Despite the substantial impact sugar-sweetened beverages (SSB) have on total energy intake and the fact that consumption has doubled in the US over the past 25 years;there are no known efficacy trials that have specifically targeted reducing SSB intake among adults. Furthermore, adults with lower health literacy consume higher amounts of SSB and the field lacks theory-based interventions to support behavior change in this population. This research explicitly targets changes in SSB intake through improvements in health literacy, defined within a nutrition context as nutrition numeracy (the ability to read, understand, and apply numbers to make appropriate dietary decisions) and nutrition-related media literacy (the ability to access, analyze, and evaluate nutrition-related media). Phase 1 of the project utilizes focus groups and pilot testing methodologies to guide development of the interventions. The primary objective for Phase 2 is to conduct a three group randomized controlled trial to determine the relative effectiveness of a Theory of Planned Behavior (TPB)-based SSB intervention with (SIPmatE) and without (SIPmart) an enhanced and integrated nutrition literacy component targeting nutrition numeracy and nutrition-related media literacy, as compared to a matched-contact control condition. All three 6-month interventions will be delivered using in- person, small-group communication channels and automated self-monitoring through interactive voice response (IVR) technology. The target population includes 639 low socioeconomic participants residing in 11 at-risk, rural southwest Virginia counties. All outcomes will be assessed at baseline, 6 months, and 12 months post intervention (i.e., 18 months post baseline). The primary outcome is SSB consumption, and secondary outcomes include body weight and a new non-invasive 13C biomarker technique for added sugar intake. Changes in the primary and secondary outcomes will be determined using a mixed effect model to account for individual, time, and group differences within a multi-treatment framework. Components from the RE-AIM framework (i.e. reach, effectiveness, adoption, implementation, &maintenance) will also be assessed and evaluated, along with cost-effectiveness models for each arm. This study fills an important void in the health literacy literature by integrating motivation/intention processes with skill-based nutrition literacy processes to understand causal pathways and complex relationships impacting a life-style behavior under real world and naturally occurring community environments. The long-term goals of this research are to improve nutrition literacy among health disparate populations, reduce SSB consumption and the associated adverse health consequences related to excessive caloric and added sugar consumption (i.e. obesity, type II diabetes, coronary heart disease, dental caries, and cancer), bridge the conceptual gap among concepts in health behavior theory and health literacy, expand the reach of simple and cost-effective interventions among hard-to- reach populations, and reduce the reliance on self-reported measures of dietary intake.

Public Health Relevance

Americans'over-consumption of sugar-sweetened beverages and the associated adverse health consequences of excessive caloric and/or added sugar consumption (i.e. obesity, type II diabetes, coronary heart disease, dental caries, and cancer) are well-established. The prospect of understanding and intervening on nutrition numeracy, nutrition-related media literacy, and motivation/intention processes to improve SSB behaviors under real world and naturally occurring community environments has widespread public health implications. The public health relevance of this application is further signified by the need to develop and disseminate effective and scalable health behavior interventions among health disparate and geographically dispersed populations.

National Institute of Health (NIH)
National Cancer Institute (NCI)
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Special Emphasis Panel (ZRG1)
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Patrick, Heather A
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Virginia Polytechnic Institute and State University
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United States
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