In this cross-sectional analysis, we examined the dietary and activity correlates of SSB consumption among girls and boys from a population based sample of 8th and 11th grade children in Texas. The analysis included an examination of the prevalence and levels of consumption of two major types of SSB (regular sodas, and flavored and sports beverages), by gender and across various socio-demographic characteristics.
Several findings are noteworthy. First, when total SSB (both regular sodas and flavored and sports beverages) is considered, the prevalence of SSB consumption among these children is very high, with 28% of children consuming three or more SSBs a day. Second, the amount of SSB consumption varies by socio-demographic characteristics as well as by type of SSB. Third, the study is the first to demonstrate pronounced and consistent associations of a variety of dietary and activity behaviors with the level of SSB consumption. Fourth, these associations vary substantially and systematically by the type of beverage considered.
The high level of consumption of sugar-sweetened beverages among adolescents has generated considerable concern because of its potential to increase weight gain. It has been estimated that daily consumption of just 1 12 oz. can of soda or other SSB could lead to as much as 15-lb weight gain in a year28
. In light of this, our findings relating to the high prevalence and level of soda and other SSB consumption among 8th
grade children are troubling. Approximately 10% of these children report consuming three or more sodas on the previous day. Average consumption of SSBs across all children is about 1.6 servings per day; this is likely an underestimate, as the questions relating to consumption were top-coded at 3, and do not include other beverages such as energy drinks or sweetened milk drinks, which frequently contain high levels of sugar.
The findings relating to differences in level of consumption by socio-demographic category have important implications for the development of interventions. Boys consume higher levels of SSB than girls, and soda consumption in particular increases with grade level among boys. African-Americans consume soda at lower levels than Hispanics or Whites, but their level of FSB consumption is substantially higher. Soda consumption increases with economic disadvantage among females, but less so among males. Different patterns of SSB consumption among different demographic subgroups, especially across racial/ethnic categories, can and should be accommodated in efforts to tailor interventions.
Our most important findings relate to the difference in behavioral correlates of FSB and soda consumption. Both soda consumption and FSB consumption are positively associated with various unhealthy dietary practices and sedentary behaviors, suggesting that these practices may be universal in the adolescent population. However, there is clear divergence between the two categories of SSBs with regard to the consumption of healthy items, such as milk, fruit and vegetables, with FSB showing a positive association and sodas showing a negative association. Similarly, physical activity increases with level of FSB consumption but decreases with level of soda consumption. The most likely explanation for these findings is that FSBs have been successfully marketed as beverages consistent with a healthy lifestyle, to set them apart from sodas. Often, these beverages contain a minimal percentage of fruit juice, or more commonly, contain artificial fruit flavors, conveying the impression that the drink is more healthful than it actually is. This may explain our finding that the behavioral correlates of FSB consumption are very similar to those of fruit juice consumption, while remaining distinct from the correlates of soda consumption. Thus, it is apparent that consumers differentiate between sodas and the sports and flavored drink groups. This product differentiation between sodas and FSB has not been made by public health advocates and scholars, who focus instead on the fact that all these beverages are sugar-sweetened13, 15, 29
. While this approach is consistent from a physiological point of view, our findings clearly underscore its inadequacy as a paradigm for informing analyses as well as the development of interventions. Analyses that examine sugar-sweetened beverages as a single category mask the differential behavioral associations with categories of SSB. Recognition of the different behavioral contexts of different categories of SSB needs to be an important input in intervention design, as well as in assessment of SSB consumption.
This study does have limitations. The associations are cross-sectional, and provide no information on the direction of causality. Our instruments for measuring both beverage consumption and behavioral correlates are blunt, given that there are only 4 response categories for most items, and that the measures are derived from self-report. Despite adjustment for several covariates, there may be some residual confounding from unmeasured variables. Nevertheless, it is unlikely that the findings are an artifact, given the large size of the dataset, and the similarity of the results across conceptually consistent categories. In conclusion, this study describes novel findings relating to the behavioral correlates of SSB consumption that may be important for intervention design.