Kids SIPsmartER Baseline Cross-Sectional Analyses of the Socioecological Impact Variables in Sugar Sweetened Beverage Behaviors among Rural Appalachian Adolescents.

Abstract

OBJECTIVE\nThe objective of this study was to identify factors across the socioecological model (SEM) associated with adolescents sugar-sweetened beverage (SSB) intake.\n\n\nDESIGN\nThis cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests, and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a 4-step model was used to identify factors associated with adolescent SSB intake - Step 1: demographics (i.e., age, gender), Step 2: intrapersonal [i.e., Theory of Planned Behavior (attitudes, subjective norms, perceived behavioral control, behavioral intentions), health literacy, media literacy, public health literacy], Step 3: interpersonal (i.e., caregiver s SSB behaviors, caregiver s SSB rules), and Step 4: environmental (i.e., home SSB availability) level variables.\n\n\nSETTING\nEight middle schools across four rural southwest Virginia counties in Appalachia.\n\n\nPARTICIPANTS\n790 7th grade students [55.4% female, 44.6% males, mean age 12 (SD=0.5) years].\n\n\nRESULTS\nMean SSB intake was 36.3 (SD=42.5) fluid ounces or 433.4 (SD=493.6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent s SSB consumption: behavioral intention (p < 0.05), affective attitude (p<0.05), perceived behavioral control (p<0.05), health literacy (p<0.001), caregiver behaviors (p<0.05), caregiver rules (p<0.05), and home availability (p<0.001).\n\n\nCONCLUSIONS\nSSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviors, and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.