Sugar-Sweetened Beverage Consumption, Perceptions, and Disparities in Children and Adolescents

Children's perspectives on sugary snacks through elicitation techniques - repertory grid and generative method

Background

Sugary snacks are prevalent in children's daily lives and may impact their diet positively or negatively, yet few studies explore children's perceptions and attitudes of these foods from their daily experiences in China.

Aims

This study aims to (i) assess children's perceptions and attitudes of sugary snacks and (ii) compare two child-centered elicitation techniques-Repertory Grid Technique (RGT) and Generative Method (GM)-based on Personal Construct Theory (PCT).

Methods

A qualitative study was conducted with 31 children (6-10 years old) in Hangzhou and Fuzhou, China. Children participated in RGT (dichotomous comparisons using product cards) and GM (creative expression through drawing/clay) in one-on-one sections. The output of the task was analyzed for thematic analysis and descriptive statistics.

Results

Themes identified included sensory, packaging, interaction, emotion, cognition, and socio-culture. Children expressed concern about food composition and showed limited understanding of sugar's functions and cultural significance. The RGT elicited more product attributes (358 vs. 190 in GM), with a significant difference (p < 0.001). RGT generated a balanced mix of concrete and abstract attributes, while GM elicited more abstract attributes.

Conclusion

The findings highlight that children can be educated about the formulation and cultural aspects of sugary snacks. Encouraging richer "in-mouth" and "in-body" interactive education could be beneficial. Adopting a child-centered approach fosters engaging conversations. RGT efficiently inspires children to generate both concrete and abstract product attributes and is easy to understand but less enjoyable. On the other hand, GM tends to generate more abstract and novel ideas that strongly reflect children's preferences. However, it requires more time and cognitive effort to understand, though it maintains a higher level of enjoyment and engagement. Understanding these findings aids in developing nutrition education that captivates and engages children. Insights into elicitation techniques can guide researchers seeking to understand children's perspectives effectively.

Prevalence and Associated Factors with Sugar-sweetened Beverages Consumption among Kurdish High-school Children

Adolescents' excessive consumption of sugar-sweetened beverages (SSBs) has become a global concern due to its detrimental effects on health. We explored the prevalence and associated factors of the consumption of SSB in high-school children in the Kurdistan Region. In this study, we included 560 students randomly from the 152 available high schools in Duhok City in the Kurdistan Region. Both genders of high school children who registered for the academic years 2021-2022 in 32 high schools were eligible. The study found that a considerable number of students did not eat breakfast (32.68%). Mostly, the students had lunch (83.21%) and dinner (53.57%), with 53.57% having extra eating portions. A significant percentage of the students consumed junk food (fast food) more than three times per week (39.82%) and consumed SSB 1-3 times/day (61.07%) at varying frequencies. The study found that 14.64% and 12.86% were overweight and obese, respectively. The prevalence of SSB consumption 4-5 times/week was 47.68% (soda), 21.61% (tea), 34.64% (coffee), 22.50% (energy drink), and 36.25% (juice). A similar prevalence of SSB consumption was found among parents (23.39%) and friends/classmates (20.36%). The male students were more likely to consume tea (P = 0.0104). However, female students were more likely to consume juice and energy drinks (P = 0.004 and P < 0.0001, respectively). Students with lower levels of education were also more likely to consume SSB. The intake of SSB was high among high school children in the Kurdistan Region and was related to gender and parents' consumption.

Social epidemiology of early adolescent nutrition

BACKGROUND

This study aimed to investigate associations between sociodemographic factors and dietary intake among a diverse population of early adolescents ages 10-13 years in the United States.

METHODS

We examined data from the Adolescent Brain Cognitive Development (ABCD) Study in Year 2 (2018-2020, ages 10-13 years, N = 10,280). Multivariable linear regression models were conducted to estimate the adjusted associations between sociodemographic factors (age, sex, race and ethnicity, household income, parental education) and dietary intake of various food groups, measured by the Block Kids Food Screener.

RESULTS

Older age among early adolescents was associated with slightly less fruit, whole grain, and dairy and more monounsaturated fat consumption. Male sex was associated with a lower intake of fruit, fruit juice, vegetables, whole grains, and fiber and a higher intake of meat/poultry/fish, added sugars, fat, as well as higher glycemic index and glycemic load compared to female sex. Racial and ethnic minority status, lower household income, and lower parental education were generally associated with less fruit and vegetable consumption and more added sugars.

CONCLUSION

These findings can guide public health interventions to reduce diet quality disparities by targeting key populations and addressing differences according to socioeconomic status, sex, and race.

IMPACT

Sociodemographic disparities in diet quality have been studied, but none have explored sociodemographic associations with specific food groups and components (e.g., different types of fat) in early adolescence. In this demographically diverse sample of 10-13-year-old early adolescents in the US, we found sociodemographic disparities in dietary intake across various food groups. Most notably, male sex, racial and ethnic minority status, lower household income, and lower parental education were associated with less fruit and vegetable consumption and more added sugars.

Effect of a Nutritional Education Intervention on the Reduction of Added Sugar Consumption in Schoolchildren in Southeastern Mexico: Community Study

Consumption of added sugars negatively affects schoolchildren's health, making it essential to promote strategies designed to reduce their intake through educational interventions. This study aimed to evaluate the effect of a nutritional education intervention, INCAI, on the consumption of added sugars among schoolchildren in southeastern Mexico. A 9-month educational intervention was designed to promote healthy eating, physical activity, and the development of socio-emotional skills among primary school children. Information on the usual intake of foods and beverages was collected from 400 schoolchildren at the beginning and end of the intervention using a semiquantitative food frequency questionnaire. For the analysis, a generalized estimating equation (GEE) model was constructed using the Poisson distribution family to estimate the effect of the intervention. The relative incidence in the final stage showed a slight increase of 4% (p = 0.093) in the percentage of added sugars compared with the baseline levels in the control group. By contrast, the intervention effect, represented by the interaction between treatment and time, showed a 10% reduction in the final stage in the intervention group (p < 0.001). Based on these findings, the INCAI educational intervention effectively reduced added sugar consumption by 10% in the intervention group, while no significant reduction was observed in the control group. These results suggest that nutritional education programs can be a useful strategy for lowering added sugar intake among schoolchildren, highlighting the importance of incorporating such interventions into public health policies targeting child populations.

Understanding Factors that Influence Parents' Provision of Beverages to Their Children: A Qualitative Evidence Synthesis

OBJECTIVE

Understand parental perceptions of beverages and factors influencing the beverage choices they make for their children.

DATA SOURCE

A literature search was conducted using PubMed, Scopus, and CINAHL.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included studies contained qualitative data examining parents' perceptions of beverages or factors that influence their child's beverage consumption, were conducted in the United States between 2000 and 2022, written in English, and enrolled parents of children aged 18 years or younger.

DATA EXTRACTION

Authors, titles, study aims, methods, qualitative results, and representative quotations were extracted using Covidence.

DATA SYNTHESIS

Qualitative findings were independently coded by two coders. Codes were compared and discrepancies resolved through discussion with a third team member. Themes and sub-themes were identified, and representative quotations selected.

RESULTS

13 studies met inclusion criteria. Five major themes emerged: 1) factors that influence parents' provision of beverages to their children, 2) parents' concerns about sugar-sweetened beverages (SSBs), 3) barriers to limiting children's SSB consumption, 4) strategies to lower children's SSB consumption, and 5) parents' perceptions of beverage healthfulness.

CONCLUSION

Though most parents are aware of unfavorable health effects of frequent SSB intake, environmental and sociocultural factors pose barriers to limiting their child's SSB consumption. Changes to policy and the food environment are needed to initiate and sustain reductions in SSB intake, along with continued nutrition education efforts.

Clusters of diet, physical activity, screen-time and sleep among adolescents and associations with 3-year change in indicators of adiposity

BACKGROUND

Clusters of health behaviours could impact changes in adiposity among adolescents over time. This study examines the clustering of screen time, physical activity, dietary behaviours and sleep, and the associations with 3-year changes in indicators of adiposity.

METHODS

Data from the UK's Millennium Cohort Study were utilised when participants were aged 14 and 17 years respectively. At age 14, demographics, screen time, dietary behaviours and sleep duration were measured via self-report, and physical activity using wrist worn accelerometers. Height, weight, and percent body fat were measured at age 14 and 17 years. Behavioural clusters were determined using k-means clustering analysis, and associations with change in indicators of adiposity between age 14 and 17 years were examined using multivariate regression models.

RESULTS

Three clusters were identified at age 14, a 'healthy cluster', a 'mixed cluster', and an 'unhealthy cluster' in the analytical sample of 3,065 participants (52.5% girls). The 'unhealthy' cluster was the most prevalent cluster among boys (53%), while the 'healthy cluster' was most prevalent among girls (55.9%). Adolescents in healthy clusters had a lower BMI z-score and percent body fat at age 14 compared to those in the unhealthy and mixed clusters, and maintained lower scores at age 17. Boys in the mixed and unhealthy clusters at 14 years had a lower change in BMI z-score between 14 and 17 compared to boys in the healthy cluster.

CONCLUSION

Adolescents in the healthy cluster had lower BMI z-scores and percent body fat at age 14 years than those in the unhealthy cluster, and they maintained this lower level at age 17. Given the upward trend in BMI during this period, this maintenance could be interpreted as a positive outcome. Further prospective research is needed to better understand these associations as well as research examining the stability of cluster membership over time.

Associations Between Perceived Parental and Michigan Middle-School Students' Lifestyle Characteristics

BACKGROUND

Parents play a critical role in their children's health. We explored the association of children's perception of their parents' health behaviors and education level with the health behaviors of middle-school students participating in a school-based wellness program.

METHODS

Students completed a baseline survey on their dietary, physical activity, and sedentary behaviors, and their parents' health behaviors and education. Descriptive statistics and generalized linear regression with random intercept analyzed which child-reported parent behaviors, parent education levels, and demographic factors were associated with healthy child behaviors.

RESULTS

Among 4607 students, for all behaviors assessed, children who perceived their parent exhibiting a healthy behavior were more likely to display the same healthy behavior. Healthier diet, more physical activity, and less sedentary habits were reported by students who reported their parents had college or higher education, compared to students who reported their parents had some college or less education.

CONCLUSIONS

These results encourage increased parental involvement in childhood wellness programs. Additionally, these data suggest interventions which target parents with lower educational attainment may also benefit their children's health behaviors. As we continue to understand how adolescent behavior is shaped, we can increase the effectiveness of targeted health education for parents and children.

Association of Sodium and Sugar-Sweetened Beverage Intake With Cardiovascular Disease Risk Factors in Adolescents and Young Adults With Obesity

Cardiovascular disease (CVD) risk factors in children have increased in prevalence. Dietary intake may modify risk. Data collected during a randomized trial testing the effect of a behavioral intervention on adiposity, blood pressure (BP), and left ventricular mass index (LVMI) were analyzed using multivariable regression to determine independent associations of sodium, sugar-sweetened beverage (SSB), and artificially sweetened beverage (ASB) intake with outcomes. High sodium intake (≥3.5 g) was associated with hypertensive BP (odds ratio 12.8; P = .027) in minimally adjusted models. High SSB intake (≥4 oz) was independently associated with body mass index z-score (β = .34; P = .035) and waist circumference z-score (β = .49; P = .022) in fully adjusted models. Any ASB intake was associated with LVMI in fully adjusted model (% change 38.22; P = .004). There was no effect modification between sodium and SSB on outcomes. Dietary factors explored in this study independently impacted CVD risk. Further effect measure modification should be explored in larger cohorts.

Social desirability bias is related to children's energy intake in a laboratory test meal paradigm

Dietary intake is notoriously difficult to measure in children. Laboratory test meals address some of the methodological concerns of self-report methods, but may also be susceptible to social desirability bias, referring to the tendency for individuals to adjust their behaviors in order to be perceived more positively. The aim of the current study was to evaluate whether social desirability bias was associated with children's energy intake during a laboratory test meal, and whether this association varied by food type (total caloric intake, snack food intake, fruit/vegetable intake) and sex. A total of 82 children (M age = 9.45 ± 0.85; 50 % girls; 84.1 % rural; 85.4 % White) completed several surveys, including the Children's Social Desirability Scale and had their body composition measured. At lunchtime, they were granted access to a multi-array test meal (>5000 kcal). After adjusting for lean mass, fat mass, depressive symptoms, and parental food restriction, children who reported higher social desirability bias consumed fewer calories from snack foods (B = -11.58, p = .009, semi-partial correlation = -0.28). Boys with higher social desirability bias consumed less calories from fruits and vegetables (B = -6.47, p = .010, semi-partial correlation = -0.411); this association was not significant in girls. The desire to be perceived in a positive manner may influence children's eating behaviors in experimental paradigms. Replication studies with larger, more diverse pediatric samples are needed, as are strategies to reduce the effects of social desirability bias on test meal intake in order to enhance the validity of this dietary assessment approach.

A Content Analysis of Online Messages about Sugar-Sweetened Beverages

Media campaigns can reduce or promote the consumption of sugar-sweetened beverages (SSBs). Brief, US-based English-language online messages were gathered from searchable media platforms, a process that yielded 112 anti-SSB videos and 29 pro-SSB commercials. Using a combination of inductive and deductive methods, a content analysis of those messages was conducted to identify their properties. They were coded for the direction (pro vs. anti), target of the advocacy (e.g., consumption vs. policy), actor demographics (gender, age, and ethnicity), persuasive theme (e.g., excessive sugar, nurturing), and message sensation value. Anti-SSB appeals primarily targeted individual-level consumption behavior. They utilized six persuasive themes and often included more than one theme in a single message. Pro-SSB messages used feel-good themes and utilized only one theme per message. The proportions of adults, adolescents, and children differed by the direction of the advocacy. Black, Hispanic, and Asian actors were under-represented in the anti-SSB sample relative to Whites. Pro-SSB appeals were slightly higher than anti-SSB appeals in message sensation value (p = 0.09). The findings illuminate the message features that characterize the universe of brief anti-SSB appeals available online, highlight messaging disparities, and reveal the absence of certain common, effective persuasive themes.

Advertising and Stocking at Small Retailers: A Sweetened Beverage Excise Tax in Philadelphia

INTRODUCTION

In 2017, Philadelphia enacted a $0.015 per ounce excise tax on SBs that covered both sugar-sweetened beverages and artificially-sweetened beverages, which reduced purchasing and consumption. This study assessed whether the tax also changed beverage advertising or stocking practices that could influence consumer behavior among stores in Philadelphia, Baltimore, and Philadelphia-adjacent counties not subject to the tax.

METHODS

Using a longitudinal difference-in-differences approach, beverage advertising and availability changes were evaluated from 4-month pretax to 6-, 12-, and 24-month post-implementation in small independent stores in Philadelphia (n=34) and Philadelphia-adjacent counties (n=38) versus Baltimore (n=43), a demographically similar city without a tax. Mixed effects models tested whether beverage advertising/availability increased in Philadelphia and surrounding counties after implementation versus Baltimore, included store-level random intercepts, and were stratified by beverage tax status, type, size, and store ZIP code income. Data were collected from 2016 to 2018, and analyses were performed in 2022-2023.

RESULTS

SB advertising increased post-tax in Philadelphia (6 months= +1.04 advertisements/store [95% CI=0.27, 1.80]; 12 months= +1.54 [95% CI=0.57, 2.52]; 24 months= +0.91 [95% CI=0.09, 1.72]) relative to Baltimore. This was driven by increased advertising of sweetened beverages in low-income ZIP codes. Marketing of SBs increased significantly in Philadelphia-adjacent counties relative to Baltimore. Although SB availability in Philadelphia did not change, it increased in surrounding county stores (6 months= +0.20 [95% CI=0.15, 0.25]; 12 months= +0.08 [95% CI=0.03, 0.12]) relative to Baltimore.

CONCLUSIONS

Marketing of SBs, especially in low-income neighborhoods and in surrounding counties, increased following Philadelphia's beverage tax among small, independent retailers. These increases in advertising might have dampened the tax's effect on purchasing behaviors, although estimated effects on sales remained large.

Pro- and Anti-Tax Framing in News Articles About California Sugar-Sweetened Beverage Tax Campaigns from 2014-2018

Sugar-sweetened beverages (SSB) contribute to illness, especially among marginalized communities and children targeted by the beverage industry. SSB taxes can reduce consumption, illness burden, and health inequities, while generating revenue for health programs, and as one way to hold the industry responsible for their harmful products and marketing malpractices. Supporters and opponents have debated SSB tax proposals in news coverage - a key source of information that helps to shape public policy debates. To learn how four successful California-based SSB tax campaigns were covered in the news, we conducted a content analysis, comparing how SSB taxes were portrayed. We found that pro-tax arguments frequently reported data to expose the beverage industry's outsized campaign spending and emphasize the health harms of SSBs, often from health professionals. However, pro-tax arguments rarely described the benefits of SSB taxes, or how they can act as a tool for industry accountability. By contrast, anti-tax arguments overtly appealed to values and promoted misinformation, often from representatives from industry-funded front groups. As experts recommend additional SSB tax proposals, and as the industry mounts legislative counter-tactics to prevent them, advocates should consider harnessing community representatives as messengers and values-based messages to highlight the benefits of SSB taxes.

Obesity, Insulin Resistance, Caries, and Periodontitis: Syndemic Framework

(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, São Luís, Brazil, in ages 18-19 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth ≥ 4 mm, clinical attachment level ≥ 3 mm, and visible plaque index ≥ 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p < 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p < 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.

A Content Analysis of Persuasive Appeals Used in Media Campaigns to Encourage and Discourage Sugary Beverages and Water in the United States

The frequent consumption of sugary beverages is associated with many health risks. This study examined how persuasive appeals and graphics were used in different media campaigns to encourage and discourage sugary beverages and water in the United States (U.S.) The investigators developed a codebook, protocol and systematic process to conduct a qualitative content analysis for 280 media campaigns organized into a typology with six categories. SPSS version 28.0 was used to analyze rational and emotional appeals (i.e., positive, negative, coactive) for campaign slogans, taglines and graphic images (i.e., symbols, colors, audiences) for 60 unique campaigns across the typology. Results showed that positive emotional appeals were used more to promote sugary beverages in corporate advertising and marketing (64.7%) and social responsibility campaigns (68.8%), and less to encourage water in social marketing campaigns (30%). In contrast, public awareness campaigns used negative emotional appeals (48.1%), and advocacy campaigns combined rational (30%) and emotional positive (50%) and negative appeals (30%). Public policy campaigns used rational (82.6%) and positive emotional appeals (73.9%) to motivate support or opposition for sugary beverage tax legislation. Chi-square analyses assessed the relationships between the U.S. media campaign typology categories and graphic elements that revealed three variables with significant associations between the campaign typology and race/ethnicity (χ²(103) = 32.445, p = 0.039), content (χ²(103) = 70.760, p < 0.001) and product image (χ²(103) = 11.930, p = 0.036). Future research should examine how positive persuasive appeals in text and graphics can promote water to reduce sugary beverage health risks.

Reducing Unhealthy Normative Behavior: The Case of Sports and Energy Drinks

American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their "healthiness" and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents' avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.

Association between sugar-sweetened beverage consumption frequency and muscle strength: results from a sample of Chinese adolescents

BACKGROUND

Although sugar-sweetened beverage consumption has become an important and widespread concern, there are few studies on the association between sugar-sweetened beverage consumption frequency and muscle strength in Chinese adolescents. The objective of this study was to analyze the association between sugar-sweetened beverage consumption frequency and muscle strength in Chinese adolescents.

METHODS

A stratified whole-group sampling method was used to survey 25,893 adolescents aged 13-15 years old in China for sugar-sweetened beverage consumption frequency and muscle strength for grip strength and standing long jump. The subjects' basic information, body mass index (BMI), and covariates were investigated. The association between sugar-sweetened beverage consumption frequency and muscle strength was analyzed by multivariate logisitc regression analysis.

RESULTS

The proportions of Chinese adolescents who consumed sugar-sweetened beverage ≥ 3 times/week, 1-2 times/week, and < 1 time/week were 12.23%, 52.79%, and 34.98%, respectively. The differences in sugar-sweetened beverage consumption frequency were statistically significant when compared across gender, parental education, duration of physical activity, snacks, and mode of commuting to school (χ² values = 228.570, 51.422, 275.552, 3165.656, 10.988, P < 0.01). Logistic regression analysis showed that overall Chinese adolescents with sugary drinks 1-2 times/week (OR = 1.207, 95% CI:1.132-1.287) and sugary drinks ≥ 3 times/week (OR = 1.771, 95% CI:1.611-1.947) were associated with lower muscle strength compared to sugary drinks < 1 time/week showed a positive association (P < 0.01). The same trend was found for boys and girls.

CONCLUSION

Chinese adolescents' sugar-sweetened beverage consumption is common, and high-frequency sugar-sweetened beverage consumption is associated with lower muscle strength. In the future, we should control the use of sugar-sweetened beverages and increase muscular strength training in Chinese adolescents to promote healthy growth.

Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review

Sugar-sweetened beverages (SSBs) are major contributors of free sugars to the diet. A strong relationship between SSB intake and weight gain is described.

METHODS

we performed a narrative review to present an overview of the role of SSBs as a pivotal contributor in the development of obesity and metabolism-related complications.

RESULTS

different factors influence SSB consumption in children, including economic variables, individual attributes and behaviors to environmental factors, parent features and parents' behaviors. Data suggest that SSB intake has a negative effect on weight and obesity-related diseases. The leading mechanism linking SSB intake to the risk of gaining weight is decreased satiety and incomplete compensatory reduction in energy intake at meals following ingestion of liquid calories. Additionally, the effects of SSBs on gut microbiota and on eating behaviors were also reported. An association between SSB intake, weight gain and cardiometabolic risks is evident. Consumption of SSBs had a significant impact on the prevalence of obesity and related metabolic risks, including insulin resistance, type 2 diabetes, hypertension and metabolic syndrome.

CONCLUSIONS

Limiting consumption of SSBs and increasing knowledge of the effect of SSBs on early metabolic and cardiovascular disorders will be useful in developing strategies to counteract the problem and to prevent obesity and related complications.Key future research areas for which further studies are needed include investigating the long-term effects of SSBs on health outcomes as well as analyzing the health effects of sugar consumed in solid compared to liquid forms and further elucidating the biological mechanisms of sugar addiction and energy compensation.

Self-efficacy and Social Settings Matter for Fostering Healthy Eating in Mexican Schoolchildren

OBJECTIVE

To identify differences in schoolchildren's self-efficacy for eating behaviors across social settings and self-efficacy sources favoring healthy and unhealthy eating.

DESIGN

A cross-sectional, mixed-methods study using self-efficacy and demographic surveys, focus groups, and school environment semistructured observations.

SETTING

Morelos, Mexico, Cuernavaca City school district, public elementary schools in the National School Lunch Program.

PARTICIPANTS AND RECRUITMENT

We studied 274 fifth- and sixth-grade children from 8 elementary schools during the 2016-2017 school year.

VARIABLES MEASURED

Children's self-efficacy for healthy and unhealthy eating across 3 settings (school cafeteria, recess, and home). Children's perceptions about sources of self-efficacy, which favor their healthy or unhealthy eating (performance accomplishments, behavior modeling, verbal persuasion, and emotional or physiological states). Sociodemographic information was obtained from parents.

ANALYSIS

We performed a variance components analysis with school and students within schools as random effects with paired t tests (quantitative data) and content analysis on the basis of the Social Cognitive Theory (qualitative data).

RESULTS

Schoolchildren's self-efficacy for healthy eating differed across social settings, being greater in the school cafeteria than at recess or home, except for drinking water. On average, self-efficacy for unhealthy eating was lower in the cafeteria than in other studied settings. Performance achievements and behavior modeling were key sources of self-efficacy for healthy and unhealthy eating.

CONCLUSION AND IMPLICATIONS

Sources of self-efficacy and social settings matter to understanding schoolchildren's healthy and unhealthy eating. Future interventions might consider developing collective efficacy among the school community and boosting children's participation in home meal planning. Further research could explore locus of control and other intrapersonal dimensions influencing self-efficacy.

Association of sugar-sweetened beverage consumption with psychological symptoms among Chinese university students during the COVID-19 pandemic

BACKGROUND

Mental health of college students has become a public health issue of common concern worldwide. Especially during the COVID-19 pandemic, the problem has become even more acute. The aim of this study was to assess the association between sugar-sweetened beverages (SSB) consumption and psychological symptoms among Chinese college students in order to promote their mental health.

METHODS

The study population was 6,120 college students aged 19-22 years from Anhui, Henan and Xinjiang, China. Basic demographic information, covariates and SSB Consumption data were collected through a self-assessment questionnaire. The "Multidimensional Sub-health Questionnaire of Adolescents" was used to assess the psychological symptoms of college students. The Chi-square test, one-way ANOVA and logistic regression analysis were used to investigate the differences and associations between SSB consumption and psychological symptoms among Chinese college students.

RESULTS

The detection rate of psychological symptoms among Chinese college students was 8.1%. The detection rate of boys students was 9.4% and that of girls students was 7.1%, and the difference was statistically significant in comparison (χ 2-value was 11.08, p < 0.001). After controlling for covariates, Model 2 analysis showed that compared to SSB consumption <2 time/week, college students with SSB consumption ≥2 time/week (OR = 2.96, 95% CI: 2.36, 3.70) had a higher risk of psychological symptoms (p < 0.001). The same trend was found for emotional symptoms, behavioral symptoms, and social adaptation difficulties dimensions.

CONCLUSION

There is an association between SSB consumption and the occurrence of psychological symptoms among Chinese college students. Future measures should be taken to reduce both SSB consumption and the incidence of psychological symptoms.

Excessive Gaming and Online Energy-Drink Marketing Exposure Associated with Energy-Drink Consumption among Adolescents

In this study, we examined excessive online gaming by adolescents and the resultant effects of their exposure to the online marketing of energy drinks and alcohol, and whether marketing literacy could serve as a mitigating factor. This cross-sectional study was conducted in 2020. Data were obtained from a sample of 2613 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted. The results showed that nearly 18% of the adolescent respondents had used energy drinks, while 75% reported seeing energy-drink advertisements on the internet in the past year. Multiple regression results indicated that factors such as being male, reporting excessive gaming, being exposed to higher levels of online energy-drink marketing, and reporting alcohol use were positively associated with energy-drink consumption. A higher level of online energy-drink marketing-affective literacy, however, was negatively associated with energy-drink consumption. In conclusion, factors that predicted energy-drink consumption among adolescents included excessive gaming and exposure to online energy-drink marketing, but marketing-affective literacy tended to lessen the impact of such advertising.

Association Between Sugar-Sweetened Beverage Consumption and Executive Function Among Chinese Tibetan Adolescents at High Altitude

Objective

To estimate the association between sugar-sweetened beverage (SSB) consumption and executive function (EF) among Chinese Tibetan adolescents.

Method

Using three stages by stratified cluster sampling, 1,427 Chinese Tibetan adolescents were recruited from Tibet, China. SSB consumption status was obtained by questionnaires and the three core EFs (inhibition, working memory, and cognitive flexibility) were tested by a modified Eriksen flanker task, N-back shift, and a more-odd shifting task. One-way ANOVA or Chi-square test was used to compare SSB consumption in different categories. Taking the SSB consumption 0 time/week group as the reference, general linear regression (for continuous variable) or Logical regression (classified variable) in three Models was conducted to analyze the relationship between SSB consumption and EF for Chinese Tibetan children and adolescents.

Result

After adjustment of all the covariant in Model 2, all the EF indexes were higher in Chinese Tibetan adolescents with SSB consumption ≥2 times/week than that with SSB consumption of 0 times/week by 21.33 ms (95%CI: 6.72, 35.93), 8.21 ms (95%CI: 7.06, 9.35), 90.46 ms (95%CI: 28.69, 152.23), 147.61 ms (95%CI: 81.42, 213.80), 116.18 ms (95%CI: 74.48, 157.87), 112.41 ms (95%CI: 71.30, 153.52) for incongruent RT, RT difference in incongruent and congruent, 1-back RT, 2-back RT, Heterogeneous RT, RT difference in Heterogeneous and Homogeneous respectively.

Conclusions

The results suggested that SSB consumption was associated with poorer EF in Chinese Tibetan adolescents. SSB consumption should be controlled for healthy brain development of Chinese Tibetan adolescents.

Toward a Recipe for Deep versus Surface Level Tailoring: Mixed-Methods Validation of Message Features to Reduce Sugary Beverage Consumption

Targeted marketing contributes to the overconsumption of sugary beverages, which contributes to obesity and diabetes disparities among African American and Latino populations in the U.S. Health communicators can similarly use culturally tailored messages to decrease sugary beverage consumption among these groups, yet the specific strategies to operationalize cultural tailoring-the message components essential for such tailoring-are ill-described. We sought to identify and validate authentically created, culturally tailored messages using a multiple step mixed-methods approach. First, we used a snowball approach to identify nutrition education messages targeting ethnic minorities about reducing sugary beverage consumption (N = 85). Via content analysis, we assessed message features (character gender and race/ethnicity), level of change of the appeal (individual or social), and level of cultural tailoring (surface level tailoring in the form of matching character gender and race/ethnicity with target audience versus deep structural tailoring in the form of appealing to values is an effective message strategy). The highest-rated videos were then validated by a sample of the target audience using a quantitative survey and qualitative comments (N = 76). The results inform theorizing on message tailoring and provide a validated pool of culturally relevant messages intended both to reduce intentions to consume sugary beverages and to engage in social change actions.

The Potential for Healthy Checkout Policies to Advance Nutrition Equity

BACKGROUND

As the only place in a store where all customers must pass through and wait, the checkout lane may be particularly influential over consumer purchases. Because most foods and beverages sold at checkout are unhealthy (e.g., candy, sweets, sugar-sweetened beverages, and salty snacks), policymakers and advocates have expressed growing interest in healthy checkout policies. To understand the extent to which such policies could improve nutrition equity, we assessed the prevalence and sociodemographic correlates of purchasing items found at (i.e., from) checkout.

METHODS

We assessed self-reported checkout purchasing and sociodemographic characteristics in a national convenience sample of adults (n = 10,348) completing an online survey in 2021.

RESULTS

Over one third (36%) of participants reported purchasing foods or drinks from checkout during their last grocery shopping trip. Purchasing items from checkout was more common among men; adults < 55 years of age; low-income consumers; Hispanic, non-Hispanic American Indian or Alaska Native, and non-Hispanic Black consumers; those with a graduate or professional degree; parents; and consumers diagnosed with type 2 diabetes or pre-diabetes (p-values < 0.05).

CONCLUSIONS

Purchasing foods or beverages from store checkouts is common and more prevalent among low-income and Hispanic, American Indian or Alaska Native, and Black consumers. These results suggest that healthy checkout policies have the potential to improve nutrition equity.