PSYCHOSOCIAL FACTORS INFLUENCING THE USE OF SUGAR-SWEETENED BEVERAGES AMONG NON-HISPANIC BLACK PRESCHOOLERS Julia Tipton, MSN, DNS, RN, CNE

SUGAR-SWEETENED BEVERAGES (beverages with added caloric sweeteners) Soft drinks Fruit drinks, punches Lemonade Other “-ades” Sports drinks Sweetened coffee and tea drinks Energy drinks Sweetened milk/milk drinks (CDC, 2010)

The Problem: SSBs and Health Weight gain/adiposity T2D Insulin Resistance Metabolic syndrome Hepatic de novo lipogenesis Decreased nutrients Hyperuricemia Renal problems Bones Blood pressure Dental caries Decreased HDL Heart disease

TRENDS IN CHILDREN’S SSB INTAKE Daily intake of SSBs: 70% of boys and 60% of girls ages 2-19 years 61.3%-70% of 2-5 years Intake among children increases with age Kcal/day doubled since 1970’s 50% of SSB kcal consumed at home Non-Hispanic blacks Low-income families Ogden C.L., Kit, B.K., Carroll, M.D. & Park, S. (2011); Popkin, B.M.(2010); Wang, Bleich & Gortmaker, 2008; Wang & Vine, 2013

PURPOSE To determine the relationships of caregivers’ attitude, beliefs, subjective norm, perceived behavioral control and past behavior with intent to serve SSBs to non-Hispanic black preschoolers  Using the Expanded Theory of Planned Behavioral as the guiding framework

EXPANDED THEORY OF PLANNED BEHAVIOR Adapted from Ajzen, I. (2006)

RESEARCH QUESTION What is the relationship between caregivers’ beliefs, attitude, subjective norm, perceived behavioral control, and past behavior with caregivers’ intent to serve SSBs to non-Hispanic black preschoolers?”

METHOD Cross-sectional, correlational study Multiple regression with path coefficients  Relationship of beliefs, attitudes, subjective norm, perceived behavioral control, and past behavior with caregivers’ intention to serve SSBs to non- Hispanic black preschoolers on a daily basis within the next week

Phase I Instrument Development Elicitation Interviews Phase II Pilot Testing of Instrument Questionnaire Phase III Model and Hypotheses Testing Questionnaire

STUDY POPULATION (All phases) Predominately low-income Caregivers of 2-5 year-old non-Hispanic black children Speak and read English Reside in same household Provide household meals > 18 years Public health clinics, childcare centers, and preschools

INITIAL SUGAR SWEETENED DRINK QUESTIONNAIRE (SSDQ) 73 items related to intention to serve SSBs Flesch Kincaid Grade Level of 5.4 Flesch Reading Ease of 77.1%

SUGAR-SWEETEND DRINK QUESTIONNAIRE (SSDQ) 58 items Concepts related to intention = 49 Demographic = 9 Flesch Reading Ease 91.1 Flesch Kincaid Grade Level 4.3 Content Validity Instrument CVI = 0.91 S-CVI range = 0.8 to 1.0 Internal consistency Cronbach’s alpha ≥ 0.7 Temporal stability Correlation coefficient ≥ 0.5

PHASE III: MODEL AND HYPOTHESES TESTING n = 165 (caregivers of predominately low-income non-Hispanic black 2-5 year-olds) 11 Sites Head Start Centers, Head Start Child Care Partner Centers, private preschools and childcare centers in metropolitan New Orleans area Self-administered SSDQ

PHASE III: MODEL AND HYPOTHESES TESTING 331 packets distributed 169 returned; 4 eliminated based on child’s age Final sample n=165 Adjusted response rate of 49.8% Pairwise deletion for missing data

DEMOGRAPHIC DATA Caregiver Mean age (range years) 91.33% female 91.88% non-Hispanic black 92.45% high school/GED 35.22% some college high school/GED 18.87% associate or bachelors 3.77% masters or higher 94.67% reside in low-income household Mean age of children 3.41 SSB Intake 35% daily 56.98% at least once over the past week

PHASE III: DATA ANALYSIS Zero-order correlation matrix  Measure relationship between an independent variable and a dependent variable with the influence of other variables held constant Multiple regression with path coefficients  Evaluate strength of linear relationship between 2 variablesBeta > 0.1 considered significant

R 2 =.606 *p≤.001 **p≤.01 ***p≤.05 No significant correlation between PBC and INT

R 2 =.587 *p≤.001 **p≤.01 ***p≤.05

CONCLUSIONS 35% of caregivers reported serving SSBs daily Significant predictors of attitude  “No major disadvantage” (knowledge or other factors?)  Taste  Convenience  Keeps child content Significant predictors of subjective norm  Doctors  Other parents of young children

Recommendations NURSING PRACTICE PATIENT EDUCATION NURSING EDUCATION POLICY RESEARCH

CLOSING Past behavior, attitude and subjective norm predictors of caregivers’ decisions to serve SSBs to preschoolers Role of perceived behavioral control and control beliefs not supported Findings can be integrated into strategies aimed at decreasing SSB consumption among young children Individually tailoring interventions essential Avoid “one size fits all” approach

REFERENCES Ajzen, I. (2006). Behavioral intentions based on the theory of planned behavior. Retrieved from Centers for Disease Control and Prevention. (2010, March). The CDC guide to strategies for reducing the consumption of sugar- sweetened beverages. Retrieved from ce_Sugar_Sweetened_Bevs.pdf ce_Sugar_Sweetened_Bevs.pdf Ogden C.L., Kit, B.K., Carroll, M.D. & Park, S. (2011). Consumption of sugar drinks in the United States, 2005–2008. NCHS data brief, no 71. Hyattsville, MD: National Center for Health Statistics.

REFERENCES Popkin, B.M. (2010). Patterns of beverage use across the lifecycle. Physiology and Behavior, 100(1), 4-9. Wang, Y.C., Bleich, S.N. & Gortmaker, S.L. (2008). Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juice intake among US children and adolescents, Pediatrics, 121, e1604-e1614 Wang, C.Y. & Vine, S.M. (2013). Caloric effect of a 16-ounce (473-Ml) portion-size cap on sugar-sweetened beverages served in restaurants. American Journal of Clinical Nutrition, 98(2),