Parental Concerns about Child and Adolescent Caffeinated Sugar-Sweetened Beverage Intake and Perceived Barriers to Reducing Consumption

Abstract

Sugar-sweetened beverage (SSB) consumption contributes to obesity and chronic disease. SSB intake in children and adolescents remains well above recommendations and reducing intake is challenging. In addition to high sugar content, SSBs are the predominant source of caffeine among youth. However, whether caffeine in SSBs presents unique barriers to reducing consumption is unknown. Herein, we examine parental concerns about child caffeinated-SSB (CSSB) intake and describe parent-reported barriers to lowering their child’s consumption. In-depth qualitative interviews were conducted with 21 parents of children and adolescents 8–17 years of age. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded using Nvivo™, and key themes were identified. Most parents expressed concern about child CSSB consumption, primarily with regard to dietary (e.g., excess sugar), health (e.g., obesity, diabetes) and/or behavioral (e.g., hyperactivity) consequences of frequent intake. Several key barriers to CSSB restriction were reported, encompassing six emergent themes: widespread availability and accessibility; child non-compliance when asked not to drink CSSBs; peer and cultural influences; negative child response to CSSB restriction; family eating behaviors; and, child preferences for CSSBs versus other beverages. Consideration of these barriers, along with the development of novel approaches to address these challenges, will likely bolster success in interventions aimed at reducing CSSB intake among children and adolescents.

Children's Sugar-Sweetened Beverage Consumption: Striking Parallels With Substance Use Disorder Symptoms

“…Signs of addiction have also been reported among children in response to frequent SSB consumption (13,14). In our qualitative study (14), parents of children 8-17 years old reported that children experienced physical and affective withdrawal symptoms when caffeinated SSB intake was restricted. Similarly, Falbe et al (13) reported that adolescents, who reported habitual SSB consumption, regardless of whether SSBs were caffeinated or caffeine-free indicated increased SSB cravings and headaches, and decreased motivation, contentment, concentration, and wellbeing during 72 h of SSB cessation.…”

“…Children who demonstrate more signs of addiction in their highly processed food consumption are more likely to have higher reward drive for food and higher body mass index (12). Signs of addiction have also been reported among children in response to frequent SSB consumption (13,14). In our qualitative study (14), parents of children 8-17 years old reported that children experienced physical and affective withdrawal symptoms when caffeinated SSB intake was restricted.…”

“…Thus, over-reliance on problem-focused criteria that interfere with day-to-day functioning, which are less relevant for children, may lead to underdiagnosis of SUDs in youth even when key indicators of addictive behavior are present (15). We examined the extent to which responses during in-depth interviews with parents (n = 21) (14) and focus groups with children (n = 37) (16) about SSB consumption (two separate cohorts, not dyads) reflected DSM-5 SUD criteria. We specifically focused on criteria pertaining to mechanistic dysfunction ( Table 1).…”

“…We specifically focused on criteria pertaining to mechanistic dysfunction ( Table 1). Details of the parent interviews and focus groups with children who reported daily caffeinated SSB consumption were previously published and are described elsewhere (14,16).…”

“…Herein, we propose that children's SSB consumption may reflect SUD symptomology and focus specifically on caffeinated SSBs, which are manufactured to contain a highly rewarding mixture of added sugar and caffeine, two ingredients that do not naturally occur in combination. (14).…”