Exploring the relationship between boil water advisories and beverage attitudes and intake in adults in Newfoundland...

Newfoundland and Labrador (NL) became the first Canadian province to implement a tax on sugar sweetened beverages (SSBs) in 2022 as an effort to reduce consumption and lower the rate obesity and diabetes. NL also launched a "Rethink Your Drink" campaign to promote water as the drink of choice. However, there may be barriers to choosing water such as the presence of boil water advisories and negative attitudes towards tap water. The objective of this study is to explore the factors influencing total water consumption in NL and assess the impact of attitudes towards tap water and boil water advisories as a predictor of total water and SSB intake. We conducted a cross-sectional online study with adults in NL before and after the implementation of the SSB tax. Attitudes towards tap water and perceptions about being under a boil water advisory impacted beverage consumption. Having negative attitudes towards tap water predicted lower total water consumption (-221 mL/week, p = 0.002) as well as reported being under a boil water advisory (-213 mL/week, p = 0.042), after accounting for sociodemographic variables. Having negative attitudes towards tap water was not a significant predictor of SSB intake after controlling for sociodemographic factors (p = 0.090). Positive health impacts of the NL SSB tax may not be fully realized if SSBs are not substituted for healthier beverage choices, such as water. Policy makers should be aware of the relationship between negative attitudes towards tap water, boil water advisories, and beverage consumption when implementing initiatives to improve public health.