Availability Of Sugar-sweetened Beverages Research Articles

Student Opposition to University Pouring Rights Contracts

IntroductionThe majority of large public universities have exclusive pouring rights contracts (PRCs) with beverage companies that produce and market sugar-sweetened beverages (SSBs). PRCs contain provisions that conflict with recommendations from major public health organizations that institutions reduce SSB availability, marketing, and consumption. This study assessed the following among students at 3 public universities: student perception of PRCs–the extent to which they favored or opposed PRCs, the association between student socioeconomic characteristics and perception of PRCs, student estimates of PRC revenue, and the association between student PRC revenue estimates and perception of PRCs. To contextualize results, actual PRC revenue as a percent of total revenues was estimated. MethodsA cross-sectional exploratory study was conducted among a convenience sample of 1,311 undergraduate SSB-consuming students recruited from 3 large and diverse public universities in Northern California. On an online questionnaire, undergraduate students indicated the extent to which they favored or opposed PRCs on a 10-point scale (oppose=1-5, favor=6-10) and provided a numeric estimate of the percentage of total university revenue they thought their university's PRC generated. Regression models were used to analyze differences in perception of PRCs by student socioeconomic status and estimates of university revenues generated by PRCs. Additionally, PRCs and financial reports were obtained from the 3 universities to estimate actual PRC revenue as a percent of total revenues. Survey data were collected between August and November 2018 and analyzed August 2022. ResultsA large majority of students (81%) opposed PRCs, and opposition did not significantly differ by student socioeconomic status, including by levels of food security, need-based financial aid, participation in federal food assistance or healthcare programs, parental education, or parental income (all p-values > 0.14). The median student estimates for PRC revenue as a percentage of total university revenue was 10%. In contrast, the estimated actual annual revenue generated from the PRCs ranged from 0.01-0.04% at these schools. Revenue estimates were not significantly associated with participants’ opposition or favoring of PRCs (p = 0.65). ConclusionsA large majority of students opposed PRCs, and this opposition was similar regardless of student socioeconomic status or student estimates of PRC revenues. Students markedly overestimated (by >100-1000-fold) the percentage of university revenue that came from PRCs. University administration should consider student views on PRCs when deciding whether to exit or continue with PRCs.

School-based intervention impacts availability of vegetables and beverages in participants' homes.

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.

Childhood Sugar-Sweetened Beverage Consumption: an Agent-Based Model of Context-Specific Reduction Efforts

Despite widespread recognition among public health experts that childhood sugar-sweetened beverage consumption should be reduced, doing so has proven to be a challenge. An agent-based model of early childhood sugar-sweetened beverage consumption was applied to data from three high-quality, longitudinal cohort studies to gain insight into potentially effective intervention strategies across contexts. From 2021 to 2023, a single agent-based model design was applied to data sets derived from three separate cohorts of children followed from infancy to childhood, with very different populations and environments (participants recruited in 1999-2002; 2003-2010; and 2009-2014). After assessing its ability to reproduce observed consumption patterns across cohorts, it was used to simulate potential impacts of multiple intervention strategies across contexts. Interventions reducing home availability of sugar-sweetened beverages consistently had the largest potential effects. Impact differed between cohort settings: a complete decrease in availability resulted in an estimated 87% decrease in overall early childhood consumption for one of the cohorts, compared with 61% and 54% in the others. Reducing availability in center-based child care resulted in substantially greater reduction in one cohort relative to the other two. There is untapped potential for strategies targeting children's sugar-sweetened beverage consumption in the home, but in some instances, other approaches might also yield meaningful effects. Tailoring approach to setting may be important, and agent-based models can be informative for doing so. This agent-based model has broad generalizability and potential to serve as a tool for designing effective, context-specific strategies to reduce childhood sugar-sweetened beverage consumption.

Enhanced Measurement of Sugar-Sweetened Beverage Marketing to Young Immigrant Children in Grocery Store Environments.

The marketing of Sugar-Sweetened Beverages (SSBs) within grocers is an obesogenic factor that negatively impacts children's nutritional behavior, specifically for people from racial and ethnic minority groups, such as immigrants. We aimed to develop and employ a methodology that more precisely assesses the availability, price, and promotion of SSBs to young immigrant children within independently owned grocery stores. A case comparison design was used to explore the differences in the grocery store landscape of SSB marketing by conducting an enhanced Nutrition Environment Measures Survey-SSB (NEMS-SSB) within 30 grocery stores in the Hispanic and Latino enclaves in Southwest Detroit, in the Arab and Chaldean enclaves in North-central Detroit, and in Warren, Hamtramck, and Dearborn, in comparison with 48 grocers in Metro Detroit. Unsweetened, plant-based, and organic toddler and infant beverages, as well as questions about marketing, were added to the original NEMS to capture the promotion tactics used in marketing SSBs. NEMS-SSB scores revealed that, in the immigrant enclaves, there was a significantly higher availability of SSBs in grocery stores (-2.38), and they had lower prices than those in the comparison group (-0.052). Unsweetened, plant-based, and organic beverages were unavailable in 97% of all participating grocery stores across both groups. Signage featuring cartoon characters was the most frequent in-store SSB marketing tactic across both groups. Widespread SSB marketing toward toddlers within the grocery stores in immigrant enclaves could be linked with the higher early childhood obesity prevalence among the immigrant population. Our findings can assist local and national organizations in developing and implementing healthy eating interventions. This study must be repeated in other immigrant enclaves across states to provide comparable results.

Exploratory Analysis of Social Networks Linked to the Provision of Beverages in Costa Rican Schools.

Sugar-sweetened beverages (SSBs) are implicated in weight gain and adverse cardiometabolic heath. Social networks of stakeholders involved in providing potable water and sugar-sweetened beverages (SSBs) in high schools in Costa Rica were studied using social analysis network. In public and private schools, the interactions between the stakeholders in charge of providing beverages are fragmented and their role in preventing the availability of SSBs is weak. School canteen owners ultimately decide what beverages are available at school, which may cause students to choose beverages that increase the risk of overweight/obesity. It is therefore urgently necessary to improve the capacity for two-way interactions between the stakeholders to enhance their roles in the provision of beverages. Hence, it is essential to reinforce the stakeholders' leadership, and set up innovative ways to exert it in order to develop a shared vision of the types of drinks that should be available in the school environment.

Availability of Sugar-Sweetened Beverages at Home as The Dominant Factor Related to Its Consumption Among Students of SMAN (State High School) 47 Jakarta, Indonesia, in 2022

AbstractSugar-sweetened beverages (SSBs) are drinks added with simple sugar, which can increase the energy because of calorie-dense and high in sugar, but low in other nutrients. Excessive consumption of SSBs can cause nutritional problems, such as increasing the risk of overweight and obesity. This study aims to determine the relationship between SSBs consumption and various factor and the dominant factor of SSBs consumption among students of SMAN (State High School) 47 Jakarta in 2022. The cross-sectional study was conducted from November 2021 to June 2022 with 120 respondents. Primary data was taken using questionnaires and analyzed by univariate, bivariate (chi-square test), and multivariate (multiple logistic regression). Univariate analysis shows that 90% of respondents consumed high levels of SSBs. Bivariate analysis shows that pocket money, advertising and media exposure, and availability of SSBs at home have a significant relationship with SSBs consumption. Multivariate analysis shows that the dominant factor associated with SSBs consumption was the availability of SSBs at home. The school is advised to provide education about the impact of high SSBs consumption, provide mineral water refills, and encourage parents to provide healthy drinks at home. The government is advised to use social media for intervention, limiting unhealthy drinks ads, and implementing a policy of SSBs excise tax.Keywords: Sugar-sweetened beverages, adolescents, high school studentsAbstrakSugar-sweetened beverages (SSBs) merupakan minuman yang diberi tambahan gula sederhana yang menambah kandungan energi karena padat kalori dan tinggi gula, namun memiliki sedikit kandungan zat gizi lain sehingga dapat meningkatkan risiko kejadian gizi lebih. Penelitian ini bertujuan untuk mengetahui hubungan konsumsi SSBs dengan berbagai faktor dan mengetahui faktor dominan konsumsi SSBs pada siswa SMAN 47 Jakarta tahun 2022. Penelitian ini menggunakan desain studi cross sectional pada bulan November 2021 - Juni 2022 dengan jumlah responden sebanyak 120 orang. Data yang diambil adalah data primer dengan pengisian kuesioner. Data yang diperoleh selanjutnya akan dianalisis secara univariat, bivariat (uji chi-square), dan multivariat (uji regresi logistik ganda). Hasil analisis univariat menunjukkan 90% responden mengonsumsi SSBs tingkat tinggi. Hasil bivariat menunjukkan bahwa uang saku, paparan iklan dan media, serta ketersediaan SSBs di rumah memiliki hubungan yang signifikan terhadap konsumsi SSBs. Analisis multivariat menunjukkan bahwa faktor dominan yang berhubungan dengan konsumsi SSBs adalah ketersediaan SSBs di rumah. Pihak sekolah disarankan untuk memberikan edukasi gizi terkait dampak konsumsi SSBs berlebih, menyediakan tempat pengisian ulang air mineral, dan mengimbau orang tua siswa untuk menyediakan makanan sehat di rumah. Pemerintah disarankan untuk memanfaatkan media sosial sebagai media intervensi, membatasi iklan minuman yang kurang sehat, dan menerapkan kebijakan pengenaan cukai SSBs.Kata kunci: Sugar-sweetened beverages, remaja, siswa SMA

Implementation, home mediators and children’s sugary drink consumption - results from DAGIS study

Abstract Background and objectives The effectiveness of a health behavior intervention can depend on the extent to which the intervention is implemented; higher degree of implementation (DOI) might associate with larger intervention effects. This study examined whether the parental DOI of an health behavior intervention had an effect on children's consumption of sugar-sweetened beverages (SSB) and was the effect mediated by home factors. Methods the DAGIS preschool intervention was conducted in 2017-2018 in Finland among 3-6-year-olds with valid data from 476 children. At baseline and follow-up parents reported 1) children's SSB consumption in a semi-quantified food frequency questionnaire, 2) availability of SSB at home, parental role modelling of drinking SSB, and norm (parental view on the suitable amount of SSB for children), and 3) DOI: a dichotomized sum variable on several aspects of parental program implementation. In the analyses, high and low DOI were compared to control group. Mediation analysis of the effect of DOI on the change in children's SSB consumption via change in availability, role modelling and norm was conducted with R statistical software. Results High DOI was associated with reduced consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No mediated effects were found. All studied mediators impacted the change in SSB consumption, but the DOI had no effect on the change in mediators. Conclusions Intervention effect on the consumption of SSB was only found in the high DOI group, which supports the importance of assessing intervention implementation. Since the found effect was not mediated by the studied mediators, other possible mediators should be examined, as understanding intervention mediators is crucial in developing successful interventions. Key messages

An agent-based model of child sugar-sweetened beverage consumption: implications for policies and practices

A strong body of evidence links young children's intake of sugar-sweetened beverages (SSBs) with myriad negative outcomes. Our research provides insight into whether and to what extent potential intervention strategies can reduce young children's consumption of SSBs. We built an agent-based model (ABM) of SSB consumption representing participants in the Project Viva longitudinal study between ages 2 and 7 y. In addition to extensive data from Project Viva, our model used nationally representative data as well as recent, high-quality literature. We tested the explanatory power of the model through comparison to consumption patterns observed in the Project Viva cohort. Then, we applied the model to simulate the potential impact of interventions that would reduce SSB availability in 1 or more settings or affect how families receive and respond to pediatrician advice. Our model produced age-stratified trends in beverage consumption that closely match those observed in Project Viva cohort data. Among the potential interventions we simulated, reducing availability in the home-where young children spend the greatest amount of time-resulted in the largest consumption decrease. Removing access to all SSBs in the home resulted in them consuming 1.23 (95% CI: 1.21, 1.24) fewer servings of SSBs per week on average between the ages of 2 and 7 y, a reduction of ∼60%. By comparison, removing all SSB availability outside of the home (i.e., in schools and childcare) had a smaller impact (0.77; CI: 0.75, 0.78), a reduction of ∼40%. These results suggest that interventions reducing SSB availability in the home would have the strongest effects on SSB consumption.

P098 Changes in Availability of Healthy Food in Homes of Participants in TX Sprouts, a School-Based Gardening, Nutrition, and Cooking Program

<h3>Objective</h3> To evaluate the effects of a school-based gardening, nutrition, and cooking intervention (TX Sprouts) compared to control on the availability of vegetables and sugar-sweetened beverages (SSBs) at home. <h3>Use of Theory or Research</h3> TX Sprouts was based on the social ecological-transactional model with a goal of empowering children to make positive changes in their family environments. <h3>Target Audience</h3> Children ages 7-11 attending public schools serving primarily low-income, Hispanic children and their families. <h3>Program Description</h3> TX Sprouts includes building an edible garden at the school and teaching 18 in-school gardening, nutrition, and cooking lessons to all 3rd-5th grade students. Lessons focused on increasing vegetables and decreasing SSBs. <h3>Evaluation Methods</h3> In a randomized-controlled trial, 16 schools were randomly assigned to TX Sprouts or control (i.e., delayed intervention) for one academic year. Parents completed a 7-item survey about the availability of vegetables and SSBs in the home at pre and post. Analyses of variance tests were used to evaluate the changes in home vegetable and SSB availability (composite score and individual questions) between intervention and control, adjusted for child's age, ethnicity, and SNAP participation. <h3>Results</h3> The analytic sample included 895 children (n = 414 intervention, n = 481 control) whose parents completed the survey at baseline and endpoint. The intervention resulted in a significant improvement in the overall availability of healthy food (more vegetables, fewer SSBs) in the home when compared to the control (composite score change 0.29 vs. -0.24; <i>P =</i> 0.012). When examining individual questions in the survey, families receiving the intervention significantly improved home availability of fresh vegetables (0.03 vs. -0.1; <i>P =</i> 0.039). <h3>Conclusions</h3> A gardening, nutrition, and cooking program delivered to children in schools can benefit children by increasing healthy food in the home environment. <h3>Funding</h3> NIH; Whole Kids Foundation; Home Depot; Sprouts Healthy Communities

'I Knew I Should Stop, but I Couldn't Control Myself': a qualitative study to explore the factors influencing adolescents' consumption of sugar-sweetened beverages and sugary snacks from a socio-ecological perspective.

To explore the factors influencing Taiwanese adolescents' consumption of sugar-sweetened beverages (SSB) and sugary snacks from a socio-ecological perspective. This study adopted a qualitative design by using face-to-face, in-depth interviews guided by a semistructured questionnaire. Eight junior high schools in New Taipei City and Changhua County, Taiwan, September to November 2018. Fifty-nine participants aged 12-14 years participated in this study. Reflexive thematic analysis was used to analyse the data. This study identified four themes to address the multifaceted factors that influence adolescents' consumption of SSB and sugary snacks. At the intrapersonal level, physiological factors, psychological factors, individual economic factors and taste preferences were mentioned in connection with people's consumption of SSB and sugary snacks. Positive or negative influences of parents, siblings, peers and teachers on SSB and sugary snack intake were identified at the interpersonal level. The availability of SSB and sugary snacks at home, their availability in vending machines or in school stores in the school environment and participants' access to convenience stores and hand-shaken drink shops in the broader community influenced SSB and sugary snack consumption. Additionally, food culture and food advertising were identified as influencing societal factors. Overall, this qualitative study determined not only that the consumption of SSB and sugary snacks is influenced by intrapersonal factors but also that interpersonal, environmental and societal factors affect adolescents' increased sugar intake. The findings are helpful to broaden the options for designing and developing interventions to decrease SSB and sugary snack consumption by adolescents.

Consumption of Sugar-Sweetened Beverages and Its Potential Health Implications in Indonesia

The broad availability of sugar-sweetened beverages (SSBs) in the Indonesian market, increasing trend of their consumption, combined with escalating incidence and prevalence of diabetes and related noncommunicable diseases (NCDs), and the ongoing debate on policies, have called for a comprehensive review as described in this study. Data was compiled from various sources but mainly gathered from the reported or published documents because of no direct access to the necessary data set. The lack of studies that assessed the direct relationship between SSB consumption and health outcomes in the Indonesian context also became a strong reason for the preparation of this review to highlight important points for further research, academic reviews, and debates on empiric policies to control sugar consumption at the population level. Sociocultural factors were an apparent and crucial determinant of the sweetness preferences of mainstream Indonesians. They were not capitalized in the available documents and should be embraced in future health promotional measures. Given the high contribution of carbohydrates and sugar to total energy intake in the Indonesian diet, it is pertinent to control the increasing trend of SSBs consumption through interventions on both the supply and demand sides.

Soda Consumption Among Mexican Construction Workers in the Context of the Sugar-Sweetened Beverage Tax.

This study explored the psychosocial determinants of consumption of soda and other taxed sugar-sweetened beverages (SSBs) in Mexican construction workers (CWs) and whether consumption changed as a result of the 2014 SSB tax. We conducted a qualitative case study involving in-depth interviews and focus groups (FGs) with 30 Mexican CWs; supplemented with descriptions of the food and beverages consumed during lunch breaks. We used NVivo 10 to classify information according to the analysis categories, primarily informed by the Reasoned Action Approach (RAA). CWs reported not having changed their consumption of soda and other taxed SSBs as a result of the SSB tax, despite the price increase and "knowing" the potential negative consequences of soda drinking. The most important determinants of soda consumption are a deep-seated social norm of soda drinking and use of soda drinking as part of their professional identity; their likeness for soda; a wide availability of soda in their environments; and a low perceived behavioral control (because they thought themselves as addicted to it). Participants indicated that the best way for them not to consume soda would be if it were not available. These findings lend support for the tight regulation of the availability of SSBs. To have a meaningful impact on these consumers, the SSB tax may need to be much higher. Policy-level interventions should be coupled with interventions at the individual and community levels that aim at denormalizing soda consumption, create new meanings in relation to water consumption, and develop behavioral control to decrease soda consumption.

Sugar-Sweetened Beverages Consumption and Associated Factors among Northeastern Chinese Children.

(1) Background: The present study aimed to investigate the association between home-related factors, community environmental factors, and sugar-sweetened beverages (SSBs) intake among Northeastern Chinese children. (2) Methods: Cross-sectional. Children with complete data were included in the analysis (n = 901). A questionnaire modified according to BEVQ-15 measured the intake of SSBs. Logistic regression was applied to determine the factors associated with the consumption of SSBs. IBM SPSS Statistics 23.0 was applied to perform all statistical analyses. (3) Results: The mean total amount of SSBs consumed on a weekly basis was 2214.04 ± 2188.62 mL. Children’s weekly pocket money, frequency of SSBs purchase, SSBs availability at home, the number of accessible supermarkets, and frequency of weekly visits to convenience stores were all found to be associated with a high intake of SSBs among all children. Among children of normal weight, the findings indicated that weekly pocket money, SSBs availability at home, and number of accessible supermarkets were associated with a high SSBs intake. At the same time, frequency of SSBs purchase, mother’s SSBs intake, and frequency of weekly visits to convenience stores were associated with a high SSBs intake among children with obesity. (4) Conclusions: Given the potential negative health effects of high SSBs intake, it is crucial to pay attention to home-related factors and community environment.

Evaluating the implementation and customer acceptability of a sugar-sweetened beverage reduction initiative in thirty Australian aquatic and recreation centres.

To assess the feasibility of implementation and customer perspectives of a sugar-sweetened beverage (SSB) reduction initiative across YMCA Victoria aquatic and recreation centres. Two data sources were used to assess implementation and customer acceptability. Photo audits were used to assess the type of drinks available for purchase 6 months prior to initiative implementation and 6 months after, in thirty centres. Change in the range of SSB targeted for removal, non-targeted SSB, as well as drinks classified as 'red' (limit), 'amber' (choose carefully) and 'green' (best choice), was reported. Customer surveys were conducted in three centres to assess acceptability and awareness of the initiative. Inductive and deductive thematic analysis was used to analyse customers' perspectives of the initiative. 30 aquatic and recreation centres in Victoria, Australia. 806 customers. At post-implementation, 87 % of centres had removed targeted SSB. 'Red' drinks reduced by an average of 4·4 drink varieties compared to pre-implementation (11·9 varieties) and 'green' drinks increased by 1·4 varieties (3·2 varieties pre-implementation). Customers were largely unaware of the SSB-reduction initiative (90 %) but supported YMCA Victoria in continuing the initiative (89 %), with many believing it would support children in making healthier choices. Implementation of an initiative that limited SSB availability across a large number of aquatic and recreation centres was feasible and considered acceptable by customers. Customers frequently mentioned the importance of protecting children from consuming SSB.

A cluster randomised controlled trial of a secondary school intervention to reduce intake of sugar-sweetened beverages: Mid-intervention impact of switchURsip environmental strategies.

Secondary schools provide an opportune setting for interventions addressing excessive sugar-sweetened beverage (SSB) intake in adolescence. This trial aimed to assess the impact of school environmental strategies, delivered as part of a broader intervention, among Year 7-9 students' SSB consumption. Between March and July 2018, we conducted a cluster randomised controlled trial with 862 students attending six secondary schools (3 intervention and 3 control) in New South Wales. The intervention targeted SSB availability, placement, promotion and pricing, and increased availability and promotion of water. Control schools followed their usual programmes. Primary outcomes included mean daily SSB consumption (millilitres) and mean daily percentage energy from SSB (kilojoules). Sub-group analysis explored primary outcomes for gender, school year level and frequency of canteen use. Of the 2265 eligible students, 1092 (50.2%) provided active parental consent and 940 (86.0%) participated in baseline data collection. No significant differences were observed between groups at follow-up for mean daily SSBs consumed (-10.17mL, CI: -24.78; 45.12, P=0.57) or mean daily percentage energy from SSBs (-0.20%, CI: -0.87; 0.47, P=.56). Significant effects were observed among girls in intervention compared to girls in control schools for mean daily SSB consumption (-52.02mL, CI 99.8; 94.14, P=.03) and mean daily percentage of energy from SSBs (-0.90%, CI: -1.82; 0.02, P=.05). At 3-month mid-intervention evaluation, the intervention failed to impact on mean daily consumption and mean percentage energy from SSBs, overall. However, an intervention effect was observed in girls. The limited overall effect is likely due to inadequate intervention dose related to the short duration, limiting opportunities for schools to fully implement the environmental strategies. SO WHAT?: A longer intervention duration with additional implementation support to allow adequate time to embed the strategies within the school is recommended. Implementation support strategies would ensure staff are supported throughout the process.

Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents.

The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents' sugar-sweetened beverage (SSB) intake. This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake - step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver's SSB behaviours, caregiver's SSB rules) and step 4: environmental (i.e., home SSB availability) level variables. Eight middle schools across four rural southwest Virginia counties in Appalachia. Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years). Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent's SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001). SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.

Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study

ABSTRACT Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment. Objectives: To assess the availability and advertising of the company’s beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge. Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted. Results: Two years following a voluntary pledge, the company’s carbonated SSBs were available for sale in 54% (CI: 45–63%) of schools with tuck shops and advertised in 31% (CI: 25–39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs. Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.

A rapid review of stocking and marketing practices used to sell sugar-sweetened beverages in U.S. food stores.

SummarySugar‐sweetened beverages (SSBs) are a primary source of added sugars in the American diet. Habitual SSB consumption is associated with obesity and noncommunicable disease and is one factor contributing to U.S. health disparities. Public health responses to address marketing‐mix and choice‐architecture (MMCA) strategies used to sell SSB products may be required. Thus, our goal was to identify original research about stocking and marketing practices used to sell SSB in U.S. food stores. We used Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and the World Health Organization (WHO) protocol for rapid reviewing. We searched six databases and Google Scholar using key terms focused on store type and SSB products. We characterized results using an MMCA framework with categories place, profile, portion, pricing, promotion, priming or prompting, and proximity. Our search resulted in the identification of 29 articles. Most results focused on profile (e.g., SSB availability) (n = 13), pricing (e.g., SSB prices or discounts) (n = 13), or promotion (e.g., SSB advertisements) (n = 13) strategies. We found some evidence of targeted MMCA practices toward at‐risk consumers and differences by store format, such as increased SSB prominence among supermarkets. The potential for systematic variations in MMCA strategies used to sell SSB requires more research. We discuss implications for public health, health equity, and environmental sustainability.

Effects of a Community-Based Pilot Intervention on Home Food Availability among U.S. Households.

The purpose of this study was to assess the effects of a pilot community-based behavioral intervention on the home food environment in U.S. households. Parents (21 females, 2 males; age = 36 ± 5.5 years; 78% Hispanic) of elementary school-aged children attended a 10-week dietary improvement behavioral intervention targeting an increase in fruit and vegetable consumption and a reduction in sugar intake. Home food availability of fruit, vegetables, and sugar-laden foods and beverages were assessed before and after the intervention using a modified version of the Home Food Inventory. Relative to baseline, the intervention resulted in significant increases in fruit availability (7.7 ± 3.2 items vs. 9.4 ± 3.1 items; p = 0.004) and low sugar cereal (2.3 ± 1.4 types vs. 2.7 ± 1.4 types; p = 0.033). There was a significant reduction in sugar-sweetened beverage availability (3.2 ± 1.9 types vs. 1.7 ± 1.3 types; p = 0.004). There was a significant increase in the number of households with accessible ready-to-eat vegetables and fruit, and a significant reduction in available prepared desserts, and candy (p < 0.01). There were no significant changes in the availability of vegetables and sugar-laden cereals. The current intervention resulted in positive changes in the home food environment. Further research to confirm these results in a randomized controlled trial is warranted.

Impact and acceptance of a state-wide policy to remove sugar-sweetened beverages in hospitals in New South Wales, Australia.

Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P<.001). The majority (79.5%) of the 2394 surveyed supported SSB removal, with nearly half (48.4%) reporting it would improve people's health. A minority (13.4%) did not support SSB removal, more than half (61.4%) of those said individuals should have free choice. More staff than visitors were aware of the change (61.9% vs 31.2%; P<.0001). Availability of SSBs in NSW hospitals was significantly reduced after implementation of a policy to remove them from sale. There was strong staff and visitor support for the initiative. SO WHAT?: This study provides clear evidence that a policy designed to provide a healthy hospital retail drink environment can be successfully implemented at scale with high levels of support from staff and visitors. A state-wide policy initiative to remove SSBs from sale in NSW hospital food outlets in 2017 was successfully implemented, with a sample of outlets having nearly 100% compliance. The majority of staff and visitors (80%) supported the removal of SSBs, mostly because they believed it would improve individual and population health.