How to be SSB-free: Assessing the attitudes and readiness for a sugar sweetened beverage-free healthcare center in the Bronx, NY

Effects of a six-day, whole-diet sweet taste intervention on pleasantness, desire for and intakes of sweet foods: a randomised controlled trial

Reduced exposure to sweet taste has been proposed to reduce sweet food preferences and intakes, but the evidence to support these associations is limited. This randomised controlled trial investigated the effects of a whole-diet sweet taste intervention for 6 d, on subsequent pleasantness, desire for and sweet food intakes. Participants (n 104) were randomised to increase (n 40), decrease (n 43) or make no change to (n 21) their consumption of sweet-tasting foods and beverages for 6 consecutive days. Pleasantness, desire to eat, sweet taste intensity and sweet food and beverage intakes were assessed on days 0 and 7. One hundred and two (98 %) participants completed the study, and self-reported adherence with the dietary interventions was moderate to good (M = 66-72/100 mm), with instructions to decrease sweet food consumption reported as more difficult than the other diets (smallest (t(81) = 2·45, P = 0·02, M diff = 14/100 mm, se = 2 mm). In intention-to-treat analyses, participants in the decreased sweet food consumption group reported higher sweet taste intensity perceptions at day 7 compared with day 0 (F(2101) = 4·10, P = 0·02, M diff = 6/100 mm, se = 2 mm). No effects were found for pleasantness (F(2101) = 2·04, P = 0·14), desire to eat (F(2101) = 1·49, P = 0·23) or any of the measures of sweet food intake (largest F(2101) = 2·53, P = 0·09). These results were confirmed in regression analyses that took self-reported adherence to the diets into account. Our findings suggest that exposure to sweet taste does not affect pleasantness, desire for or intakes of sweet-tasting foods and beverages. Public health recommendations to limit the consumption of sweet-tasting foods and beverages to reduce sweet food preferences may require revision.

Factors Driving Individuals' Attitudes toward Sugar and Sweet-Tasting Foods: An Analysis within the Scope of Theory of Planned Behavior

Public health authorities are undertaking initiatives aimed at reducing sugar intake because it is linked to detrimental health outcomes. Individuals' attitudes and intentions toward sugar can be significant factors affecting intake. Therefore, we here aimed to evaluate individuals' attitudes and intentions toward sugar intake by combining the theory of planned behavior with different frameworks. Accordingly, we developed an online questionnaire and reached 940 participants. We observed that subjective norms (β = -0.140; p < 0.001) and perceived behavioral control (β = -0.138; p < 0.001) as defined in the theory of planned behavior significantly affected attitude. Subsequently, examining the effect of attitude (β = -0.209; p = 0.018) and intention (β = 0.717; p < 0.001) on sugar intake showed that intention had a positive effect, whereas attitude had no significant effect. Mediation analysis showed that attitude influenced sugar intake through intention (β = -0.286; p = 0.001). Furthermore, we determined that components including habits, perceived understanding, perceived nonautonomy, negativity, and apathy can affect attitude toward sugar intake (p < 0.001). Analyzing the effects of sociodemographic factors revealed that sugar intake was lower in individuals with food allergies (p < 0.05). In conclusion, these findings suggest that the theory of planned behavior, when combined with different frameworks, can be effective in predicting sugar intake and individuals' intentions.

Associations between attitudes towards and reported intakes of sugars, low/no-calorie sweeteners, and sweet-tasting foods in a UK sample

Public health initiatives are currently aiming to lower free sugar intakes for health benefits, but attitudes towards sugars, their alternatives such as low/no-calorie sweeteners (LNCS), and towards sweet-tasting foods may be hampering efforts. This work investigated associations between attitudes towards and the reported intakes of sugars, LNCS and sweet-tasting foods, and identified latent attitude profiles in subpopulations of adults in the United Kingdom. A total of 581 adults completed a questionnaire assessing their usual intake of sugars, LNCS and sweet-tasting foods, attitudes towards these foods and various demographic characteristics. Six principal components explained 39.1% of the variance in the attitude responses, named: 'Personal Impact', 'Personal Management', 'Apathy', 'Negativity', 'Perceived Understanding' and 'Perceived Nonautonomy'. Personal Impact was negatively associated with reported consumption of sugar-food and sweet-tasting food groups more frequently (smallest β = -0.24, p < .01). Personal Management was positively associated with reporting adding sugar and consuming sugar-food and sweet-tasting food groups more frequently (smallest β = 0.14, p < .01). Three latent classes of participants with distinct patterns of attitudes were identified, labelled: 'Feeling Ill-equipped' (n = 52), 'Actively Engaged' (n = 162) or 'Unopinionated' (n = 367). Individuals who were classed as Actively Engaged reported adding LNCS more frequently than those classed as Feeling Ill-equipped (t(212) = -2.14, p<.01), who reported consuming sweet-tasting food groups more frequently than those classed as Unopinionated (t(417) = 2.65, p < .01). These findings suggest the need for personalised approaches within public health initiatives, to reduce free sugar intakes.

Staff Knowledge, Attitudes, and Beliefs About Child Sugar-Sweetened Beverage Intake and Acceptability of a Pediatric Clinic-Based Beverage Screener

Beverages are the leading source of sugar in children's diets and a modifiable risk factor for adverse health conditions. Electronic health record-based screeners could facilitate health systems' efforts to reduce child consumption of sugary beverages. Before implementing a sugar-sweetened beverage screener in the electronic health record within academic healthcare system, 228 pediatric and family medicine clinic staff completed an online educational training to familiarize them with the screener and its rationale. Pretraining and posttraining surveys were used to examine the association between staff knowledge of sugar-sweetened beverages and the acceptability of the screening workflow. Respondents displayed high levels of pretraining knowledge about health consequences of added sugar intake, but lower levels of pediatric beverage guideline knowledge. Knowledge improved from pretraining to posttraining surveys, with high acceptability of the screening process. Staff compliance with sugar-sweetened beverage screening was examined using electronic health record data. During the 6 months after screener implementation, 47% of eligible pediatric patients were screened, with some variation in compliance by age group and practice type. This study demonstrated that engaging nursing and frontline staff to screen pediatric patients for behavioral determinants of health is feasible. Ongoing outreach and refreshers may improve sustainability.

How have media campaigns been used to promote and discourage healthy and unhealthy beverages in the United States? A systematic scoping review to inform future research to reduce sugary beverage health risks

Sugary beverage consumption is associated with many health risks. This study used a proof-of-concept media campaign typology to examine U.S. beverage campaigns that promoted healthy beverages and encouraged or discouraged sugary beverages. We used a three-step systematic scoping review to identify, organize, analyze, and synthesize evidence. Step 1 used Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines to search four electronic databases and gray literature through 2021. Step 2 categorized relevant media campaigns using a media campaign typology. Step 3 examined campaign evaluation outcomes. We identified 280 campaigns organized into six campaign typology categories. The media landscape was dominated by corporate marketing campaigns for branded sugary beverages (65.8%; n = 184) followed by public awareness (9.6%; n = 27), public policy (8.2%; n = 23), social marketing (7.1%; n = 20), corporate social responsibility (5.7%; n = 16), and countermarketing (3.6%; n = 10) campaigns. Evaluations for 20 unique campaigns implemented over 30 years (1992-2021) across 14 states showed reduced sugary beverage or juice and increased water or low-fat milk sales and intake. Positive short-term cognitive and mid-term retail and behavioral changes were reported. There was limited evidence for long-term policy, social norm, and population health outcomes. Future research is needed to use media campaigns in strategic communications to reduce sugary beverage health risks for Americans.

Sweet Talk: A Qualitative Study Exploring Attitudes towards Sugar, Sweeteners and Sweet-Tasting Foods in the United Kingdom

Worldwide initiatives currently aim to reduce free sugar intakes, but success will depend on consumer attitudes towards sugar and the alternatives. This work aimed to explore attitudes towards sugar, sweeteners and sweet-tasting foods, towards consumption and related policies, in a sample of the general public of the UK. Focus groups and interviews were conducted with 34 adults (7 males, ages: 18-65 years). Thematic analysis identified six themes: 'Value' (e.g., pleasure, emotions), 'Angle' (e.g., disinterest), 'Personal Relevance' (to be concerned and/or change one's own behavior), 'Personal Responsibility' (one has an active relationship with these food items), 'Understanding' (the acquisition, comprehension and application of information) and 'It's Not Up to Me' (a passive approach, because intake is subjected to other factors). Both positive and negative attitudes towards sugar, sweeteners and sweet-tasting foods were expressed in all themes. Participants also reported varied engagement with and motivations towards all food items, with implications for intakes. Suggested challenges and potential strategies for reducing free sugar intakes highlighted the need for differing approaches. Future work should assess associations between attitudes and intakes. For greatest population benefit, evidence of the dominant attitudes in those in greatest need of reduced free sugar intakes would be of value.

Knowledge, Attitude, and Practice of Adolescent Parents on Free Sugar and Influencing Factors about Recognition

Physiological problems caused by excessive intake of free sugar have been concerning important public health issues, especially the impact on adolescents. The World Health Organization (WHO) strongly recommends controlling daily sugar intake in order to reduce the stress caused by high sugar uptake. Finding out the factors that affect adolescents’ sugar intake will help further interventions to control the intake of sugar. Therefore, we conducted a cross-sectional study among 10 middle schools in Changsha, the capital of Hunan province. Two classes of the first and second grades were randomly selected from each school, and their parents in these classes participated in the survey. Questionnaires were used to access the status of adolescent parents’ knowledge, attitude and practice (KAP) towards free sugar. Out of 1136 valid participants, 70.4% of respondents were female with the mean (Standard Deviation) age of 41.76 (±5.27) years. They had a good attitude but relatively poor knowledge and behavior towards free sugar. Binary logistic regression analysis found that parents whose gender is female, with a high education level and a girl as their child, hold a high level of free sugar recognition. These findings could help free sugar control interventions for adolescents in the future.