Factors and pathways influencing sugar-sweetened beverage consumption among children in middle childhood: a cross-sectional survey of 1,127 third-grade students in Beijing.

BACKGROUND

Sugar-sweetened beverage (SSB) consumption among children represents a significant risk factor for health problems, including obesity and dental caries. Children aged 8 ~ 9 years are in a critical developmental period for behavioral habit formation; however, the mechanisms underlying these behaviors require deeper investigation. Grounded in social-ecological theory, this study systematically explores the associations between multilevel factors-encompassing individual, interpersonal, environmental, and awareness of health labeling-and children's SSB consumption.

METHODS

We conducted a cross-sectional survey from October to November 2024 among 1,127 students from six elementary schools in Beijing. Using multistage cluster random sampling, we administered standardized questionnaires to collect data on SSB consumption and its multilevel influencing factors. Structural equation modeling was employed to analyze the pathways linking individual, interpersonal, environmental, and health labeling factors to SSB consumption.

RESULTS

The prevalence of SSB consumption in the past week among the study population was 81.90% (923/1,127). The structural equation model demonstrated acceptable fit. Students' SSB consumption was significantly predicted by caregivers' SSB consumption (β = 0.378), peer influence (β = 0.254), home SSB storage (β = 0.230), caregivers' rewards (β = 0.096), teachers' rewards (β = 0.081), and students' attitudes (β = -0.148), all p < 0.05. Students' attitudes were positively influenced by awareness of health labeling (β = 0.778), students' knowledge level (β = 0.427), and caregivers' attitudes (β = 0.183), all p < 0.001. Health education courses positively predicted students' knowledge level (β = 0.188, p < 0.001). Caregivers' SSB consumption was positively associated with convenience store access (β = 0.148, p < 0.001) and home SSB storage (β = 0.106, p < 0.01). Significant indirect effects were observed via students' attitudes and caregivers' SSB consumption. The model explained 35.2% of the variance in students' SSB consumption.

CONCLUSION

SSB consumption is highly prevalent among elementary school students in Beijing, with interpersonal factors (caregivers and peers) exerting the most prominent influence. Future interventions should establish an integrated, comprehensive system coordinating family, school, and community efforts to reduce children's SSB consumption and promote healthy behavioral patterns.