugar intake on body image (e.g., weight gain). The main barriers to reducing sugar intake identified were environmental (e.g., time restrictions, food available at the university). Still, participants could identify several individual strategies to effectively regulate sugar intake. By identifying knowledge gaps and sources of bias related to sugar consumption, our findings are useful to inform future interventions aiming to address the problem of high sugar intake among university students.

An In-Depth Exploration of Knowledge and Beliefs Associated with Soda and Diet Soda Consumption

The need to reduce sugar-sweetened beverage (SSB) consumption is widely accepted, but whether artificially sweetened beverages (ASBs) are a recommended alternative is a growing policy issue because of emerging evidence of potential health effects associated with excess consumption. This study aimed to establish the extent of the Australian population's knowledge of the risks associated with consuming SSBs (e.g., soda) and ASBs (e.g., diet soda), which is essential for identifying which facets of knowledge to target with public health interventions. A national computer-assisted telephone survey of 3430 Australian adults was conducted in 2017. The survey included a range of measures to test associations between SSB and ASB knowledge and beliefs, demographic characteristics, and soda and diet soda consumption. Participants had an overall awareness that there were health risks associated with SSB and ASB consumption, but they lacked more detailed knowledge of health effects and nutritional composition of these drinks. These knowledge gaps are concerning given that SSBs and ASBs are consumed in large quantities in Australia. Public health interventions targeting consumers' limited knowledge and perceptions of health risks associated with excess sugar, calorie intake and artificial sweeteners are essential in reducing the health burden of obesity.