Shape Up Somerville: change in parent body mass indexes during a child-targeted, community-based environmental change intervention.

OBJECTIVES: We investigated the body mass index (BMI; weight in pounds/[height in inches](2) × 703) of parents whose children participated in Shape Up Somerville (SUS), a community-based participatory research study that altered household, school, and community environments to prevent and reduce childhood obesity. METHODS: SUS was a nonrandomized controlled trial with 30 participating elementary schools in 3 Massachusetts communities that occurred from 2002 to 2005. It included first-, second-, and third-grade children. We used an inverse probability weighting estimator adjusted for clustering effects to isolate the influence of SUS on parent (n=478) BMI. The model's dependent variable was the change in pre- and postintervention parent BMI. RESULTS: SUS was significantly associated with decreases in parent BMIs. SUS decreased treatment parents' BMIs by 0.411 points (95% confidence interval=-0.725, -0.097) relative to control parents. CONCLUSIONS: The benefits of a community-based environmental change childhood obesity intervention can spill over to parents, resulting in decreased parental BMI. Further research is warranted to examine the effects of this type of intervention on parental health behaviors and health outcomes.

The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults.

OBJECTIVE: Research is limited on whether mistrust of tap water discourages plain water intake and leads to a greater intake of sugar-sweetened beverages (SSB). The objective of the present study was to examine demographic differences in perceptions of tap water safety and determine if these perceptions are associated with intake of SSB and plain water. DESIGN: The study examined perceptions of tap water safety and their cross-sectional association with intake of SSB and plain water. Racial/ethnic differences in the associations of tap water perceptions with SSB and plain water intake were also examined. SETTING: Nationally weighted data from the 2010 HealthStyles Survey (n 4184). SUBJECTS: US adults aged ≥18 years. RESULTS: Overall, 13·0 % of participants disagreed that their local tap water was safe to drink and 26·4 % of participants agreed that bottled water was safer than tap water. Both mistrust of tap water safety and favouring bottled water differed by region, age, race/ethnicity, income and education. The associations of tap water mistrust with intake of SSB and plain water were modified by race/ethnicity (P < 0·05). Non-white racial/ethnic groups who disagreed that their local tap water was safe to drink were more likely to report low intake of plain water. The odds of consuming ≥1 SSB/d among Hispanics who mistrusted their local tap water was twice that of Hispanics who did not (OR = 2·0; 95 % CI 1·2, 3·3). CONCLUSIONS: Public health efforts to promote healthy beverages should recognize the potential impact of tap water perceptions on water and SSB intake among minority populations.

Consumption of sugar-sweetened beverages among US adults in 6 states: Behavioral Risk Factor Surveillance System, 2011.

INTRODUCTION: Sugar-sweetened beverage (SSB) intake is linked to weight gain. Our objective was to examine state-specific SSB intake and behavioral characteristics associated with SSB intake. METHODS: We used data from the 2011 Behavioral Risk Factor Surveillance System for 38,978 adults aged 18 years or older from 6 states: Delaware, Hawaii, Iowa, Minnesota, New Jersey, and Wisconsin. Multivariate logistic regression was used to estimate adjusted odds ratios for characteristics associated with SSB intake from regular soda and fruit drinks. RESULTS: Overall, 23.9% of adults drank SSBs at least once a day. Odds of drinking SSBs 1 or more times per day were significantly greater among younger adults; males; non-Hispanic blacks; adults with lower education; low-income adults or adults with missing income data; adults living in Delaware, Iowa, and Wisconsin versus those living in Minnesota; adults with fruit intake of less than 1 time a day versus 1 or more times a day; adults who were physically inactive versus highly active adults; and current smokers versus nonsmokers. Odds for drinking SSBs 1 or more times per day were significantly lower among adults with 100% fruit juice intake of less than 1 time per day versus 1 or more times per day and among adults who drank alcohol versus those who did not drink alcohol. CONCLUSION: SSB intake varied by states and certain sociodemographic and behavioral characteristics. States can use findings from this study to tailor efforts to decrease SSB intake and to encourage consumption of more healthful beverages (eg, water) among their high-risk populations.

Childhood obesity task forces established by state legislatures, 2001-2010.

INTRODUCTION: States and communities are considering policy and environmental strategies, including enacting legislation, to reduce and prevent childhood obesity. One legislative approach has been to create task forces to understand key issues and develop a course of action. The goal of this study was to describe state-level, childhood obesity task forces in the United States created by legislation from 2001 through 2010. METHODS: We used the Center for Disease Control and Prevention's Division of Nutrition, Physical Activity, and Obesity database to identify state-level childhood obesity task forces created through legislation from 2001 through 2010. RESULTS: We identified 21 states that had enacted legislation creating childhood obesity task forces of which 6 had created more than one task force. Most task forces were charged with both gathering and reviewing information and making recommendations for obesity-prevention actions in the state. Most legislation required that task forces include representation from the state legislature, state agencies, community organizations, and community members. CONCLUSION: Evaluation of the effectiveness of obesity-prevention task forces and the primary components that contribute to their success may help to determine the advantages of the use of such strategies in obesity prevention.

Behaviors and attitudes associated with low drinking water intake among US adults, Food Attitudes and Behaviors Survey, 2007.

INTRODUCTION: Water is vital for life, and plain water is a calorie-free option for hydration. Increasing consumption of drinking water is a strategy to reduce energy intake and lose or maintain weight; however, information on the characteristics of consumers who drink water is limited. Our objective was to describe the characteristics of people who have a low intake of drinking water and to determine associations between their behaviors and attitudes and their intake of water. METHODS: We analyzed data from a nationally representative sample of 3,397 US adults who participated in the National Cancer Institute's 2007 Food Attitudes and Behaviors Survey. Multivariable logistic regression was used to identify sociodemographic characteristics and health-related behaviors and attitudes associated with self-reported drinking water intake of less than 4 cups per day. RESULTS: Overall, 7% of adults reported no daily consumption of drinking water, 36% reported drinking 1 to 3 cups, 35% reported drinking 4 to 7 cups, and 22% reported drinking 8 cups or more. The likelihood of drinking less than 4 cups of water daily was significantly higher among participants aged 55 years or older than among those aged 18 to 34 (adjusted odds ratio [AOR], 1.3), among residents of the Northeast than among residents of the South (AOR, 1.4), among participants who consumed 1 cup or less of fruits or vegetables per day than among those who consumed 4.5 cups or more (AOR, 3.0), among participants who did not exercise than among those who exercised 150 minutes or more per week (AOR, 1.7), and among participants who were neither trying to gain nor lose weight than among those trying to lose weight (AOR, 1.3). CONCLUSION: Low drinking water intake was associated with age, region of residence, and several unhealthful behaviors and attitudes. Understanding characteristics associated with low drinking water intake may help to identify populations that could benefit from interventions to help adults drink more water.

Factors associated with sugar-sweetened beverage intake among United States high school students.

This cross-sectional study examined associations of demographic characteristics, weight status, availability of school vending machines, and behavioral factors with sugar-sweetened beverage (SSB) intake, both overall and by type of SSB, among a nationally representative sample of high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,209 students (grades 9-12) were used. SSB intake was based on intake of 4 nondiet beverages [soda, other (i.e., fruit-flavored drinks, sweetened coffee/tea drinks, or flavored milk), sports drinks, and energy drinks]. Nationwide, 64.9% of high school students drank SSB ≥1 time/d, 35.6% drank SSB ≥2 times/d, and 22.2% drank SSB ≥3 times/d. The most commonly consumed SSB was regular soda. Factors associated with a greater odds for high SSB intake (≥3 times/d) were male gender [OR = 1.66 (95% CI = 1.41,1.95); P < 0.05], being non-Hispanic black [OR = 1.87 (95% CI = 1.52, 2.29); P < 0.05], eating at fast-food restaurants 1-2 d/wk or eating there ≥3 d/wk [OR = 1.25 (95% CI = 1.05, 1.50); P < 0.05 and OR = 2.94 (95% CI = 2.31, 3.75); P < 0.05, respectively] and watching television >2 h/d [OR = 1.70 (95% CI = 1.44, 2.01); P < 0.05]. Non-Hispanic other/multiracial [OR = 0.67 (95% CI = 0.47, 0.95); P < 0.05] and being physically active ≥60 min/d on <5 d/wk were associated with a lower odds for high SSB intake [OR = 0.85 (95% CI = 0.76, 0.95); P < 0.05]. Weight status was not associated with SSB intake. Differences in predictors by type of SSB were small. Our findings of significant associations of high SSB intake with frequent fast-food restaurant use and sedentary behaviors may be used to tailor intervention efforts to reduce SSB intake among high-risk populations.

Healthy Habits, Happy Homes: methods and baseline data of a randomized controlled trial to improve household routines for obesity prevention.

OBJECTIVE: To develop a home-based intervention for parents of 2-5 year old children to promote household routines to prevent overweight/obesity. METHODS: We recruited 121 children from health centers in Boston between 2011 and 2012 and randomized 62 to intervention and 59 to the control condition. The 6-month intervention included 1) motivational coaching at home and by phone with a health educator, 2) mailed educational materials, and 3) weekly text messages. The intervention promoted three household routines: eating meals as a family, obtaining adequate sleep, and limiting screen time. RESULTS: Of the 121 children, mean (SD) age was 4.0 (1.1) years; 52% were Hispanic, 34% Black, and 14% White/Other. Nearly 60% of the sample had annual household incomes ≤ $20,000. Approximately 64% of families reported eating together ≥ 7 times per week, however, many meals were eaten in front of a TV. Over half of the children slept less than the recommended 11h/night and 78% viewed ≥ 2 h/day of screen time. CONCLUSIONS: Household routines that increase obesity risk were prevalent among low-income families in this study. If proven to be effective, promotion of household routines related to family meals, sleep, and screen time may prevent young children from becoming overweight/obese.

Use of parks or playgrounds: reported access to drinking water fountains among US adults, 2009.

BACKGROUND: As a first step to determining the public availability of drinking water, self-reported access to water fountains in parks and playgrounds was examined. METHODS: A cross-sectional analysis was conducted on a convenience sample of 4163 US adults (aged ≥ 18 years) using the 2009 HealthStyles Survey. The outcome measure was reported access to water fountains in parks/playgrounds. Among those who reported using parks/playgrounds, multivariable logistic regression was used to examine the associations between sociodemographic variables and reported access to water fountains. RESULTS: About half (54.7%) of participants used parks/playgrounds. Among those, 55.0% reported access to water fountains. Factors significantly associated with reported access to water fountains were being male [odds ratio (OR) = 1.42; 95% confidence interval (CI) = 1.09, 1.85] and living in the Pacific region (versus East North Central region, OR = 2.56; 95% CI = 1.61, 4.06). Age, race/ethnicity, household income, marital status, education, smoking and physical activity were not significantly associated with reported access to water fountains. CONCLUSIONS: Among 54.7% of adults using parks/playgrounds, reported access to water fountains was significantly differed by sex and region. This study provides information that can be considered when developing interventions to increase access to drinking water in public facilities.

Characteristics of parents receiving counseling from child's doctor to limit child's sugar drink consumption.

BACKGROUND: Due to limited information on sugar drink counseling, characteristics of parents who reported ever receiving counseling from a child's doctor to limit a child's sugar drink intake were examined. METHODS: This cross-sectional analysis was conducted on a convenient sample of 1570 US parents (aged ≥ 18 years) using the 2009 HealthStyles Survey. The outcome measure was parents with children aged ≤ 18 years who reported being told by a child's doctor to limit a child's sugar drink intake. Data were weighted to provide national estimates. Multivariable logistic regression was used to examine factors associated with ever receiving sugar-drink counseling from a child's doctor. RESULTS: Only 23% of parents reported receiving counseling from a child's doctor to limit a child's sugar drink intake. Parental factors significantly associated with receiving this counseling were: being male (adjusted odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.02, 1.86), having an annual household income of <$25 000 (versus ≥$60 000, OR = 2.12; 95% CI = 1.33, 3.38) and parents who agreed with 'enjoying learning about health issues' (versus disagree, OR = 2.43; 95% CI = 1.36, 4.36). Age, race/ethnicity, education and marital status were not significantly associated with receiving counseling. CONCLUSIONS: Few parents reported ever receiving counseling from a child's doctor, and we found a few differences among those reporting sugar drink counseling.

Incidences of obesity and extreme obesity among US adults: findings from the 2009 Behavioral Risk Factor Surveillance System.

BACKGROUND: No recent national studies have provided incidence data for obesity, nor have they examined the association between incidence and selected risk factors. The purpose of this study is to examine the incidence of obesity (body mass index [BMI] ≥ 30.0 kg/m2) and extreme obesity (BMI ≥ 40.0 kg/m2) among US adults and to determine variations across socio-demographic characteristics and behavioral factors. METHODS: We used a weighted sample of 401,587 US adults from the 2009 Behavioral Risk Factor Surveillance System. Incidence calculations were based on respondent's height and current and previous weights. Logistic regression was used to examine associations between incidence and selected socio-demographic characteristics and behavioral factors. RESULTS: The overall crude incidences of obesity and extreme obesity in 2009 were 4% and 0.7% per year, respectively. In our multivariable analyses that controlled for baseline body mass index, the incidences of obesity and extreme obesity decreased significantly with increasing levels of education. Incidences were significantly higher among young adults, women, and adults who did not participate in any leisure-time physical activity. Incidence was lowest among non-Hispanic whites. CONCLUSIONS: The high incidence of obesity underscores the importance of implementing effective policy and environmental strategies in the general population. Given the significant variations in incidence within the subgroups, public health officials should prioritize younger adults, women, minorities, and adults with lower education as the targets for these efforts.

Physician practices related to use of BMI-for-age and counseling for childhood obesity prevention: a cross-sectional study.

BACKGROUND: Screening for obesity and providing appropriate obesity-related counseling in the clinical setting are important strategies to prevent and control childhood obesity. The purpose of this study is to document pediatricians (PEDs) and general practitioners (GPs) with pediatric patients use of BMI-for-age to screen for obesity, confidence in explaining BMI, access to referral clinics, and characteristics associated with screening and counseling to children and their caregivers. METHODS: The authors used 2008 DocStyles survey data to examine these practices at every well child visit for children aged two years and older. Counseling topics included: physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages. Chi-square tests were used to examine differences in proportions and logistic regression to identify characteristics associated with screening and counseling. RESULTS: The final analytic sample included 250 PEDs and 621 GPs. Prevalence of using BMI-for-age to screen for obesity at every well child visit was higher for PEDs than GPs (50% vs. 22%, χ2 = 67.0, p ≤ 0.01); more PEDs reported being very/somewhat confident in explaining BMI (94% vs. GPs, 87%, p < 0.01); more PEDs reported access to a pediatric obesity specialty clinic for referral (PEDs = 65% vs. GPs = 42%, χ2 = 37.5, p ≤ 0.0001).In general, PEDs reported higher counseling prevalence than GPs. There were significant differences in the following topics: TV viewing (PEDs, 79% vs. GPs, 61%, χ2 = 19.1, p ≤ 0.0001); fruit and vegetable consumption (PEDs, 87% vs. GPs, 78%, χ2 = 6.4, p ≤ 0.01). The only characteristics associated with use of BMI for GPs were being female (OR = 2.3, 95% CI = 1.5-3.5) and serving mostly non-white patients (OR = 1.8, 95% CI = 1.1-2.9); there were no significant associations for PEDs. CONCLUSIONS: The findings for use of BMI-for-age, counseling habits, and access to a pediatric obesity specialty clinic leave room for improvement. More research is needed to better understand why BMI-for-age is not being used to screen at every well child visit, which may increase the likelihood overweight and obese patients receive counseling and referrals for additional services. The authors also suggest more communication between PEDs and GPs through professional organizations to increase awareness of existing resources, and to enhance access and referral to pediatric obesity specialty clinics.

Child-feeding strategies are associated with maternal concern about children becoming overweight, but not children's weight status.

BACKGROUND: Research suggests that parents use specific child-feeding strategies to influence their child's weight based on perceptions and concerns about their child's overweight risk, but limited data are available on ethnically diverse low-income populations. OBJECTIVE: This cross-sectional study examined associations between mothers' perception and concern about children's weight, child-feeding strategies, and child overweight in an ethnically diverse population. SUBJECTS: Mothers of preschool children (n=967) who participated in a federally funded nutrition program were asked how they fed their child, how they perceived child's weight, and whether or not they were concerned about their child becoming overweight. STATISTICAL ANALYSES PERFORMED: Logistic regression to calculate odds of maternal perception/concern given child weight, feeding strategy given maternal perception/concern, and child overweight given feeding strategy. RESULTS: Only 21% (n=23/108) of overweight preschoolers were perceived as overweight. Maternal perception of overweight was not associated with feeding strategies. About 53% (n=76/144) of Hispanic, 42% (n=23/55) of African-American, and 29% (n=223/768) of white mothers reported concern about their child becoming overweight. Mothers reporting concern were more likely to restrict child's intake of select foods (odds ratio 5.94; 95% confidence interval 1.74 to 20.28) and less likely to pressure child to eat (odds ratio 0.39; 95% confidence interval 0.15 to 0.99); however, these strategies did not predict child overweight. CONCLUSIONS: Mothers concerned about their child becoming overweight were more likely to restrict children's intake of specific foods and less likely to pressure their child to eat; however, this study did not detect an association between feeding strategies and child overweight.

Healthier School Environment Leads to Decreases in Childhood Obesity: The Kearney Nebraska Story.

BACKGROUND: Schools play a role in addressing childhood obesity by implementing healthy eating and physical activity strategies. The primary aim of this case study was to describe prevalence of overweight and obesity among elementary school students in a rural Mid-western community between 2006 and 2012. The secondary aim was to use a novel approach called "population dose" to retrospectively evaluate the impact dose of each strategy implemented and its estimated potential population level impact on changes in overweight and obesity. METHODS: Weight and height were directly measured annually beginning in January 2006 to assess weight status, using BMI (kg/m(2)), for all kindergarten to fifth-grade students (N ≈ 2400 per year). Multiple evidence-based strategies were implemented in nine schools to increase physical activity and healthy eating behaviors. BMI reporting and revised school meal programs were implemented districtwide. Comprehensive school physical activity programs, school food environment, and supportive/promotional strategies were implemented at individual schools. RESULTS: The absolute change in prevalence of obesity (BMI ≥95th percentile) decreased from 16.4% to 13.9%, indicating a 15.2% relative change in prevalence of obesity in 6 years. There was an inverse relationship between the number of strategies implemented and prevalence of overweight and obesity over time. CONCLUSIONS: District and school-level approaches have the potential to impact childhood obesity. Schools can successfully implement strategies to address overweight and obesity, but the extent of implementation between schools may vary. Population dose analysis can be used to estimate impact of clusters of strategies to address overweight/obesity.

Knowledge of sugar content of sports drinks is not associated with sports drink consumption.

PURPOSE: To examine U.S. adult knowledge of the sugar content of sports drinks and whether this knowledge and other characteristics are associated with their sports drink consumption. DESIGN: Nonexperimental. SETTING: Nationally representative 2011 Summer ConsumerStyles survey data. SUBJECTS: 3929 U.S. adults. MEASURES: The outcome variable was sports drink consumption in the past 7 days. The main exposure variable was knowledge about sports drinks containing sugar. The covariates were sociodemographic characteristics, physical activity, and weight status. ANALYSIS: Multivariable logistic regression analysis was used to estimate adjusted odds ratios (ORs) for adults consuming sports drinks ≥1 times/wk after controlling for other characteristics. RESULTS: Approximately 22% of adults reported consuming sports drinks ≥1 times/wk. Most adults (71%) agreed that sports drinks contain sugar; however, this agreement was not significantly associated with adults' sports drink consumption. The odds of drinking sports drinks ≥1 times/wk were significantly higher among younger adults aged 18 to 64 years (OR range: 5.46-2.71), males (OR = 2.09), high-school graduates (OR = 1.52), and highly active adults (OR = 2.09). CONCLUSION: There were disparities in sports drink consumption by sociodemographic characteristics and physical activity level; however, knowledge of sports drinks' sugar content was not associated with consumption. Understanding why some population groups are higher consumers may assist in the development of education, providing those groups with a better understanding of sports drinks' nutritional value and health consequences of excessive sugar consumption in any form.

Trends in state-specific prevalence of overweight and underweight in 2- through 4-year-old children from low-income families from 1989 through 2000.

OBJECTIVES: To document overweight and underweight state-specific prevalence and examine trends among 2- through 4-year-old children from low-income families. METHODS: State-specific and overall overweight and underweight prevalence for 1989, 1994, and 2000 and trend analyses during the study period are documented. Overweight was defined as a sex-specific body mass index (BMI) for age in the 95th percentile or higher and underweight as a sex-specific BMI for age in less than the fifth percentile on the 2000 Centers for Disease Control and Prevention (CDC) growth charts. These analyses are based on one randomly selected record per child per year for 30 states consistently participating in the CDC Pediatric Nutrition Surveillance System in 1989, 1994, and 2000. Prevalence in 1989 and 1994 is adjusted to state-specific age and race/ethnicity distribution of the population in 2000. Overweight and underweight prevalence were categorized as 5% or less, more than 5% to 10%, more than 10% to 15%, more than 15% to 20%, and more than 20%. RESULTS: The number of states that reported overweight prevalence of more than 10% increased from 11 in 1989 to 28 in 2000. Underweight decreased during the study period: 9 states in 1989 and 23 states in 2000 had a prevalence of 5% or less. No geographic predominance was apparent. Trend analyses showed significant increases in overweight in 30 states (P < .01) and decreases in underweight in 26 states (P < .05). CONCLUSIONS: Overweight is increasing and underweight is decreasing in our study population. We need to expand prevention and intervention efforts to reverse the rising trend of overweight in the United States.

Maternal-child feeding patterns and child body weight: findings from a population-based sample.

BACKGROUND: Certain mother-child feeding patterns (MCFPs) may promote childhood obesity and/or disordered eating. OBJECTIVES: To assess the demographic correlates of MCFPs and to test whether differences in MCFPs are associated with child body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) z scores in a population-based study. DESIGN: A secondary analysis of the National Longitudinal Survey of Youth main and child cohorts was conducted on more than 1000 Hispanic, African American, and non-Hispanic/non-African American children, aged 3 to 6 years. The MCFPs were measured by means of 3 interview questions probing mother-allotted child food choice, child compliance during meals, and child obedience during meals. RESULTS: Mothers of non-Hispanic/non-African American children allotted greater food choice than mothers of African American or Hispanic children. Maternal BMI and other demographic measures were unrelated to MCFPs. The lowest levels of mother-allotted child food choice and child eating compliance were associated with reduced child BMI, with mean BMI z scores of -0.36 and -0.41, respectively. Effect sizes were small, however, and MCFPs did not discriminate children who were overweight or at risk for being overweight from children who were not (P>.05). CONCLUSIONS: Feeding strategies providing the least child food choice were associated with reduced child BMI. However, MCFPs did not relate to child overweight status.

Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers.

Parents play an important role in the development of their children's eating behaviors. We conducted 12 focus groups (three white, three African-American, and three Hispanic-American low-income groups; three white middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children to explore maternal attitudes, concerns, and practices related to child feeding and perceptions about child weight. We identified the following major themes from responses to our standardized focus group guide: 12 groups wanted to provide good nutrition, and most wanted children to avoid eating too many sweets and processed foods; 12 groups prepared foods their children liked, accommodated specific requests, and used bribes and rewards to accomplish their feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and 11 of 12 groups believed their children were prevaricating when they said they were full and mothers encouraged them to eat more. The common use of strategies that may not promote healthful weight suggests work is needed to develop culturally and socioeconomically effective overweight prevention programs. Further study is needed to verify racial/ethnic or income differences in attitudes, practices, and concerns about child feeding and perceptions of child weight.

The association of sugar-sweetened beverage intake during infancy with sugar-sweetened beverage intake at 6 years of age.

OBJECTIVES: To examine whether sugar-sweetened beverage (SSB) intake during infancy predicts SSB intake at 6 years of age. METHODS: A longitudinal cohort analysis of 1333 US children was conducted by using data from the 2005-2007 Infant Feeding Practices Study II and the 2012 Follow-Up Study at 6 years of age. The exposure variables were maternal-reported SSB intakes during infancy. The outcome variable was maternal-reported SSB intake at age 6 years. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for associations of SSB intake during infancy with consuming SSBs ≥1 time/day at 6 years old after controlling for baseline child's and parent's characteristics. RESULTS: Based on maternal recall, approximately one-fifth of children consumed SSBs at least 1 time/day at age 6 years. Adjusted odds of consuming SSBs at age 6 years ≥1 time/day was significantly associated with any SSB intake during infancy (aOR, 2.22 vs none), age at SSB introduction (aOR, 2.33 for age ≥6 months and 2.01 for age <6 months vs never), and mean SSB intake during age 10 to 12 months (aOR, 2.72 for 1 to <2 times/week and 2.57 for ≥3 times/week vs none). CONCLUSIONS: SSB intake during infancy significantly increased the likelihood of consuming SSBs ≥1 time/day at 6 years of age. Our findings suggest that infancy may be an important time for mothers to establish healthy beverage practices for their children and these findings can be used to inform intervention efforts to reduce SSB intake among children.

The relationship between health-related knowledge and sugar-sweetened beverage intake among US adults.

Because there is limited information on associations between health-related knowledge and sugar-sweetened beverage (SSB) intake, our cross-sectional study examined this question using the 2010 HealthStyles Survey data for 3,926 adults (aged ≥18 years). Multivariable logistic regression analysis was used to estimate the adjusted odds ratios and 95% CIs for drinking SSBs ≥2 times per day. About 31% of adults consumed SSBs ≥1 time per day, with 20% doing so ≥2 times per day. About eight of 10 adults agreed that drinking SSBs can contribute to weight gain, yet, eight of 10 adults in this study did not know the actual kilocalorie content of a 24-oz fountain soda. After controlling for age, sex, race/ethnicity, education level, annual household income, and geographic region, the odds for drinking SSBs ≥2 times per day were significantly higher among adults who neither agreed nor disagreed (ie, were neutral) that drinking SSBs can contribute to weight gain (odds ratio 1.61, 95% CI 1.15 to 2.25 vs agree); however, knowledge about the energy content of regular soda was not associated with SSB intake. Our finding that knowledge about the adverse effects of SSB intake is significantly associated with SSB intake among adults suggests that health education regarding the potential contribution of excess energy intake from SSBs to weight gain could contribute to lowered consumption and lower rates of obesity. Although knowledge about the kilocalorie content of regular soda was unrelated to SSB intake, health education on the kilocalorie content of SSBs may still be beneficial because most adults did not know the actual kilocalorie content of SSBs. Longitudinal studies are needed to explore associations between knowledge about energy provided by SSBs and SSB intake.