Abstract
Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.
Highlights
Among children under the age of 24 months in the United States (U.S.), high infant weight-for-length prevalence among Hispanic/Latino children (11.3%) and non-HispanicBlack children (10.2%) is higher than non-Hispanic White (8.8%) counterparts [1,2,3,4,5]
We randomized with a 1:1 allocation ratio to 1 of 3 arms: (1) unhealthy beverage avoidance messages framed as graphic health warnings, (2) messages framed as information for parents on beverage-specific sugar content, and (3) attention control
In this randomized controlled trial of two different sugar-sweetened beverage (SSB) reduction text messaging interventions—graphic health warnings and beverage sugar content information—delivered by mobile technology-based health interventions (mHealth) for one month to low-income, predominantly Hispanic/Latina mothers in the first 1000 days, we found no difference in 1-month change in maternal SSB consumption among intervention groups versus an attention control group
Summary
Among children under the age of 24 months in the United States (U.S.), high infant weight-for-length prevalence among Hispanic/Latino children (11.3%) and non-HispanicBlack children (10.2%) is higher than non-Hispanic White (8.8%) counterparts [1,2,3,4,5]. Childhood obesity risk factors exist during the first 1000 days—gestation through the age of. Racist practices and policies that promote segregation and discrimination, inequitable access to healthy, affordable foods, and targeted marketing of calorie-dense, nutrient-poor foods and beverages perpetuate racial/ethnic disparities in obesity risk factors starting early in life [12,13,14]. Maternal sugar-sweetened beverage (SSB) consumption in pregnancy and infant SSB consumption in infancy are risk factors for later childhood overweight/obesity [15,16] and other adverse child health consequences [17,18]. Interventions to curb SSB consumption and promote healthy beverage intake in low-income and Hispanic/Latino adults with children may help reduce maternal and infant SSB consumption, yet SSB-specific interventions in this life course period are lacking. In our prior formative qualitative research, pregnant women and mothers of infants identified graphic health warning labels and beverage-specific information on sugar content as motivating towards SSB avoidance [24]
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