Children's Measured Sugar-Sweetened Beverages in Quick-Service Restaurants: Interactions with Neighborhood Food Swamp...

Objective: This study examined the association between neighborhood food swamp environments and sugar-sweetened beverage (SSB) consumption in quick-service restaurants (QSRs) and whether ethnicity and race moderated this association. Methods: Observational data were collected from parent-child dyads patronizing four QSRs in Massachusetts (n = 82 dyads) and New Hampshire (n = 67 dyads), including children's SSB consumption (measured by plate waste) categorized as high (>25 g) versus lower sugar. The neighborhood food environment of each QSR was categorized as food swamp versus nonfood swamp based on the ratio of unhealthy to total food outlets in the neighborhood. Logistic regression analysis was used to test the relationship between food swamps, ethnicity/race, and SSB consumption. Results: Of the 149 children (49% Latinx, 58% between the ages of 7 and 12), most visited QSRs located in food swamps (63%). All children consumed a beverage in QSRs, and 83% consumed high-sugar SSBs. Children patronizing QSRs in food swamps did not differ significantly in the likelihood of consuming high SSBs relative to children in QSRs in nonfood swamps [82% vs. 83%, adjusted odds ratio (aOR) = 0.8, 95% confidence interval (CI): 0.3-2.2]. However, Latinx children were more likely than non-Latinx children to consume high-sugar SSBs in QSRs (93% vs. 72%, aOR = 3.4, 95% CI: 1.1-10.5). SSB consumption did not differ significantly between racial minority and White children. SSB consumption in food swamps did not differ by ethnicity/race. Conclusions: Regardless of the neighborhood food environment, children consume high-sugar SSBs in QSRs. Latinx children had higher odds of consuming high-sugar SSBs in QSRs. These findings support incentives promoting healthier beverage options for children across all food outlets.