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A qualitative exploration of parents’, youths’ and food establishment managers’ perceptions of beverage industry self-regulation for obesity prevention

  • Laura M Bogart (a1), Gabriela Castro (a1) and Deborah A Cohen (a1)



We aimed to explore the range of stakeholders’ perceptions of the Balance Calories Initiative (BCI), under which the American Beverage Association pledged to decrease per capita US consumption of beverage energy by 20 % by 2025.


Semi-structured cross-sectional interviews were conducted in 2017.


Participants were recruited from communities targeted by the BCI (Montgomery, AL; North Mississippi Delta, MS; Eastern Los Angeles, CA).


A total of thirty-three parents and thirty-eight youths aged 10–17 years were recruited through youth-serving organizations, street intercept and snowball sampling; sixteen store/restaurant managers were recruited at businesses. Participants were asked about their awareness of the BCI. Parents and youths were asked to ‘think aloud’ as they viewed BCI messages (e.g. ‘Balance What You Eat, Drink, and Do’) and managers were asked about beverage marketing.


Twelve parents and twenty-four youths had seen BCI messages; only four managers were aware of the BCI. Many parents and youths showed some misunderstanding of BCI messages (e.g. that they should drink more sugar-sweetened beverages (SSB) or they needed to equalize healthy and unhealthy beverage intake). Only one manager had communicated with beverage companies about the BCI.


We found mixed comprehension and low awareness of BCI messages in communities targeted by the American Beverage Association for reduced SSB consumption. Industry self-regulation attempts to reduce SSB consumption may have limited effectiveness if stakeholder input is not addressed. Public health practitioners should be aware of the need to address youths’ and parents’ misunderstandings about SSB consumption, especially in BCI-targeted communities.


Corresponding author

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1. Singh, GM, Micha, R, Khatibzadeh, S et al. (2015) Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation 135, 639666.
2. Chen, L, Caballero, B, Mitchell, DC et al. (2010) Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults. Circulation 121, 23982406.
3. Curhan, GC & Forman, JP (2010) Sugar-sweetened beverages and chronic disease. Kidney Int 77, 569570.
4. Collison, KS, Zaidi, MZ, Subhani, SN et al. (2010) Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health 10, 234.
5. Beck, AL, Tschann, J, Butte, NF et al. (2013) Association of beverage consumption with obesity in Mexican American children. Public Health Nutr 17, 338344.
6. Jia, M, Wang, C, Zhang, Y et al. (2012) Sugary beverage intakes and obesity prevalence among junior high school students in Beijing – a cross-sectional research on SSBs intake. Asia Pac J Clin Nutr 21, 425430.
7. Malik, VS, Willett, WC & Hu, FB (2009) Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. Am J Clin Nutr 89, 438439.
8. Francis, DK, Van den Broeck, J, Younger, N et al. (2009) Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents. Public Health Nutr 12, 11061114.
9. Santiago-Torres, M, Cui, Y, Adams, AK et al. (2015) Familial and individual predictors of obesity and insulin resistance in urban Hispanic children. Pediatr Obes 11, 5460.
10. Cantoral, A, Tellez-Rojo, MM, Ettinger, AS et al. (2016) Early introduction and cumulative consumption of sugar-sweetened beverages during the pre-school period and risk of obesity at 8–14 years of age. Pediatr Obes 11, 6874.
11. Papandreou, D, Andreou, E, Heraclides, A et al. (2013) Is beverage intake related to overweight and obesity in school children? Hippokratia 17, 4246.
12. Bray, GA, Nielsen, SJ & Popkin, BM (2004) Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 79, 537543.
13. Te Morenga, L, Mallard, S & Mann, J (2013) Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 346, e7492.
14. Bremer, AA, Byrd, RS & Auinger, P (2011) Racial trends in sugar-sweetened beverage consumption among US adolescents: 1988–2004. Int J Adolesc Med Health 23, 279286.
15. Kenney, EL, Long, MW, Cradock, AL et al. (2015) Prevalence of inadequate hydration among US children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009–2012. Am J Public Health 105, e113e118.
16. Levy, DT, Friend, KB & Wang, YC (2011) A review of the literature on policies directed at the youth consumption of sugar sweetened beverages. Adv Nutr 2, issue 2, 182S200S.
17. Ebbeling, CB, Feldman, HA, Osganian, SK et al. (2006) Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 117, 673680.
18. Mesirow, MS & Welsh, JA (2015) Changing beverage consumption patterns have resulted in fewer liquid calories in the diets of US children: National Health and Nutrition Examination Survey 2001–2010. J Acad Nutr Diet 115, 559–566.e4.
19. Wilde, P (2009) Self‐regulation and the response to concerns about food and beverage marketing to children in the United States. Nutr Rev 67, 155166.
20. Simon, M (2006) Can food companies be trusted to self-regulate – an analysis of corporate lobbying and deception to undermine children’s health. Loy L A L Rev 39, 169.
21. Ronit, K & Jensen, JD (2014) Obesity and industry self-regulation of food and beverage marketing: a literature review. Eur J Clin Nutr 68, 753759.
22. Alliance for a Healthier Generation (2014) Alliance for a Healthier Generation and America’s beverage companies announce landmark CGI commitment to reduce beverage calories consumed across the nation 2014. (accessed March 2018).
23. Van Kleef, E, Van Trijp, H, Paeps, F et al. (2008) Consumer preferences for front-of-pack calories labelling. Public Health Nutr 11, 203213.
24. Centers for Disease Control and Prevention ( 2016) Behavioral Risk Factor Surveillance System | 2016 BRFSS Survey Data and Documentation. (accessed March 2018).
25. van Someren, MW, Barnard, YF & Sandberg, JAC (1994) The Think Aloud Method: A Practical Guide to Modelling Cognitive Processes. London: Academic Press.
26. Sudman, S, Bradburn, NM & Schwarz, N (1996) Thinking About Answers: The Application of Cognitive Processes to Survey Methodology. San Francisco, CA: Jossey-Bass.
27. Fonteyn, ME, Kuipers, B & Grobe, SJ (1993) A description of think aloud method and protocol analysis. Qual Health Res 3, 430441.
28. Ryan, GW & Bernard, HR (2003) Techniques to identify themes. Field Methods 15, 85109.
29. Ryan, GW & Bernard, HR (2011) Data management and analysis methods. In Handbook of Qualitative Research, 4th ed., pp. 796802 [NK Denzin and YS Lincoln, editors]. Thousand Oaks, CA: SAGE Publications, Inc.
30. Cohen, J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20, 3746.
31. Lang, T (2009) Reshaping the food system for ecological public health. J Hunger Environ Nutr 4, 315335.
32. Lang, T & Rayner, G (2007) Overcoming policy cacophony on obesity: an ecological public health framework for policymakers. Obes Rev 8, 165181.
33. Keybridge (2018) 2025 Beverage Calories Initiative: Report on 2017 Progress toward the National Calorie Goal. Washington, DC: Keybridge.
34. Sharma, LL, Teret, SP & Brownell, KD (2010) The food industry and self-regulation: standards to promote success and to avoid public health failures. Am J Public Health 100, 240246.
35. Landman, A, Ling, PM & Glantz, SA (2002) Tobacco industry youth smoking prevention programs: protecting the industry and hurting tobacco control. Am J Public Health 92, 917930.
36. Wakefield, M, Terry McElrath, Y, Emery, , S et al. (2006) Effect of televised, tobacco-company funded smoking prevention advertising on youth smoking-related beliefs intentions, and behavior. Am J Public Health 96, 21542160.


A qualitative exploration of parents’, youths’ and food establishment managers’ perceptions of beverage industry self-regulation for obesity prevention

  • Laura M Bogart (a1), Gabriela Castro (a1) and Deborah A Cohen (a1)


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