Research reportFactors influencing the frequency of children's consumption of soft drinks☆
Introduction
Child obesity is a primary focus of obesity prevention interventions because of the potential benefits for both current and future cohorts. The risk of obesity in adulthood is higher for overweight children (Biro, Wien, 2010, Magarey et al, 2003), and encouraging healthy eating habits can be easier in childhood before taste preferences and habits consolidate (American Dietetic Association, 2004). While efforts to date appear to have had some effect on reducing the rate of increase in child obesity, prevalence rates remain at alarming levels and the search continues for effective methods of modifying relevant risk factors (Australian National Preventive Health Agency, 2014, World Health Organization, 2013).
As part of a larger study examining the factors that influence food preferences (blinded for review Pettigrew et al, 2013, Pettigrew et al, 2015), the present study investigated the predictors of children's consumption of soft drinks. In the Australian context, soft drinks are defined as carbonated beverages (Moretto et al., 2014), and they are one product type within the broader category of sugar-sweetened beverages that also includes cordials, juices, sports drinks, and energy drinks (Hu, 2013, National Health and Medical Research Council, 2013). Sugar-sweetened beverages are in turn part of the larger group of unhealthy food products that are energy dense, nutrient poor (EDNP: Kant, 2000). There are mounting concerns relating to the particular contribution of sugar-sweetened beverages to child obesity (Gill et al, 2006, Grimes et al, 2013, Hu, 2013, Vartanian et al, 2007, World Health Organization, 2015). Studies have found that sugar-sweetened beverage consumption is associated with a higher risk of weight gain and obesity (Martin-Calvo et al, 2014, Zheng et al, 2015, Zheng et al, 2014). In the specific case of soft drinks, Martin-Calvo et al. (2014) found daily consumption to be associated with a 69% relative increase in the risk of obesity. This growing evidence base is reflected in the recent inclusion of guidance to limit intake of these beverages in the Australian Dietary Guidelines (NHMRC, 2013).
Theoretical frameworks of the factors that are associated with children's diets and parents' child-feeding practices include a large number of variables, which range from individual parent attributes and behaviours through to environmental factors (Adamo, Brett, 2014, Davison, Birch, 2001, Faith et al, 2012, Golan, 2006, Golan, Weizman, 2001, Patrick, Nicklas, 2005, Pocock et al, 2010, Ventura, Birch, 2008). Individual attributes include parents' food-related knowledge and attitudes, socioeconomic status (SES), weight status (body mass index: BMI), and family structure. Parent behaviours include food preparation and consumption modelling, parenting style, and television viewing habits. Environmental factors include the available food supply, food-related government policies, food advertising, the cost of food products, and social norms relating to the consumption of unhealthy beverages. This diverse range of factors reflects the complex nature of food decisions and the difficulties associated with attempting to encourage behavioural change in this domain (Conner, 1993, Freeland-Graves, Nitzke, 2013).
The World Health Organization has recently noted the “need to evaluate different behavioural-change approaches to promote the reduction of free sugars intake; in particular, the intake of sugar-sweetened beverages” (WHO, 2015, p. 20). Intervention development requires a detailed understanding of the relative importance of influencing factors to enable prioritisation of those that have the most potential to improve outcomes (Swinburn et al., 2013). Given the strong socio-cultural role of food (Douglas & Isherwood, 1979), the relative weighting of different factors can vary between countries, necessitating formative research in specific national contexts. However, there are also likely to be similarities between countries that share cultural heritages and marketplace characteristics (e.g., the UK, the US, Canada, and Australia). The present study assessed the relative importance of different factors that influence children's consumption of soft drinks in the Australian context. Specifically, the pathways by which various individual and environmental factors impact on the reported frequency of children's consumption of soft drinks were estimated using structural equation modelling. The resulting model can facilitate the development of interventions that cater for the specific antecedents of consumption.
Section snippets
Sample
The sample comprised 1302 parents of children aged 8 to 14 years. Data were collected from parents because of their critical roles in controlling the supply of food in the home and modelling food consumption behaviours to their children (Birch, Fisher, 1998, Brown, Ogden, 2004, Golan, 2006, Skouteris et al, 2012). The selected child age range reflects a period in which children's soft drink consumption increases dramatically (Australian Bureau of Statistics [ABS], 2014), and is similar to that
Results
Parents' reports of the frequency of their children's consumption of soft drinks are presented in Table 2. Just over half of the respondents reported that their children consumed soft drinks at least weekly and one in eight reported that their children drink them on a daily basis.
Discussion
The aim of this study was to investigate the contribution of a range of factors to children's consumption of soft drinks to inform future interventions designed to reduce children's intake of these products. Of the various individual and environmental factors included in the study, parents' attitudes to soft drinks, children's pestering behaviours, and perceived social norms were found to be the most influential. The structural equation model developed from a large sample of Australian parents
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