- Title
- Investigating nutrition in adolescents and piloting an intervention to reduce adolescent sugar-sweetened beverage consumption
- Creator
- Ooi, Jia Ying
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The rise in childhood and adolescent obesity poses a concerning health matter that should be addressed urgently. Although sugar-sweetened beverages (SSBs) are a key source of added sugar in adolescent diets, at the time of the conception of this thesis, such an intervention had yet to be conceived in New South Wales (NSW), Australia. Therefore, the aim of this thesis was to investigate the current SSB consumption patterns in children and adolescents, and pilot an intervention to reduce their SSB consumption. To do so, a systematic review was conducted investigating SSB consumption of children and adolescents in three regions particularly burdened by dietary-related chronic diseases: the Western Pacific Region, South-East Asian Region and Region of the Americas (n=73). The most recent studies with data on SSB consumption in children under 18 years of age collected between 2010 to 2019 were appraised. Forty-eight studies reporting SSB consumption for 51 countries were included. The pooled synthesis was 326.0mLs per day. Heterogeneity was high and subgroup analyses by region, country income level and age groups did not reveal any significant differences. The review highlighted the need for public health efforts to focus on reducing their consumption. Next, an investigation of the current prevalence of the implementation of recommended school-level nutrition policies and practices, and barriers and facilitators to their adoption, was conducted in secondary schools in NSW. A cross-sectional study design using a telephone survey was used to contact 137 schools. Access to drinking water, healthy food and beverage marketing, and healthy eating learning opportunities had a high implementation rate of over 90%. However, the implementation of restriction of unhealthy drinks in school canteens, healthy school fundraisers, and staff training related to healthy eating were under 25%. No significant differences were found for subgroup analyses by school sector, socio-economic status, and geographic location. The main reported barrier was having other priorities and commitments (28.5%), while the main reported facilitator was support from stakeholders, staff, students and their parents (37.2%). This study concluded that strategies are required to target barriers to the implementation of nutrition practices. From these findings, a school-based cluster randomised controlled trial (switchURsip) to reduce SSB consumption in adolescents was developed and piloted in six schools (1:1) in the Hunter New England Region of NSW. The aim of this six-month intervention was to reduce the daily SSB consumption (millilitres (mLs)) and daily percentage energy from SSBs (kilojoules (kJ)). Secondary outcomes included SSB intake in schools, daily energy intake and body mass index z-scores. The strategies were lesson plans on SSB, communication with students and parents, a school challenge, and school nutrition environment modifications. Environmental strategies were implemented in the first three months of the intervention, with the curriculum and partnership components added in the final three months. Data were collected from students in years 7 to 9. A total of 1092 students provided active parental consent, with 940 (86%) participating in baseline data collection. No significant results were found for mean daily SSBs consumed (-10.17mL, p=0.57) or daily percentage energy from SSBs (-0.20%, p=0.56) at three-month midpoint data collection. Among girls in the intervention schools, there was a significant decrease in mean daily SSB consumption (-52.02mL, p=0.03) and daily percentage of energy from SSBs (-0.90%, p=0.05) compared to girls in the control schools. At six months follow-up, 862 students were included in the final analysis. No significant changes were found for mean daily intake of SSBs (8.55mL, p=0.63) and percentage daily energy from SSBs (0.12% kJ, p=0.72. Analyses of secondary outcomes and subgroups also did not yield statistically significant results. Findings from the study suggested that intervention fidelity could be improved using certain strategies such as co-designing with schools and parents. Additionally, more thorough methods of assessing intervention fidelity should be implemented. Furthermore, intervention duration could be lengthened to increase intervention dose. Finally, more acceptable forms of parent engagement need to be utilised to better involve parents in improving their child’s health and nutrition. Results from the review and survey reiterates the urgency and importance of well-designed trials utilising sound implementation strategies to reduce the consumption of SSB in children.
- Subject
- nutrition; obesity; sugar-sweetened beverages; children; adolescents; behavioural science; population health; schools; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1510716
- Identifier
- uon:56444
- Rights
- Copyright 2021 Jia Ying Ooi
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 456 KB | Adobe Acrobat PDF | View Details Download |