Beverage Advertisement Receptivity Associated With Sugary Drink Intake and Harm Perceptions Among California...

Evaluate associations of adolescents' beverage marketing receptivity with sugar-sweetened beverage (SSB) perceived harm and intake.

School-based cross-sectional health behavior survey.

Seven rural schools in California, 2019-2020.

815 student participants in grades 9 or 10.

Participants viewed 6 beverage advertisement images with brand obscured, randomly selected from a larger pool. Ads for telecommunications products were an internal control. Receptivity was a composite of recognizing, liking, and identifying the displayed brand (later categorized: low, moderate, high). Weekly SSB servings were measured with a quantitative food frequency questionnaire and perceived SSB harm as 4 levels ("no harm" to "a lot").

Outcomes SSB intake (binomial regression) and perceived harm (ordered logistic regression) were modeled according to advertisement receptivity (independent variable), with multiple imputation, school-level clustering, and adjustment for presumed confounders (gender, age, screen time, etc.).

In covariable-adjusted models, greater beverage advertisement receptivity independently predicted higher SSB intake (ratio of SSB servings, high vs. low receptivity: 1.48 [95% CI: 1.15, 1.89]) and lower perceived SSB harm (odds ratio, high vs. low receptivity: 0.59 [0.40, 0.88]). Perceived SSB harm was inversely associated with SSB intake.

Beverage advertisement receptivity was associated with less perceived SSB harm and greater SSB consumption in this population. Policy strategies, including marketing restrictions or counter-marketing campaigns could potentially reduce SSB consumption and improve health.