Role of social ecological model level on young Pacific children’s sugar-sweetened beverage and water intakes: Children’s Healthy Living intervention

• Published in: Public health nutrition Vol. 24; no. 8; pp. 2318 - 2323
• Main Authors: Korn, Ariella R, Butel, Jean, Davis, James, Yamanaka, Ashley B, Coleman, Patricia, Wilkens, Lynne R, Economos, Christina D, Novotny, Rachel
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2021
• Subjects: Advocacy; Beverages; Caregivers; Child, Preschool; Children; Children & youth; Cross-Sectional Studies; Drinking; Ecological models; Energy drinks; Ethnicity; Healthy Lifestyle; Humans; Intervention; Interventions; Jurisdiction; Multilevel; Pacific Islander people; Pediatric Obesity - prevention & control; Preschool education; Regression analysis; Regression models; Short Communication; Social marketing; Substitutes; Sugar; Sugar-Sweetened Beverages; Teams; Water consumption; Water intake; Water intakes; United States > US; Pacific region; Guam; Hawaii; Alaska; American Samoa; Northern Mariana Islands; Water; Sugar-sweetened beverages; Young children; Social ecological model; Pacific region; Multilevel trial
• ISSN: 1368-9800; 1475-2727
• DOI: 10.1017/S1368980020004796

To examine children's sugar-sweetened beverage (SSB) and water intakes in relation to implemented intervention activities across the social ecological model (SEM) during a multilevel community trial. Children's Healthy Living was a multilevel, multicomponent community trial that reduced young child obesity (2013-2015). Baseline and 24-month cross-sectional data were analysed from nine intervention arm communities. Implemented intervention activities targeting reduced SSB and increased water consumption were coded by SEM level (child, caregiver, organisation, community and policy). Child SSB and water intakes were assessed by caregiver-completed 2-day dietary records. Multilevel linear regression models examined associations of changes in beverage intakes with activity frequencies at each SEM level. US-Affiliated Pacific region. Children aged 2-8 years (baseline: n 1343; 24 months: n 1158). On average (± sd), communities implemented 74 ± 39 SSB and 72 ± 40 water activities. More than 90 % of activities targeted both beverages together. Community-level activities (e.g. social marketing campaign) were most common (61 % of total activities), and child-level activities (e.g. sugar counting game) were least common (4 %). SSB activities across SEM levels were not associated with SSB intake changes. Additional community-level water activities were associated with increased water intake (0·62 ml/d/activity; 95 % CI: 0·09, 1·15) and water-for-SSB substitution (operationalised as SSB minus water: -0·88 ml/d/activity; 95 % CI: -1·72, -0·03). Activities implemented at the organization level (e.g. strengthening preschool wellness guidelines) and policy level (e.g. SSB tax advocacy) also suggested greater water-for-SSB substitution (P < 0·10). Community-level intervention activities were associated with increased water intake, alone and relative to SSB intake, among young children in the Pacific region.