The purpose of this study was to explore awareness and opinions about sugar-sweetened beverage policy—specifically pouring rights contracts—on a university campus. Participants were 915 students, staff, and faculty currently studying or under employment at the University of Iowa. Participants completed an online survey. Nearly two-thirds (64.2%) of participants reported not being aware of pouring rights prior to completing the survey. Over one-third (38.0%) of participants reported they agreed with universities engaging in pouring rights contracts, while 30.9% of participants neither agreed or disagreed, and 31.0% disagreed with universities engaging in pouring rights contracts. Respondents who identified as male, undergraduate students, and those who agreed that individuals are responsible for their own sugar-sweetened beverage consumption were more likely to support engaging in pouring rights contracts. Understanding awareness, support, and determinants of support for pouring rights contracts is important for those involved in establishing policies targeting sugar-sweetened beverage availability on college campuses.

<p>Various factors, including low levels of physical activity (PA), and high consumption levels of sugar-sweetened drinks (SD), have been implicated in the general increase of fat mass (FM) levels seen in youth. <b>Purpose</b>: To determine if a significant relationship exists between fat mass (FM) and physical activity (PA) or sugar-sweetened drink (SD), in boys and girls, using longitudinal analysis. <b>Methods</b>: 105 boys and 103 girls were assessed repeatedly during childhood and adolescence, for a maximum of 7 years. Height was measured annually, as was fat free mass (FFM) and FM estimated by dual X-ray absorptiometry (DXA). PA was evaluated bi-annually using a questionnaire for children (PAQ-C/A: 1 low, 5 high), and SD was assessed using a 24-hour dietary intake questionnaire completed 1-4 times/year. Years from peak height velocity were used as a biological age indicator. Random effects models were used to analyze the data, subsequent to log linearization of the FM variable since it was not initially normally distributed. <b>Results</b>: The constructed model, controlling for maturation, FFM, and adjusted energy intake, found no interaction effect between SD and PA (p>0.05). After removal of the interaction term from the model, SD was found to have no significant relationship (p>0.05) with FM of boys or girls. In contrast, PA level was found to have a significant relationship (p<0.05) with FM of males; but not with FM of females. <b>Conclusion</b>: The longitudinal models employed revealed a significant negative relationship between level of PA and FM in males but not females, after controlling for maturational status, body size and dietary energy intake. This finding lends support, to proponents of increasing PA in youth to control FM. Regarding SD and FM, the models employed showed no relationship. Future investigation with more complex models, accounting for more covariates, may be warranted in this area.</p>

<p>Various factors, including low levels of physical activity (PA), and high consumption levels of sugar-sweetened drinks (SD), have been implicated in the general increase of fat mass (FM) levels seen in youth. <b>Purpose</b>: To determine if a significant relationship exists between fat mass (FM) and physical activity (PA) or sugar-sweetened drink (SD), in boys and girls, using longitudinal analysis. <b>Methods</b>: 105 boys and 103 girls were assessed repeatedly during childhood and adolescence, for a maximum of 7 years. Height was measured annually, as was fat free mass (FFM) and FM estimated by dual X-ray absorptiometry (DXA). PA was evaluated bi-annually using a questionnaire for children (PAQ-C/A: 1 low, 5 high), and SD was assessed using a 24-hour dietary intake questionnaire completed 1-4 times/year. Years from peak height velocity were used as a biological age indicator. Random effects models were used to analyze the data, subsequent to log linearization of the FM variable since it was not initially normally distributed. <b>Results</b>: The constructed model, controlling for maturation, FFM, and adjusted energy intake, found no interaction effect between SD and PA (p>0.05). After removal of the interaction term from the model, SD was found to have no significant relationship (p>0.05) with FM of boys or girls. In contrast, PA level was found to have a significant relationship (p<0.05) with FM of males; but not with FM of females. <b>Conclusion</b>: The longitudinal models employed revealed a significant negative relationship between level of PA and FM in males but not females, after controlling for maturational status, body size and dietary energy intake. This finding lends support, to proponents of increasing PA in youth to control FM. Regarding SD and FM, the models employed showed no relationship. Future investigation with more complex models, accounting for more covariates, may be warranted in this area.</p>

Background: In the U.S., Hispanics have among the highest rates of overweight and obesity when compared to other racial/ethnic groups placing them at a greater risk for obesity-related disease. Identifying intervention strategies to reduce caloric intake and/or improve cardiometabolic health in Hispanics is critical to reducing morbidity and mortality among this large and growing population. Evidence exists to support diet-specific behavioral interventions, including beverage modifications, in reducing obesity-related health risks. However, the acceptability and feasibility of a beverage intervention in obese Hispanic adults has not been robustly evaluated. Methods: The objective of this pilot study is to assess the feasibility and acceptability of a randomized, controlled beverage intervention in 50 obese Hispanic adults ages 18-64 over 8-weeks. Eligible participants were obese (30-50.0 kg/m(2)), between the ages 18-64, self-identified as Hispanic, and were able to speak, read, and write in either English and/or Spanish. Study recruitment was completed August 2017. Upon the completion of baseline assessments, participants will be randomized to either Mediterranean lemonade, Green Tea, or flavored water control. After completing a 2-week washout period, participants will be asked to consume 32 oz. per day of study beverage for 6-weeks while avoiding all other sources of tea, lemonade, citrus, juice, and other sweetened beverages; water is permissible. Primary outcomes will be recruitment, retention, and acceptability of the intervention strategies. Our study will also evaluate participant-reported tolerance and as an exploratory aim, assess safety/toxicity-related to renal and/or liver function. Fasting blood samples will be collected at baseline and 8-weeks to assess the primary efficacy outcomes: total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Secondary outcomes include fasting glucose, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP). Discussion: This pilot study will provide important feasibility, safety, and early efficacy data necessary to design a larger, adequately-powered randomized controlled trial.

The former finance minister stated in his budget speech in 2016 that sugar tax would come into force in South Africa from 1 April 2017. The treasury's reason for implementing sugar taxation is to reduce the health problems caused by sugar. It is nothing new to use fiscal measures to recover both taxes and to prevent health problems but it was not yet possible to reach a definite conclusion about the impact of sugar tax on the consumption of sugary drinks and the prevalence of obesity. The reason for this is that there is evidence that the implementation of food tax in different countries has shown different results in terms of public health issues and tax benefits. In South Africa, the implementation of sugar tax can either reduce the prevalence of obesity and thereby have a positive effect on the economy or its implementation may adversely affect the economy. If treasury does not implement sugar tax the economy can also be adversely affected by the prevalence of obesity. This dissertation deals with the effects of non-communicable diseases and sugar tax on the South African economy. The focus is on how sugar tax is being implemented internationally and how South Africa intends to implement sugar tax. / Die voormalige minister van finansies het in sy begrotingstoespraak in 2016 vermeld dat suikerbelasting vanaf 1 April 2017 in Suid-Afrika in werking gaan tree. Die tesourie se rede vir die implementering van suikerbelasting is om, in samewerking met die Departement van Gesondheid, die gesondheidsprobleme wat deur suiker veroorsaak word te verminder. Dit is niks nuuts om fiskale maatstawwe te gebruik om beide belasting in te vorder en gesondheidsprobleme te voorkom nie, maar dit was nog nie moontlik om tot ’n definitiewe gevolgtrekking te kom oor die impak van suikerbelasting op die verbruik van suikerversoete drankies en die voorkoms van vetsug nie. Die rede hiervoor is dat daar bewyse is dat die implementering van voedselbelasting in verskillende lande verskillende resultate getoon het in terme van openbare gesondheidskwessies en belastingvoordele. In Suid-Afrika kan die implementering van suikerbelasting óf die voorkoms van vetsug verminder en sodoende die ekonomie bevoordeel óf die implementering daarvan kan die ekonomie negatief beïnvloed. Indien die tesourie nie suikerbelasting implementeer nie kan die ekonomie as gevolg van die voorkoms van vetsug negatief beïnvloed word. Die kern van hierdie skripsie handel oor die gevolge van nieoordraagbare siektes en suikerbelasting op die Suid-Afrikaanse ekonomie. Daar word spesifiek gefokus op hoe suikerbelasting internasionaal geïmplementeer word en hoe Suid-Afrika beoog om suikerbelasting te implementeer. / Mini Dissertation (LLM)--University of Pretoria, 2017. / Mercantile Law / LLM / Unrestricted

Background: Low health literacy is a significant problem affecting our country.  While the associations between low health literacy and poorer health outcomes have been well documented (Berkman et al., 2011), the literature lacks evidence of effective strategies to address health literacy in the context of health behaviors such as diet and physical activity (PA). Likewise, few interventions have reported on how health literacy status influences performance and engagement in the intervention. Two potential intervention strategies include the teach back method or teach to goal approach and interactive voice response (IVR) technology. These strategies hold promise as a means of improving health literacy and reaching vulnerable, low health literate populations, but these strategies have not been widely explored in the literature (Paasche-Orlow et al., 2005; Baker et al., 2011; Schillinger et al., 2009; Bennett et al., 2012; Piette et al., 1999). Primary Aims: This research was embedded in a larger trial, Talking Health, which is a 6-month, 2 group randomized controlled trial to determine the effects of a health behavior intervention on reducing sugar-sweetened beverage (SSB) consumption in Southwest Virginians. The primary aims of this study were to examine the associations between health literacy status and 1) number of rounds of teach back needed to reinforce key concepts, 2) proportion of correct answers on the first round of teach back, 3) level of intervention engagement (i.e., completion rates for teach back call, IVR calls, and small group classes), and 4) perceptions of the intervention components. Methods: The data reported represent the first 3 cohorts of the Talking Health trial including participants in Lee, Giles, and Pulaski Counties. Eligibility requirements included being 18 years or older, English speaking, consuming at least 200 calories per day from SSB, able to participate in moderate intensity PA, and having reliable access to a telephone. Data were collected at baseline and at the 6-month follow-up assessment. Health literacy was assessed using the validated Newest Vital Sign. Participants were randomized to a behavioral intervention aimed at decreasing SSB consumption (SipSmartER) or to a matched-contact control group targeting PA (Move More). Both groups participated in 3 small group education sessions, received a live teach back call, and 11 supportive IVR calls. Participants completed a summative evaluation at the 6-month follow-up, which captured their perceptions of the intervention components. ANOVAs were used to measure differences in outcomes by health literacy status, randomized condition, and interactions. Results: Of the 125 enrolled participants, 92.0% were Caucasian, 76.8% were female, 29.6% had d high school education, 64.0% had <$25,000 annual household income, and 32.8% had low health literacy skills. Eighty-five participants (68.0%) completed the teach back call. The overall model when looking at the degree to which health literacy status and randomized condition predicted the number of rounds of teach back needed to reinforce key concepts was significant (F= 8.323, p < 0.001). Out of 3 possible teach back attempts, participants in the low health literacy category required a significantly higher number of teach back attempts as compared to those with high health literacy (F= 16.769, p <0.001), and participants randomized to Move More required a significantly higher number of teach back attempts compared to SipSmartER participants (F=7.296, p= 0.008). Similarly, the overall model when looking at the degree to which health literacy status and randomized condition predicted the proportion correct on the first round of teach back was significant (F= 9.836, p<0.001), such that those with higher health literacy status  (F= 19.176, p< 0.001) and those randomized to SipSmartER condition answered a significantly higher proportion of questions correct (F= 9.783, p= 0.002). Intervention engagement including completion of the small group education sessions, the live teach back call, and the IVR calls did not vary significantly across randomized condition or literacy levels. Low health literate participants had a significantly higher overall perceived satisfaction with the IVR, as compared to high health literate participants (F= 5.849, p= 0.020). However, perceptions of other intervention components (e.g., small group sessions, teach back call, personal action plans, drink diaries/exercise logs,) were similar among participants with low and high health literacy status and across randomized conditions.   Conclusion: These data confirm the importance for multiple teach back opportunities and additional exposure to health information to ensure participant comprehension of key intervention content"in particular for those with lower health literacy. This research also supports that IVR is an effective approach to reaching vulnerable, low health literate populations. Future research should investigate the efficacy and cost-effectiveness of utilizing teach back methods delivered using automated technologies. Future research also is needed to determine how teach back performance are related to other study factors such as retention, engagement, and health outcomes. / Master of Science

BACKGROUND: Current efforts to control the obesity epidemic has focused on sugar sweetened beverages (SSB), particularly soda, and less on alcohol intake even though alcohol is also a source of “empty calories”. Few data are available about the association between soda and excessive alcohol consumption and whether people may substitute one form of beverage for the other, essentially “choosing their poison”. METHODS: We used the Behavioral Risk Factor Surveillance System (BRFSS) data from 2017 to examine the relationship between alcohol and soda consumption in adults 18 and older. We first compared the rates of different types of sweetened beverage consumption soda in our population. We then examined the association between the sugar-sweetened beverage and alcohol drinking status using regression models adjusted for potential confounders. Analyses were weighted and adjusted using SAS 9.4 to account for the complex sampling methods. RESULTS: Based on 2017 BRFSS data, we found an inverse relationship between heavy drinking and soda consumption after adjusting for age, sex, race, income, education, marital and insurance status, smoking, diabetes, and hypertension. Compared to those who don’t drink soda, the odds ratio of heavy drinking was 0.75 (95% CI 0.63, 0.90) for those who drink up to one soda/week; 0.66 (0.53, 0.81) for those drinking >1 to <7 sodas/week; 0.73 (0.65, 0.97) for ≥7 to <14 sodas/week; and 0.70 (0.49, 1.02) for ≥14 sodas/week. CONCLUSION: There seems to be an inverse association between soda and alcohol consumption. Public health efforts may want to consider targeting both behaviors concurrently to avoid beverage substitution.

No description available.

The overconsumption of added sugars leads to negative effects on health such as an increased risk for obesity, cardiovascular disease, and diabetes. With approximately 50% of added sugars in the American diet being attributed to sugar-sweetened beverage (SSB) intake, non-nutritive sweeteners (NNS) are recommended as potential replacements. The purpose of this secondary analysis of Talking Health, a 6-month SSB reduction intervention, was to explore 1) changes in NNS consumption patterns between SIPsmartER (n=101) and MoveMore (n=97) interventions, and 2) differences in demographics between three groups of various SSB-NNS consumption change patterns (Group 1: decreased SSB, increased NNS; Group 2: decreased SSB, no change in NNS; Group 3: increased SSB, regardless of NNS). Results showed that the SIPsmartER intervention significantly created more new NNS users than MoveMore after the 6 month intervention. There were significant between group over time differences for intake of aspartame, sucralose, and total NNS, with intake increasing for SIPsmartER participants as compared to MoveMore. However, when exploring demographics between the three SSB-NNS consumption change groups, no differences were found between those who successfully decreased SSB while increasing NNS and the other groups. While diet beverages were the most commonly consumed dietary source of NNS across groups over time, other sources such as tabletop sweeteners, yogurt, and meal replacement products contributed to total NNS intake. Future research is needed to identify those who would benefit most from using NNS as a tool to decrease SSB intake. This will help inform future interventions and provide appropriate strategies to decrease added sugars intake. / Master of Science / The overconsumption of added sugars leads to negative effects on health such as an increased risk for obesity, cardiovascular disease, and diabetes. With approximately 50% of added sugars in the American diet being attributed to sugar-sweetened beverage (SSB) intake, non-nutritive sweeteners (NNS) are recommended as potential replacements. The purpose of this secondary analysis of Talking Health, a 6-month SSB reduction intervention, was to explore 1) changes in NNS consumption patterns between SIPsmartER (n=101) and MoveMore (n=97) interventions, and 2) differences in demographics between three groups of various SSB-NNS consumption change patterns (Group 1: decreased SSB, increased NNS; Group 2: decreased SSB, no change in NNS; Group 3: increased SSB, regardless of NNS). Results showed that the SIPsmartER intervention significantly created more new NNS users than MoveMore after the 6 month intervention. There were significant between group over time differences for intake of aspartame, sucralose, and total NNS, with intake increasing for SIPsmartER participants as compared to MoveMore. However, when exploring demographics between the three SSB-NNS consumption change groups, no differences were found between those who successfully decreased SSB while increasing NNS and the other groups. While diet beverages were the most commonly consumed dietary source of NNS across groups over time, other sources such as tabletop sweeteners, yogurt, and meal replacement products contributed to total NNS intake. Future research is needed to identify those who would benefit most from using NNS as a tool to decrease SSB intake. This will help inform future interventions and provide appropriate strategies to decrease added sugars intake.

Attention on beverage intake, specifically sugar-sweetened beverages (SSB), has increased in recent years (1). Energy-containing beverages do not provide the same satiety as solid foods, and intake of solid food is not spontaneously reduced when energy-containing beverages are consumed (2,3). This may contribute to positive energy balance (1). Conversely, a reduction in energy intake occurs by replacing SSB with water and may facilitate weight loss (4,5). A valid, reliable and sensitive assessment tool for quantifying beverage consumption and determining its influence on weight status could help advance research on this topic. Three studies were conducted to develop the BEVQ, a self-administered quantitative beverage intake questionnaire. First study (n=105): the 19-item BEVQ's validity was examined by comparing participant's beverage intake to the "gold standard" of dietary intake assessment, food intake records; reliability was assessed by comparing two BEVQ's, administered two weeks apart. The BEVQ demonstrated acceptable validity (R2=0.53, water g; 0.46, 0.61 total beverage g, kcal; 0.49, 0.59 SSB g, kcal) as well as reliability (all correlations P<0.001) (6). Second study (n=1,596): the BEVQ underwent exploratory factor analyses (EFA) to identify the potential to reduce items. Three beverage items, which contributed <10% to total beverage intake g, kcal, were eliminated; EFA identified beer and light beer as a combined category. The refinement led to the 15-item BEVQ, which produced a lower readability score of 4.8 and shorter administration time (~2 min) (7). Third study (n=70): the ability of the BEVQ-15 to detect changes in beverage intake was evaluated by increasing participant water and fruit juice consumption and evaluating BEVQ-15 outcomes before and after the feeding period. Increases in water, juice and total beverage (g) were detected during the intervention period (P<0.001) (8). This rapid, valid, reliable and sensitive beverage intake assessment tool may determine the habitual intake of SSB and other beverages, and evaluate the effectiveness of clinical and public health interventions which aim to address national SSB recommendations. Future work is needed to evaluate the validity and reliability of the BEVQ-15 in children, as well as develop cost-effective noninvasive biomarkers that can objectively estimate intake of specific foods/dietary components (9). / Ph. D.