Misperceptions of peer norms as a risk factor for sugar-sweetened beverage consumption among secondary school students

Research has shown that excess calories from sugar-sweetened beverages are associated with weight gain among youth. There is limited knowledge, however, regarding perception of sugar-sweetened beverage consumption norms. This study examined the extent of misperception about peer sugar-sweetened beverage consumption norms and the association of perceived peer norms with personal self-reported consumption. Among 3,831 6th- to 12th-grade students in eight schools who completed anonymous cross-sectional surveys between November 2008 and May 2009, students' personal perception of the daily sugar-sweetened beverage consumption norm in their school within their grade (School Grade group) was compared with aggregate self-reports of daily sugar-sweetened beverage consumption for each School Grade group. The median daily sugar-sweetened beverage consumption from personal reports was one beverage in 24 of 29 School Grade groups, two beverages in four School Grade groups, and three beverages in one School Grade group. Seventy-six percent of students overestimated the daily norm in their School Grade group, with 24% perceiving the norm to be at least three beverages or more per day. Fixed-effects multiple regression analysis showed that the perceived peer sugar-sweetened beverage consumption norm was much more positively associated with personal consumption than was the estimated actual sugar-sweetened beverage consumption norm per School Grade group. Misperceptions of peer sugar-sweetened beverage consumption norms were pervasive and associated with unhealthy sugar-sweetened beverage consumption behavior. These misperceptions may contribute to intake of excess calories, potentially contributing to adolescent obesity. Future research should assess the pervasiveness of sugar-sweetened beverage consumption misperceptions in other school populations as well as causes and consequences of these misperceptions. Health professionals may wish to consider how normative feedback interventions could potentially reduce consumption.     

Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents

The purpose of this study was to investigate whether perceived parenting practices and parenting style dimensions (strictness and involvement) are associated with adolescents' consumption of sugar-sweetened beverages. In this cross-sectional study, secondary school students (n = 383, mean age 13.5 years) completed a self-administered questionnaire on their consumption of sugar-sweetened beverages, attitude, social influences, self-efficacy, habit strength, food-related parenting practices and the general parenting style dimensions of 'strictness' and 'involvement'. Data were analyzed using multiple linear regression analyses. More restrictive parenting practices were associated with lower consumption of sugar-sweetened beverages (beta = -38.0 ml; 95% CI = -48.1, -28.0). This association was highly mediated ( approximately 55%) by attitude, self-efficacy and modeling from parents. Nevertheless, a significant direct effect remained (beta = -17.1 ml; 95% CI = -27.2, -6.90). Interactions between perceived parenting style and parenting practices showed that the association between parenting practices and sugar-sweetened beverage consumption was stronger among adolescents who perceived their parents as being moderately strict and highly involved. Parents influence their children's sugar-sweetened beverage consumption and should therefore be involved in interventions aimed at changing dietary behaviors. Interventions aimed at the promotion of healthy parenting practices will improve when they are tailored to the general parenting style of the participants.     

The association between home environmental variables and soft drink consumption among adolescents. Exploration of mediation by individual cognitions and habit strength

Soft-drink consumption is one of the important target behaviours for the prevention of excessive weight gain among adolescents. To be able to modify these behaviours in obesity prevention interventions, further understanding of the underlying factors and mediational pathways is required. The present study aimed to explore associations between home environment variables and adolescent soft drink consumption and potential mediation of these associations by individual cognitions derived from the Theory of Planned Behaviour and habit strength. The ENDORSE study (N=1005) provided data on soft drink consumption and on home environment variables related to soft drink consumption (availability, accessibility, parental modelling, and parental rules), cognitive variables (intention, attitude, perceived behaviour control, and parental norm) and habit strength. Multiple mediation analyses were conducted using regression analyses according to the steps described by MacKinnon to assess the association between home environment variables and soft drink consumption and mediation of these associations by cognitive variables and habit strength. The bootstrapping method was used to calculate the confidence intervals. There were significant associations between the home environment variables and soft drink consumption. After inclusion of the mediators the strength of these associations was reduced. In the multiple mediator models, habit strength (39.4-62.6%) and intention (19.1-36.6%) were the strongest mediators. Intention and habit strength partly mediate the associations between home environment factors and soft drink consumption, suggesting that home environment variables influence soft drink consumption both indirectly and directly.     

控制儿童青少年含糖饮料消费国际策略研究进展

儿童青少年摄入过量含糖饮料,会增加龋齿和肥胖等多种疾病的发生风险。本文对中国儿童青少年含糖饮料消费状况及国内外降低含糖饮料消费的策略措施进行综述,旨在为中国出台相关政策控制儿童青少年含糖饮料摄入提供借鉴。总结发现,一些国家采取了征收糖税、实施正面标识体系、限制营销、宣传教育等措施控制儿童含糖饮料消费,而中国主要采取大众宣传教育的方式,建议中国也应尽快采取综合政策措施控制儿童含糖饮料摄入。     

Modeling Parental Influence on Food Consumption among Chinese Adolescents through Self-Efficacy: A Path Analysis

This study aimed to investigate the associations between perceived parental control, perceived parental modeling and parent–teen co-decision making, and fruit and vegetable (F&V) and sugar-sweetened beverage and junk food (S&J) consumption among Chinese adolescents, and examine whether self-efficacy mediates the associations. Data were collected in a cross-sectional survey of Chinese adolescents carried out in the fall of 2019. The questionnaires were adapted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Ordinary least-squares regressions and a path analysis were performed to evaluate the hypothesized associations. The final sample included 3595 Chinese adolescents (mean (SD) age, 14.67 (1.73) years; 52.82% (n = 1899) males). Perceived parental control was positively associated with adolescents’ F&V consumption, and was negatively associated with adolescents’ S&J consumption. Perceived parental modeling and parent–teen co-decision making were both positively associated with adolescents’ F&V consumption and negatively associated with their S&J consumption. Adolescents’ self-efficacy was positively associated with F&V consumption and negatively associated with S&J consumption. These results suggest that serving as a positive role model, having adolescents participate in the decision-making process, and increasing adolescents’ self-efficacy can be feasible and efficacious strategies to improve the nutritional quality of Chinese adolescents’ diets.     

Impact of social norms and social support on diet,physical activity and sedentary behaviour of adolescents: a scoping review

The prevalence of non‐communicable diseases (NCDs) in adulthood is rapidly increasing, and it is essential that risk factors for NCDs be addressed in adolescence, both for the health of individuals during adolescence and for their health in later life. These risk factors include diet, physical activity and sedentary behaviour. No literature has been published that comprehensively summarizes the impact of social norms and social support on these behaviours among adolescents. Therefore, a scoping review was conducted to determine the extent of recent (since 2000) literature available on this topic. A comprehensive search strategy was used to search PubMed and EMBASE for eligible reviews. Review papers (narrative reviews, systematic and non‐systematic reviews) published in English in peer‐reviewed journals from 2000 to February 2013 were included in the overview. Two of the authors screened the titles and abstracts of the search results independently. Thirty reviews were included in the scoping review. This scoping review has shown sufficient evidence for parental influences, and especially the positive impact of an authoritative parenting style, on healthy behaviours of adolescents, although the evidence is somewhat more compelling for diet than for physical activity and sedentary behaviour. More research is needed to investigate parental and family influences on physical activity and sedentary behaviour. And the effect of peer influences on diet, physical activity and sedentary behaviour of adolescents requires further investigation. The evidence presented affirms the consideration of social norms and social support in the development of interventions to address these behaviours in adolescents. The evidence regarding parenting style provides some concrete guidance for such interventions.     

Design and evaluation protocol of "FATaintPHAT", a computer-tailored intervention to prevent excessive weight gain in adolescents

Background  

Computer tailoring may be a promising technique for prevention of overweight in adolescents. However, very few well-developed, evidence-based computer-tailored interventions are available for this target group. We developed and evaluated a computer-tailored intervention for adolescents targeting energy balance-related behaviours: i.e. consumption of snacks, sugar-sweetened beverages, fruit, vegetables, and fibre, physical activity, and sedentary behaviours. This paper describes the planned development of a school-based computer-tailored intervention aimed at improving energy balance-related behaviours in order to prevent excessive weight gain in adolescents, and the protocol for evaluating this intervention.     

Perceived Parental Attitudes Are Indirectly Associated with Consumption of Junk Foods and Sugar-Sweetened Beverages among Chinese Adolescents through Home Food Environment and Autonomous Motivation: A Path Analysis

This study aimed to use path analysis to determine the association between perceived parental attitudes toward restricting junk food (JF)/sugar-sweetened beverage (SSB) intake and JF/SSB consumption among Chinese adolescents, and whether JF/SSB availability in the home environment and autonomous motivation of adolescents mediated the association. A cross-sectional survey was conducted using questionnaires adapted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to collect data on 3819 participants with an average age of 14.7 years (SD = 1.7). Spearman correlations and path analysis were performed. It was found that perceived parental attitudes were not directly associated with adolescents’ JF/SSB consumption frequency, but indirectly related to them through JF/SSB availability in the home environment and autonomous motivation of adolescents. When parents held a less positive attitude toward JF/SSB consumption and kept less JFs/SSBs at home, youth displayed more autonomous motivation for restricting JF/SSB intake and consumed fewer JFs/SSBs.     

Peer Reviewed: Effect of School District Policy Change on Consumption of Sugar-Sweetened Beverages Among High School Students, Boston, Massachusetts, 2004-2006

Introduction

Consumption of sugar-sweetened beverages has increased among youth in recent decades, accounting for approximately 13% of total calories consumed. The Boston Public Schools passed a policy restricting sale of sugar-sweetened beverages in Boston schools in June 2004. The objective of this study was to determine whether high school students'' consumption of sugar-sweetened beverages declined after this new policy was implemented.

Methods

We conducted a quasi-experimental evaluation by using data on consumption of sugar-sweetened beverages by public high school students who participated in the Boston Youth Survey during February through April 2004 and February through April 2006 (N = 2,033). We compared the observed change with national trends by using data from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Regression methods were adjusted for student demographics.

Results

On average, Boston''s public high school students reported daily consumption of 1.71 servings of sugar-sweetened beverages in 2004 and 1.38 servings in 2006. Regression analyses showed significant declines in consumption of soda (−0.16 servings), other sugar-sweetened beverages (−0.14 servings), and total sugar-sweetened beverages (−0.30 servings) between 2004 and 2006 (P < .001 for all). NHANES indicated no significant nationwide change in adolescents'' consumption of sugar-sweetened beverages between 2003-2004 and 2005-2006.

Discussion

Data from Boston youth indicated significant reductions in consumption of sugar-sweetened beverages, which coincided with a policy change restricting sale of sugar-sweetened beverages in schools. Nationally, no evidence was found for change in consumption of sugar-sweetened beverages among same-aged youth, indicating that implementing policies that restrict the sale of sugar-sweetened beverages in schools may be a promising strategy to reduce adolescents'' intake of unnecessary calories.     

Children and adolescents' choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups.

PURPOSE: To determine associations between intakes of the primary food and beverage sources of added sugars and intakes of key nutrients and food pyramid groups among U.S. children aged 6-17 years. METHODS: The 1994-96 and 1998 U.S. Department of Agriculture (USDA) Continuing Survey of Food Intakes by Individuals (CSFII) were used to examine the diets of U.S. children aged 6-17 years, who provided 2 full days of dietary data. The nationally representative sample (n = 3038) included children age 6-11 (n = 1913) and adolescents age 12-17 (n = 1125). Food codes for sweetened foods and beverages were selected from the USDA Food Coding Scheme and categorized into five food and beverage categories. The Statistical Analysis System software program was used to recode and format the data for statistical analysis and the Survey Data Analysis System was used to apply sample weights and generate statistical procedures. RESULTS: The consumption of sweetened dairy products was positively associated with calcium intakes for children and adolescents. Consumption of presweetened cereals increased the likelihood of the children and adolescents meeting recommendations for the essential shortfall micronutrients calcium, folate, and iron, whereas the consumption of sugar-sweetened beverages, sugars and sweets, and sweetened grains decreased the likelihood of meeting the Dietary Reference Intakes (DRI) for these nutrients. Only children who were nonconsumers of sugar-sweetened beverages had a mean calcium intake that met the adequate intakes (AI). Consumption of sweetened dairy products and presweetened cereals was positively associated with the number of dairy servings consumed per day for both age groups. CONCLUSIONS: On average, consumption of sweetened dairy foods and beverages and presweetened cereals had a positive impact on children and adolescents' diet quality, whereas sugar-sweetened beverages, sugars and sweets, and sweetened grains had a negative impact on their diet quality.     

Does weight status influence weight-related beliefs and the consumption of sugar-sweetened beverages and fast food purchases in adolescents?

OBJECTIVE: To determine if weight status affects the relationship between weight-related beliefs and consumption of sugar-sweetened beverages (SSB) and fast and convenience store food purchases (FCFP). DESIGN: Observational, cross-sectional. SETTING: Twin Cities Metropolitan area, Minnesota, USA. METHODS: Body composition and psychosocial survey were obtained for 345 adolescents. General Linear Models tested adjusted (age and sex) associations between weight-related beliefs and consumption of SSB and FCFP. Significant associations were tested for moderation by weight status. RESULTS: SSB was positively related to perceptions that people worry too much about their weight (β = 0.103, p = 0.016), with no moderation present. FCFP were positively associated to perceived barriers to maintaining a healthy weight (β = 0.042, p = 0.004) with a subsequent significant interaction by weight status. Stratified models showed a significant association between perceived barriers to a healthy weight and FCFP for overweight adolescents (β = 0.345, p = 0.022). CONCLUSIONS: Addressing perceived barriers to a healthy diet may lead to important risk reduction.     

Adolescent soft drink consumption, television viewing and habit strength. Investigating clustering effects in the Theory of Planned Behaviour

Clustering refers to the co-occurrence of behaviour and may be particularly relevant in light of the present obesity epidemic. Since evidence regarding clustering of motivational and habitual constructs within the framework of the Theory of Planned Behaviour (TPB) is limited, clustering effects of TPB cognitions and habit strength regarding soft drink consumption and television viewing were studied in a sample of Dutch adolescents (n = 312; mean age = 14.62; SD = 1.62) using cross-sectional data. Results showed that not only soft drink consumption and television viewing cluster (r = .42), but also their intentional (r = .36) and habitual (r = .37) constructs. Furthermore, unmediated effects were found between habit strength and its respective behaviour, whereas habit strength was associated with its clustered behaviour through decreased perceptions of controllability. Our findings suggest that interventions that aim to change habitual soft drink consumption and television viewing may need to incorporate an environmental component, as well as explore the potential usefulness of synergistic effects of incorporating multiple clustered behaviours, as well as their corresponding beliefs and habits in health behaviour change interventions.     

Association between Emotional Eating and Frequency of Unhealthy Food Consumption among Taiwanese Adolescents

Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwan Adolescent to Adult Longitudinal Study (TAALS) were fitted into multivariate logistic regression models adjusted for sex, school type, Body Mass Index (BMI), eating while doing something, nutrition label reading, skipping breakfast, smoking, binge drinking, sedentary lifestyle, physical activity, peer and school support, and parental education level. Among the 18,461 participants (48.5% male and 51.5% female), those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18–2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12–2.49), processed meat products (OR = 1.92, 95% CI: 1.78–2.08), dessert foods (OR = 2.49, 95% CI: 2.31–2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70–1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups. In conclusion, adolescents with high emotional eating were more likely to report frequent consumption of unhealthy foods in Taiwan. Our findings showed that male participants appeared to consume fast foods, high-fat snacks, processed meat, and SSBs more often and dessert foods less often than females. Future longitudinal studies are recommended for understanding the causal relationship between emotional eating and unhealthy food consumption.     

Reducing Calories and Added Sugars by Improving Children's Beverage Choices

Because childhood obesity is such a threat to the physical, mental, and social health of youth, there is a great need to identify effective strategies to reduce its prevalence. The objective of this study was to estimate the mean calories from added sugars that are saved by switching sugar-sweetened beverages (including soda, fruit-flavored drinks, and sport drinks) and flavored milks consumed to unflavored low-fat milk (<1% fat) at meals and water between meals. Simulation analyses used 24-hour dietary recall data from the third School Nutrition Dietary Assessment Study (n=2,314), a 2005 national cross-sectional study of schools and students participating in the National School Lunch Program, to estimate changes in mean calories from added sugars both at and away from school. Overall, these changes translated to a mean of 205 calories or a 10% savings in energy intake across all students (8% among children in elementary school and 11% in middle and high schools). Eighty percent of the daily savings were attributed to beverages consumed away from school, with results consistent across school level, sex, race/ethnicity, and weight status. Children's consumption of sugar-sweetened beverages at home contributed the greatest share of empty calories from added sugars. Such findings indicate that parental education should focus on the importance of reducing or eliminating sugar-sweetened beverages served at home. This conclusion has implications for improving children's food and beverage environments for food and nutrition educators and practitioners, other health care professionals, policy makers, researchers, and parents.     

Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children

OBJECTIVE: To examine the relationship between consumption of sugar-sweetened beverages (eg, nondiet carbonated drinks and fruit drinks) and the prevalence of overweight among preschool-aged children living in Canada. DESIGN: Data come from the Longitudinal Study of Child Development in Québec (1998-2002). SUBJECTS/SETTING: A representative sample (n=2,103) of children born in 1998 in Québec, Canada. A total of 1,944 children (still representative of the same-age children in this population) remaining at 4 to 5 years in 2002 participated in the nutrition study. STATISTICAL ANALYSES PERFORMED: Data were collected via 24-hour dietary recall interview. Frequency of sugar-sweetened beverage consumption between meals at age 2.5, 3.5, and 4.5 years was recorded and children's height and weight were measured. Multivariate regression analysis was done with Statistical Analysis System software. Weighted data were adjusted for within-child variability and significance level was set at 5%. RESULTS: Overall, 6.9% of children who were nonconsumers of sugar-sweetened beverages between meals between the ages of 2.5 to 4.5 years were overweight at 4.5 years, compared to 15.4% of regular consumers (four to six times or more per week) at ages 2.5 years, 3.5 years, and 4.5 years. According to multivariate analysis, sugar-sweetened beverage consumption between meals more than doubles the odds of being overweight when other important factors are considered in multivariate analysis. Children from families with insufficient income who consume sugar-sweetened beverages regularly between the ages of 2.5 and 4.5 years are more than three times more likely to be overweight at age 4.5 years compared to nonconsuming children from sufficient income households. CONCLUSIONS: Regular sugar-sweetened beverage consumption between meals may put some young children at a greater risk for overweight. Parents should limit the quantity of sweetened beverages consumed during preschool years because it may increase propensity to gain weight.     

Understanding How Latino Parents Choose Beverages to Serve to Infants and Toddlers

To determine Latino parents’ beliefs on the health effects of beverages on infants and toddlers, their sources of information on beverages and perceived barriers to following guidelines for healthy beverage consumption by children. We conducted 29 interviews with parents of Latino children ages 6–36 months. Parents were recruited in three community health centers in Northern California. The interviews were recorded, transcribed and analyzed using standard qualitative methods. The following dominant themes emerged. Parents believed that water and milk were healthy beverages for children and that sugar-sweetened beverages (SSBs) were unhealthy. Views on 100 % fruit juice were mixed. Parents distinguished between homemade beverages such as “agua fresca” which they considered healthy, despite containing added sugar, and beverages from stores which were viewed as unhealthy. Participants’ main source of information on beverages was the federal nutrition program for Women, Infants, and Children (WIC). Parents were confused, however, as to why WIC provides juice yet counseled parents to avoid giving their children juice. Parents preferred to receive information on beverages from experts. Differing practices among family members regarding which beverages they provide to children was the most important barrier to following beverage guidelines. Our study suggests that Latino parents are receptive to counseling on beverages from expert sources. Such counseling should address both store-bought and homemade beverages. The WIC program is a key source of information on beverages for Latino parents; thus counseling offered by WIC should be evidence-based and avoid mixed messages.     

Einfluss der Ernährung und des Essverhaltens auf die Entwicklung der Adipositas bei Kindern und Jugendlichen

Diet is of major interest in research on the etiology of obesity. Research in this field comprises investigation of the role of individual nutrients and foods, nutrient composition, as well as dietary patterns and habits. Longitudinal data on the association between dietary factors and the development of obesity in childhood and adolescence are sparse; therefore, conclusions on the impact of energy density, consumption of carbohydrates and proteins, snack foods and fast food, meal patterns and speed of eating cannot be drawn. More data exist with respect to the role of energy intake and consumption of fat and sugar-sweetened beverages; however, findings are inconsistent. This could be due to methodological shortcomings that mark dietary assessment in children and adolescents. However, as a direct modulator of energy balance, diet still needs to be part of a comprehensive strategy to combat overweight and obesity in children and adolescents.