Healthy beverages in a sugary world: Dutch adolescents' perspectives on water and other healthy beverages; a qualitative multi-method study.

Despite extensive research on adolescents' sugar-sweetened beverage consumption, little is known about their perceptions, barriers and facilitators in relation to healthier beverages. The aim of this study is twofold: (1) to explore how adolescents conceptualise healthy beverages; (2) to gain a holistic understanding of the lived experiences that shape their behaviour with respect to healthy beverages. We used a qualitative multi-method approach, combining street intercept interviews, an interactive group session, and semi-structured, in-depth interviews. Sixty Dutch adolescents (aged 12-16) attending pre-vocational secondary schools were recruited using a combination of convenience and purposive sampling. Data were collected from April to June 2025 in the Netherlands, both online and in person, and analysed using reflexive thematic analysis. Dutch teenagers perceived water as the healthiest, while energy drinks and regular soft drinks were identified as unhealthy. Confusion persisted about the safety or the health effects of tap water, fruit juices and artificially sweetened beverages. This was fuelled largely by online influencers and marketing strategies. Adolescents struggled to identify truly healthy beverages due to grey areas, rumours, and mis- and disinformation, often amplified by platforms like TikTok. Scepticism about tap water safety and confusion about fruit juices further clouds their perceptions. Clear, consistent and discerning communication from scientific, governmental and public health organisations, along with stricter marketing regulations and strategies to counter misinformation, is essential to support young people in making healthier beverage choices. Additionally, there is a clear need for a broader range of healthy beverages that genuinely meet adolescent preferences.