The intake of sugar-sweetened beverages (SSB, e.g., soda/pop, sweet tea, sports and energy drinks, fruit drinks) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. There are strong and consistent scientific data and systematic reviews documenting relationships among high SSB consumption and numerous chronic health conditions such obesity, some types of obesity-related cancers, diabetes, cardiovascular disease, and dental erosion and decay. Reaching adolescents with behaviorally- focused health programs where they spend the majority of their time, at school, shows promise. However, engaging caregivers who serve as their child?s most influential role model as well as the gatekeeper for the home environment may be equally as important in changing adolescents? SSB behaviors. Finally, there is a great need to understand how to support schools and teachers to deliver and maintain evidence-based health education programs, especially among rural schools. Thus, the overarching goal of this proposal is to work in partnership with Appalachian middle schools to implement and evaluate Kids SIPsmartER. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy curriculum aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short service message (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior as well as health literacy, media literacy, numeracy, and public health literacy concepts. In our proposed cluster-randomized controlled trial, we target 12 middle schools in medically underserved Appalachian counties in southwest Virginia. Our study is guided by the RE-AIM (reach, adoption, effectiveness, implementation, and maintenance) framework and is a type 1 hybrid design. The primary aim is to assess changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. We will also evaluate changes in secondary student outcomes (e.g., BMI, quality of life, theory-related variables), changes in caregiver outcomes (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of outcomes. The reach and representativeness of Kids SIPsmartER will be assessed. Furthermore, we will use a mixed-methods approach with interviews, surveys, observation, and process evaluation strategies to determine the degree to which teachers implement Kids SIPsmartER as intended and the potential for institutionalization within the schools. The long-term goal of this health promotion and prevention line of research is to establish an effective, scalable, and sustainable multi-level strategy to improve SSB behaviors and reduce SSB-related health inequities and chronic conditions (e.g. obesity, cancer, type II diabetes, heart disease, dental caries) in rural Appalachia.

Public Health Relevance

Excessive sugar-sweetened beverages (SSB) consumption among Appalachian adolescents is well-established and is associated with numerous chronic health conditions (e.g., obesity, some cancers, type II diabetes, heart disease, dental caries). Collaborating with local Appalachian school systems to evaluate the effectiveness of multi-level intervention strategies to reduce SSB consumption among middle- school students and their caregivers has important public health implications. The public health relevance of this prevention and disparities focused research is further signified by our efforts to promote and determine the capacity of partnering school districts to implement and sustain the multi-level SSB reduction intervention.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Community-Level Health Promotion Study Section (CLHP)
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Jean-Francois, Beda
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University of Virginia
Public Health & Prev Medicine
Schools of Medicine
United States
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