Economic Evaluations of Obesity-Targeted Sugar-Sweetened Beverage (SSB) Taxes-A Review to Identify Methodological Issues.

INTRODUCTION: Economic evaluations of public health interventions like sugar-sweetened beverage (SSB) taxes face difficulties similar to those previously identified in other public health areas. This stems from challenges in accurately attributing effects, capturing outcomes and costs beyond health, and integrating equity effects. This review examines how these challenges were addressed in economic evaluations of SSB taxes. METHODS: A systematic review was conducted to identify economic evaluations of SSB taxes focused on addressing obesity in adults, published up to February 2021. The methodological challenges examined include measuring effects, valuing outcomes, assessing costs, and incorporating equity. RESULTS: Fourteen economic evaluations of SSB taxes were identified. Across these evaluations, estimating SSB tax effects was uncertain due to a reliance on indirect evidence that was less robust than evidence from randomised controlled trials. Health outcomes, like quality-adjusted life years, along with a healthcare system perspective for costs, dominated the evaluations of SSB taxes, with a limited focus on broader non-health consequences. Equity analyses were common but employed significantly different approaches and exhibited varying degrees of quality. CONCLUSION: Addressing the methodological challenges remains an issue for economic evaluations of public health interventions like SSB taxes, suggesting the need for increased attention on those issues in future studies. Dedicated methodological guidelines, in particular addressing the measurement of effect and incorporation of equity impacts, are warranted.

Is food and drink advertising across various settings associated with dietary behaviours and intake among Australian adolescents? Findings from a national cross-sectional survey.

ISSUE ADDRESSED: The pervasive promotion of energy-dense, nutrient-poor food and drinks undermines efforts by adolescents and their parent/carers to maintain a nutritious diet during a crucial developmental period. This study examined the association between awareness of food and drink advertisements and adolescents' dietary behaviours and intake. METHODS: A sample of Australian secondary students aged 12-17 years (N = 8763) self-reported their awareness of food and drink advertisements across seven settings, whether they had tried a new product or asked a parent/carer to purchase a product they had seen advertised, and their consumption of various unhealthy food and drink types. Analyses used multilevel mixed-effects generalised linear models adjusted for school-level clustering, socio-demographic factors and television viewing. RESULTS: Students with higher advertising awareness were more likely to have tried a new product they had seen advertised (adjusted prevalence ratio [APR] = 1.62, 95% CI = 1.51-1.73, p < .001) and asked their parent/carer to buy an advertised product (APR = 1.62, 95% CI = 1.51-1.73, p < .001) at least once in the past month. As advertising awareness increased, so too did students' likelihood of reporting these dietary behaviours. A high unhealthy food intake was more commonly reported among students with higher advertising awareness (APR = 1.45, 95% CI = 1.32-1.58, p < .001), as was a high unhealthy drink intake (APR = 1.29, 95% CI = 1.18-1.42, p < .001). CONCLUSIONS: Australian adolescents are vulnerable to the persuasive effects of food and drink marketing. SO WHAT?: Greater restrictions on the way the food and drink industry can market their products to adolescents are needed to better support them in developing and maintaining positive dietary behaviours.

Effect of prolonged hospitalization on the maintenance of oral health: A self-report survey.

OBJECTIVES: This study aims to evaluate the effect of prolonged hospitalization on the maintenance of dental health and to assess the nursing staff's approach to addressing these concerns. METHODS: A survey questionnaire explored changes in the routine dental care of patients hospitalized for over a month. The involvement of nursing staff in addressing dental care was also evaluated. RESULTS: Fifty adult patients aged 18-89 years (mean age 62.4 ± 20.54 years), 27 (54%) males, completed the survey. During hospitalization (mean 58.59 ± 38.63 days) 26% and 18%, increased consumption of sweets and sugary beverages, between meals, respectively; 26% and 20% of the patients reduced the frequency of tooth brushing in the morning and in the evening, respectively, and 42.2% of them, reduced the quality of their toothbrushing during hospitalization. Nevertheless, 95.9% and 93.9% of them were never instructed during hospitalization to limit their consumption of sweets and sugary beverages and 83.3% and 62.5% of them had never been reminded or offered assistance during hospitalization in performing toothbrushing, respectively. The lower frequency of morning toothbrushing was significantly correlated with a lack of nurses' assistance (p = 0.004). In contrast, 62.6% reported they were reminded every day to shower. Patients in the rehabilitation and geriatrics departments reported a greater need for a brush/toothpaste (p < 0.0001) and assistance in toothbrushing (p < 0.0001). CONCLUSIONS: Prolonged hospitalization leads to significant deterioration in inpatients' dental health maintenance. Raising awareness among nurses regarding their inpatient's oral health maintenance is warranted. Providing patients with toothbrushes, toothpaste and educational materials upon hospitalization is recommended.

A Content Analysis of Online Messages about Sugar-Sweetened Beverages.

Media campaigns can reduce or promote the consumption of sugar-sweetened beverages (SSBs). Brief, US-based English-language online messages were gathered from searchable media platforms, a process that yielded 112 anti-SSB videos and 29 pro-SSB commercials. Using a combination of inductive and deductive methods, a content analysis of those messages was conducted to identify their properties. They were coded for the direction (pro vs. anti), target of the advocacy (e.g., consumption vs. policy), actor demographics (gender, age, and ethnicity), persuasive theme (e.g., excessive sugar, nurturing), and message sensation value. Anti-SSB appeals primarily targeted individual-level consumption behavior. They utilized six persuasive themes and often included more than one theme in a single message. Pro-SSB messages used feel-good themes and utilized only one theme per message. The proportions of adults, adolescents, and children differed by the direction of the advocacy. Black, Hispanic, and Asian actors were under-represented in the anti-SSB sample relative to Whites. Pro-SSB appeals were slightly higher than anti-SSB appeals in message sensation value (p = 0.09). The findings illuminate the message features that characterize the universe of brief anti-SSB appeals available online, highlight messaging disparities, and reveal the absence of certain common, effective persuasive themes.

The equitable impact of sugary drink taxation structures on sugary drink consumption among Canadians: a modelling study using the 2015 Canadian Community Health Survey-Nutrition.

OBJECTIVE: Estimate the impact of 20 % flat-rate and tiered sugary drink tax structures on the consumption of sugary drinks, sugar-sweetened beverages and 100 % juice by age, sex and socio-economic position. DESIGN: We modelled the impact of price changes - for each tax structure - on the demand for sugary drinks by applying own- and cross-price elasticities to self-report sugary drink consumption measured using single-day 24-h dietary recalls from the cross-sectional, nationally representative 2015 Canadian Community Health Survey-Nutrition. For both 20 % flat-rate and tiered sugary drink tax scenarios, we used linear regression to estimate differences in mean energy intake and proportion of energy intake from sugary drinks by age, sex, education, food security and income. SETTING: Canada. PARTICIPANTS: 19 742 respondents aged 2 and over. RESULTS: In the 20 % flat-rate scenario, we estimated mean energy intake and proportion of daily energy intake from sugary drinks on a given day would be reduced by 29 kcal/d (95 % UI: 18, 41) and 1·3 % (95 % UI: 0·8, 1·8), respectively. Similarly, in the tiered tax scenario, additional small, but meaningful reductions were estimated in mean energy intake (40 kcal/d, 95 % UI: 24, 55) and proportion of daily energy intake (1·8 %, 95 % UI: 1·1, 2·5). Both tax structures reduced, but did not eliminate, inequities in mean energy intake from sugary drinks despite larger consumption reductions in children/adolescents, males and individuals with lower education, food security and income. CONCLUSIONS: Sugary drink taxation, including the additional benefit of taxing 100 % juice, could reduce overall and inequities in mean energy intake from sugary drinks in Canada.

Implicaciones del consumo de bebidas azucaradas en la salud de los adolescentes / Implications of sugary beverage consumption on adolescent health

Fundamentos: La ingesta de bebidas azucaradas constituye un problema de salud pública, este estudio tuvo como objetivo explorar la literatura científica existente sobre los efectos que ocasiona el consumo de estas bebidas en la salud de los adolescentes. Métodos: A través de una revisión integrativa de la literatura (2016 y junio 2022), se realizó búsquedas en bases de datos, como Google Scholar, PubMed, LILACS, Science Direct, Web of Science y Scopus, empleando términos MeSH y DeCS. La revisión se centró en responder a la pregunta sobre los efectos del consumo de bebidas azucaradas en la salud de los adolescentes. Resultados: De 114 artículos recopilados se eliminaron los duplicados y se excluyeron 60 artículos tras la revisión de títulos y resúmenes. Después del análisis exhaustivo de 25 artículos, 15 se excluyeron por no cumplir con los criterios de elegibilidad, resultando en la selección final 10 artículos. El análisis reveló que el consumo de bebidas azucaradas se relaciona con alteraciones mentales y exceso de peso en adolescentes. Conclusiones: El consumo de bebidas azucaradas causa efectos perjudiciales en la salud de los adolescentes, aumentando el riesgo de exceso de peso y alteraciones en la salud mental como depresión, comportamientosagresivos y conductas suicidas. (AU)

Background: The intake of sugary drinks constitutes a public health problem. This study aimed to explore the existing scientific literature on the effects caused by the consumption of these drinks on the health of adolescents. Methods: Through an integrative review of the literature (2016 and June 2022), searches were carried out in databases, such as Google Scholar, PubMed, LILACS, Science Direct, Web of Science and Scopus, using MeSH and DeCS terms. The review focused on answering the question about the effects of consuming sugary drinks on the health of adolescents. Results: From 114 articles collected; Duplicates were removed and 60 articles were excluded after reviewing titles and abstracts. After an exhaustive analysis of 25 articles, 15 were excluded for not meeting the eligibility criteria, resulting in the final selection of 10 articles. The analysis revealed that the consumption of sugary drinks is related to mental disorders and excess weight in adolescents. Conclusions: The consumption of sugary drinks causes harmful effects on the health of adolescents, increasing the risk of excess weight and alterations in mental health such as depression, aggressive behaviors and suicidal behaviors. (AU)

Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency.

OBJECTIVES: Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS: A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS: PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS: Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.

Frecuencia del consumo de bebidas azucaradas en una población universitaria con conocimientos sobre salud en México / Consumption ‘s frequency of sugar sweetened beverage in a university population with knowledge about health in Mexico

Introducción: En México el consumo de bebidas azucaradas (BA) es muy alto, siendo el mayor consumidor de refrescos en el mundo, omitiendo las consecuencias negativas en la salud. Por otra parte, la FAO reconoce la importancia de la educación como herramienta para mejorar la salud y nutrición de la población a través de la educación alimentaria-nutricional.Objetivo: Identificar la prevalencia de la frecuencia y cantidad del consumo de bebidas azucaradas en jóvenes inscritos a licenciaturas relacionadas a ciencias de la salud.Material y métodos: Estudio cuantitativo, transversal, de tipo descriptivo, con tamaño de población de N=245 alumnos inscritos a programas educativos correspondientes a las áreas de las ciencias de la salud, con un intervalo de confianza al 95% y un límite de confianza al 4.9%. Para el cuestionario se utilizó el instrumento Beverage Questionnaire (BEVQ-15), adaptándolo al contexto sociocultural y disponibilidad de bebidas de la población objetivo.Resultados: La mayoría de los jóvenes externó sí consumir bebidas azucaradas (82.8%), el tipo de bebidas azucaradas que se consume, fueron los refrescos (42%), las aguas naturales de sabor endulzadas con azúcar (38.4%) y los lácteos saborizados (28.6%).Discusión: Los estudiantes poseen un hábito usual de consumo de bebidas azucaradas, con alto contenido de calorías sin un aporte nutricional benéfico para la salud. Se podría pensar que al estudiar una licenciatura del área de la Ciencias de la Salud este consumo debería estar limitado. Sin embargo, el consumo es alto.Conclusiones: Estos datos ofrecen un punto de partida para analizar la importancia de la educación para la salud sobre todo en estudiantes del área de Ciencias de la Salud, para proponer acciones concretas y prácticas que puedan fomentar la disminución del consumo de bebidas azucaradas.(AU)

ntroduction: Sugar-sweetened beverages (SB) containcaloric sweeteners such as sucrose, high fructose corn syrupor fruit concentrates, all with similar metabolic effects. Mexicois considered one of the countries with the highest consump-tion of these drinks, ignoring the negative consequences onhealth. On the other hand, FAO recognizes the importance ofeducation as a tool to improve the health and nutrition of thepopulation through food-nutrition education.Aim: Identify the prevalence of consumption of sugarydrinks (frequency and quantity) and its association with knowledge in young people enrolled in bachelor’s degrees re-lated to health sciences.Material and methods: Quantitative, cross-sectional, de-scriptive study carried out on students enrolled in health sci-ences educational programs. The Beverage Questionnaire(BEVQ-15) instrument was used, adapting it to the socioculturalcontext and availability of beverages of the target population.Results: 293 students were included. The prevalence ofBA consumption was 82.6%; The relationship between BAconsumption and grade level presented a statistically signifi-cant association, with the students with the lowest grade levelbeing those who had the highest BA consumption with27.3%. 41.2% of the young people studied identified softdrinks as the drink they consume most, with a frequency of 2to 3 times a week, followed by flavored waters sweetenedwith sugar, referred to by 38% of the students.Conclusions: The results of this study show a high preva-lence of BA consumption associated with the school grade ofyoung people enrolled in Health Sciences Degrees. It is rec-ommended to continue studying other health determinantsthat could be associated with consumption, such as geo-graphic context, individual characteristics, among others.(AU)

Consumo de bebidas azucaradas, agua y alcohol en adolescentes chilenos / Consumption of sugary drinks, water, and alcohol among chilean adolescents

Fundamentos: El objetivo de este estudio fue determinar el consumo de bebidas azucaradas, agua y alcoholen adolescentes chilenos.Métodos: Este estudio analizó datos secundarios de la Encuesta Nacional de Salud (ENS) de Chile 2016-2017,enfocándose en adolescentes de 15 a 18 años. Se analizó el consumo de bebidas azucaradas, agua y alcohol,así como variables antropométricas.Resultados: El estudio incluyó 226 adolescentes con una mediana de edad de 16 años (RI 15,0-17,0), siendoun 58,8% de sexo femenino y un 84,9% residentes en zonas urbanas. Se encontró que el 46,4% de losparticipantes tenían exceso de peso y el 24,1% presentaba riesgo de obesidad abdominal. El consumo regularde bebidas azucaradas fue del 87,6%, el 44,7% consumía al menos 1 trago en un día típico de consumo dealcohol y el 39,8% bebía menos de 3 vasos de agua diarios. No se observaron diferencias estadísticamentesignificativas en el comportamiento de las variables según el sexo y estado nutricional, pero sí se encontró unaumento en la proporción a medida que aumenta la edad.Conclusiones: Se observa una alta prevalencia de consumo de bebidas azucaradas y alcohol, y bajo consumode agua. Resalta la necesidad de promover el agua como principal fuente de hidratación en el ámbito escolary familiar.(AU)

Background: The objective of this study was to determine the consumption of sugary drinks, water, andalcohol among Chilean adolescents.Methods: This study analyzed secondary data from the Chilean National Health Survey (ENS) 2016-2017,focusing on adolescents aged 15 to 18 years. The consumption of sugary drinks, water, and alcohol, as well asanthropometric variables, were analyzed.Results: The study included 226 adolescents with a median age of 16 years (IQR 15.0-17.0), of whom 58.8%were female, and 84.9% resided in urban areas. It was found that 46.4% of the participants were overweight,and 24.1% had abdominal obesity risk. The regular consumption of sugary drinks was 87.6%, 44.7% consumedat least 1 alcoholic drink on a typical day, and 39.8% drank fewer than 3 glasses of water daily. There were nostatistically significant differences in the behavior of the variables according to sex and nutritional status, butan increase in the proportion was observed as age increased.Conclusions: A high prevalence of consumption of sugary drinks and alcohol, along with low water intake,highlights the need to promote water as the primary source of hydration in both school and family environments.(AU)

Effects of a front-of-package disclosure on accuracy in assessing children's drink ingredients: two randomised controlled experiments with US caregivers of young children.

OBJECTIVE: Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children's drinks. DESIGN: In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children's drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children's drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored. SETTING: Online survey. PARTICIPANTS: Six hundred and forty-eight US caregivers of young children (1-5 years). RESULTS: FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research. CONCLUSIONS: FOP disclosures on children's drink packages can increase caregivers' understanding of product ingredients and aid in selecting healthier children's drinks.

Household Food Security and Consumption of Sugar-Sweetened Beverages among New York City (NYC) Children: A Cross-Sectional Analysis of 2017 NYC Kids' Data.

Food insecurity is a stressor associated with adverse health outcomes, including the consumption of sugar-sweetened beverages (SSBs). Our study tests the hypothesis that other socioeconomic vulnerabilities may magnify this effect using cross-sectional data from the 2017 New York City (NYC) Kids Survey. Households providing an affirmative response to one or both food security screener questions developed by the US Department of Agriculture were coded as households with low food security. The number of sodas plus other SSBs consumed was standardized per day and categorized as 1 = none, 2 = less than one, and 3 = one or more. We tested the joint effect of low food security with chronic hardship, receipt of federal aid, and immigrant head of household on a sample of n = 2362 kids attending kindergarten and beyond using ordinal logistic regression and accounting for the complex survey design. Only having a US-born parent substantially magnified the effect of low household food security on SSB consumption (OR = 4.2, 95%CI: 2.9-6.3, p < 0.001) compared to the reference group of high household food security with an immigrant parent. The effect of low food security on SSB consumption among NYC children warrants intersectional approaches, especially to elucidate US-based SSB norms in low-food-security settings.

Malnutrición e inadecuados hábitos de alimentación en bomberos de Panamá

La malnutrición por exceso es un problema de salud pública en Panamá. En bomberos, la malnutrición tiene graves implicaciones en la salud. El objetivo del presente estudio fue evaluar el estado nutricional, los hábitos alimentarios y el riesgo cardiovascular de unidades del Benemérito Cuerpo de Bomberos de la Región de Panamá Oeste en Panamá. Se realizó un estudio descriptivo y transversal de marzo a diciembre 2022. Para la recopilación de hábitos alimentarios se utilizó el formulario de frecuencia de consumo. Para la evaluación nutricional se midió peso, talla y circunferencia de la cintura. El riesgo cardiovascular fue estimado a partir de la razón cintura-altura (WHtR, por su acrónimo en inglés). Se evaluaron 100 participantes (79% son hombres) con edad entre 18 a 60 años. El exceso de peso se observó en el 88%, la obesidad en el 58%. El 97% consume frituras y 94% consume bebidas azucaradas. Solo el 20% y 16% consume vegetales y frutas diariamente. El 51% presenta riesgo cardiovascular por WHtR, siendo 39.2% en hombres y 95% en mujeres (p= 0.000). Se observa una alta proporción de exceso de peso, obesidad, obesidad abdominal y riesgo cardiovascular entre los bomberos evaluados. Bajo consumo de frutas y vegetales junto con un alto consumo de bebidas azucaradas y frituras. Es necesario implementar programas de prevención y control de la obesidad, así como brindar educación en alimentación y nutrición para abordar estos problemas de salud.

Malnutrition is a public health problem in Panama. In firefighters, malnutrition has serious health implications. We aim to evaluate the nutritional status, eating habits, and cardiovascular risk of units of the Fire Department of the West Panama Region in Panama. A descriptive and cross-sectional study was carried out from March to December 2022. For the collection of eating habits, a food frequency questionnaire was used. Weight, height, and waist circumference were used for the nutritional status evaluation. Cardiovascular risk was estimated from the waist-height ratio (WHtR). 100 participants (79% are men) aged between 18 and 60 years were evaluated. Excess weight was observed in 88%, and obesity in 58%. Cardiovascular risk by WHtR was presented in 51%, 39.2% of males, and 95% of females (p= 0.000). 97% consume fried foods and 94% consume sugary drinks. Only 20% and 16% consume vegetables and fruits daily. A high proportion of excess weight, obesity, abdominal obesity, and cardiovascular risk among the evaluated firefighters was observed. Low consumption of fruits and vegetables along with a high consumption of sugary drinks and fried foods. It is necessary to implement obesity prevention and control programs, as well as provide food and nutrition education to address these health problems.

Do Peers Matter? Unhealthy Food and Beverages Preferences among Children in a Selected Rural Province in China.

With the growing problem of childhood obesity, unhealthy dietary preferences among children have become an issue of worldwide concern. This article examines the class-peer effect of these preferences using random class assignment data from a field survey. The results show significant positive peer effects for both unhealthy food and beverages preference. These results remained robust after controlling for endogeneity issues using instrumental variables. Further analysis of the mechanism of peer effect shows that the better the relationship between classmates, the greater the influence peers have on unhealthy diet preferences among rural children. The same peer effect is found in situations where it is easy for children to obtain unhealthy food and beverages. The analysis of heterogeneity finds that the peer effects of unhealthy dietary preferences are stronger for girls, older students, and obese students. This paper also discusses the role of parents and schools in mitigating the peer effect. This paper proposes policy recommendations for rural areas in China to improve dietary preferences in children. These results may also provide useful guidelines for policy in other developing countries.

Effects of pictorial warnings on parents' purchases and perceptions of sugar-sweetened beverage categories.

BACKGROUND: Sugar-sweetened beverage (SSB) consumption remains high among US children. Warning labels on SSBs hold promise for reducing consumption, but their impact may differ by SSB category. OBJECTIVES: This study examined the effects of pictorial warnings on parents' beverage purchases and perceptions across SSB categories. METHODS: Parents of children ages 2-12 (n = 326) visited a convenience store laboratory in North Carolina. Participants were randomly assigned to see SSBs carrying either pictorial warning labels or control labels. Parents purchased a beverage for their child and completed a survey. RESULTS: Responses from parents in the control arm suggest underlying perceptions of flavoured milk (2.8 on scale ranging from 1 to 5), flavoured water (2.6), and fruit-flavoured drinks (2.5) as the most healthful SSB categories. Compared to the control, pictorial warnings led to the largest reductions in purchases of fruit drinks (-61%), soda (-36%) and flavoured milk (-32%). Warnings also lowered the perceived healthfulness of flavoured water (d = -0.34), flavoured milk (d = -0.28), sports drinks (d = -0.25), and a reduction in intentions to give one's child sports drinks (d = -0.30), flavoured water (d = -0.24) and sweet tea (d = -0.22, all p < 0.05). CONCLUSIONS: Warning labels may have heterogeneous effects across SSB categories. Future research should assess the psychological mechanisms underlying these heterogeneous effects.

Tax on sugary drinks and trends in daily soda consumption by family affluence: an international repeated cross-sectional survey among European adolescents.

BACKGROUND: The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear. OBJECTIVES: We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence. METHODS: Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently. RESULTS: Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (Pinteractions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (ORlower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (Pinteractions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (Pinteractions ≤ 0.08, increased inequalities). CONCLUSIONS: Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.

Food purchasing practices in various retail settings and dietary intake: A cross-sectional survey of Australian adolescents.

BACKGROUND/AIMS: Discretionary, energy-dense, nutrient-poor food and drinks are heavily marketed and readily available in retail settings frequented by adolescents. This study examines associations between food purchasing practices in various retail settings and dietary intake among Australian adolescents. METHODS: Participants were students in years 8 to 11 (ages 12-17 years) who completed the 2009-10 (n = 13 790), 2012-13 (n = 10 309) or 2018 (n = 9102) National Secondary Students' Diet and Activity (NaSSDA) cross-sectional survey. Multistage stratified random sampling was used. An online survey completed at school assessed self-reported frequency of food purchasing practices in various retail settings and consumption of discretionary food, sugary drinks, fruit and vegetables. Generalised linear regression models examined associations between food purchasing practices and dietary behaviour. RESULTS: Relative to students who brought lunch from home, those who purchased lunch from school or nearby outlets reported higher intake of discretionary food and sugary drinks and lower fruit intake. Buying lunch from school was also associated with lower vegetable intake. Buying food or drinks on the school commute, outside school grounds during school hours, from supermarket checkouts, and using mobile phone apps were each associated with higher discretionary food and sugary drink intake (all P < .01). CONCLUSIONS: Purchasing food or drink in various retail settings is associated with higher intake of discretionary food and drink among Australian adolescents, and some purchasing practices appeared to displace fruit and vegetable intake. SO WHAT?: These findings highlight a need to improve the accessibility and promotion of healthier food and drink options in schools and other retail settings.

Decline in dental caries experience among schoolchildren in Taiwan, 2012-2020.

OBJECTIVES: This study investigated the association between the decline of the decayed, missing, and filled teeth (DMFT) index and several family-level and individual-level factors among 6- to 18-year-old Taiwanese children from 2012 to 2020. METHODS: This study used data from the 2012 and 2020 Taiwan National Oral Health Survey of Children and Adolescents. Both surveys used similar methods and were performed in the same study age group. A structured questionnaire was used to collect data on parents' sociodemographic background; the number of children in the family; oral health-related knowledge, attitudes, and behaviours; and children's dietary habits. Dental caries was recorded through standardized oral examinations. Multivariable multilevel zero-inflated negative binomial regression models were used to determine the association between family-level and individual-level factors and the DMFT index from 2012 to 2020. RESULTS: A total of 10 217 and 10 436 schoolchildren completed the oral examinations and questionnaires in the 2012 and 2020 surveys, respectively. The adjusted mean DMFT index of 12-year-old Taiwanese schoolchildren in 2020 was 2.01, denoting a significant decline from 2.50 in 2012 (adjusted mean ratio = 0.20, 95% confidence interval [CI] = 0.17, 0.23, p < .0001). Furthermore, children who often consumed sugar-rich drinks had a significantly higher risk (mean ratio = 1.05, 95% CI = 1.01, 1.10) of having DMFT than those who seldom consumed such drinks (p = .017). CONCLUSIONS: In the period of 2012-2020, the DMFT index among Taiwanese children significantly declined. Children who often consumed sugar-rich drinks had a higher DMFT index than those who seldom consumed such drinks. Our findings are valuable to paediatricians, dentists, nutritionists, and public health policymakers.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation.

BACKGROUND: Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. METHODS: The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. RESULTS: Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09). CONCLUSIONS: Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior. TRIAL REGISTRATION: ISRCTN57165350 (8 January, 2015).

Alaska's Play Every Day Campaign Encourages Parents to Serve Healthy Drinks to Young Children.

BACKGROUND: Sugary drink consumption by young children is a public health concern. The State of Alaska, partnering with the Alaska Native Tribal Health Consortium, implemented the Play Every Day social marketing campaign in 2019-2021 to encourage parents to serve healthy drinks to young children. The campaign's intended audience was parents who experience disproportionately poor nutrition outcomes: Alaska Native people, those living in rural communities, and those with low incomes and/or educational attainment. We described campaign development, implementation, and performance. METHOD: Parents from the identified disproportionately affected populations participated in formative research. Campaign awareness and engagement questions were added to Alaska's child health surveillance system. Regression models assessed associations between campaign exposure and outcomes. RESULTS: The sample included 476 Alaska mothers of 3-year-old children. Of the 34% who reported seeing the campaign, 21% said they changed drinks served to their child because of the campaign. Campaign awareness, engagement, and reported changes in drinks given to children because of the campaign were greater among Alaska Native mothers than White mothers. Among all mothers, those who said the campaign gave them new information or that they shared the campaign had 7 to 8 times greater odds for reporting changes in behavior than those not engaged with the campaign. IMPLICATIONS FOR PRACTICE: Social marketing campaigns that encourage parents to serve healthy drinks to young children may change behavior. Resources should be systematically dedicated to research, implementation, and evaluation focused on specific populations. Partnering with trusted community-serving organizations likely improves outcomes in disproportionately affected populations.

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia.

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.