Role of social ecological model level on young Pacific children's sugar-sweetened beverage and water intakes: Children's Healthy Living intervention

Objective: To examine children's sugar-sweetened beverage (SSB) and water intakes in relation to implemented intervention activities across the social ecological model (SEM) during a multilevel community trial. Design: Children's Healthy Living was a multilevel, multicomponent community trial that reduced young child obesity (2013-2015). Baseline and 24-month cross-sectional data were analysed from nine intervention arm communities. Implemented intervention activities targeting reduced SSB and increased water consumption were coded by SEM level (child, caregiver, organisation, community and policy). Child SSB and water intakes were assessed by caregiver-completed 2-day dietary records. Multilevel linear regression models examined associations of changes in beverage intakes with activity frequencies at each SEM level. Setting: US-Affiliated Pacific region. Participants: Children aged 2-8 years (baseline: n 1343; 24 months: n 1158). Results: On average (+/- sd), communities implemented 74 +/- 39 SSB and 72 +/- 40 water activities. More than 90 % of activities targeted both beverages together. Community-level activities (e.g. social marketing campaign) were most common (61 % of total activities), and child-level activities (e.g. sugar counting game) were least common (4 %). SSB activities across SEM levels were not associated with SSB intake changes. Additional community-level water activities were associated with increased water intake (0 center dot 62 ml/d/activity; 95 % CI: 0 center dot 09, 1 center dot 15) and water-for-SSB substitution (operationalised as SSB minus water: -0 center dot 88 ml/d/activity; 95 % CI: -1 center dot 72, -0 center dot 03). Activities implemented at the organization level (e.g. strengthening preschool wellness guidelines) and policy level (e.g. SSB tax advocacy) also suggested greater water-for-SSB substitution (P < 0 center dot 10). Conclusions: Community-level intervention activities were associated with increased water intake, alone and relative to SSB intake, among young children in the Pacific region.