Unhealthy Attitude or Behavior Factors and Habitual Sugar Sweetened Beverages Consumption in Junior School Students: a Cross-Sectional Study in 2020 and Long Term Trend From 2012 to 2020

Abstract

BackgroundSugar-sweetened beverages (SSBs) consumption is the major source of added sugar intake and a common unhealthy eating behavior among youth in China and around the world. Excessive intake of SSBs has a negative impact on both short- and long-term health of adolescent. The targeting nutritional education and behavioral guidance, single use or as a supplement to the policy intervention like sales ban, is a low cost and effective intervening approach. The purpose of this study was to identify unhealthy attitudes and behaviors that affect youth's consumption of sugary drinks to provide evidence for subsequent targeted interventions.MethodsUsing the stratified cluster sampling method, a questionnaire survey was conducted among 1560 junior school students in Jinzhong City, Shanxi Province, in northern China and Suzhou City, Jiangsu Province, in southern China. The content of the questionnaire included sociodemographic characteristics, self-reported consumption frequency of SSBs, attitude, behaviors and habits related to SSBs consumption. The Cronbach coefficient of questions was 0.855. Data from the series surveys of 2012 and 2018 were also used in the long-term trend analysis.ResultsIn 1466 Chinese junior school students, 5.1 % consumed SSBs every day and 13.6 % consumed it 3-6 times/week. The binary logistic regression was significant (R2=31.1%, P=0.001), and the attitude and behavior factors contributed to 22.1% of the 31.1% variation that could be explained. Among all factors, four unhealthy attitudes or behaviors with the highest OR were "Drink SSBs as water" (OR=10.288, 95%CI: 6.392~16.558), "Deem SSBs not affect health” (OR=2.735, 95%CI: 2.032~3.681), "Just want to drink SSBs” (OR=2.302, 95%CI: 1.524~3.478) and “Purchase SSBs in advance” (OR=2.245, 95%CI: 1.454~3.465). The SSBs consumption frequency increased with the increase of risk score of unhealthy attitudes and behaviors. (χ²-trend=127.470, P<0.001). Both frequency of drinking SSBs and holding rates of unhealthy attitudes or behaviors decreased with the passage of time (P trend<0.005). The drinking times per month was significantly positively correlated with the risk scores from 2012 to 2020 (r=0.314, P<0.001).ConclusionThe consumption of sugary drinks was largely influenced by unhealthy attitudes and behaviors. Adolescents are in the critical period of cognitive and habit formation, thus targeted intervention should be taken to promote their SSBs related healthy attitude and behavior to reduce the intake of added sugar and benefit them for life.