Role of social ecological model level on young Pacific children’s sugar-sweetened beverage and water intakes: Children’s Healthy Living intervention

Abstract

Objective To examine children’s sugar-sweetened beverage (SSB) and water intakes in relation to implemented intervention activities across the social ecological model (SEM) during a multilevel community trial. Design Children’s Healthy Living was a multilevel, multicomponent community trial that reduced young child obesity (2013-2015). Baseline and 24-month cross-sectional data were analyzed from nine intervention arm communities. Implemented intervention activities targeting reduced SSB and increased water consumption were coded by SEM level (child, caregiver, organization, community, policy). Child SSB and water intakes were assessed by caregiver-completed two-day dietary records. Multilevel linear regression models examined associations of changes in beverage intakes with activity frequencies at each SEM level. Setting US-Affiliated Pacific region. Participants Children aged 2-8 years (baseline: n=1343; 24-months: n=1158). Results On average (±SD), communities implemented 74±39 SSB and 72±40 water activities. More than 90% of activities targeted both beverages together. Community-level activities (e.g., social marketing campaign) were most common (61% of total activities) and child-level activities (e.g., sugar counting game) were least common (4%). SSB activities across SEM levels were not associated with SSB intake changes. Additional community-level water activities were associated with increased water intake (0.62 mL/day/activity; 95% CI: 0.09, 1.15) and water-for-SSB substitution (operationalized as SSB minus water: -0.88 mL/day/activity; 95% CI: -1.72, -0.03). Activities implemented at the organization-level (e.g., strengthening preschool wellness guidelines) and policy-level (e.g., SSB tax advocacy) also suggested greater water-for-SSB substitution (p<0.10). Conclusions Community-level intervention activities were associated with increased water intake, alone and relative to SSB intake, among young children in the Pacific region.

Maintenance Outcomes of the Children’s Healthy Living Program on Overweight, Obesity, and Acanthosis Nigricans Among Young Children in the US-Affiliated Pacific Region

“…A total of 4333 children aged 2 to 8 years were recruited for measurements at schools or community events at time 1; 4048, at time 2; and 1475, at time 3 (Figure 1). The recruitment goal for times 1 and 2 of 150 children per community for anthropometry and 100 for dietary and physical activity assessment was established to detect effect sizes of 0.26 to 0.31, assuming α = .05 (2-sided), β = 0.20, and an intraclass correlation coefficient within communities of 0.02 . The goal of 50 per community for time 3 was set to detect differences compared with times 1 or 2 with effect sizes of 0.15 and 0.18, assuming the observed intraclass correlation coefficient of 0.005.…”

“… 12 , 15 , 16 It sought to identify and build on what was currently working in communities by engaging community partners and members in ways sensitive to their culture and putting the health and well-being of young children at the forefront of community decisions and actions in a way that could be sustained through the land grant college network and local coalitions. 17 , 18 In addition, the trial developed and used a template for implementation and had exceptional accuracy of anthropometric measurements. 19 It was also novel in terms of the diversity and range of understudied racial and ethnic groups (ie, Alaska Native, Native Hawaiian, and Pacific Islander) and regions (ie, USAP jurisdictions) included in a single trial with populations at high risk for chronic disease.…”

“…The trial was guided by the ANGELO (Analysis Grid for Elements Linked to Obesity) framework and designed by merging community input and evidence-based strategies . It sought to identify and build on what was currently working in communities by engaging community partners and members in ways sensitive to their culture and putting the health and well-being of young children at the forefront of community decisions and actions in a way that could be sustained through the land grant college network and local coalitions . In addition, the trial developed and used a template for implementation and had exceptional accuracy of anthropometric measurements .…”

Feasibility of Healthy Beverages Policies in American Samoa and Federated States of Micronesia: Water and Coconut Water Only Community Interventions

“…Scaling up of healthy beverage policies widely across organizations in the USAPI combined with planned media campaigns using communication channels that have a wide reach in communities should be further explored with rigorous evaluations, especially tracking dose measures (Korn et al, 2021). Future interventions should use multi-level implementation research study designs (e.g., experimental, quasi-experimental, mixed methods) (Hwang et al, 2020) to rigorously evaluate the efficacy of healthy beverage interventions (Korn et al, 2021). Systematic and rigorous efforts to evaluate healthy beverage consumption and PSE interventions would strengthen future health promotion research, policy, and practice.…”

“…S. Department of State, 2019). This healthy nutrition intervention builds on limited interventions to decrease SSBs in the Pacific and responds to recommendations to limit SSBs availability in public spaces, such as not making SSBs the default beverage choice (Korn et al, 2021).…”