PSYCHOSOCIAL FACTORS INFLUENCING

THE USE OF

SUGAR-SWEETENED BEVERAGES AMONG

NON-HISPANIC BLACKPRESCHOOLERS

Julia Tipton, MSN, DNS, RN, CNE

SUGAR-SWEETENED BEVERAGES(beverages with added caloric sweeteners)

• Soft drinks • Fruit drinks, punches• Lemonade• Other “-ades”• Sports drinks

• Sweetened coffee and tea drinks• Energy drinks• Sweetened milk/milk drinks• (CDC, 2010)

The Problem: SSBs and Health

• Weight gain/adiposity• T2D• Insulin Resistance• Metabolic syndrome• Hepatic de novo lipogenesis• Decreased nutrients

• Hyperuricemia• Renal problems• Bones• Blood pressure• Dental caries• Decreased HDL• Heart disease

TRENDS IN CHILDREN’S SSB INTAKE• Daily intake of SSBs:

• 70% of boys and 60% of girls ages 2-19 years• 61.3%-70% of 2-5 years• Intake among children increases

with age

• Kcal/day doubled since 1970’s• 50% of SSB kcal consumed at

home• Non-Hispanic blacks• Low-income families

Ogden C.L., Kit, B.K., Carroll, M.D. & Park, S. (2011); Popkin, B.M.(2010); Wang, Bleich & Gortmaker, 2008; Wang & Vine, 2013

PURPOSE• To determine the relationships of caregivers’

attitude, beliefs, subjective norm, perceived behavioral control and past behavior

with intent to serve SSBs to non-Hispanic black preschoolers

Using the Expanded Theory of Planned Behavioral as the guiding framework

EXPANDED THEORY OF PLANNED BEHAVIOR

Adapted from Ajzen, I. (2006)

RESEARCH QUESTION

• What is the relationship between caregivers’ beliefs, attitude, subjective norm, perceived behavioral control, and

past behavior with

caregivers’ intent to serve SSBs to

non-Hispanic black preschoolers?”

METHOD

•Cross-sectional, correlational study•Multiple regression with path coefficients

Relationship of beliefs, attitudes, subjective norm, perceived behavioral control, and past behavior with caregivers’ intention to serve SSBs to non-Hispanic black preschoolers on a daily basis within the next week

Phase

I

• Instrument Development• Elicitation Interviews

Phase II

• Pilot Testing of Instrument• Questionnaire

Phase III

• Model and Hypotheses Testing• Questionnaire

STUDY POPULATION (All phases)

•Predominately low-income •Caregivers of 2-5 year-old non-Hispanic black

children•Speak and read English•Reside in same household•Provide household meals•> 18 years

Public health clinics, childcare centers, and preschools

INITIAL SUGAR SWEETENED DRINK QUESTIONNAIRE (SSDQ)

73 items related to intention to serve SSBs• Flesch Kincaid Grade Level of 5.4• Flesch Reading Ease of 77.1%

SUGAR-SWEETEND DRINK QUESTIONNAIRE (SSDQ)• 58 items• Concepts related to intention =

49• Demographic = 9• Flesch Reading Ease 91.1• Flesch Kincaid Grade Level 4.3

• Content Validity• Instrument CVI = 0.91• S-CVI range = 0.8 to 1.0

• Internal consistency• Cronbach’s alpha ≥ 0.7

• Temporal stability• Correlation coefficient ≥ 0.5

PHASE III: MODEL AND HYPOTHESES TESTING• n = 165

(caregivers of predominately low-income non-Hispanic black 2-5 year-olds)

• 11 Sites• Head Start Centers, Head Start Child Care Partner Centers, private preschools

and childcare centers in metropolitan New Orleans area

• Self-administered SSDQ

PHASE III: MODEL AND HYPOTHESES TESTING• 331 packets distributed• 169 returned; 4 eliminated based on child’s age• Final sample n=165• Adjusted response rate of 49.8%• Pairwise deletion for missing data

DEMOGRAPHIC DATA• Caregiver

• Mean age 31.33 (range 18-67 years)• 91.33% female• 91.88% non-Hispanic black• 92.45% high school/GED• 35.22% some college• high school/GED • 18.87% associate or bachelors• 3.77% masters or higher

• 94.67% reside in low-income household• Mean age of children 3.41• SSB Intake

• 35% daily• 56.98% at least once over the past

week

PHASE III: DATA ANALYSIS

• Zero-order correlation matrixMeasure relationship between an independent variable and a dependent

variable with the influence of other variables held constant

• Multiple regression with path coefficientsEvaluate strength of linear relationship between 2 variables Beta >

0.1 considered significant

EXPANDED THEORY OF REASONED ACTION

.663*

`

.236* .423*

.377* .269*

Behavioral beliefs x Outcome evaluation Belief r Beta Hyperactive - .386* n.s. Bad for teeth -.366* n.s. Too much sugar -.393* n.s. Child drinks what he/she likes .394* .149*** Diabetes risk - .420* n.s. Feel special .359* n.s. Kidney risk -.446* n.s. Overweight risk -.423 n.s. Convenient .463* .221* Keeps child content .504* .175*** No major disadvantages .621 .418*

Attitude

Normative beliefs x Motivation to Comply Belief r Beta Parents of young children .459* .347* Doctors .398* .231**

Subjective norm

Intention to serve SSBs

Past Behavior

R2 = .587*p≤ .001 **p≤ .01***p≤ .05

CONCLUSIONS

• 35% of caregivers reported serving SSBs daily• Significant predictors of attitude

“No major disadvantage” (knowledge or other factors?) TasteConvenienceKeeps child content

• Significant predictors of subjective normDoctorsOther parents of young children

Recommendations

• NURSING PRACTICE • PATIENT EDUCATION• NURSING EDUCATION• POLICY• RESEARCH

CLOSING

• Past behavior, attitude and subjective norm predictors of caregivers’ decisions to serve SSBs to preschoolers• Role of perceived behavioral

control and control beliefs not supported

• Findings can be integrated into strategies aimed at decreasing SSB consumption among young children• Individually tailoring

interventions essential• Avoid “one size fits all” approach

REFERENCES• Ajzen, I. (2006). Behavioral intentions based on the theory of

planned behavior. Retrieved from http://people.umass.edu/aizen/pdf/tpb.intervention.pdf• Centers for Disease Control and Prevention. (2010, March). The

CDC guide to strategies for reducing the consumption of sugar-sweetened beverages. Retrieved from http://www.cdph.ca.gov/sitecollectiondocuments/StratsoReduce_Sugar_Sweetened_Bevs.pdf• Ogden C.L., Kit, B.K., Carroll, M.D. & Park, S. (2011).

Consumption of sugar drinks in the United States, 2005–2008. NCHS data brief, no 71. Hyattsville, MD: National Center for

Health Statistics.

REFERENCES

• Popkin, B.M. (2010). Patterns of beverage use across the lifecycle. Physiology and Behavior, 100(1), 4-9.•Wang, Y.C., Bleich, S.N. & Gortmaker, S.L. (2008). Increasing

caloric contribution from sugar-sweetened beverages and 100% fruit juice intake among US children and adolescents, 1988-2004. Pediatrics, 121, e1604-e1614•Wang, C.Y. & Vine, S.M. (2013). Caloric effect of a 16-ounce

(473-Ml) portion-size cap on sugar-sweetened beverages served in restaurants. American Journal of Clinical Nutrition, 98(2), 430-435.