ArticlePublic health nutrition2021
Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents.
Article in Public health nutrition, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 25 citations in OpenAlex.
- Comparison of Researcher-Led versus Teacher-Led effectiveness and fidelity: A Hybrid Type 1 study of Kids SIPsmartER in Appalachia middle schools.Translational behavioral medicine · 2024Trial
- Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial.The international journal of behavioral nutrition and physical activity · 2024Trial
- How does the Kids SIPAmerican journal of agricultural economics · 2026Article
- Systematic Review of Health Literacy and Health Behavior in Adolescents Research.Epidemiologia (Basel, Switzerland) · 2026Review
- What influences Indian primary school children's food behaviors? - Perceptions of children, mothers and teachers.BMC public health · 2025Article
- Assessing the determinants of food choices among adolescents in India: A rainbow model using the socio-ecological framework.PLOS global public health · 2025Article
- Feasibility and preliminary effects of the mindful healthy family project among rural families.Health psychology and behavioral medicine · 2025Article
- Student and caregiver acceptability of a school-based intervention to improve sugar-sweetened beverage behaviors: a mixed methods study.Health education research · 2024Article
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- Associations of Body Mass Index with Self-Rated Health and Weight Perceptions Among Rural Appalachian Adolescent Students.The Journal of school health · 2024Article
- Factors Influencing the Sugar-Sweetened Beverage Intake of Caregivers of Adolescents in Appalachia.Journal of nutrition education and behavior · 2022Article
- Sugar-sweetened beverage consumption among adults in rural Appalachia.Preventive medicine reports · 2021Article
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveThe objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents' sugar-sweetened beverage (SSB) intake.
designThis cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake - step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver's SSB behaviours, caregiver's SSB rules) and step 4: environmental (i.e., home SSB availability) level variables.
settingEight middle schools across four rural southwest Virginia counties in Appalachia.
participantsSeven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years).
resultsMean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent's SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001).
conclusionsSSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.
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