Tucked neatly at the edge of rolling Appalachian foothills, the parking lot of a local high school is a meadow of flickering green ribbons tied to car antennas, reminding students about the dangers of drinking -- drinking sugar-filled beverages, that is.
The ribbons are part of a program developed by local teens and Laureen Smith, RN, PhD, a researcher from The Ohio State University, to help reduce the overconsumption of sugary drinks, which are closely linked to Appalachia's glaring health disparities.
"Teens that grow up in this region are ultimately more likely to die from cancer, diabetes and heart disease than any other place in the nation, and obesity is the common risk factor for all of those illnesses," said Smith. "A child's odds of becoming obese increases almost two times with each additional daily serving of a sugar sweetened drink, and Appalachian kids drink more of these types of beverages than kids in other parts of the country."
Dubbed "Sodabriety" -- the teen-led program Smith helped create is trying to reverse that trend. The 30-day project asked groups of teens from two southern Ohio high schools to develop and then lead educational campaigns designed to convince their peers to reduce consumption of sugar-sweetened beverages like soda and tea, and to drink more unsweetened beverages. By the end of the program, not only did some teens completely give up sugared drinks, but water consumption nearly doubled.
Smith, who was supported by funding from Ohio State's Center for Clinical and Translational Science (CCTS), was inspired to start the "Sodabriety" project when previous research found that among teens in the area, the daily intake of sugared liquids equaled water consumption. Oversized drinks were particularly popular among the teens -- many of who later admitted they had no idea the mega serving could add almost 500 calories to their daily intake.
"Sugar sweetened beverages are the largest source of sugar in the American diet. For some teens, they account for almost one-third of daily caloric intake, and that amount is even higher among Appalachian adolescents," said Smith, who is also an associate professor of Ohio State's College of Nursing "If we can help teens reduce sugared-beverage intake now, we might be able to help them avoid obesity and other diseases later in life."
But in a place where sugar laden sweet tea is more popular than water, and soda vending machines are easily accessible -- the researchers knew they were in for a challenge. Cindy Oliveri, a project assistant on Smith's team recalls doing a site visit to prepare for the program, and looking into classroom after classroom only to see sugared drinks sitting on the desks of students and teachers alike.
"We knew it there would be cultural and social obstacles to getting people to give up the sugar. Teens don't want to hear an adult tell them what's good for them," Oliveri said. "That attitude completely changes when you get kids to talk to other kids. It's an example of where peer pressure can have a positive impact."
Groups of teens representing a range of grades and interests came up with a variety of ways to educate peers about sugared drinks ranging from ribboning students' cars and including daily "sugar facts" during morning announcements, to performing soda themed rap songs at student events and giving away free water bottles emblazoned with a 'what's in your cup?' slogan. The students also encouraged their classmates to choose water or diet versions of sugared drinks.
At the start of the challenge, the average number of daily sugared drinks dropped from nearly 2.5 servings to 1.3, and the number of days students reported having a sugary drink dropped from 4 days a week to 2 days. Water consumption increased nearly 30 percent from baseline.
Smith collected data at the end of the 30-day program, and then went back a month after the challenge ended to see if the behavior changes were still in effect.
"We found that the changes in sugared drink and water consumption remained relatively stable without any intervention from the program's teacher coordinators or the research group. They kids were doing it on their own," said Smith.
Smith says that the model of using students to design and implement the education campaign has intriguing implications for not just Appalachian teens, but any community looking to help kids adopt better health behaviors. She also noted that on-site vending machines with high-sugar drinks offer particular challenges not only because they are easily accessible, but because they are often a source of revenue for the schools. "We're not suggesting that schools need to get rid of their vending machines and all sugared beverages. By offering a healthier range of options that include water, plus educating kids on what's healthy, we think it can be a win-win for everyone."
For her next study, Smith also plans on looking even more closely at long term outcomes due to encouraging anecdotal reports from the challenge participants.
"We had students tell us about significant weight loss, increased energy, even a reduction in acne. We heard that prom organizers decided to offer water bottles along with punch. Another group started an exercise club," recalled Smith. Seeing these kids continue to make healthy choices and let them influence other parts of their lives is truly amazing, and it's worth seeing how we might be able to replicate that."
The above story is based on materials provided by Ohio State University Center for Clinical and Translational Science. Note: Materials may be edited for content and length.
- Laureen H. Smith, Christopher Holloman. Piloting “Sodabriety”: A School-Based Intervention to Impact Sugar-Sweetened Beverage Consumption in Rural Appalachian High Schools. Journal of School Health, 2014; 84 (3): 177 DOI: 10.1111/josh.12134
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