The target population for the SYF/RYD program was Oklahoma adults with children living in the home. In 2015, prior to the launch of the SYF/RYD media program, we surveyed 1118 Oklahomans. After the launch of the SYF/RYD program, we surveyed 1538 Oklahomans. The American Association for Public Opinion Research (AAPOR) response rate (RR1) was 10% in 2015 and 5% in 2017; the cooperation rates were 90 and 89% respectively, both within acceptable ranges for both survey periods [26, 27]. The demographic characteristics during both time periods were similar and included predominantly female (55% in 2015 versus 54% in 2017) and white (66% versus 68%), with about half (47%) reporting having a high school education or less. About two-thirds (69% versus 63%) reported they participated in moderate to intense physical exercise three or more days every week. While most (82% versus 85%) perceived their health status as excellent, very good, or good, only half or less (50% versus 42%) drank the recommended eight cups of water or more daily, and less than one quarter ate the recommended daily three or more servings of fruits (23% versus 20%) and vegetables (19% versus 21%) [28]. Only one third strongly agreed they could afford to buy healthy foods in 2015 (34%), compared to about half (48%) in 2017. Statistically significant differences between 2015 and 2017 survey results existed for only two variables, daily water consumption (p < 0.05) and ability to afford healthy food (p < 0.0001) (Table 1).
Consumption of SSBs
Following the SYF/RYD media program, the prevalence of daily consumption of any SSB was 36.3% compared to 44.6% in 2015 (p = 0.0232), a decrease of 19%. The prevalence of daily sugary soda consumption was 21.1% in 2017 compared to 29.4% in 2015 (p = 0.0119), a decrease of 28%. The prevalence of daily non-soda SSB consumption was 22.9% in 2017 compared to 29.3% in 2015 (p = 0.0543), a decrease of 22%, and the prevalence of heavy SSB consumption was 9.2% compared to 16.1% in 2015 (p = 0.0083), a decrease of 43% (Table 2).
While there were no statistically significant differences in SSB consumption between 2015 and 2017 within subgroups by gender, age, or race, several approached significance (p < 0.10), Table 2). Conversely, among those with a high school education or less, the prevalence of daily SSB consumption decreased 31% from 61% in 2015 to 42% in 2017 (p < 0.01). Additionally, in those who perceived their health status as excellent, very good, or good, there was a statistically significant 24% decrease in SSB consumption between 2015 (33%) and 2017 (24%). Additional significant decreases in SSB consumption occurred in those who drink eight or more cups of water per day (31% ↓), who eat less than the recommended 3 servings of fruit (19% ↓) and vegetables (18% ↓) daily, and in those who are not able to afford healthy foods (20% ↓) (Table 2).
SYF/RYD campaign exposure
About 24% of Oklahomans with children in the home demonstrated confirmed exposure to SYF/RYD (Table 1). While women were more likely to have confirmed exposure than men (29% versus 18%), the program reached similar proportions with respect to age, education, self-perceived health status, water consumption, dietary consumption of fruits and vegetables, weekly amount of physical exercise, and the ability to afford healthy food, a measure of economic status. One notable exception was race. Although there was not a statistically significant difference within that variable, confirmed exposure among American Indian/Alaska Natives was lower than all other groups (Table 1).
With respect to outcome measures, there were no significant differences in total SSB consumption, sugary soda consumption, or other SSB consumption by campaign exposure status. Similarly, there was no difference among those with and without confirmed campaign exposure in plans to limit SSB consumption for their families or perceived ability to substitute water for SSBs for their families. There was, however, a statistically significant difference in knowledge about the consequences of SSB consumption by exposure to the campaign. Among those with confirmed exposure, three quarters (76%) knew SSB consumption is linked to obesity, diabetes, and heart disease compared to 64% without confirmed exposure (p = 0.0045, Table 3).
Factors associated with daily SSB consumption
The results of the multivariable logistic regression analysis of the 2017 survey data revealed a number of factors were independently associated with consuming one or more SSB of any kind per day. These included high school education or less (aOR = 1.33, 95% CI = 1.02, 1.73), perceived health status as fair or poor (aOR = 2.02, 95% CI = 1.47, 2.78), and inability to afford healthy foods (aOR = 1.33, 95% CI = 1.06, 1.67, Table 4). Other dietary behaviors were also associated with total SSB consumption including drinking less than eight cups of water per day (aOR = 1.77 with a 95% CI = 1.39, 2.25), fewer than three daily servings of fruits (aOR = 1.70 with a 95% CI = 1.23, 2.34) and fewer than three daily servings of vegetables (aOR = 1.35 with a 95% CI = 1.01, 1.81). After adjusting for other variables in the model, the odds of SSB consumption were also higher in American Indian/Alaska Natives compared to Whites (aOR = 1.59, 95% CI = 1.10, 2.29).
Factors associated with daily soda consumption
When sugary soda was considered, three factors remained independently associated with daily consumption. The odds of sugar-sweetened soda consumption were higher for American Indian/Alaska Natives compared to Whites (aOR = 1.66, 95% CI = 1.12, 2.46) and in those who consumed less than the recommended eight cups of water daily (aOR = 1.79, 95% CI = 1.36, 2.36). Additionally, the odds of sugar-sweetened soda consumption were higher for those who did not meet the daily dietary recommendation of three servings of fruits (aOR = 1.49, 95% CI = 1.02, 2.17, Table 4).
Factors associated with daily SSB consumption not including soda
Five factors were associated with increased odds of SSB consumption, other than soda. The odds of SSB consumption not including sodas were higher in men (aOR = 1.61, 95% CI = 1.24, 2.08), American Indian/Alaska Natives (aOR = 1.57, 95% CI = 1.05, 2.34), and among those with a high school education or less (aOR = 1.55, 95% CI = 1.16, 2.07). Additionally, fair or poor perceived health status (aOR = 1.82, 95% CI = 1.29, 2.58), and drinking fewer than eight cups of water a day (aOR = 1.79, 95% CI = 1.37, 2.36, Table 4) were significantly associated with SSB consumption not including sodas.
Factors associated with heavy SSB consumption
Heavy consumption of any SSB was defined as three or more SSBs of any kind per day and was reported by 9.2% of Oklahomans with children in the home in 2017. After adjusting for other variables in the model, the odds of consuming three or more SSBs per day were twice as high among American Indian/Alaska Natives compared to White (aOR = 2.06, 95% CI = 1.27, 3.36), and among those who perceive their health as fair or poor (aOR = 2.19, 95% CI = 1.42, 3.38). Heavy SSB consumption was also significantly associated with drinking less than eight cups of water per day (aOR = 2.12 with 95% CI = 1.41, 3.18, Table 4).
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