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Running head: BRIEFING BOOK SEC 2

Briefing Book Sec 2

Summary Sheet for each cluster of articles

Renán Peña

SOPH 603: Assessment and Intervention: Wicked Problems in Public Health

Texas A&M University School of Public Health

November 4, 2018

1 BRIEFING BOOK SEC 2

Peer-Reviewed Article #1

Elisabeth, L. M., & Merete, H. H. (2018). Soft drinks for lunch? self-control, intentions and

social influences. British Food Journal, 120(8), 1735-1748.

doi:http://dx.doi.org.ezproxy.library.tamu.edu/10.1108/BFJ-11-2017-0605

 Question: How much self-control do kids have during lunch at school?

 Methods: Multiple logistic regression was used to explore associations between the independent variables and SSB consumption. Psychometric evaluation of the self-control

measure included factor analysis and internal consistency reliability. A web-based survey

was conducted among 694 Norwegian high school students.

 Major Finding(s): o Factor analysis resulted in two food-related self-control dimensions: resistance

and avoidance.

o Multiple logistic regression showed that intentions was the strongest predictor of SSB consumption in the sample.

o Avoidance and descriptive peer norms appeared as weaker predictors. o Food-related lifestyle, parenting styles and parenting practices have been found to

be associated with SSB consumption in adolescents. Overly strict practices may

have adverse effects on eating behavior by increasing the consumption of

unhealthy foods. For younger children, it is suggested that this may be the result

of an increased appeal of the restricted foods that lead to over-consumption in

situations where restrictions are removed.

o Perceived peer behavior (i.e. descriptive norms) is also shown to be important, and in some cases even more strongly associated with adolescents’ intake than the

actual behavior of the members of the peer group. Influence from peers seems as

an important element for understanding adolescents’ SSB consumption.

 Key Facts: o Options are available to the students o Competing facilities with SSBs are a factor o Availability and accessibility have consistently been identified as important

predictors

o Positive association between intentions and SSB consumption during school lunch

 Feasibility/Scalability: o The study only measured one county in Norway and did not take into account

other parts of the country where behavior to SSBs may be different

o The study did not account for SSBs consumed outside of the school setting or time

 Key quote: “Today’s food environment with its ready availability of low-nutrient/high- energy foods and beverages calls not only for structural and social-environmental

interventions to confront unhealthy temptations. Also personal tools like self-controlling

strategies may be helpful to steer adolescents’ food and beverage consumption in a

favourable direction—at least in contexts where structural and social-environmental

interventions are not planned in the near future.”

2 BRIEFING BOOK SEC 2

Peer-Reviewed Article #2

Gortmaker, S. L., Wang, Y. C., Long, M. W., Giles, C. M., Ward, Z. J., Barrett, J. L., . . .

Cradock, A. L. (2015). Three interventions that reduce childhood obesity are projected to

save more than they cost to implement. Health Affairs, 34(11), 1932-65A.

doi:http://dx.doi.org.ezproxy.library.tamu.edu/10.1377/hlthaff.2015.0631

 Question: Can we reduce childhood obesity by the year 2025 in the United States and how much will it cost?

 Methods: Evidence review and microsimulation modeling project concerning the cost effectiveness and population-level impact of seven interventions

 Major Finding(s): o The childhood obesity epidemic in the US affects all segments of society. o Communities and health agencies have limited resources to address high rates of

childhood obesity and need to know how best to invest those resources.

o Reducing television viewing and other screen time leads to significant reductions in BMI and obesity prevalence, mainly via dietary changes.

 Key Facts: o For adolescence an excess weight has accumulated for more than a decade, with

an average imbalance of almost 200 extra kcal/day. The typical adult with a BMI

greater than 35 consumes 500 kcal/day more than is needed to maintain a healthy

body weight. Improving energy balance via improved diet and physical activity

early in childhood thus requires much smaller changes than those needed once

obesity is established in adolescence and adulthood.

o There is clear evidence of the effectiveness of reducing the intake of sugar sweetened beverages on reducing BMI and obesity prevalence.

o Three of the interventions studied were found to be cost-saving across the range.

 Policy Implications: o The elimination of the tax deductibility of advertising costs for television ads seen

by children and adolescents for nutritionally poor foods and beverages

o Restaurant menu calorie labeling modeled on the federal menu regulations to be implemented under the Affordable Care Act.

o Implementation of nutrition standards for federally reimbursable school meals sold through the National School Lunch.

o Implementation of nutrition standards for all foods and beverages sold in schools outside of reimbursable school meals.

o Improved early childhood education policies and practices. o A nationwide fourfold increase in the use of adolescent bariatric surgery.

 Feasibility/Scalability: The reach of bariatric surgery, the smallest, was very limited, even assuming a fourfold increase in the number of adolescents who receive the

procedure.

 Key quotes (if relevant): “Setting nutrition standards for school meals would reach a very large population of children and have a substantial impact.”

 Key stakeholders: US policy makers, researchers, and nutrition and physical activity experts to provide advice concerning the selection of interventions, evaluation of data,

analyses, and implementation and equity issues.

3 BRIEFING BOOK SEC 2

Commentary/ Opinion Article #1

Sugary drinks linked to high death toll for diabetes. (2015). Medical Economics, 92(15), 68.

Retrieved from http://ezproxy.library.tamu.edu/login?url=https://search-proquest-

com.ezproxy.library.tamu.edu/docview/1715905902?accountid=7082

 Question: Are sugary drinks linked to high death toll for diabetes?

 Major Finding(s): o Sugary drinks may lead to an estimated 184,000 adult deaths each year worldwide o Reduced consumption of SSBs could potentially save tens of thousands of deaths

annually.

o There is a direct impact on diabetes and the obesity-related effects on cardiovascular disease CVD, diabetes and cancer.

 Key Facts: o Researchers estimate that SSB consumption may have been responsible for

approximately 133,000 deaths from diabetes, 45,000 deaths from cardiovascular

disease (CVD), and 6,450 deaths from cancer.

o Estimates of consumption were made from 62 dietary surveys including 611,971 individuals, conducted between 1980 and 2010 across 51 countries, along with

data on national availability of sugar in 187 countries and other information. This

o allowed capture of geographical, gender and age variation in consumption levels of SSBs in different populations.

 Key quotes (if relevant): o “Many countries in the world have a significant number of deaths occurring from

a single dietary factor, sugar-sweetened beverages. It should be a global priority

to substantially reduce or eliminate SSBs from the diet.”

o “Sugar-sweetened beverages (SSB) are a single, modifiable component of diet that can impact preventable death/disability in adults in high, middle, and low-

income countries, according to the study authors, indicating an urgent need for

strong global prevention programs.”

4 BRIEFING BOOK SEC 2

Commentary/ Opinion Article #2

Keller, J. (1995). Sweet perspective. Beverage World, 114(1589), 4. Retrieved from

http://ezproxy.library.tamu.edu/login?url=https://search-proquest-

com.ezproxy.library.tamu.edu/docview/213322789?accountid=7082

 Question: How will the dissolution of sugar supports affect high-fructose corn syrup (HFCS) sweetened beverages?

 Major Finding(s): o Free market production will lead to fair prices on all sugars o The nations sugar policy and the shifts are likely to alter beverage production o Forward-thinking HFCS suppliers, thanks to major continuing investments have

in place an efficient infrastructure with which they can bring to market top-quality

sweetener at a price likely below the free-market price of refined cane or beet

sugar.

o Large investments in HFCS have affected the production of SSBs and how feasible it is to make cheaper drinks

 Key Facts: o 75 percent of all North American HFCS production is dedicated to beverages o There is a need for the ongoing presence of HFCS suppliers and their market-

balancing choice.

o The 1974 switch from sucrose to HFCS was triggered by the volatility of a free market, when a wretched sugar beet crop in Europe pushed the global price of

sucrose sky-high.

 Key quotes (if relevant): o “Last November US voters sent our government a message: Dissolve yourself a

little.”

o “The phase-out of the sugar supports isn’t official yet, and the timing is very far from being settled. But from here, it looks like a win-win-win situation. Now

that’s sweet.”

 Key stakeholders (if relevant): o Refined sugar producers o HFCS producers o Investors for both sucrose and HFCS

British Food Journal Soft drinks for lunch? Self-control, intentions and social influences Elisabeth Lind Melbye, Merete Hagen Helland,

Article information: To cite this document: Elisabeth Lind Melbye, Merete Hagen Helland, (2018) "Soft drinks for lunch? Self-control, intentions and social influences", British Food Journal, Vol. 120 Issue: 8, pp.1735-1748, https://doi.org/10.1108/ BFJ-11-2017-0605 Permanent link to this document: https://doi.org/10.1108/BFJ-11-2017-0605

Downloaded on: 01 November 2018, At: 06:28 (PT) References: this document contains references to 69 other documents. To copy this document: [email protected] The fulltext of this document has been downloaded 96 times since 2018*

Users who downloaded this article also downloaded: (2018),"Exploring the visual appeal of food guide graphics: A compositional analysis of dinner plate models", British Food Journal, Vol. 120 Iss 8 pp. 1682-1695 <a href="https://doi.org/10.1108/ BFJ-02-2018-0112">https://doi.org/10.1108/BFJ-02-2018-0112</a>

(2018),"Alternative food networks: sustainable business models for anti-consumption food cultures", British Food Journal, Vol. 120 Iss 8 pp. 1776-1791 <a href="https://doi.org/10.1108/ BFJ-12-2017-0731">https://doi.org/10.1108/BFJ-12-2017-0731</a>

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*Related content and download information correct at time of download.

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Soft drinks for lunch? Self-control, intentions and

social influences Elisabeth Lind Melbye

Norwegian School of Hotel Management, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway, and

Merete Hagen Helland Department of Education and Sports Science, Faculty of Arts and Education,

University of Stavanger, Stavanger, Norway

Abstract Purpose – The purpose of this paper is to explore associations between food-related self-control, intentions, descriptive peer norms, parents’ healthy eating guidance and adolescents’ consumption of sugar-sweetened beverages (SSB) in a school lunch setting. An additional aim was to evaluate the psychometric properties of the measure used to assess food-related self-control in order to reveal potential multi-dimensionality. Design/methodology/approach – A web-based survey was conducted among 694 Norwegian high school students. Multiple logistic regression was used to explore associations between the independent variables and SSB consumption. Psychometric evaluation of the self-control measure included factor analysis and internal consistency reliability. Findings – Factor analysis resulted in two food-related self-control dimensions: resistance and avoidance. Multiple logistic regression showed that intentions was the strongest predictor of SSB consumption in the sample. Avoidance and descriptive peer norms appeared as weaker predictors. Research limitations/implications – Based on the findings, the authors suggest that future studies may consider developing guiding principles on how to create health-promoting eating intentions in adolescents, how to deal with peer norms related to foods and beverages and how to avoid tempting stimuli in the environment. Such strategies may be helpful when structural changes in the environment are not feasible in the near future. Originality/value – An original aspect of the present study is that it includes a psychometric analysis of a supposedly one-dimensional self-control measure. Further, it adds to the knowledge about variables associated with adolescent SSB consumption in a school lunch context. Keywords Intentions, Adolescents, Social influence, Soft drinks, Self-control Paper type Research paper

Introduction A low intake of foods and beverages with added sugar is recommended by national and international health authorities (Nordic Council of Ministers, 2014; WHO, 2003). In Norway, which is the setting of the present study, a recent decline in the consumption of sugar-sweetened beverages (SSB) has been reported. Still, Norwegian adolescents have higher intakes than recommended (Fismen et al., 2016). According to a national survey among high schools (n ¼ 447) conducted by the Norwegian Directorate of Health (2013), the share of high school students drinking SSB with lunch on a daily basis is estimated to be more than 20 per cent. The majority (92 per cent) of the surveyed schools reported that they have a school cafeteria or other facilities were students can buy various foods and beverages, and that approximately 60 per cent of these facilities offer sugar-sweetened soft drinks, while 80 per cent offer milkshake/chocolate milk and iced coffee (of which most are sweetened with sugar) on a daily basis. Furthermore, students at most schools (96 per cent) have easy access to local shops and restaurants offering a wide variety of unhealthy foods and beverages. The survey also revealed that schools find it challenging to offer foods and beverages that are in accordance with national nutritional advice when having to compete with neighbouring facilities. With this easy access to SSB, both at school and in the school

British Food Journal Vol. 120 No. 8, 2018

pp. 1735-1748 © Emerald Publishing Limited

0007-070X DOI 10.1108/BFJ-11-2017-0605

Received 3 November 2017 Revised 24 April 2018

6 June 2018 Accepted 6 June 2018

The current issue and full text archive of this journal is available on Emerald Insight at: www.emeraldinsight.com/0007-070X.htm

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neighbourhood, it seems important to reveal other key influences on adolescents’ SSB consumption during school time.

Several studies have explored correlates of soft drink consumption in adolescence, and environmental factors such as availability and accessibility have consistently been identified as important predictors (De Coen et al., 2012; Gebremariam et al., 2016; Verloigne et al., 2012). Also family rules, food-related lifestyle, parenting styles and parenting practices have been found to be associated with SSB consumption in adolescents (Gebremariam et al., 2016; van der Horst et al., 2007; Verzeletti et al., 2009). Although parents and the home environment appear as important predictors of adolescents’ soft drink intake, their influence has to compete with the influence of friends, peers at school and media (Chan et al., 2012). Furthermore, eating behaviours seem (like many other types of behaviour) to be linked to the construction and expression of identity both at a personal and a social level (Bisogni et al., 2002; Vartanian et al., 2007), and particularly during adolescence, they may fulfil a function of self-expression (Guidetti and Cavazza, 2008). Apart from extrinsic (social) factors like parent and peer influences, also intrinsic (personal) factors such as the levels of self-control and impulsivity have been shown to correlate with adolescents’ consumption of SSB (Melbye et al., 2016) and other unhealthy foods (Honkanen et al., 2012). Since extrinsic and intrinsic factors are hypothesised to act in conjunction to influence human behaviour (Fox and Calkins, 2003; Ryan and Deci, 2000), they should not be seen in isolation from each other. Thus, it appears relevant to lean on elements from well-established socio-cognitive models such as Bandura’s (1977) social learning theory (SLT) and Ajzen’s (1991) theory of planned behaviour (TPB), as well as aspects of self-control theories, when exploring correlates of adolescents’ SSB consumption. While the socio-cognitive theories have their primary focus on extrinsic factors such as the context of social interactions, experiences and outside influences, self-control theories also include intrinsic factors such as temperament and inhibitory control (Vohs and Baumeister, 2016).

Based on the discussion above, the following variables were included in the current study: food-related self-control, intentions to consume SSB with school lunch, perceived descriptive peer norms related to SSB consumption with school lunch and perceived parental healthy eating guidance (HEG). Each of these variables is further described below.

Food-related self-control Individual differences in self-control have been associated with dietary behaviours in youth, whereby individuals with high levels of self-control exhibit healthier eating habits than those with lower levels of self-control (Junger and van Kampen, 2010; Luszczynska et al., 2013; Stok et al., 2015). Generally, self-control is described as the ability to resist temptations and impulses. However, the ability to resist temptations and impulses seems to depend on an individual’s overall self-controlling capacity, which has been shown to fluctuate across time (Baumeister et al., 1994). According to Baumeister et al.’s (2007) strength model of self-control, the fluctuation of self-controlling capacity may be caused by depletion of willpower (defined as a type of strength or energy), which is regarded as a limited resource. With other words: self-control appears vulnerable to deterioration over time from repeated efforts, like a muscle that gets tired. Thus, according to this model, if people rely on their willpower alone, they are likely to fail repeatedly because some temptations will inevitably turn up when one’s level of resistance is low (i.e. the muscle is tired). Interestingly, recent research suggests that self-control is also linked to avoiding temptations (Ent et al., 2015). Avoiding temptations may prevent instances of self-control failure caused by depleted willpower. Hence, avoidance appears as an important element of effective self-control. Yet, widely used measures of self-control such as Tangney et al. (2004) 36-item self-control scale, and the corresponding 13-item brief self-control scale (BSCS), do not explicitly distinguish between resistance and avoidance dimensions. Rather, they tend to include items reflecting

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both resistance and avoidance (and other possible self-control dimensions) in calculating one total self-control score, thus presuming a unidimensional construct. According to Maloney et al. (2012), there is a general lack of well-validated measures of self-control, and despite the widespread use of Tangney et al.’s BSCS, questions about its unidimensionality and validity still remain. Maloney et al. (2012) have addressed these concerns, and their study is one of very few examining the dimensionality of the BSCS. Results from their analyses failed to support a one-factor structure, indicating that self-control is a construct with various facets. Thus, it seems important to further explore the dimensionality of this and other self-control measures.

Intentions According to traditional socio-cognitive models, such as Ajzen’s (1991) TPB, intention is the immediate precursor of behaviour. The TPB proposes that intentions result from the joint impact of attitudes, subjective norms and perceived behavioural control. According to Gollwitzer (1996), however, intentions are the end result of the deliberations of wishes and desires in the pre-decisional phase of decision making. Thus, wishes and desires are seen as important precursors of intention. There are several possible motivations underlying adolescents’ intentions to consume SSB with school lunch. Among them are hedonic motives and impression-management motives such as appearing autonomous (i.e. self-directed or independent) (Stok et al., 2010), “fitting in” or being popular among peers (De la Haye et al., 2010).

Descriptive peer norms For adolescents, the consumption of specific food products may help them create and present a desired identity and to express friendship (Stead et al., 2011). As a result, individual snack and soft drink consumption is shown to be higher when friends and peers have a high consumption (Wouters et al., 2010). Significant peer effects have also been found for the frequency of eating at fast food restaurants, suggesting that an individual is more likely to engage in these behaviours if his or her friends do (Ali et al., 2011). Further, a review by Salvy et al. (2012) reports that peers’ (actual) intake of snacks has been found to be a predictor of youths’ snack consumption. Interestingly, perceived peer behaviour (i.e. descriptive norms) is also shown to be important, and in some cases even more strongly associated with adolescents’ intake than the actual behaviour of the members of the peer group (Perkins et al., 2010). According to Lally et al. (2011), adolescents have a tendency to overestimate their peers’ intake of snacks and soft drinks and underestimate their consumption of fruits and vegetables. Furthermore, adolescents often feel a significant social pressure from their peers, and presenting a positive social profile is important to them (Stevenson et al., 2007). Accordingly, influence from peers seems as an important element for understanding adolescents’ SSB consumption.

Parents’ HEG A variety of food-related parenting practices are used to influence children and adolescents’ diet (Birch and Davidson, 2001; Blissett, 2011; Patrick and Nicklas, 2005). Previous studies have indicated that overly strict practices may have adverse effects on eating behaviours by increasing the consumption of unhealthy foods. For younger children, it is suggested that this may be the result of an increased appeal of the restricted foods that lead to over-consumption in situations where restrictions are removed (Birch et al., 2003; Fisher and Birch, 1999). For adolescents, it may represent an opposition to parental control, indicating an increased need for autonomy and self-presentation (Melbye et al., 2016; Parkin and Kuczynski, 2012). However, parenting practices involving positively framed eating

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guidance are shown to be associated with increased consumption of healthy food items and decreased consumption of unhealthy ones (Melbye and Hansen, 2015).

The aim of the present research was to explore the impact of relevant intrinsic and extrinsic factors on adolescents’ consumption of SSB with school lunch. More specifically, and based on the preceding literature review, we aimed to reveal the unique contribution of adolescents’ food-related self-control, behavioural intentions, perceived parent HEG and perceived descriptive peer norms in explaining the variance in SSB consumption in a school lunch context. An additional aim was to evaluate the psychometric properties of the self-control measure applied in the current study in order to reveal potential multi-dimensionality (i.e. resistance and avoidance dimensions).

Materials and methods Participants and procedures The first draft of the survey questionnaire was pre-tested by 15 second grade high school students from different schools in Rogaland. These students were recruited from the authors’ network (i.e. colleagues’ and friends’ children) and did not take part in the main survey. The pre-test was conducted in two steps. Initially, four students were asked to answer the questions orally, and to discuss all questions with an interviewer (one of the authors). Revisions were made according to their comments. Next, the questionnaire was pre-tested for clarity and length among 11 (other) students. The students filled in the questionnaire at home and sent it back to the researchers with comments. Based on these comments, a few minor revisions were made before the final draft was ready. The Norwegian Centre for Research Data, which is the Norwegian data protection officer for all Norwegian universities and several hospitals and research institutes, was notified about the study and approval was given before data collection started.

All high schools (n ¼ 25) in Rogaland County, Norway, were invited to participate in the web-based survey. Four schools situated in different parts of the county agreed to participate (two schools close to the city centre and two rural schools). The response rates among eligible first and second grade students at these schools were 14, 36, 68 and 72 per cent, giving 694 completed questionnaires. The school administration gave consent for their students’ participation in the survey, and participants were recruited through an invitation on the school website, with a link to the survey. Students were given information about the study, that participation was voluntary and anonymous and that completing the survey questionnaire implied their consent to participate. The survey was conducted using the EyeQuestion software version 3.15.3 (Logic8 BV, Wageningen, The Netherlands). The two schools with the highest response rates allowed the students to answer the survey during class (which was highly recommended by the investigators). If the survey was not finished in one session, it was possible for the respondent to return to the link and finish it at a later time. However, it was only possible to take it once. Students who missed answering some questions (n ¼ 142) were excluded from data analyses. The population of interest for this study was late adolescents (i.e. 16–19 years old), thus respondents younger than 16 and older than 19 years were excluded (n ¼ 20). The mean age in our sample was 17.1 years (SD ¼ 0.8), 67 per cent of the respondents were female and 94 per cent were of Norwegian or other Nordic origin.

Measures Consumption of SSB with school lunch was measured in days per week. Participants were asked to report their usual intake: “How many days per week do you normally consume SSB as part of your school lunch?” (SSB was defined as sugar-sweetened drinks such as carbonated soft drinks, lemonade, iced tea, sweet coffee drinks, energy drinks, milkshake/ chocolate flavoured milk, etc.). Diet drinks (i.e. drinks that do not contain sugar) were not

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