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. Author manuscript; available in PMC: 2023 May 23.
Published in final edited form as: Health Educ J. 2023 Feb 28;82(3):324–335. doi: 10.1177/00178969231157699

Urban Youth Perceptions of Sports and Energy Drinks: Insights for Health Promotion Messaging

Erin K Maloney a, Amy Bleakley a, Robin Stevens b,c, Morgan Ellithorpe a,d, Amy Jordan e
PMCID: PMC10205042  NIHMSID: NIHMS1895059  PMID: 37223247

Abstract

Objective:

This study aimed to examine urban adolescents’ beliefs about sports and energy drinks to identify factors for health messaging to discourage youth consumption.

Design:

Focus group study involving thirty-four adolescents in urban areas (12 female, 12 male, and 10 unreported sex; 19 Hispanic, 11 Non-Hispanic Black, 2 Asian, and 1 unknown race or ethnicity).

Setting:

Four focus groups were conducted with adolescents in urban areas.

Method:

Each on-time moderated group discussion was structured to generate an inventory of attitudinal, normative and efficacy beliefs associated with sports and energy drink consumption and reduction. Thematic analysis was used to analyse the data.

Results:

Attitudinal and normative beliefs were more positive towards sports drink consumption and energy drink reduction. Misperceptions about the need for sports drinks to avoid dehydration during physical activity were evident. Product accessibility and advertising pervasiveness were facilitators influencing consumption and barriers to reduction for both products.

Conclusion:

Results highlight important differences in perceptions about sports and energy drinks that indicate the need for different approaches and messages for interventions designed to curb consumption of these products. Recommendations for message design are provided.

Keywords: sugar sweetened beverages, sports drinks, energy drinks, urban youth, reasoned action approach, focus groups, formative research

Introduction

Sugar-sweetened beverages (SSBs), defined as sports drinks, non-diet soft drinks and sodas, energy drinks, fruit drinks, and flavoured milk products, (Farhangi et al., 2020; Imamura et al., 2015; Laniado et al., 2020; Malik and Hu, 2019; Malik et al., 2013; Valenzuela et al., 2021), cause dental erosion (Coombes, 2005) and dental caries (Marshall, 2013) and play a significant role in overweight, obesity and diabetes in the USA (Malik et al., 2010; Ogden et al., 2010; Palmer et al., 2008). In the USA, adolescents (ages 12-19 years) consume more SSBs than other age groups (i.e., 6-11 years; < 20 years) (Marriott et al., 2019), with lower income youth, Black, and Mexican American children and teens reporting the highest consumption patterns (Harris et al., 2020). Small corner stores, well-established dwellings in USA urban landscapes, are frequently used food sources particularly in low-income, urban areas and ethically-diverse communities often have incentivised agreements to give these products prime shelf placement (Borradaile et al., 2009; Cannuscio et al., 2010; Emond et al., 2012; Sanders-Jackson et al., 2015). This potentially contributes to existing health disparities between members of these populations and those who have access to larger grocery stores with healthier options (Hales et al., 2017).

Health messaging to reduce sugary drink consumption has focused primarily on sugary drinks in general, with an emphasis on carbonated drinks such as soda (Malik et al., 2010; Narain et al., 2016; Vargas-Garcia et al., 2017). Although there have been declines in other sugary drink consumption among adolescents over time, sports and energy drink consumption has increased among young people (Bleich et al.; Vercammen et al.), with 57.6% of adolescents in the USA reporting sports drink consumption during the past week in a 2015 survey of a nationally representative sample of high school students (Cordrey et al., 2018) and 1.4% of adolescents in the USA reporting energy drink consumption in 2016 (Vercammen et al.). Although energy drink consumption remains somewhat low, adolescent consumption of these products has been linked to thousands of visits to the emergency room among 12-17-year-olds in the USA for energy drink related emergencies (United States Department of Health and Human Sevices, 2013), highlighting the need for interventions to minimise adverse events related to using these products. There are currently no federal health policies in the USA to reduce consumption, so public health interventions to motivate individuals to decrease consumption on their own are warranted.

Research has identified beliefs associated with sugary drink reduction in general (Jordan et al., 2012; Kassem and Lee, 2004; Zoellner et al., 2012; Miller et al., 2020), but little is known about urban adolescents’ beliefs about sports and energy drinks specifically. Sports and energy drinks represent a unique sub-type of SSB’s because advertising promotes the belief that these products are healthy and helpful for achieving one’s goals (Bleakley et al., 2022), and there is more public uncertainty about their healthiness compared to other SSBs including carbonated beverages such as sodas (Hennessy et al., 2015; Munsell et al., 2016; Pfender et al., 2022).

This study was conducted to examine beliefs about sports and energy drinks held by urban adolescents in the USA that can be incorporated into health messaging to educate this population about the true risks and benefits associated with consumption of these beverages. Using behavioural theory to guide in the design of dietary intake patterns improves message effectiveness (Ammerman et al., 2002). The Reasoned Action Approach (RAA; (Fishbein and Ajzen, 2010) provides insight into the cognitive determinants of a given target behaviour. According to the RAA, health behaviours are determined by behavioural outcome expectancies (Behling and Starke, 1973) - the “underlying beliefs” that predict the determinants of intention (i.e., attitudes, normative pressure, and autonomy/efficacy) (Yzer, 2012). Attitudes are conceptualised as a composite of one’s beliefs about positive and negative outcomes associated with each behaviour. Descriptive and injunctive norms comprise normative pressure. People who are important to the target population serve as injunctive referents for approval of different behaviours and perceptions of whether groups like themselves are engaging in a particular behaviour shape descriptive normative perceptions. Intention is also shaped by individuals’ confidence in their ability to engage in the behaviour (perceived behavioural control). Confidence is impacted by the presence of facilitators and barriers to engaging in the behaviour of interest. Each of these constructs are based on corresponding underlying beliefs.

We sought to elicit beliefs about four behaviours: sports drink consumption and reduction, and energy drink consumption and reduction. Informed by the RAA, we proposed the following research questions:

RQ’s 1-4: What are the most prevalent (a) positive and (b) negative outcomes associated with (1) sports drink consumption, (2) sports drink reduction, (3) energy drink consumption, and (4) energy drink reduction?

RQ’s 5 and 6: Who are the most common referents of (a) consumption, (b) approval, and (c) disapproval discussed about (5) sports drinks and (6) energy drinks?

RQ’s 7-10: What are the most prevalent (a) facilitators and (b) barriers to sports drink (7) consumption, (8) sports drink reduction, (9) energy drink consumption, and (10) energy drink reduction?

Methods

Sample

We conducted a series of focus groups with primarily Black and Hispanic youth aged 14-18 years old. The sample was drawn from Philadelphia, PA, and Camden, New Jersey, a large city located in the greater Philadelphia region with a predominately Black and Puerto Rican population. Thirty-four young people (M = 15.78, SD = 1.28; 12 female, 12 male, and 10 unreported sex; 19 Hispanic, 11 Non-Hispanic Black, 2 Asian, and 1 unknown race or ethnicity) were recruited to participate in a 60-90-minute focus group in exchange for a $40 gift card. Groups ranged in size from 4 to 10 participants.

Participants’ responses to introductory questions about their levels of sports and physical activity as well as their sports and energy drink and soda consumption indicated that the sample was fairly active, as most reported participating in at least 60 minutes of physical activity that raised their heart rates more than twice in the past seven days. Participants reported a range of sports and energy drink and soda consumption. Several participants reported consuming no sports drinks or soda in the week prior to the group, but several others reported consuming sports drinks and soda every day in the seven days prior to the study. Energy drink consumption was low, as most participants had not consumed any energy drinks in the seven days prior to the group and those who had done so only consumed them once in seven days. Participants were recruited through youth recruiters and through a partner youth serving organisation.

Procedures

Participants first completed a brief demographic questionnaire and then came together for the moderated focus group discussion. In total, four focus groups were conducted at the university or on site at partner community organisation between November 2019 and February 2020. Groups were structured using a detailed guide to generate a reasoned action-informed inventory of attitudinal, normative and efficacy beliefs associated with sports and energy drink consumption and reduction. Sports drinks were defined as flavoured beverages often containing carbohydrates, minerals, and electrolytes (salts), and sometimes vitamins or other nutrients. Energy drinks were defined as sugar-sweetened beverages that contain stimulants, with caffeine as the primary source of “energy,” along with varying amounts of other ingredients. All focus groups started off with a sorting task that helped to ensure agreement on what beverages were sports drinks vs. energy drinks for the remainder of the focus group discussion and provided visual cues of beverages that may not initially be top of mind for participants.

Attitudinal beliefs were elicited by asking: What are the good things that can happen if you were to reduce sports/energy drink consumption? What are the bad things? Descriptive normative perceptions were assessed by asking participants to list important others in their lives who regularly consume sports/energy drinks. To elicit injunctive normative perceptions, participants were asked who in their lives approve of their consumption of each beverage, and who would disapprove of their reducing consumption of each beverage. To assess efficacy beliefs, participants were asked: what might make it easier for you to reduce sports drink consumption; and what might make it harder? This approach is a standardised and validated methodology for identifying beliefs specific to a target behaviour (Fishbein and Ajzen, 2010).

This set of questions was asked in four different rounds per focus group, with each combination of behaviour – consumption and reduction – and SSB type – sports drinks and energy drinks – as a focus. The order in which each behaviour (consumption or reduction)-SSB type (sports drinks or energy drinks) combination was asked was randomised for each group. Focus groups were audio recorded for transcription purposes and extensive notes were kept during each discussion. All procedures were approved by the Institutional Review Boards at the University of Pennsylvania and the University of Delaware. Data were analysed using an approach to thematic analysis following the six steps developed by Braun and Clark (Braun and Clarke, 2006): 1.) familiarisation; 2.) coding; 3.) generating themes; 4.) reviewing themes with the larger team; 5.) defining and naming themes; and 6.) writing.

Results

Attitudes

Sports Drinks

Hydration was listed as a positive outcome associated with drinking sports drinks in all four focus groups. This outcome was most often discussed in terms of replenishing electrolytes, vitamins and nutrients and quenching thirst during and after sports or exercise participation. Taste was also discussed in multiple groups. Participants noted that they got bored drinking water, so sports drinks were a good supplement to ensure that they are drinking enough fluids.

Participant responses indicated that they did not view sports drink consumption as an unhealthy behaviour. When asked to list bad things that could happen from consumption, one participant responded “nothing.” Those who expressed negative outcomes associated with consumption most often cited ingredients in sports drinks that could potentially cause illness over time (e.g., too much sugar causing weight gain and other unnamed health problems; red dye and other ingredients causing cancer; products breaking down nutrients in the body or slowing metabolism). Multiple participants used the word “addiction” when describing drawbacks associated with consumption, referring to a potential mental or physical dependency on certain sports drinks for a specific type of energy or mindset during sports participation.

Most negative outcomes associated with sports drink consumption were discussed as minor risks that athletes take in order to maximise their sports performance and avoid other more serious health risks (e.g., dehydration and nutrient depletion), and some people specified that certain drawbacks are only a concern when sports drinks are consumed outside of athletic or exercise-based contexts (e.g., drinking sports drinks without utilising the energy they provide is unhealthy; calories consumed in the absence of exercise can lead to weight gain).

The most referenced positive outcomes associated with sports drink reduction were decreased sugar intake and weight management. When asked about negative outcomes associated with reduction, several participants speculated that sports drink reduction may impair athletic performance.

Energy Drinks

Most benefits associated with energy drink consumption were related to productivity. Participants described energy drinks as a means for performing undesirable tasks such as school work or exercising when one is too tired or unmotivated to complete them unassisted. Fewer participants described energy drinks as “fun,” which may be related to consumption in social settings such as parties. Unlike sports drinks, participants did not consistently perceive any health benefits to drinking energy drinks that might offset the health drawbacks associated with consumption.

In contrast to sports drinks, participants expressed consensus that energy drinks are unhealthy. Health concerns associated with consumption were more immediate and serious in nature compared to sports drinks. Potential addiction was a recurrent theme across groups. Many participants described withdrawal symptoms associated with cutting back on energy drinks, including “tweaking” (i.e., a slang term often used to describe erratic behaviour exhibited by a drug user), headaches, sickness and mood swings. Several participants specifically noted anger as a byproduct of cutting back. Participants described the experience of energy drinks making them feel like they had “too much energy,” “jittery,” and “anxious for no reason at all,” which negatively impacted their sleep patterns and led some to worry about doing damage to their hearts. Multiple participants also expressed concern about energy drinks damaging their teeth.

In all four groups, saving money and being healthier overall were listed as positive outcomes associated with energy drink reduction. Negative outcomes of reduction were mostly tied to withdrawal symptoms once one develops a dependency on energy drinks (e.g., mood swings, headaches, tweaking), which were described in all four groups.

Norms

Sports Drinks

Friends and family members were most commonly listed as those who consume sports drinks themselves. Participant responses about approval of consumption and disapproval of reduction reflected normative pressure and approval to replenish electrolytes with sports drinks at specific times when dehydration was a concern (i.e., during sports participation, while exercising, and while sick). Coaches and teammates were most often named as those who approve of sports drink consumption and would disapprove of a reduction, followed by groups who profit from their sales (e.g., manufacturers).

Patterns of sports drink disapproval of consumption and approval of reduction were less clear. Multiple participants named doctors, parents and specific family members when asked about disapproval, noting concerns about sugar and calories, but several others specifically stated that “nobody” disapproved of their sports drink consumption because, as stated by one participant, “it’s not a bad thing.” Thus, normative pressure to consume sports drinks seems to be limited mostly to replenishment to avoid dehydration when exercising and participants did not seem to perceive any consistent normative pressure to reduce consumption in any context.

Energy Drinks

When asked who approved of their energy drink consumption, participants most often responded “nobody” and noted that “everyone” wanted them to reduce their intake. Similar to sports drinks, multiple participants listed people who make money from sales (e.g., manufacturers, advertisers) as those who approve of energy drink consumption and would disapprove of cutting back.

When asked about people who disapproved of their energy drink consumption and approved of their cutting back, participants listed a broad range of important individuals including family, friends, coaches and doctors.

Efficacy

Sports Drinks

Participants discussed multiple sources of sports drink advertising exposure, including television, social media (specifically, Instagram), and point-of-purchase advertising. Participants most often referred to advertisements featuring sports figures and considered celebrity endorsements of these products to be particularly persuasive. Advertising pervasiveness was a strong theme across all groups. Participants described sports drink advertising as being “everywhere,” and asserted these ads were barriers to reducing sports drink consumption.

In addition to advertisements, participants also noted that the sports drinks themselves were ubiquitous in their daily lives. One participant discussed sports drink prominence in terms of how much space it takes up, describing purchasing scenarios in which one goes out of his or her way to get around sports drinks to get to water. When asked about facilitators of sports drink consumption and barriers to cutting back on sports drinks, participants discussed the availability of the products sold in corner stores and school vending machines, provided by coaches while participating in athletics, and stocked in their own home refrigerators make them a quick and convenient option.

Prevalence of advertising and availability of the product were also the top two issues raised when participants were asked about facilitators to reduction and barriers to sports drink consumption. Across multiple groups, participants stated that they would be less likely to consume sports drinks if they were not constantly exposed to advertisements and opportunities to consume them.

Participants in multiple groups cited drinking water as a healthy alternative to sports drink consumption and suggested that this could be facilitated by making water options more available and appealing. For example, a participant in one group raised the possibility of making water dispensers more readily available for participants to refill reusable containers, however, another noted the unappealing nature of water dispensers they currently had access to and suggested that they could be improved by offering filtered cold water.

Energy Drinks

Advertising and accessibility were common facilitators of energy drink consumption across all groups. Unlike sports drinks, however, these factors were not as clearly delineated as the most important barriers to energy drink reduction as they were for sports drinks. Discussions of energy drink availability were limited to convenience stores, as opposed to the expansive access through on-campus vending machines, athletic participation, and home refrigerators that participants described regarding sports drinks. Further, although availability was a facilitator of consumption across all four groups, the decision to consume energy drinks was described as a more deliberate action taken for the purpose of staying awake and completing undesirable tasks in comparison to the mindless, simple hydration option participants described regarding sports drinks.

Multiple participants noted barriers to consumption that were either internal (e.g., disliking the taste or the way that the drink makes them feel while consuming the product or afterwards) and external (e.g., age requirements for purchasing energy drinks in some convenience stores, parents forbid it). One participant suggested getting more sleep as a facilitator of energy drink reduction, but the most common facilitator that was raised in all four focus groups was substituting a different type of drink to keep them awake (e.g., drinking a smoothie, shocking the system awake with cold water).

Discussion

Results from this study highlighted stark attitudinal and normative differences between sports drinks and energy drinks and important similarities in advertising and availability that impact efficacy beliefs, all of which have implications for further research and message design efforts. Differences in attitudinal, normative and efficacy beliefs between the two types of beverages signify efforts to educate adolescent about the risks and benefit associated with SSB consumption and reduction likely should distinguish among different types of drinks and take different persuasive approaches when designing interventions and messages to reduce consumption.

Implications for Educational Interventions

Results highlight both population-level and individual-level factors that contribute to urban adolescents’ consumption of sports and energy drinks. This suggests an ecological approach to interventions to curb consumption may be warranted (McLeroy et al., 1988). At the intrapersonal and interpersonal levels, messages to correct misperceptions about the utility of SSB’s for performance, particularly sports drinks, may be necessary. At the community and institutional levels, data call for efforts to decrease accessibility of SSBs and increase accessibility of healthier options. Finally, at the policy level, restrictions on misleading advertising claims (e.g., that sports drinks hydrate better than water) could play an important role in efforts to reduce SSB consumption.

Analysis of sports drink data suggest three strategies may be effective future efforts to fully inform the target population and curb consumption: 1) consciousness-raising about the negative health outcomes associated with consumption, 2) correcting misperceptions about the health benefits and competitive edge these products offer, and 3) reducing access and availability of these products and their promotions in comparison to healthier options such as water.

Stage models of health behaviour change that have guided public health interventions for decades highlight the importance of the population of interest’s awareness and acknowledgement that a change in existing behaviour would be optimal for one’s health maintenance or improvement (Prochaska and DiClemente, 1983; Rogers, 1962). Attitudinal beliefs expressed by participants suggest that many members of these groups have not acknowledged reducing or abstaining from sports drinks as a heathy behaviour because they are unaware of the negative outcomes associated with consumption. In addition to this lack of awareness, several prevalent misperceptions about these products and the degree to which they are necessary for maximal performance and replenishment also emerged. Thus, many adolescents in this study not only failed to recognise sports drink reduction as a healthy behaviour, but they also seemed to believe that abstaining from sports drinks during physical activity may, in fact, be an unhealthy behaviour that puts them at risk of dehydration. Despite the noted lack of evidence for the efficacy of sports drinks to improve athletic performance or prevent dehydration more effectively than water, electrolytes, replenishment and maximising sports performance were commonly cited positive outcomes associated with sports drink consumption in group discussions.

Participants’ normative beliefs about sports drinks suggest that misperceptions about the hydration and athletic performance that these products offer are not limited to the young people in this study. The fact that sports drinks are provided and promoted by coaches during athletic activity and are made readily available to in university vending machines and in the home indicates that caregivers and authority figures may also be underinformed about the negative aspects of sports drink consumption and misinformed about the benefits they offer. Thus, interventions aimed at correcting misperceptions about these products may be more successful if they include parents, caregivers and authority figures as a secondary target audience.

Research on correcting misperceptions suggests that enhanced correctives that evoke emotion and tell a story that can fill in any processing gaps that may occur from countering a previously held belief may correct misperceptions more completely than simple negation correctives (Lewandowsky et al., 2012; Cappella et al., 2015). One story that may serve as a basis for narrative correctives about the health and athletic benefits to be gained from sports drink consumption is a description of sports drink companies’, retailers’ and advertisers’ efforts to mislead the public about the utility of these products for improving athletic performance and replenishment more effectively than water. A recent content analysis of online and television sports drink advertising indicated that an improved athletic performance and competitive edge were common themes in sports drink advertisements despite a lack of scientific evidence to support such claims (Bleakley et al., 2022). Product advertising and promotions were the most frequently listed facilitator of sports drink consumption and barrier to sports drink reduction in this study and multiple participants acknowledged that sports drink companies, retailers, and advertisers are among those most likely to disapprove of their reducing sports drink consumption. Thus, adolescents in this study recognised both stakeholder motivation to sell sports drinks and the degree to which advertising plays a role in their own consumption of sports drinks, but their assertions that sports drinks serve an important role in hydration and athletic performance suggest they are unaware of how misleading promotions about the utility of the product for enhancing performance and maintaining health are.

In contrast to sports drink consumption, which seemed to be largely driven by positive attitudes and normative pressure to consume them, decisions to consume energy drinks were more closely tied to efficacy. Participants expressed negative attitudes towards the product and felt normative pressure to reduce consumption, but still intended to engage in the behaviour because they did not have confidence in their own ability to be productive and complete certain tasks in the absence of the stimulant. Identification of a substitute behaviour that would provide the same energy and stimulation offered by energy drinks was a commonly discussed facilitator of energy drink reduction, and advertising and availability were noted as common barriers to reduction. This suggests that effective messages designed to reduce energy drink consumption might promote a healthy substitute through methods similar to current energy drink advertising. Promotion of a substitute behaviour that is like energy drink consumption (e.g., drinking water, unsweetened tea, or black coffee) and highlighting the substitute’s viability as a superior stimulant may be preferable to promoting strategies that would require more of a lifestyle change or long-term commitment (e.g., time management strategies and getting more sleep).

Limitations

As with all studies, findings from this research are limited in some aspects. First, although the focus group moderator provided clear definitions at the beginning of the group and engaged participants in a short exercise to ensure that they understood what was meant by the terms “sports drink” and “energy drink,” some participant responses suggested that they were thinking of products that were not a focus of this study (e.g., a participant referral to coffee as an energy drink, but black coffee would not qualify as a sugar-sweetened beverage). This limits internal validity of some responses. Additionally, the self-selected convenience sample from this study limits external generalizability of findings. Generalizing beyond the study sample is not the objective of focus group research. Instead, this methodology allows for an unconstrained exploration of beliefs members of the population of interest hold about the product.

Conclusion

Results from this study indicate that public health messages about different types of sugar-sweetened beverages (i.e., sports drinks and energy drinks) need to be different as perceptions about, and motivations to consume, each product differ. Participants not only failed to recognize sports drink consumption as an unhealthy behavior, but they also expressed the viewpoint that reducing sports drink consumption may be an unhealthy behavior that puts one at risk of serious health complications resulting from dehydration. Energy drinks are almost universally recognized as unhealthy among urban youth, but the risks of consumption were considered necessary on a situational basis. Sports and energy drink accessibility and advertising pervasiveness were facilitators of consumption and barriers to reduction for both products.

Table 1.

Attitudinal Themes: Positive and Negative Outcomes for Each Behaviour as Expressed in at least Two Groups

Consume: Good Consume: Bad Cut Back: Good Cut Back: Bad
Sports Drinks      Electrolytes

     Hydration*

     Quench Thirst

     Tastes Good		      Consume too much sugar (and salt)

     Get sick in some way (e.g., red 40 causing cancer, break down nutrients in body, slow metabolism; dye specifically was brought up in 2 groups)
      Sugar reduction is good

     Weight management		      Athletes may be negatively affected
Energy Drinks      Extra energy

     May help with academic performance (staying up to get homework done, make it to class)		      Addiction

     Damage teeth

     Too much energy (jittery)

     Concerns about the heart		      Save money*

     Healthier* 		     Withdrawal symptoms (headaches, twitching, bad mood*
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Note: Responses marked with * were expressed in all four groups

Table 2.

Normative Themes: Important Others Who Will Approve/Disapprove of Each Behaviour as Expressed in at least Two Groups

Consumption Approval Consumption Disapproval Reduction Approval Reduction Disapproval
Sports Drinks      Coach

     Teammates

     Friends

     Doctor		      Nobody

     Parents

     Doctor		      Family members      Coaches
Energy Drinks      Nobody      Parents      Family members (specifically Mom)      Energy drink companies/advertisers

     Family members (regarding coffee in one group and actual energy drinks in another)
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Table 3.

Efficacy Themes: Facilitators and Barriers to Each Behaviour as Expressed in at least Two Groups

Consumption Facilitators Consumption Barriers Reduction Facilitators Reduction Barriers
Sports Drinks      Accessibility (university, corner stores, home, provided at sporting events etc.)*

     Advertising* 		     Price

     Availability (sold out or do not have a preferred flavour)		      Accessibility*

     Advertising*
Energy Drinks      Accessibility (corner stores, parties, Dunkin Donuts)*

     Advertising* 		     Taste

     Price		      Substitute something else (e.g., smoothie, water, Minute Maid)      Accessibility*

     Advertising*
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Note: Responses marked with * were expressed in all four group

Acknowledgements

The authors would like to acknowledge LUCY Outreach -- a Philadelphia-based program that welcomes all youth to take part in educational, social, leadership, and service-oriented programing for youth development -- for helping to provide study participants.

Funding

This research was funded by a grant from the US National Institute of Dental and Craniofacial Research (NIDCR: 1R21DE028414-01)

References

  1. Ammerman AS, Lindquist CH, Lohr KN, et al. (2002) The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Preventive Medicine 35(1): 25–41. [DOI] [PubMed] [Google Scholar]
  2. Behling O and Starke FA (1973) The postulates of expectancy theory. Academy of Management Journal 16(3): 373–388. [Google Scholar]
  3. Bleakley A, Ellithorpe ME, Jordan AB, et al. (2022) A content analysis of sports and energy drink advertising. Appetite 174: 106010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bleich SA-O, Vercammen KA, Koma JW, et al. Trends in Beverage Consumption Among Children and Adults, 2003-2014. (1930-739X (Electronic)). [DOI] [PubMed] [Google Scholar]
  5. Borradaile KE, Sherman S, Vander Veur SS, et al. (2009) Snacking in children: the role of urban corner stores. Pediatrics 124(5): 1293–1298. [DOI] [PubMed] [Google Scholar]
  6. Braun V and Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77–101. [Google Scholar]
  7. Cannuscio CC, Weiss EE and Asch DA (2010) The contribution of urban foodways to health disparities. Journal of Urban Health 87(3): 381–393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cappella JN, Maloney E, Ophir Y, et al. (2015) Interventions to Correct Misinformation About Tobacco Products. Tobacco Regulatory Science 1(2): 186–197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Coombes JS (2005) Sports drinks and dental erosion. The American Journal of Dentistry 18(2): 101–104. [PubMed] [Google Scholar]
  10. Cordrey K, Keim SA, Milanaik R, et al. (2018) Adolescent consumption of sports drinks. Pediatrics 141(6). [DOI] [PubMed] [Google Scholar]
  11. Emond JA, Madanat HN and Ayala GX (2012) Do Latino and non-Latino grocery stores differ in the availability and affordability of healthy food items in a low-income, metropolitan region? Public Health Nutrition 15(2): 360–369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Farhangi MA, Nikniaz L and Khodarahmi M (2020) Sugar-sweetened beverages increases the risk of hypertension among children and adolescence: a systematic review and dose-response meta-analysis. Journal of Translational Medicine 18(1): 344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Fishbein M and Ajzen I (2010) Predicting and Changing Behavior: A Reasoned Action Approach. New York: Taylor & Francis. [Google Scholar]
  14. Hales CM, Carroll MD, Fryar CD, et al. (2017) Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief (288): 1–8. [PubMed] [Google Scholar]
  15. Harris JL et al. (2020) Sugary Drink Facts 2020, UConn Rudd Center for Food Policy and Health. Available at: https://uconnruddcenter.org/research-archive/sugary-drink-facts-2020/ (Accessed: January 23, 2023).
  16. Hennessy M, Bleakley A, Piotrowski JT, et al. (2015) Sugar-Sweetened Beverage Consumption by Adult Caregivers and Their Children: The Role of Drink Features and Advertising Exposure. Health Education & Behavior 42(5): 677–686. [DOI] [PubMed] [Google Scholar]
  17. Imamura F, O’Connor L, Ye Z, et al. (2015) Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. British Medical Journal 351: h3576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Jordan A, Taylor Piotrowski J, Bleakley A, et al. (2012) Developing Media Interventions to Reduce Household Sugar-Sweetened Beverage Consumption. The ANNALS of the American Academy of Political and Social Science 640(1): 118–135. [Google Scholar]
  19. Kassem NO and Lee JW (2004) Understanding Soft Drink Consumption Among Male Adolescents Using the Theory of Planned Behavior. Journal of Behavioral Medicine 27(3): 273–296. [DOI] [PubMed] [Google Scholar]
  20. Laniado N, Sanders AE, Godfrey EM, et al. (2020) Sugar-sweetened beverage consumption and caries experience: An examination of children and adults in the United States, National Health and Nutrition Examination Survey 2011-2014. Journal of the American Dental Association 151(10): 782–789. [DOI] [PubMed] [Google Scholar]
  21. Lewandowsky S, Ecker UKH, Seifert CM, et al. (2012) Misinformation and Its Correction: Continued Influence and Successful Debiasing. Psychological Science in the Public Interest 13(3): 106–131. [DOI] [PubMed] [Google Scholar]
  22. Malik VS and Hu FB (2019) Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence. Nutrients 11(8). [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Malik VS, Pan A, Willett WC, et al. (2013) Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. The American Journal of Clinical Nutrition 98(4): 1084–1102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Malik VS, Popkin BM, Bray GA, et al. (2010) Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 33(11): 2477–2483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Marriott BP, Hunt KJ, Malek AM, et al. (2019) Trends in Intake of Energy and Total Sugar from Sugar-Sweetened Beverages in the United States among Children and Adults, NHANES 2003–2016. Nutrients, 11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Marshall TA (2013) Preventing dental caries associated with sugar-sweetened beverages. Journal of the American Dental Association 144(10): 1148–1152. [DOI] [PubMed] [Google Scholar]
  27. McLeroy KR, Bibeau D, Steckler A, et al. (1988) An ecological perspective on health promotion programs. Health Education Quarterly 15(4): 351–377. [DOI] [PubMed] [Google Scholar]
  28. Miller C, Braunack-Mayer A, Wakefield M, et al. (2020) “When we were young, it really was a treat; now sugar is just the norm every day”-A qualitative study of parents’ and young adults’ perceptions and consumption of sugary drinks. Health Promotion Journal of Australia 31(1): 47–57. [DOI] [PubMed] [Google Scholar]
  29. Munsell CR, Harris JL, Sarda V, et al. (2016) Parents’ beliefs about the healthfulness of sugary drink options: opportunities to address misperceptions. Public Health Nutrition 19(1): 46–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Narain A, Kwok CS and Mamas MA (2016) Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis. International Journal of Clinical Practice 70(10): 791–805. [DOI] [PubMed] [Google Scholar]
  31. Ogden CL, Carroll MD, Curtin LR, et al. (2010) Prevalence of high body mass index in US children and adolescents, 2007-2008. Journal of the American Medical Association 303(3): 242–249. [DOI] [PubMed] [Google Scholar]
  32. Palmer JR, Boggs DA, Krishnan S, et al. (2008) Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Archives of Internal Medicine 168(14): 1487–1492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Pfender E, Bleakley A, Ellithorpe M, et al. (2022) Perceptions of Sports and Energy Drinks: Factors Associated with Adolescent Beliefs. American Journal of Health Promotion: 08901171221113521. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Prochaska JO and DiClemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology 51(3): 390. [DOI] [PubMed] [Google Scholar]
  35. Rogers EM (1962) Diffusion of innovations. New York: Free Press of Glencoe. [Google Scholar]
  36. Sanders-Jackson A, Parikh NM, Schleicher NC, et al. (2015) Convenience store visits by US adolescents: rationale for healthier retail environments. Health & Place 34: 63–66. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. United States Department of Health and Human Services (2013). The DAWN Report: Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern. Rockville, MD: United States Department of Health and Human Services. [PubMed] [Google Scholar]
  38. Valenzuela MJ, Waterhouse B, Aggarwal VR, et al. (2021) Effect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis. European Journal of Public Health 31(1): 122–129. [DOI] [PubMed] [Google Scholar]
  39. Vargas-Garcia EJ, Evans CEL, Prestwich A, et al. (2017) Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis. Obesity Reviews 18(11): 1350–1363. [DOI] [PubMed] [Google Scholar]
  40. Vercammen KA, Koma JW and Bleich SN Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003-2016. (1873-2607 (Electronic)). [DOI] [PubMed] [Google Scholar]
  41. Yzer M (2012) Perceived Behavioral Control in Reasoned Action Theory: A Dual-Aspect Interpretation. The ANNALS of the American Academy of Political and Social Science 640(1): 101–117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Zoellner J, Estabrooks PA, Davy BM, et al. (2012) Exploring the theory of planned behavior to explain sugar-sweetened beverage consumption. Journal of Nutrition Education and Behavior 44(2): 172–177. [DOI] [PMC free article] [PubMed] [Google Scholar]

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