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BACKGROUND: It is recommended that children under 6 years old avoid sugar-sweetened beverages (SSBs), yet 25% of toddlers and 45% of preschool-aged children consume SSBs on a given day, with the highest intakes reported among Hispanic and African American children. OBJECTIVE: To investigate characteristics that predominantly low-income Hispanic and African American parents perceive to reflect a healthy beverage, and examine the influence of these characteristics on parents’ perceptions of the beverages they provide to their young children. DESIGN: This study consisted of two activities: a qualitative activity where parents (n=102) were asked to report what characteristics they perceive to reflect a healthy beverage and a quantitative activity where parents (n=96) indicated the extent to which each of the reported characteristics influence parents’ perceptions of the beverages they provide to their young children. PARTICIPANTS/SETTING: Hispanic and African American parents of young children (

Purpose: Despite recommendations that children accrue ≥60 min/day of moderate-to-vigorous physical activity (MVPA), numerous barriers may exist. We examined school-day MVPA patterns in lower-income children (pre-K to 5th grade) to determine whether they were meeting the minimum school-day guidelines of at least 30-min/day of MVPA and to identify opportunities for intervention. Methods: Students (N = 629, pre-K-5th grade) from 4 urban schools wore Actigraph GT3X+ accelerometers over 2 school days. Mixed effects models evaluated sex- and grade-specific differences in MVPA and sedentary time. Results: Only 34.6% of elementary and 25.3% of pre-K students met the school-time MVPA recommendation. Among elementary-aged children, boys accrued more MVPA than girls (30.8 ± 13.3 vs. 23.5 ± 10.7 min/day; p < 0.0001) with similar sex differences observed among pre-K children (51.3 ± 17.1 vs 41.9 ± 17.5 min/day; p < 0.001). Sedentary time also increased significantly with grade among elementary-aged children (207.9 ± 34.7 vs. 252.0 ± 36.1 min/day for those in 1st and 5th grade, respectively; p < 0.001), with girls accruing more sedentary time than boys (242.5 ± 48.2 vs. 233.8 ± 46.8 min/day; p < 0.0001). Conclusion: MVPA declines across elementary school years, with sex disparities observed as early as pre-K. Extended sedentary bouts and clustering of activity highlight opportunities for more movement throughout the school day.

Background Sugary drinks (SDs) are key contributors to excess added sugar intake and the predominant source of caffeine among children. Chronic caffeine intake causes dependence, and evidence for sugar dependence is emerging. Development of withdrawal symptoms may pose an obstacle to SD cessation among children. We examined the feasibility and acceptability of a three-arm randomized controlled trial (RCT) designed to investigate withdrawal symptoms resulting from replacement of children's usual caffeinated SD intake with either caffeine-free alternatives or caffeine-free and sugar-free alternatives, compared with continued consumption of caffeinated SDs. Methods Twenty-nine children 8–12 years old, who consumed ≥12 ounces caffeinated SDs daily, enrolled. The two-week RCT required three in-person meetings and daily completion of electronic questionnaires to assess withdrawal symptoms and intervention adherence. Children were randomized to replace their usual caffeinated SD consumption with 1) caffeine-free alternatives, 2) caffeine-free and sugar-free alternatives, or 3) caffeinated SDs (control), provided by the study team. Feasibility and acceptability were assessed quantitatively and qualitatively. Results Twenty-eight participants (97%) completed the study. Adherence was high, with 73% reporting compliance with beverage assignments, and 76% completing all questionnaires. In qualitative interviews at follow-up, children described feelings of importance and commitment, and parents did not find the procedures to be overly burdensome. While challenges to adherence were reported (e.g., child wanting other SDs, time commitment), participants described innovative strategies (e.g., designating a place for study drinks in the refrigerator) to maintain adherence. Conclusion Results indicated high levels of RCT feasibility and acceptability. The reported barriers and strategies for adherence will inform modifications required to design a larger and longer-term trial investigating withdrawal symptoms after SD cessation in children.

Background: Excess sugar-sweetened beverage (SSB) consumption is associated with type 2 diabetes, obesity, and cardiometabolic disease. In addition to having high added sugar content, caffeinated sugar-sweetened beverages (CSSBs) are the predominant source of caffeine among children. However, the extent to which the caffeine and sugar in CSSBs promote continued CSSB intake among children has not been rigorously studied. Aim: To develop a conceptual framework of children’s CSSB consumption using group concept mapping. Methods: Children, ages 8-14, recruited from the Washington, D.C. area who reported consuming ≥ 12 ounces of CSSBs per day participated in concept mapping, an applied social research multimethodology. Concept mapping involved 3 participant-driven activities, including: (1) brainstorming (n=51), during which children reported reasons or determinants for their CSSB consumption, from which 58 unique determinants were identified, (2) sorting (n=72), during which children categorized each of the determinants and named each category, and (3) rating (n=74), during which children rated the influence of each determinant on their own consumption (Likert scale, 1-5). Similarity matrices, multidimensional scaling, and hierarchical cluster analysis were applied to generate concept maps. Results: The concept maps generated from this study displayed the 58 determinants in a 9-cluster solution, reflective of 3 overarching motives: Perceived Mental and Physical Benefits, Energy and Function, and Preference and Palatability. Among the 58 determinants, the greatest drivers of consumption related to Energy and Function and Preference and Palatability. Conclusions: The use of concept maps to illuminate the importance of certain determinants, such as energy improvements or taste preferences related to caffeine and/or sugar, as drivers of consumption will inform the development of tailored interventions to reduce CSSB consumption. Disclosure S.E. Halberg: None. A.J. Visek: None. E.F. Blake: None. J.M. Sacheck: None. A. Sylvetsky: None.

Background The extent to which low-calorie sweeteners (LCSs) are helpful or harmful for weight management and metabolic health is unclear, because LCS effects may depend on the context in which they are consumed. Objective To develop a conceptual framework for LCS consumption. Methods Young adults ages 18–35 y, who reported LCS consumption, were recruited from a private, urban, university in the mid-Atlantic United States. Concept mapping, a mixed-method approach was used to identify, organize, and quantify determinants of LCS consumption. First, participants (n = 68) identified reasons for their LCS consumption through brainstorming; content analysis of those reasons identified 37 specific determinants of LCS consumption. Second, participants (n = 93) sorted all 37 determinants conceptually. Third, participants (n = 97) rated the extent to which each of the 37 determinants was reflective of their own consumption. Similarity matrices, multidimensional scaling, and hierarchical cluster analysis produced a series of 2-dimensional concept maps (SWEET MAPS). Results The SWEET MAPS identified 37 determinants, organized within 8 factors reflective of 3 overarching motives: perceived health benefits, palatability, and accessibility of LCSs. At the determinant level, the most highly rated determinants that exceeded the boundary (rating >3.0) were: “I want something that tastes sweet,” “I am trying to maintain/control my weight,” “They contain fewer calories,” “They are available,” and “I want to save calories because I am eating a high-calorie meal.” Conclusions LCS consumption is a function of many inter-related determinants spanning biological, psychological, and social domains. The SWEET MAPS are an important and novel use of concept mapping methods that can be used to inform the design and interpretation of future studies evaluating LCS effects.