Understanding Attitudes and Practices of Low-Income Caregivers Toward Sugar-Sweetened Beverage Consumption in Preschool-Aged Children

Main Article Content

Christen C Cooper Angela Northrup, Ph.D, RN, FNP Michelle Iannacchino, BS, MS, RDN

Abstract

Sugar-sweetened beverage (SSB) consumption during early childhood has been linked to adverse health outcomes across the lifespan. Caregivers of young children are often unaware of the potential health harms of SSB and may lack knowledge, skills and environmental supports to limit SSB. The objectives of this study were to explore caregivers’ attitudes and practices with regard to SSB and to identify themes that may inform future policies and interventions to limit these beverages. Guided by the Social Ecological Model (SEM), the research team interviewed low-income caregivers of children ages two to five at a health clinic in urban New York State. Interviews were recorded, transcribed, and coded for themes and further analyzed for determinants of behavior with regard to providing SSB. Five major themes emerged: Greater SSB knowledge led to healthier choices; confusion about the healthfulness of some SSB; SSB affordability, accessibility and cultural acceptability; children’s “pester power” to obtain SSB; and, lack of SSB information from healthcare providers. Determinants such as perceived barriers to action, self-efficacy, cues to action, and perceived threat emerged from the themes. SSB are widely available, affordable and palatable. Healthcare providers seldom discuss children’s SSB intake specifically at well visits. SSB are frequently marketed and labeled as “healthy.” SSB are a significant source of empty calories and added sugars. Helping parents limit SSB may reduce child overweight and obesity and minimize lifelong chronic disease risks. Heathcare providers, health campaigns and nutrition assistance programs may collaborate to help parents limit SSB intake in young children.


 

Keywords: child obesity, sugar-sweetened beverages, nutrition in young children, parenting and nutrition

Article Details

How to Cite
COOPER, Christen C; NORTHRUP, Angela; IANNACCHINO, Michelle. Understanding Attitudes and Practices of Low-Income Caregivers Toward Sugar-Sweetened Beverage Consumption in Preschool-Aged Children. Medical Research Archives, [S.l.], v. 11, n. 3, mar. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3459>. Date accessed: 20 apr. 2024. doi: https://doi.org/10.18103/mra.v11i3.3459.
Section
Research Articles

References

1. Anderson SE, Whitaker RC. Prevalence of obesity among US preschool children in different racial and ethnic groups. Arch Pediatr Adolesc Med. 2009;163(4):344–348.
2. Bandura, A. (1989). Social cognitive theory. In R. Vasta (Ed.), Annals of child development. Vol. 6. Six theories of child development. (pp. 1-60). Greenwich, CT: JAI Press.
3. Bany, J. A., Bredow, V. L., Zender, R., Tiso, S., Grasska, M., & Berg, J. (2013). Latina mothers feeding their children: A focus group pilot study.
4. Beck, A. L., Takayama, J. I., Halpern-Felsher, B., Badiner, N., & Barker, J. C. (2014). Understanding how Latino parents choose beverages to serve to infants and toddlers. Maternal and child health journal, 18(6), 1308-1315.
5. Birch L.L., McPhee L., Steinberg, L., Sullivan, S. (1990). Conditioned flavor preferences in young children. Physiology & Behavior, 47:501-505.
6. Bleich, S. N., & Vercammen, K. A. (2018). The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC obesity, 5(1), 6.
7. Braun V. & Clarke V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
8. Campbell, K.J, Crawford, D.A., Ball, K. (2006). Family food environment and dietary behaviors likely to promote fatness in 5-6 year-old chiildren, International Journal of Obesity, 30(8), 1272-1280.
9. Centers for Disease Control and Prevention (CDC) (2019). Childhood obesity fact. https:// www.cdc.gov/obesity/data/childhood.html
10. Centers for Disease Control and Prevention (CDC) (2018). Defining Childhood Obesity
https://www.cdc.gov/obesity/childhood/defining.html
11. Champion, V. L., & Skinner, C. S. (2008). The health belief model. Health behavior and health education: Theory, research, and practice, 4, 45-65.
12. Charvet, A., & Huffman, F. G. (2019). Beverage intake and its effect on body weight status among WIC preschool-age children. Journal of obesity.
13. Choy, C., & Isong, I.A. (2017). Assessing preschoolers’ beverage consumption using the theory of a planned behavior. Clinical Pediatrics, 57(6):711-721.
14. Coon, K.A., Goldberg., J., Rogers, B.L., Tucker, K.L. Relationships between ue of television during meals and children’s food consumption patternnss. (2001). Pediatrics, 107(1):e7.
15. Cooper, C. C., & Contento, I. R. (2019). Urban Preschool Teachers’ Nutrition Beliefs, Mealtime Practices, and Associations With Training. Journal of Nutrition Education & Behavior, 51(9), 1047-1057.
16. Cooper, C.C. (2020). Tough Love or laissez-faire? Exploring the feeding styles of urban preschool teachers and sssociations with nutrition-focused professional development. Early Childhood Education Journal, 1-10.
17. Darling N, Steinberg L. Parenting style as context: an integrative model. Psychological Bulletin. 1993;113:487–496
18. Davis, J. N., Koleilat, M., Shearrer, G. E., & Whaley, S. E. (2014). Association of infant feeding and dietary intake on obesity prevalence in low‐income toddlers. Obesity, 22(4), 1103-1111.
19. DeBoer, M. D., Scharf, R. J., & Demmer, R. T. (2013). Sugar-sweetened beverages and weight gain in 2- to 5-year-old children. Pediatrics, 132(3), 413-420. https://doi.org/10.1542/peds.2013-0570
20. Department of Health and Human Services. (2020). National Diabetes Statistics Report: Estimates of Diabetes Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
21. Devries S, Willett W, Bonow RO. (2019). Nutrition Education in Medical School, Residency Training, and Practice. JAMA, 321(14):1351–1352.
22. Dubois, L., Farmer, A., Girard, M., & Peterson, K. (2007). Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. Journal of the American Dietetic Association, 107(6), 924-934.
23. Foster, B.A., Hale, D. (2015). Perceptions of weight and health practices in Hispanic children: a mixed-methods study. International Journal of Pediatrics. 2015:761515.
24. Frederick, C. B., Snellman, K., & Putnam, R. D. (2014). Increasing socioeconomic disparities in adolescent obesity. Proceedings of the National Academy of Sciences, 111(4), 1338-1342.





25. Fox T, Corbett A, Story M, on behalf of the RWJF HER Expert Panel on Recommendations for Healthier Beverages. 2013. Recommendations for Healthier Beverages. Durham, NC: Healthy Eating Research. Available at: http://healthyeatingresearch.org/wp-content/uploads/2013/12/HER-Healthier- Bev-Rec-FINAL-3-25-13.pdf.
26. Fox M.K., Pac S., Devaney, B. & Jankowski, L. (2004). Feeding Infants and Toddlers Study: What foods are infants and toddlers eating? Journal of the Academy of Nutrition and Dietetics, 104: Supplement 1: 22-30.
27. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behavior And Health Education: Theory, Research, And Practice. John Wiley & Sons.
28. Grimes, C. A., Riddell, L. J., Campbell, K. J., & Nowson, C. A. (2013). Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics, 131(1), 14-21.
29. Lincoln, YS. & Guba, EG. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage Publications.
30. Han, E., & Powell, L., M. (2013). Consumption patterns of sugar-ssweetened beveragess in the United States, Journal of the Academy of Nutrition and Dietetics, 13(1), 6-13.
31. Hu, F. B., & Malik, V. S. (2010). Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav, 100(1), 47-54.
32. Hughes, S.O., Power, T.G., Orlet Fisher, J., Mueller, S. & Nicklas, T.A. (2005). Revisiting a neglected construct: Parenting styles in a child feeding context. Appetite, 44, 83-92.
33. Hughes, S.O., Shewchuk, R.M., Baskin. & Qu Haiyan. (2008). Indulgent feeding style and children’s weight status in preschool. Journal of Developmental and Behavioral Pediatrics. 29(5): 403- 410.
34. Kay, M. C., Welker, E. B., Jacquier, E. F., & Story, M. T. (2018). Beverage consumption patterns among infants and young children (0-47.9 months): Data from the Feeding Infants and Toddlers Study, 2016. Nutrients, 10(7), 825.
35. Kit, B. K., Fakhouri, T. H., Park, S., Nielsen, S. J., & Ogden, C. L. (2013). Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. The American Journal of Clinical Nutrition, ajcn. 057943.
36. Lamont, M., & White, P. (2008). Interdisciplinary standards for systematic qualitative research. Washington, DC: National Science Foundation. Retrieved from: http://www.nsf.gov/sbe/ses/soc/ISSQR_rpt.pdf
37. Lim, S., Zoellner, J. M., Lee, J. M., Burt, B. A., Sandretto, A. M., Sohn, W., Ismail, A. I., & Lepkowski, J. M. (2009). Obesity and sugar‐sweetened beverages in African‐American preschool children: a longitudinal study. Obesity, 17(6), 1262-1268.
38. Lopez, N.V., Ayala, G.X., Corder, K., Eisenberg, C.M., Zive, M.M., Wood, C., Elder J.P. (2012). Parent support and parent-mediated behaviors are associated with children’s sugary beverage consumption. Journal of the Academy of Nutrition and Dietetics, 112(4), 542-547.
39. Lytle, L. A. (2009). Examining the etiology of childhood obesity: The IDEA study. American Journal of Community Psychology, 44(3-4), 338-349.
40. McAlister, A.R. & Cromwell, T.B. (2010). Children's brand symbolism understanding links to theory of mind and executive functioning, Psychology & Marketing, 27(3).
41. Munsell, C. R., Harris, J. L., Sarda, V., & Schwartz, M. B. (2016). Parents’ beliefs about the healthfulness of sugary drink options: opportunities to address misperceptions. Public Health Nutrition, 19(1), 46-54.
42. Muth, N. D., Dietz, W. H., Magge, S. N., Johnson, R. K. (2019). Public policies to reduce sugary drink consumption in children and adolescents. Pediatrics, 143(4), e20190282.
43. Nezami, B.T., Lytle, L. A. & Tate, D.F. (2016). A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial. BMC Public Health, 16, 837.
44. Northrup, A. A., & Smaldone, A. (2017). Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2-and 3-Year-Old Children. Journal of Pediatric Health Care, 31(3), 262-274.
45. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the united states, 2011-2012. JAMA, 311(8), 806-814. https://doi.org/10.1001/jama.2014.732
46. Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA, 315(21), 2292-2299.
47. Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014. JAMA, 315(21), 2292-2299.
48. Pai, H.L & Contento, I.R. (2014). Parental perceptions, feeding practices, feeding styles, and level of acculturation of Chinese Americans in relation to their school-age child's weight status. Appetite, (80): 174-182.
49. Pan, L., Li, R., Park, S., Galuska, D., Sherry, B., & Freedman, D. (2014). A longitudinal analysis of sugar-sweetened beverage intake during infancy and obesity at six years of age (267.2). The FASEB Journal, 28(1_supplement), 267.262.
50. Pasch, P.A, Penilla, C., Tschann, J.M., Martine, S.M., Deardorff, J., deGroat, C. L., Gregorich, S.E., Flores, E., Butte, N.F. & Greenspan, L.C. (2016). Preferred child body size and parental underestimation of child weight in Mexican American families. Maternal and Child Health Journal, 20(9): 1842-1848.
51. Perera, T., Frei., S., Frei., B., Wong, S.S., & Bobe, G. (2015). Improving nutrition education in U.S. elementary schools: challenges and opportunities. Journal of Education and Practice, 6(30): 41-50.
52. Papousti, G., Klonaris, S & Drichoutis, A. (2019). The health-taste trade-off in consumer decision making: an experimental approach. British Food Journal. (No. 2018-2).
53. Public Health Advocacy Institute. (2017) Issue Brief: Reining in Peaster Power Food and Beverage Marketing.
54. Powell, E. S., Smith-Taillie, L. P., & Popkin, B. M. (2016). Added sugars intake across the distribution of US children and adult consumers: 1977-2012. J Acad Nutr Diet, 116(10), 1543-1550. e1541.
55. Rosinger, A., Herrick, K., Gahche, J., & Park, S. (2017). Sugar-Sweetened Beverage Consumption among US Youth, 2011-2014. NCHS Data Brief. Number 271. National Center for Health Statistics.
56. Salahuddin, M., Pérez, A., Ranjit, N., Kelder, S. H., Barlow, S. E., Pont, S. J., Butte, N. F., & Hoelscher, D. M. (2017). Predictors of Severe Obesity in Low-Income, Predominantly Hispanic/Latino Children: The Texas Childhood Obesity Research Demonstration Study. Preventing Chronic Disease, 14, E141-E141.
57. Shefferly, A., Scharf, R. J., & DeBoer, M. D. (2016). Longitudinal evaluation of 100% fruit juice consumption on BMI status in 2–5‐year‐old children. Pediatric Obesity, 11(3), 221-227.
58. Skerrett, P. & Willett, W.C. (2010). Essentials of healthy eating: a guide. Journal of Midwifery & Women’s Health, 55(6): 492-501.
59. Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics. https://doi.org/10.1542/peds.2017-3459
60. Skinner, A. C., & Skelton, J. A. (2014). Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatrics, 168(6), 561-566.
61. Speziale, H. S., Streubert, H. J., & Carpenter, D. R. (2011). Qualitative Research in Nursing: Advancing The Humanistic Imperative. Lippincott Williams & Wilkins.
62. Stark, L. J., Spear, S., Boles, R., Kuhl, E., Ratcliff, M., Scharf, C., Bolling, C., & Rausch, J. (2011). A pilot randomized controlled trial of a clinic and home‐based behavioral intervention to decrease obesity in preschoolers. Obesity, 19(1), 134-141.
63. Story, M., French, S. (2004). Food advertising and marketing directed at children and adolescents in the U.S. International Journal of Behavioral Nutrition and Physical Activity, 1, 3 (2004).
64. Strauss, A., & Corbin, J. (1994). Grounded theory methodology. Handbook of Qualitative Research, 17, 273-285.
65. Swindle, T. M., Ward, W. L., & Whiteside-Mansell, L. (2018). Facebook: the use of social media to engage parents in a preschool obesity prevention curriculum. Journal of Nutritionn Education & Behavior, 50(1), 4-10. e11.
66. Teng, A. M., Jones, A. C., Mizdrak, A., Signal, L., Genç, M., & Wilson, N. (2019). Impact of sugar‐sweetened beverage taxes on purchases and dietary intake: Systematic review and meta‐analysis. Obesity Reviews, 20(9), 1187-1204.
67. Tipton, J.A. (2014). Using the theory of planned behavior to understand caregivers’ intention to serve sugar-sweetened beverages to non-Hispanic black preschoolers. Journal of Pediatric Nuring, Nov-Dec 2014; 29(6): 564-75.
68. UConnRuddCenter.com (2019). Sales, Nutrition, and Marketing of Children’s Drinks. http://uconnruddcenter.org/childrensdrinkfacts
69. U.S. Department of Education. (2015, April). A matter of equity: Preschool in America. Washington, DC: Author.
70. Van der Horst, K. & Sleddens, E. F. (2017). Parenting styles, feeding styles and food-related parenting practices in relation to toddlers’ eating styles: A cluster-analytic approach. PlosOne, May 24, 2017.
71. Vinke, P.C., Blijleven, K.A., Luitjens, M.H.H.S & Corpeleijn, E. (2020). Young Children’s Sugar Sweetened Beverage Consumption and 5-Year Change in BMI: Lessons Learned from the Timing of Consumption. Nutrients. 12(8): 2486.
72. Vinnakota, S., Mohan, M.D. 2020. Importance of pester power for marketers: an investigation of the evolving concept in marketing. International Journal of Multidisciplinary and Educational Research, 2(4), 195-204.
73. Vos, M. B., Kaar, J. L., Welsh, J. A., Van Horn, L. V., Feig, D. I., Anderson, C. A., Patel, M. J., Cruz Munos, J., Krebs, N. F., & Xanthakos, S. A. (2017). Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation, 135(19), e1017-e1034.
74. Wang YC, Bleich SN, Gortmaker SL. (2008). Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics 121(6): e1604-1614.
75. Welsh, J. A., Cogswell, M. E., Rogers, S., Rockett, H., Mei, Z., & Grummer-Strawn, L. M. (2005). Overweight among low-income preschool children associated with the consumption of sweet drinks: Missouri, 1999–2002. Pediatrics, 115(2), e223-e229.
76. Wilcox., B., Kunkel, D., Cantor., J., Dowrick., P., Linn, S., & Palmer, E. (2004). Report. Of the APA Task Force on Advertising and Children https:www.apa.org/pi/families/resources/advertising-children.pdf (accessed January 2, 2020).
77. Yang, O., Sivey, P., de Silva, A.M. & Scott, A. (2020). Parents' demand for sugar sweetened beverages for their preschool children: evidence from a stated reference experiment. American Journal of Agricultural Economics, 102 (2): 480-504.