Objective:To assess whether a community water service is associated with the frequency of sugar-sweetened beverages (SSB) consumption, obesity, or perceived health status in rural Alaska.Design:We examined the cross-sectional associations between community water access and frequency of SSB consumption, body mass index categories, and perceived health status using data from the 2013 and 2015 Alaska Behavioral Risk Factor Surveillance System (BRFSS). Participants were categorized by zip code to ‘in-home piped water service’ or ‘no in-home piped water service’ based on water utility data. We evaluated the univariable and multivariable (adjusting for age, household income and education) associations between water service and outcomes using log-linear survey-weighted generalized linear models.Setting:Rural Alaska, USA.Subjects:Eight hundred and eighty-seven adults, aged 25 years and older.Results:In unadjusted models, participants without in-home water reported consuming SSB more often than participants with in-home water (1·46, 95 % CI: 1·06, 2·00). After adjustment for potential confounders, the effect decreased but remained borderline significant (1·29, 95 % CI: 1·00, 1·67). Obesity was not significantly associated with water service but self-reported poor health was higher in those communities without in-home water (1·63, 95 % CI: 1·05, 2·54).Conclusions:Not having access to in-home piped water could affect behaviours surrounding SSB consumption and general perception of health in rural Alaska.

Although monitoring childhood obesity prevalence is critical for state public health programs to assess trends and the effectiveness of interventions, few states have comprehensive body mass index measurement systems in place. In some states, however, assorted school districts collect measurements on student height and weight as part of annual health screenings. To estimate childhood obesity prevalence in Alaska, we created a logistic regression model using such annual measurements along with public data on demographics and socioeconomic status. Our mixed-effects model-generated prevalence estimates validated well against weighted estimates, with 95% confidence intervals overlapping between methodologies among 7 of 8 participating school districts. Our methodology accounts for variation in school-level and student-level demographic factors across the state, and the approach we describe can be applied by other states that have existing nonrandom student measurement data to estimate childhood obesity prevalence.

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Background Sugary drink consumption by young children is a public health concern. The State of Alaska, partnering with the Alaska Native Tribal Health Consortium, implemented the Play Every Day social marketing campaign in 2019–2021 to encourage parents to serve healthy drinks to young children. The campaign’s intended audience was parents who experience disproportionately poor nutrition outcomes: Alaska Native people, those living in rural communities, and those with low incomes and/or educational attainment. We described campaign development, implementation, and performance. Method Parents from the identified disproportionately affected populations participated in formative research. Campaign awareness and engagement questions were added to Alaska’s child health surveillance system. Regression models assessed associations between campaign exposure and outcomes. Results The sample included 476 Alaska mothers of 3-year-old children. Of the 34% who reported seeing the campaign, 21% said they changed drinks served to their child because of the campaign. Campaign awareness, engagement, and reported changes in drinks given to children because of the campaign were greater among Alaska Native mothers than White mothers. Among all mothers, those who said the campaign gave them new information or that they shared the campaign had 7 to 8 times greater odds for reporting changes in behavior than those not engaged with the campaign. Implications for Practice Social marketing campaigns that encourage parents to serve healthy drinks to young children may change behavior. Resources should be systematically dedicated to research, implementation, and evaluation focused on specific populations. Partnering with trusted community-serving organizations likely improves outcomes in disproportionately affected populations.