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Background Added sugar intake in the form of sugar-sweetened beverages (SSB) has been considered a contributor to weight gain and cardiometabolic dysfunction in adults and youth. Adolescents are some of the highest consumers of added sugars, taking in ~16% of their total calories from added sugars with ~40% of these calories coming from SSB. Youth’s food preferences and self-regulation of dietary intake can be influenced by parents. Objective To evaluate the Theory of Planned Behavior’s (TPB) effectiveness in understanding and predicting adolescents' SSB consumption, identify which constructs are the most important when evaluating SSB consumption in adolescents, and determine if and how adolescents' beverage choices are influenced by parents' reactions to their beverage choices. Design Measurements for this cross-sectional study included four record-assisted 24-hour dietary recalls and responses to a SSB-specific TPB questionnaire from 100 adolescents. Consenting parents completed a beverage intake questionnaire, a TPB questionnaire, and Parent Response to Beverage Choice Questionnaire. Results The TPB explained 34% of the variance in adolescents' and parents' intention to limit SSB to less than one cup per day. Parents' perceived behavioral control (b=1.35, p=0.002) and adolescents' subjective norms (b=0.57, p=0.001) were the strongest predictors of intention, and intention was the strongest predictor of SSB consumption in both adolescents and parents (b=−37, p=0.026, b=−49, p=0.003). The TPB explained more variance in parent SSB consumption (R2=0.38) than adolescents (R2=0.22). Parents did more discouraging of SSB and encouraging of non-SSB. Adolescents' intention to limit SSB moderated the relationship between parents' reactions encouraging SSB and adolescents' predicted SSB consumption (p=0.021). Conclusions The TPB explained a small, but significant amount of variance in adolescents' SSB consumption. When addressing adolescent SSB intake, people in addition to parents may influence their intentions and SSB consumption.

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BackgroundBrief, valid, and reliable dietary and physical activity assessment tools are needed, and interactive computerized assessments (ie, those with visual cues, pictures, sounds, and voiceovers) can reduce administration and scoring burdens commonly encountered with paper-based assessments.ObjectiveThe purpose of this pilot investigation was to evaluate the comparative validity and reliability of interactive multimedia (IMM) versions (ie, IMM-1 and IMM-2) compared to validated paper-administered (PP) versions of the beverage intake questionnaire (BEVQ-15) and Stanford Leisure-Time Activity Categorical Item (L-Cat); a secondary purpose was to evaluate results across two education attainment levels.MethodsAdults 21 years or older (n=60) were recruited to complete three laboratory sessions, separated by three to seven days in a randomly assigned sequence, with the following assessments–demographic information, two IMM and one paper-based (PP) version of the BEVQ-15 and L-Cat, health literacy, and an IMM usability survey.ResultsResponses across beverage categories from the IMM-1 and PP versions (validity; r=.34-.98) and the IMM-1 and IMM-2 administrations (reliability; r=.61-.94) (all P<.001) were significantly correlated. Paired t tests revealed significant differences in sugar-sweetened beverage (SSB) grams and kcal (P=.02 and P=.01, respectively) and total beverage kcal (P=.03), on IMM-1 and IMM-2; however, comparative validity was demonstrated between IMM-2 and the PP version suggesting familiarization with the IMM tool may influence participant responses (mean differences: SSB 63 grams, SEM 87; P=.52; SSB 21 kcal, SEM 33; P=.48; total beverage 65 kcal, SEM 49; P=.19). Overall mean scores between the PP and both IMM versions of the L-Cat were different (both P<.001); however, responses on all versions were correlated (P<.001). Differences between education categories were noted at each L-Cat administration (IMM-1: P=.008; IMM-2: P=.001; PP: P=.002). Major and minor themes from user feedback suggest that the IMM questionnaires were easy to complete, and relevant to participants' typical beverage choices and physical activity habits.ConclusionsIn general, less educated participants consumed more total beverage and SSB energy, and reported less engagement in physical activity. The IMM BEVQ-15 appears to be a valid and reliable measure to assess habitual beverage intake, although software familiarization may increase response accuracy. The IMM-L-Cat can be considered reliable and may have permitted respondents to more freely disclose actual physical activity levels versus the paper-administered tool. Future larger-scale investigations are warranted to confirm these possibilities.

Background: Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary

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