Rethink your drink: Development of a social marketing campaign to reduce intake of sugar-sweetened beverages among school-age children


General Information

Rethink your drink

Sugar-sweetened beverages, such as soft drinks, juice drinks, flavored waters, electrolyte replacement beverages, and sweetened teas and coffees, represent a considerable component of the US diet. These beverages are of concern for several reasons including their association with childhood overweight/obesity and their potential to displace more healthful beverages (e.g., low-fat milk, 100% juice and water).

There have been many efforts undertaken to make sugar-sweetened beverages less available at school. These efforts are reflected in federally mandated school wellness policies as well as the Clinton Foundation's successful negotiations with the American Beverage Association.

The purpose of this study is to build on these environmental changes and develop a multi-faceted campaign, based on the principles of social marketing, that will lead to a reduced intake of sugar-sweetened beverages among school-age children participating in the Supplemental Nutrition Assistance Program (SNAP).

Toward that end, formative research will be conducted with SNAP participants to determine the campaign messages, materials and approaches. In addition, an evaluation plan will be developed and community partnerships will be established in anticipation of implementing the campaign.

Personnel

Department of Nutrition
Phone: (775) 784-6445

BackGround

There are a large and growing number of drinks that fall into the category of sugar-sweetened beverages.  These include carbonated soft drinks, juice drinks/ades, flavored and vitamin-fortified waters, electrolyte-replacement beverages, energy drinks, and flavored coffees and teas.  The sweeteners used are generally sucrose, corn sweetener, fructose, and/or high-fructose corn syrup. 

Sugar-sweetened beverages represent a significant component of the US diet.  Based on a nationally-representative sample of Americans age 2 and older, it is estimated that sugar-sweetened beverages account for 47% of total added sugars in the diet (Guthrie et al., 2000).  Among children and adolescents, Wang et al (2008) reported an increase in sugar-sweetened beverage consumption between the years of 1999-2004, with a greater increase observed among children age 2-11 from low-income households.  They estimated that energy intake from these beverages averaged 224 kcal/day across all child age/gender groups. 

Therefore, consumption of sugar-sweetened beverages remains a significant concern for children.   Longitudinal studies indicate that milk and fruit juice consumption decline in early childhood to late adolescence with a concurrent increase in sweetened beverages (e.g., Fiorito et al., 2006).  In addition, high levels of soda, negatively impacts children’s dietary quality (Harnack et al, 1999; Mrdjenovic et al, 2003).  A recent study conducted by Fiorito et al (2010) found that girls’ consumption of soda at age five predicted unhealthful nutrient intake patterns that persisted throughout childhood and into adolescence.  These nutrient patterns reflected the inclusion of soda as well as the displacement of other nutritious beverages (e.g., milk).

Although there are some conflicting results, greater intake of sugar-sweetened beverages appears to be associated with great adiposity among children and adults.  In a systematic review of 30 published studies, Malik et al (2006) concluded that greater consumption of sugar-sweetened beverages is associated with weight gain and obesity (p. 274).      

Because of these concerns, the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010 advised, “Consumption of sugar-sweetened beverages in childhood should be discouraged (1) because of the positive association with increased adiposity and (2) because of the need to replace empty calories with nutrient-rich energy for optimal growth and development.” (http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm;  E1-4).

Interventions seeking to decrease the consumption of sugar-sweetened beverages have been conducted (Karanja et al, 2010), including those funded through Supplemental Nutrition Assistance Program (SNAP-Ed).  Although a comprehensive evaluation of such programs isn’t readily available, there are reports of success in changing attitudes and behaviors (e.g., BANPAC Soda Free Summer Evaluation Summary) using strategies similar to what we are proposing.  

In addition to these interventions, there have been many efforts undertaken to make sugar-sweetened beverages less available to school-age children.  These efforts are reflected in federally mandated school wellness policies as well as the Clinton Foundation’s successful negotiations with the American Beverage Association. 

Social marketing represents an ideal framework for the purpose of building on these interventions and environmental changes to accomplish our goal of decreasing consumption of sugar-sweetened beverages among school-age children. 

Social marketing is generally described as the application of commercial marketing techniques to the planning and execution of programs designed to bring about a social change (Andreasen,1995).  With this approach, a health behavior and its associated benefits are viewed as a “product.”  The intent is to promote the acceptability of the product and minimize the “price,” which includes tangible and intangible costs such as time, effort and inconvenience.

Because social marketing is consumer-oriented, the success of such efforts depends greatly on the degree to which the messages, materials and approaches meet the needs of the target audience.  Toward that end, formative research (aka: formative evaluation) is often needed to answer these and other questions:

“What meaning does the behavior or issue in question have for the target audience or for sub-groups? What are the best ways (i.e., channels of communications) to reach the target audience? What barriers exist to communicating with the target audience? What strategies exist for overcoming these barriers? Does the target audience understand the message?  Is its format appealing to the target audience?” (Hersey and Daugherty, 1999; p. 7-8).

 

Formative research methods include qualitative (e.g., focus groups and interviews) and quantitative methods (e.g., surveys).  One example of such work was recently reported by Roth-Yousey et al (2009) who conducted focus groups with 10-13 YO children to learn about parenting practices that moderate beverage intake. 

A local example of a program based on social marketing is “Calcium, It’s Not Just Milk.” It was Nevada’s first SNAP-Ed Program and continues to be successful today. 

Objectives

The overall goal of this effort is to develop a multi-faceted campaign, based on the principles of social marketing, that will lead to a reduced intake of sugar-sweetened beverages among children participating in Supplemental Nutrition Assistance Program (SNAP) and those eligible for SNAP.  Our goal is consistent with Nevada’s state objective, “Promote healthy eating and active lifestyles based on key messages in the Dietary Guidelines.”    

References

Andreasen, A.R., 1995.  Marketing Social Change.  San Francisco, CA:  Jossey-Bass.

Fiorito, L., Smiciklas-Wright, H., Mitchel, D.C., Birch, L.L. (2006).  Dairy and dairy-related nutrient intake during middle childhood.  Journal of the American Dietetic Association, 106, 534-542.

Fiorito, L., Marini, M., Mitchell, D.C., Smiciklas-Wright, H. & Birch, L.L. (2010).  Girls’ early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence.  Journal of the American Dietetic Association, 110, 543-550.

Guthrie, J. & Morton, J.  (2000).  Food sources of added sweeteners in the diets of Americans.  Journal of the American Dietetic Association, 100,  43-48, 51.

Harnack, L, Stang, J., Story, M.  (1999).  Soft drink consumption among US children and adolescents:  Nutritional consequences.  Journal of the American Dietetic Association, 99, 436-441.

Hersey, J., & Daugherty, S. (1999).  Evaluating Social Marketing in Nutrition:  A Resource Manual.  Health Systems Research, Inc. 

Karanja, N., Lutz, T., Ritenbaugh, C., Maupome, G., Jones, J., Becker, T. & Aickin, M.  (2010).  The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth:  A feasibility and efficacy study.  Journal of Community Health, Published online, May.

Malik, V.S., Schulze, M.B., Hu, F.B. (2006). Intake of sugar-sweetened beverages and weight gain:  A systematic review.  American Journal of Clinical Nutrition, 84, 274-288.

Mrdjenovic, G., Levitsky, D.A. (2003). Nutritional and energetic consequences of sweetened drink consumption in 6-13 year-old children.  Journal of Pediatrics, 142, 604-610.

Roth-Yousey, Reicks, M., Pollack, V.  (2009).  Perceived parenting practices used to moderate beverage intakes in children:  Focus group results.  Journal of the American Dietetic Association, 109, A-89.

Wang, Y.S., Bleich, S.N., & Gortmaker, S.L. (2008).  Increasing caloric constribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004.  Pediatrics, 121, e1604-e1614.