Misperceptions about added sugar, non-nutritive sweeteners and juice in popular children's drinks: Experimental and cross-sectional study with U.S. parents of young children (1-5 years)

Visual communication design: a neglected factor in nutrition promotion via packaged food labels

Packaging design is a communication device and a critical component in branding strategy, and has relevance for food policy. Presently, packaging-related nutrition policy initiatives focus on the role of regulated claims, nutrition information panels and front-of-pack nutrition labels to help guide consumer food choices and address high prevalences of discretionary and ultra-processed food consumption in many countries. However, these nutrition labelling systems are not optimized as public health policy tools as many consumers do not use them to inform their food choices. Visual communication design theory posits that a designer orders the elements and principles of design into hierarchies that prioritize certain elements over others, and that some of these elements are more dominant and given more emphasis than others. The overall design of the package thereby directs consumer attention to some aspects of pack design (e.g., characters, contents of the package) and away from others (e.g., nutrition details). Dual processing frameworks propose that food decisions are made with the interplay between automatic and rational thinking processes. Packaging designs affect whether consumers rely predominantly on automatic or rational thinking to select a food. This narrative review outlines the role of food packaging design and how it impacts the clear communication of nutrition aspects of food products and how the use of nutrition information by consumers to make decisions may depend upon design structures in packaging. This article attests that nutrition scientists and policy makers should incorporate visual communication design into research on the food packaging as a public health promotion tool. A stronger focus on the communication of regulated front-of-pack nutrition information can be made with a re-evaluation of the hierarchy of elements in the front-of-pack design enabling consumers to make healthier decisions.

Effects of a front-of-package disclosure on accuracy in assessing children's drink ingredients: two randomised controlled experiments with US caregivers of young children

OBJECTIVE

Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children's drinks.

DESIGN

In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children's drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children's drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored.

SETTING

Online survey.

PARTICIPANTS

Six hundred and forty-eight US caregivers of young children (1-5 years).

RESULTS

FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research.

CONCLUSIONS

FOP disclosures on children's drink packages can increase caregivers' understanding of product ingredients and aid in selecting healthier children's drinks.

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.

Retailer Marketing Strategies and Customer Purchasing of Sweetened Beverages in Convenience Stores

BACKGROUND

Marketing strategies for sweetened beverages (SBs) are pervasive across food retail. Yet few studies have examined how these strategies associate with planned and unplanned SB purchasing.

OBJECTIVE

This study aimed to examine whether customers with greater exposure to SB retail marketing (eg, advertisements and product placement) were more likely to purchase an SB and whether this varied by customer characteristics.

DESIGN

This was an observational, cross-sectional study using objective customer purchasing and store assessment data from convenience and other small food stores.

PARTICIPANTS/SETTING

Participants were 1,604 food and beverage customers at 144 randomly sampled convenience and other small food stores in Minneapolis-St Paul, MN.

EXPOSURE

Marketing strategies, including SB advertisements, placement, and shelf space were included.

MAIN OUTCOME MEASURES

We determined the probability of customers purchasing ≥4 fluid ounces of a ready-to-drink sugar and/or artificially sweetened beverage.

STATISTICAL ANALYSES PERFORMED

Associations between marketing strategies and purchasing were estimated using mixed regression models, controlling for customer characteristics and accounting for customers nested within stores.

RESULTS

Fifty-six percent of customers purchased an SB; 14% also specified that it was an unplanned purchase. Customers were more likely to purchase an SB when exterior advertisements (P < .001) and advertisements hanging from the ceiling (P < .001) that promoted SBs were present. Customers with moderate and high cumulative exposure to SB marketing were significantly more likely to purchase SBs (51.2% and 54.9%, respectively) than those with lower exposure (34%); this effect was particularly salient for men. There were no significant associations between retail marketing strategies and unplanned purchases.

CONCLUSIONS

Findings demonstrate that feasible and sustainable approaches are required from policy makers, retailers, and public health professionals to shift store environments away from cues that promote unhealthy beverage selections. Given that numerous retail actors are invested in the availability, promotion, and sales of SBs, changing the predominance of SB marketing in convenience stores will likely be challenging and require cross-sector collaboration.

Designing for downsizing: Home-based barriers and facilitators to reduce portion sizes for children

Evidence confirms that parents know that they should limit non-core foods for their children since these tend to be high in energy density (HED), fat, salt and sugar. However, it is unclear how knowledge of portion size limits, such as the 100 kcal guide from Public Health England are applied in practice. To observe in real-time children’s home food environment related to portion control and to explore with parents their reported portion size strategies, a mixed methods study was designed. Families with children aged 1–5 years were recruited (n = 21) to a three-part study: (1) to complete questionnaires and interviews on household food intake and portion control; (2) to report daily food intake for 4 days (n = 13) for one parent and their child(ren); (3) to observe home-based food provisioning via videorecording during dinner, breakfast and snack time (n = 6). Although the problem of large portion sizes of HED foods was recognised by mothers, strategies to downsize portions were not necessarily applied at home, as revealed in home observations and diaries. A mismatch between what was observed at home, what was reported in food diaries and what was said in interviews became apparent for some families. Mothers reported the need for greater support and guidance to downsize HED foods since they relied on pre-packaging as a guide to intake. Education and engagement were identified as important parameters for downsizing by mothers. One strategy which could be explored and applied by manufacturers is packaging design to faciliate the 100 kcal guidance using physical and engaging ways to assist parents in downsizing HED foods for their children. To facilitate effective government communication, innovative packaging design can be used to convey clear guidance and to tailor portion size messages for children. Packaging design, alongside government recommendations, can support parents’ goals to achieve healthy eating and can reinforce guidance for portion norms through innovation involving learning, playful engagement, and interaction.

Effects of Sugary Drink Countermarketing Videos on Caregivers' Attitudes and Intentions to Serve Fruit Drinks and Toddler Milks to Young Children

Objectives. To test the effects of countermarketing videos addressing common misperceptions about ingredients and claims on children's sugary drinks. Methods. We conducted an online randomized controlled experiment in January 2021 with US caregivers (n = 600) of young children (aged 8‒37 months) to assess the effects of watching countermarketing versus control videos on intentions to serve sugary and healthy drinks (6-point scales) and attitudes (10-point scales) about fruit drinks and toddler milks. Results. The countermarketing videos significantly reduced positive attitudes about fruit drinks (mean difference = 0.92) and toddler milks (mean difference = 2.10), reduced intentions to serve both (mean difference = 0.50 and 0.92, respectively), and increased intentions to serve plain milk (mean difference = 0.52) versus control videos (all Ps < .001). Intentions differed by individual characteristics, but the videos remained effective after we controlled for these characteristics. Moreover, the videos were more effective for toddler milks versus fruit drinks, and effects on fruit drink intentions were greater for Black versus White caregivers and caregivers of children aged 24 months or younger. Conclusions. A countermarketing campaign aimed at diverse caregivers of young children designed to correct misleading children's drink marketing presents a promising public health approach for reducing sugary drink consumption in the first 1000 days. (Am J Public Health. 2022;112(S8):S807-S816. https://doi.org/10.2105/AJPH.2022.307024).

Child-Directed Marketing, Health Claims, and Nutrients in Popular Beverages

INTRODUCTION

Fruit drinks are a major source of added sugar in children's diets. This study describes the associations between front-of-package child-directed marketing (i.e., sports, fantasy, or child-directed imagery; child-directed text) and (1) health-related claims and (2) nutrient content of fruit drinks, 100% juices, and flavored waters.

METHODS

Beverage purchase data from a national sample of 1,048 households with children aged 0-5 years were linked with front-of-package label and nutrition data to conduct a content analysis on fruit drinks (n=510), 100% juices (n=337), and noncarbonated flavored waters (n=40) in 2019-2020. Unstratified and stratified regression models assessed the differences in the prevalence of claims (macronutrient, micronutrient, natural/healthy, and fruit and juice), non-nutritive sweeteners, and nutrient content (calories, total sugar, and percent daily value of vitamin C) between drinks with and those without child-directed marketing in 2021.

RESULTS

Fruit drinks with child-directed marketing were more likely to show front-of-package micronutrient claims (OR=2.1, 95% CI=1.5, 3.1) and contained more vitamin C (18.5% daily value, 95% CI=1.6, 35.5) than fruit drinks without child-directed marketing. 100% juices with child-directed marketing contained less vitamin C (-35.6% daily value, 95% CI= -57.5, -13.8) and 3.0 (95% CI= -5.5, -0.4) fewer grams of sugar than 100% juices without child-directed marketing. Flavored waters with child-directed marketing contained less vitamin C (-37.9% daily value, 95% CI= -68.1, -7.6) than flavored waters without child-directed marketing.

CONCLUSIONS

The combination of child-directed marketing with health-related claims may mislead parents into believing that fruit drinks are healthy and appealing to their children, highlighting the need for government regulation of sugary drink marketing.

Marketing of sugar-sweetened children's drinks and parents' misperceptions about benefits for young children

Despite expert recommendations, US parents often serve sugar-sweetened children's drinks, including sweetened fruit-flavoured drinks and toddler milks, to young children. This qualitative research explored parents' understanding of common marketing tactics used to promote these drinks and whether they mislead parents to believe the drinks are healthy and/or necessary for children. We conducted nine focus groups in Washington, DC and Hartford, CT with parents of children (9-36 months) of diverse race/ethnicity and socioeconomic status (N = 50). Semistructured discussions elicited parents' responses to four concepts designed to correct common misperceptions about toddler milks and sweetened fruit-flavoured drinks (fruit drinks and flavoured waters) by providing information about drink ingredients and potentially misleading marketing tactics. Participants expressed widespread misperceptions about sweetened fruit-flavoured drinks and toddler milks, including perceived healthfulness and benefits for children and confusion between sweetened and unsweetened drink categories (sweetened fruit-flavoured drinks vs. juice, toddler milk vs. infant formula). They confirmed that common marketing strategies contributed to misperceptions, including front-of-package claims and marketing messages that imply benefits for children and/or hide problematic ingredients; cross-branding and product extensions from trusted brands; side-by-side shelf placement at retailers; lower price than healthier products; and targeted marketing to children and parents. Some parents expressed anger about deceptive marketing and supported increased regulation and consumer education campaigns. Findings support the need for policies to address potentially misleading marketing of sweetened fruit-flavoured drinks and toddler milks and revealed opportunities to reduce parents' provision of these drinks through countermarketing campaigns communicated via trusted sources.

Beverage Characteristics Perceived as Healthy among Hispanic and African-American Parents of Young Children

BACKGROUND

It is recommended that children younger than 6 years of age avoid sugar-sweetened beverages (SSBs); yet, 25% of toddlers and 45% of preschool-aged children consume SSBs on a given day, with the highest intakes reported among Hispanic and African-American children.

OBJECTIVE

To investigate characteristics that predominantly low-income Hispanic and African-American parents perceive to reflect a healthy beverage, and to examine the influence of these characteristics on parents' perceptions of the beverages they provide to their young children.

DESIGN

This study consisted of two activities: a qualitative activity where parents (n = 102) were asked to report what characteristics they perceive to reflect a healthy beverage and a quantitative activity where parents (n = 96) indicated the extent to which each of the reported characteristics influence parents' perceptions of the beverages they provide to their young children.

PARTICIPANTS AND SETTING

Hispanic and African-American parents of young children (younger than 6 years of age) were recruited from the District of Columbia metropolitan area.

MAIN OUTCOME MEASURES

Beverage characteristics and influence scores.

STATISICAL ANALYSES PERFORMED

Characteristics were categorized by the research team based on their perceived meaning. Perceived influence scores for each characteristic and category were compared across Hispanic and African-American parents using nonparametric, Mann-Whitney U tests, and false discovery rate adjustment was used to correct for multiple testing.

RESULTS

The characteristics perceived to be most influential included those pertaining to perceived beverage sugar and sweetener content, being natural, and containing certain nutrients. Characteristics such as being homemade, made with fruit, and containing vitamins were reported to be more influential among Hispanic parents compared with African-American parents.

CONCLUSIONS

Findings emphasize the need to address misperceptions about the healthfulness of beverages among Hispanic and African-American parents. Differences in the perceived influence of specific beverage characteristics across Hispanic and African-American parents underscore the importance of developing culturally relevant interventions to improve parents' beverage selection for their children.

Caregivers' provision of sweetened fruit-flavoured drinks to young children: importance of perceived product attributes and differences by socio-demographic and behavioural characteristics

OBJECTIVE

Drinks containing added sugar and/or non-nutritive sweeteners are not recommended for children under 6 years. Yet, most young children consume these products. The current study examined factors associated with caregivers' provision of sweetened drinks to their young child.

DESIGN

Caregivers reported frequency of providing sweetened fruit-flavoured drinks (fruit drinks and flavoured water) and unsweetened juices (100 % juice and juice/water blends) to their 1- to 5-year-old child in the past month and perceived importance of product attributes (healthfulness, product claims and other characteristics), other drinks provided, reading the nutrition facts panel and socio-demographic characteristics. A partial proportional odds model measured the relationship between these factors and frequency of providing sweetened fruit-flavoured drinks.

SETTING

Online cross-sectional survey.

PARTICIPANTS

U.S. caregivers (n 1763) with a young child (ages 1-5).

RESULTS

The majority (74 %) of caregivers provided sweetened fruit-flavoured drinks to their child in the past month; 26 % provided them daily. Provision frequency was positively associated with some drink attributes, including perceived healthfulness, vitamin C claims and box/pouch packaging; child requests and serving other sweetened drinks and juice/water blends. Provision frequency was negatively associated with perceived importance of 'no/less sugar' and 'all natural' claims. Reading nutrition facts panels, serving water to their child and child's age were not significant.

CONCLUSION

Misunderstanding of product healthfulness and other marketing attributes contribute to frequent provision of sweetened drinks to young children. Public health efforts to address common misperceptions, including counter marketing, may raise awareness among caregivers about the harms of providing sweetened drinks to young children.

Front-of-package claims & imagery on fruit-flavored drinks and exposure by household demographics

Young children regularly consume sugary fruit drinks, in part because parents may falsely believe they are healthful due to front-of-package (FOP) claims and imagery. The goal of this study was to assess: 1) the prevalence of FOP claims/imagery on fruit-flavored beverages purchased by U.S. households with 0-5-year-olds, and 2) proportional differences in beverages purchased with FOP claims/imagery across household demographic groups. A content analysis of FOP claims/imagery (e.g., nutrient claims, fruit imagery) on beverages (n = 1365) purchased by households with 0-5-year-olds was conducted by linking beverage sales with FOP marketing data. Results were merged with purchasing data from a nationally representative sample of households (FoodAPS), and survey-weighted logistic regression was used to assess differences in the proportions of 100% juices and fruit drinks with specific FOP claims/imagery purchased by household race/ethnicity, income, and SNAP/WIC participation. The most common claims on fruit-flavored beverages included nutrient claims (fruit drinks: 73%; 100% juices: 68%; flavored waters: 95%), which most commonly highlighted vitamin C (35-41% across beverage categories) and the absence of sugar (31-48%). Most beverages also contained implied-natural claims (fruit drinks: 60%; 100% juices: 64%; flavored waters: 95%) and natural imagery (fruit drinks: 97%; 100% juices: 96%; flavored waters: 73%). A large proportion of fruit drinks and 100% juices purchased by households across all demographic groups contained FOP claims and imagery, with a few minor differences between racial/ethnic groups. In conclusion, most fruit drinks, 100% juices, and flavored waters purchased by households with 0-5-year-olds contained FOP claims and imagery that may lead consumers to believe the beverages are healthy and natural. FDA regulations should ensure parents are not misled by this marketing.

Nutrition-related claims lead parents to choose less healthy drinks for young children: a randomized trial in a virtual convenience store

BACKGROUND

Consumption of sugar-sweetened beverages, including fruit drinks (i.e., fruit-flavored drinks containing added sugar), contributes to childhood obesity.

OBJECTIVES

We aimed to examine whether nutrition-related claims on fruit drinks influence purchasing among parents and lead to misperceptions of healthfulness.

METHODS

We conducted an experiment in a virtual convenience store with 2219 parents of children ages 1-5 y. Parents were randomly assigned to view fruit drinks displaying 1 of 3 claims ("No artificial sweeteners," "100% Vitamin C," and "100% All Natural") or no claim (i.e., control group). Parents selected among each of 2 drinks for their young child: 1) a fruit drink or 100% juice (primary outcome), and 2) a fruit drink or water.

RESULTS

When choosing between a fruit drink and 100% juice, 45% of parents who viewed the fruit drink with the "No artificial sweeteners" claim, 51% who viewed the "100% Vitamin C" claim, and 54% who viewed the "100% All Natural" claim selected the fruit drink, compared with 32% in the no-claim control group (all P < 0.001). "No artificial sweeteners" (Cohen's d = 0.13, P < 0.05) and "100% All Natural" (d = 0.15, P < 0.05) claims increased the likelihood of parents choosing the fruit drink instead of water but "100% Vitamin C" did not (P = 0.06). All claims made parents more likely to incorrectly believe that the fruit drinks contained no added sugar and were 100% juice than the control (d ranged from 0.26 to 0.84, all P < 0.001), as assessed in a posttest survey. The impact of claims on selection of the fruit drink (compared with 100% juice) did not vary by any of the moderators examined (e.g., race/ethnicity, income; all moderation P > 0.05).

CONCLUSIONS

Nutrition-related claims led parents to choose less healthy beverages for their children and misled them about the healthfulness of fruit drinks. Labeling regulations could mitigate misleading marketing of fruit drinks.This trial was registered at clinicaltrials.gov as NCT04381481.

The Impact of Toddler Milk Claims on Beliefs and Misperceptions: A Randomized Experiment with Parents of Young Children

BACKGROUND

Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been marketed increasingly in the United States with structure/function claims on product packaging that are potentially misleading.

OBJECTIVE

This study examined how structure/function claims impact parents' beliefs and perceptions about a toddler milk product.

DESIGN

This was a 3-arm between-subjects randomized experiment.

PARTICIPANTS

A diverse sample of 2,190 US parents of children aged 1 to 5 years were chosen to take an online survey.

INTERVENTION

Participants were randomly assigned to view a toddler milk package with either an unrelated claim ("new and improved," ie, control condition), a "brain development" claim (ie, "brain" claim), or an "immunity-related" claim (ie, "immunity" claim).

MAIN OUTCOME MEASURES

Outcomes included perceptions, intentions, and beliefs about the toddler milk product.

STATISTICAL ANALYSES PERFORMED

Linear regression for continuous outcomes and logistic regression for dichotomous outcomes.

RESULTS

Parents who were exposed to the "brain" claim or the "immunity" claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow's milk compared with those who saw the control claim (89% for brain claim, 87% for immunity claim, and 79% for control; P < .001 for both comparisons). Parents exposed to either the brain or immunity claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared with parents exposed to the control (all, P < .001).

CONCLUSIONS

These findings suggest that structure/function claims on toddler milk packaging may mislead parents and increase the appeal of toddler milk. Our findings support calls for public health policies to regulate marketing on toddler milk packaging.

United States: Protecting Commercial Speech under the First Amendment

The First Amendment to the US Constitution protects commercial speech from government interference. Commercial speech has been defined by the US Supreme Court as speech that proposes a commercial transaction, such as marketing and labeling. Companies that produce products associated with public health harms, such as alcohol, tobacco, and food, thus have a constitutional right to market these products to consumers. This article will examine the evolution of US law related to the protection of commercial speech, often at the expense of public health. It will then identify outstanding questions related to the commercial speech doctrine and the few remaining avenues available in the United States to regulate commercial speech including the use of government speech and addressing deceptive and misleading commercial speech.

Caregivers' Understanding of Ingredients in Drinks Served to Young Children: Opportunities for Nutrition Education and Improved Labeling

BACKGROUND

Against expert recommendations, sugar-sweetened beverages, especially fruit drinks, are consumed by young children. Misperceptions about drink ingredients and healthfulness can contribute to caregivers' provision.

OBJECTIVES

To assess caregivers' reasons for serving sweetened fruit-flavored drinks and unsweetened juices to their young children (1-5 y) and perceptions of product healthfulness and drink ingredients.

METHODS

A cross-sectional online survey assessed participants' (n = 1614) perceptions of sweetened fruit-flavored drinks (fruit drinks and flavored water) and unsweetened juices (100% juice and water/juice blends) provided to their child in the past month, including product healthfulness, reasons for providing, and knowledge of product ingredients [added sugar, nonnutritive sweeteners (NNSs), percentage juice]. One-factor ANOVA compared perceived healthfulness of drink categories and types of sugar and NNSs, and differences between participants who could compared with those who could not accurately identify drink ingredients.

RESULTS

Participants' top reasons for providing sweetened drinks included child liking it, being inexpensive, child asking for it, and being a special treat. Participants perceived 100% juice as healthiest, followed by juice/water blends, flavored waters, and, lastly, fruit drinks (P < 0.05). Many participants inaccurately believed the fruit drink or flavored water they served their child most often did not contain NNSs (59.0% and 64.9%) and/or added sugars (20.1% and 42.2%), when in fact they did, and 81.3-91.1% overestimated the percentage juice in the drink. Perceived healthfulness of fruit drinks was associated with caregivers' belief that the drink contained added sugar (P < 0.05), but not with their belief that it contained NNS; increased accuracy was associated with decreased perceived healthfulness (P < 0.05).

CONCLUSIONS

Inaccurate understanding of added sugar, NNSs, and percentage juice in drinks served to young children was common and could contribute to sugary drink provision. Public health efforts should seek to improve labeling practices and revise nutrition education messages.

Race, Ethnicity, and Neighborhood Food Environment Are Associated with Adolescent Sugary Drink Consumption During a 5-Year Community Campaign

Background

A multi-level county-wide campaign to reduce sugary drink consumption was associated with significant decreases in retail sales of soda and fruit drinks. The aim of the current study was to examine changes in adolescent beverage consumption during the campaign by race/ethnicity and neighborhood food environment.

Methods

Beverage consumption among adolescents was evaluated at four time points in a repeated cross-sectional survey of a racially and ethnically diverse sample of sixth graders (N = 13,129) from public middle schools in the county. Each school’s surrounding attendance zone (i.e., neighborhoods where students live) was characterized as providing high or low exposure to unhealthy food retail (e.g., convenience stores, fast-food restaurants). Logistic and multiple linear regression models were used to evaluate changes in beverage consumption over time by student race/ethnicity and high versus low unhealthy food exposure.

Results

Over the 5 years, there were significant declines in the overall share of students who reported daily sugary drink consumption (49.4 to 36.9%) and their reported daily calories from these products (220 to 158 calories). However, disparities were observed, with higher levels of consumption among Black and Hispanic youth and among youth living in neighborhoods with more unhealthy food retail. Notably, Black students living in healthier neighborhood food environments reported significant decreases in daily consumption and calories after 5 years, while Black students living in neighborhoods with more convenience stores and fast-food outlets did not.

Conclusion

These findings suggest that both race/ethnicity and neighborhood food environments are important considerations when designing interventions to reduce sugary drink consumption among adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-021-01074-9.