Consumption of sugar-sweetened beverages and energy drinks and adherence to physical activity and screen time recommendations among adolescents

Criterion-Related Validity of the Sugar-Sweetened Beverage (SSB) Questionnaire Among Children and Adolescents in Malaysia

Sugar-sweetened beverages (SSBs) are a major source of dietary sugar, and their consumption is on the rise among children and adolescents. Excessive sugar intake is a significant contributor to overweight, obesity, and non-communicable diseases (NCDs). The consumption of SSBs, particularly that of children and adolescents, has been of interest as of late, as they are implicated in affecting body weight status. Thus, the goal of this study was to determine the predictive criterion-related validity of the SSB questionnaire that was administered to children and adolescents to assess their SSB and non-SSB intake. A nationwide cross-sectional study involving 5211 respondents aged 7-17 years old and their parents was conducted. The self-administered Malay questionnaire was distributed to collect information on socioeconomic background, the frequency of eating out at restaurants or other food premises, the availability of SSBs at home, and SSB consumption patterns of children and adolescents within a week. The predictive criterion-related validity was determined by using six hypotheses that can differentiate between two independent sample means of SSB consumption based on age, gender, locality, monthly household income, frequency of eating out at restaurants or other food premises, and availability of SSBs at home. The independent samples t-test and one-way ANOVA were used to conduct the validation process. Five out of six hypotheses were accepted. Significant mean differences were observed between sociodemographic factors, such as age (t=-10.56, p<0.001), localities (t=-5.37, p<0.001), monthly household income (F=26.83, p<0.001), and SSB consumption. Behavioural factors, including eating out at restaurants or other food premises (t=9.93, p<0.001) and environmental factors such as the availability of SSBs at home (F=136.24, p<0.001) also showed a significant difference with SSB consumption. The SSB questionnaire demonstrated the ability to differentiate between groups. Thus, this SSB questionnaire appears to be valid to measure the SSB consumption of children and adolescents.

Interaction effect of screen time and sugar-sweetened beverages with depressive symptoms in adolescents: evidence from a large sample-based survey in China

Excessive screen time and the consumption of sugar-sweetened beverages are found to be independent predictors of depressive symptoms. However, the potential interaction effect of screen time and sugar-sweetened beverages, that is, whether one exposure factor strengthens the association of another with depressive symptoms, remains unclear. A large-scale adolescent health surveillance survey was conducted in 27 schools in eight regions across China. A total of 22,868 students were recruited to complete an eligible questionnaire to provide details of their screen time and sugar-sweetened beverage consumption. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Multiplicative and additive interaction models were performed to estimate the interaction effects of screen time and sugar-sweetened beverages on depressive symptoms, and whether the relationship varied by age group was also examined. The multivariate logistic regression model showed that even if the confounding factors were controlled, screen time and sugar-sweetened beverages were still risk factors for depressive symptoms in adolescents. Interaction models indicated that screen time and sugar-sweetened beverages in combination were related to greater odds of depressive symptoms. Compared with late adolescents, early adolescents had a higher probability of depressive symptoms when exposed to the joint effects. Our study may hopefully deepen the understanding of the association between screen time and sugar-sweetened beverages and depressive symptoms. Future research should further explore how and why screen time and sugar-sweetened beverages affect individuals more profoundly in early adolescence than in late adolescence and how to mitigate this.

Sex-Based Differences in Factors Associated With Sugar-Sweetened Beverage Consumption Among Korean High School Students

This study aimed to identify sex-based differences in the individual and environmental factors associated with sugar-sweetened beverage (SSB) consumption among Korean high school students. Secondary data were obtained from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. In this study, we analyzed data from 13,066 high school students (5,874 boys and 7,192 girls) who answered questions regarding SSB consumption and individual and environmental factors. Complex sampling analysis (descriptive statistics and logistic regression analysis) was conducted using the SPSS Statistics 26.0 software. Most adolescents (97% boys and 95.2% girls) reported having consumed SSBs in the last seven days. Individual factors, such as increased stress, sleep dissatisfaction, and fast-food intake (more than thrice a week) were positively associated with SSB consumption among adolescent boys and girls. Environmental factors like high education levels (above college) of mothers were negatively associated with SSB consumption among both boys and girls. Furthermore, current alcohol consumption, smoking, low vegetable intake (less than thrice a week) in boys, and more than 2 h a day of screen-based sedentary behavior in girls were positively associated with SSB consumption. According to the results, individual factors associated with SSB consumption varied according to the sex of adolescents. Thus, sex differences in factors associated with SSB consumption in adolescents should be considered as basic knowledge for developing strategies for reducing SSB consumption.

Risky behaviors, substance use, and other lifestyle correlates of energy drink consumption in children and adolescents: a systematic review

Increasing concerns have been raised on the health-related risks connected with energy drink (ED) consumption in children and adolescents, with high acute or chronic consumers exceeding 10% in either age group in Europe in 2011. Preliminary evidence has suggested a common pattern of ED and substance use, especially alcohol. Additional evidence has been accumulating very fast; in addition, other lifestyle and risky behaviors may contribute to shed light on the complex interplay of factors involved in ED consumption. We have undertaken a comprehensive systematic review of the evidence on psychosocial correlates of ED consumption in 0-18 years subjects, as published up to April 1, 2021, in MEDLINE/PubMed, PsycINFO, and Cochrane Reviews and Central Register of Controlled Trials, which allowed to select 104 original articles. Only ~ 10% of the papers provided results based on longitudinal analyses. A common pattern of ED consumption and polysubstance use, including alcohol, tobacco, and soft and hard drugs, was still confirmed in adolescents; violent and risky behaviors were also related to a higher ED consumption. In addition, frequent ED consumers are more likely to have bad dietary habits, including consumption of sugar-sweetened beverages and junk foods. A generally inconclusive evidence was found for sport/physical activities, although sedentary behaviors were generally related to ED consumption.

CONCLUSIONS

Frequent ED consumption might be a screening indicator to identify students at risk of substance use or other risky/problem behaviors; enquiring about an adolescent's recent ED consumption could create opportunities for early intervention/prevention by informed pediatricians.

WHAT IS KNOWN

• Substances, especially alcohol, are associated with energy drinks in most cross-sectional studies.

WHAT IS NEW

• Violent behaviors are associated with energy drink consumption, in the absence of longitudinal studies; problematic use of internet/videogames deserves further investigation; unhealthy dietary patterns are related to energy drinks; evidence on physical activity is inconclusive, but sedentary behaviors are related to energy drinks.

Association between sociodemographic, dietary, and substance use factors and accelerometer-measured 24-hour movement behaviours in Brazilian adolescents

Sociodemographic factors and lifestyle behaviours were evidenced as correlates of self-reported 24-hour movement behaviours in high-income settings. However, it is unclear how these relations occur in a middle-income country setting, with unique cultural and social characteristics. This study aimed to examine the association between sociodemographic, dietary, and substance use factors with accelerometer-measured 24-hour movement behaviours in Brazilian adolescents. Information on sex, age, socioeconomic status (SES), family structure, dietary behaviours, and history of substance use were collected by a questionnaire. Sleep duration, sedentary behaviour, and light- and moderate-to-vigorous physical activity (LPA and MVPA) were measured using wrist-worn accelerometers. On average, females slept more (β = 21.09, 95%CI 13.18; 28.98), engaged in more LPA (β = 17.60, 95%CI 8.50; 27.13), and engaged in less sedentary behaviour (β = -16.82, 95%CI -30.01; -4.30) and MVPA (β = -4.76, 95%CI -7.48; -1.96) than males. Age and sedentary behaviour were positively associated (β = 8.60, 95%CI 2.53; 14.64). Unprocessed foods were positively related to LPA (β = 2.21, 95%CI 0.55; 3.92), whereas processed foods were positively related to sedentary behaviour (β = 3.73, 95%CI 0.03; 7.38) and inversely related to MVPA (β = -0.89, 95%CI -1.68; -0.10). Family structure, SES, and substance use factors were not significantly associated with any 24-hour movement behaviour.Conclusions: Sex, age, and dietary behaviours, unlike SES or substance use, were associated with 24-hour movement behaviours in this sample of Brazilian adolescents and are important factors to consider in interventions, policies, and practice. What is Known: • The 24-hour movement behaviours are composed of sleep, sedentary behaviour, and physical activity and are important determinants of health. • Most adolescents do not engage in adequate levels of physical activity, sedentary behaviour, and sleep, and there is a need to better understand factors related to these behaviours. What is New: • Sex, age, and dietary behaviours were associated with the 24-hour movement behaviours. • No associations were found between socioeconomic status and substance use with the 24-hour movement behaviours.

Associations between Sociodemographic, Dietary, and Substance Use Factors with Self-Reported 24-Hour Movement Behaviors in a Sample of Brazilian Adolescents

We aimed to identify sociodemographic, dietary, and substance use factors associated with self-reported sleep duration, physical activity (PA), and sedentary behavior (SB) indicators in a sample of Brazilian adolescents. Adolescents (n = 731, 51% female, mean age: 16.4 years) answered a questionnaire. The volume of total PA, sports, non-sports, total SB, leisure-time SB, involuntary SB, sleep duration, dietary behaviors, sociodemographic, and substance use indicators were self-reported. Multilevel linear models were fitted. Females engaged in less total PA, sports, total SB, and leisure-time SB, but in more involuntary SB than males. Age was positively associated with non-sports and involuntary SB. Socioeconomic status was positively associated with total PA. Adolescents who lived with the mother only practiced more sports compared to those living with two parents. Unprocessed food was positively associated with total PA and sports. Processed food was inversely associated with total PA and non-sports, and positively associated with total SB and leisure-time SB. Alcohol use was positively associated with total PA, and tobacco smoking was negatively associated with total PA. No associations were observed for sleep duration. In conclusion, sociodemographic, dietary, and substance use factors are associated with the 24 h movement behaviors among Brazilian adolescents, and some associations are type specific.

Health behavior patterns of sugar-sweetened beverage consumption among Brazilian adolescents in a nationally representative school-based study

Studies on sugar-sweetened beverage consumption patterns can help in the individual and population level management of chronic non-communicable diseases and other conditions. This study aimed to identify the association between health behavior patterns and the consumption of sugar-sweetened beverages among Brazilian adolescents from a nationally representative school-based study. A cross-sectional study analyzed data from 71,553 adolescents aged 12-17 years who attended public and private schools in Brazilian cities, from the Study of Cardiovascular Risk in Adolescents. Principal component analysis was performed to identify health behavior patterns, and ordered logistic regression was performed to identify the association between health behavior patterns and sugar-sweetened beverage consumption. Sugar-sweetened beverage consumption (mL/day) was used as the dependent variable. The analyses were performed using Stata software version 14.0 with a significance level of 0.05. Patterns 2 (alcoholic beverage and smoking habit) and 3 (ultra-processed food and screen time) of health behaviors and regularly purchasing snacks in the school cafeteria increased the odds of sugar-sweetened beverage consumption, while pattern 1 (water, unprocessed and minimally processed food and physical activity) decreased these odds. The adoption of healthy habits can indirectly stimulate the adoption of other habits beneficial to health. These results indicate the importance of adopting a set of regulatory measures to reduce sugar-sweetened beverage consumption.

A systematic review of screen-time literature to inform educational policy and practice during COVID-19

There is an urgent need for consensus around the matter of screen time (ST) during the COVID-19 pandemic. Some governments announced restrictions for online schooling time per day to protect students from perceived risks of prolonged screen-use, but critics and an emerging body of research question such regulations. Our review of 52 empirical studies found (a) an overwhelming majority of literature shows effect sizes too small to be of practical or clinical significance, and (b) findings more specifically on educational ST are inconclusive and critically underrepresented. These facts, along with the undeniable benefits of online learning in the absence of brick-and-mortar schooling and the ominous forecasts of learning loss caused by prolonged school closure, inform our recommendations for a more moderate policy and practical stance on restrictions - one that is focused on responsibly leveraging the educational and social benefits of ST in a world still recovering from the COVID-19 pandemic.

Energy drink consumption, psychological distress, and suicidality among middle and high school students

BACKGROUND

Previous research has found links between energy drink consumption and mental health outcomes in youth. However, little is known about the factors that could moderate these relationships. The present study examined the associations between energy drink consumption and psychological distress, suicidal thoughts, and suicide attempts among adolescents, and tested whether sex and school type (i.e. middle vs. high school) would moderate these associations.

METHODS

Data on students in grades 7 through 12 was obtained from the 2017 Ontario Student Drug Use and Health Survey (N  =  5,538). Multivariable Poisson regression analyses were used to examine associations between energy drink consumption and mental health outcomes. Analyses were weighted and adjusted for the complex survey design.

RESULTS

Energy drink consumption was associated with greater risk of moderate to serious (adjusted incidence rate ratio (IRR) 1.19, 95% confidence interval (CI) 1.03-1.37) and serious (IRR: 1.45, 95% CI: 1.13-1.86) levels of psychological distress, suicidal thoughts (IRR: 1.98, 95% CI: 1.62-2.42), and suicide attempts (IRR: 3.67, 95% CI: 2.26-5.95). The association between energy drink consumption and mental health outcomes was much stronger among boys and middle school students.

LIMITATIONS

The cross-sectional nature of the data precludes causal inferences and there is possibility of bias related to self-reports.

CONCLUSIONS

Energy drink consumption among adolescents is strongly and differentially associated with mental health problems among male and female middle and high school students. Future research is necessary to replicate and disentangle the observed differences in more detail to inform the development of tailored interventions.

Energy Drink Consumption and Substance Use Among Middle and High School Students

This study examined the association between energy drink consumption and substance use among adolescents and tested whether sex and/or grade level (i.e., middle vs. high school) moderate the association. Data were derived from the 2017 Ontario Student Drug Use and Health Survey, a representative survey of students in 7th to 12th grade. Analyses included 10,662 students who self-reported information on energy drink consumption and substance use. Poisson regression models were used with adjustments for important covariates. Energy drink consumption was associated with tobacco cigarette smoking (incidence rate ratio (IRR): 3.74; 95% confidence interval (CI): 3.22-4.35), cannabis use (IRR: 2.90; 95% CI: 2.53-3.32), binge drinking (IRR: 2.46; 95% CI: 2.05-2.96), opioid use (IRR: 2.23; 95% CI: 1.85-2.68), and alcohol use (IRR: 1.31; 95% CI: 1.26-1.36). The associations of energy drink consumption with tobacco cigarette smoking, cannabis use, and alcohol consumption were modified by grade level (two-way interaction terms p < 0.05). The association between energy drink consumption and substance use was generally much stronger among middle school students compared with high school students. The findings suggest that middle school students may be more vulnerable to the negative effects of energy drinks in relation with substance use.

Social media use and parent-child relationship: A cross-sectional study of adolescents

We examined the association between social media use and parent-child relationship quality and tested whether this association is independent of total screen time. Data on 9,732 students (48.4% female) aged 11-20 years were obtained from a provincially representative school-based survey. Heavy use of social media (daily use of more than 2 hr) was associated with greater odds of negative relationships between mother-daughter (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.27-2.52), father-daughter (OR = 1.56; 95% CI: 1.16-2.09), father-son (OR = 2.19; 95% CI: 1.58-3.05) but not mother-son (OR = 1.17; 95% CI: 0.88-1.55). Results were similar after further adjusting for total screen time. There were no significant associations between regular use of social media (2 hr or less) and parent-child relationships. These findings suggest that heavy use of social media is associated with negative parent-child relationships. Longitudinal research is necessary to disentangle the pathways between social media use and the parent-child relationship.

Association of sugar-sweetened beverage intake with risk of metabolic syndrome among children and adolescents in urban China

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.

Electronic device use and beverage related sugar and caffeine intake in US adolescents

Background

Despite recent declines in consumption of sugary beverages, energy drinks (ED) and sodas continue to contribute a substantial amount of sugar and caffeine to the diet of youth. Consumption of these beverages has been linked with electronic device use, however in-depth associations between sugar and caffeine intake from energy drinks and sodas with various electronic devices are not clear.

Objective

Describe the relationship of soda and energy drink consumption and associated added sugar and caffeine intake with electronic device use among adolescents.

Methods

Secondary data from the 2013–2016 cycles of Monitoring the Future Survey, a national, repeated, cross-sectional study, were analyzed. Information on energy drink and soda consumption by students in grades 8 and 10 (n = 32,418) from 252–263 schools randomly sampled from all US states was used.

Results

Soda and energy drink consumption decreased each year from 2013–2016 while daily use of electronic devices remained stable. An additional hour/day of TV was linked to a 6.92g (6.31,7.48; p<0.001) increase in sugar intake and a 32% (OR = 1.32; 1.29,1.35; p < .001) higher risk of exceeding World Health Organization (WHO) recommended sugar intakes. Further, each hour/day of TV was linked to a 28% increased risk of exceeding caffeine recommendations (OR = 1.25–1.31; p<0.001). Each hour per day talking on a cellphone was associated with an increased risk of exceeding WHO sugar and caffeine intakes by 14% (OR = 1.11–1.16; p<0.001) and 18% (OR = 1.15–1.21; p<0.001) respectively. Video game use was only weakly linked to caffeine intake. Computer use for school was associated with lower likelihood of exceeding sugar intake cut-offs.

Conclusion

While a trend towards reduced energy drink and soda intake from 2013–2016 was evident, greater electronic device use, especially TV time, was linked to higher intake of beverage-derived added sugar and caffeine amongst adolescents. Addressing these behaviours through counselling or health promotion could potentially help to reduce excess sugar and caffeine intake from sodas and energy drinks among this population.