Factors Influencing the Sugar-Sweetened Beverage Intake of Caregivers of Adolescents in Appalachia

Objective: To identify factors that influence the sugar-sweetened beverage (SSB) intake of caregivers of middle school-aged adolescents. Design: Cross-sectional. Setting: Southwestern Virginia, US, part of Central Appalachia. Participants: Caregivers (n = 362) of adolescents enrolled in the Kids SIPsmartER trial. Participants were mostly female (91%) and non-Hispanic White (96%), and 21% received Supplemental Nutrition Assistance Program (SNAP) benefits. Main Outcome Measures: Caregiver daily SSB intake and demographics, personal-level, interpersonal-level, and environmental-level determinants. Analysis: Descriptive statistics, 1-way ANOVA, and stepwise regression. Results: On average, caregivers consumed 25.7 (SD, 33.2) fluid ounces of SSB per day. In the final model, which included all variables, age (beta = -0.41; P < 0.05), receiving SNAP benefits (beta = 14.19; P <= 0.01), behavioral intentions (beta = - 5.48; P <= 0.001), affective attitudes (beta = - 2.15, P < 0.05), perceptions of whether their adolescent frequently consumes high amounts of SSB (beta = 1.92; P <= 0.001), and home availability (beta = 7.43; P <= 0.01) were significantly associated with SSB intake. Conclusions and Implications: Caregivers of Appalachian middle school students are high SSB consumers. Findings highlight the importance of implementing behavioral interventions for caregivers of adolescents that target multiple levels of influence, including demographic, personal-level, interpersonal-level, and environmental-level factors. Interventions may be particularly important for communities and groups with higher SSB intakes, such as those in Appalachia and who receive SNAP benefits.