Adolescents' Beverage Advertisement Receptivity: Sugary Drink Intake and Perceived Harm

Objectives: Sugar-sweetened beverages (SSB) are a top dietary source of added sugars for adolescents, increasing their risk of chronic diseases, including dental caries. This study evaluates the association of beverage marketing receptivity with SSB intake.
Methods: In 2019, students (N=682) attending 5 rural high schools in California (USA) completed in-person health behavior surveys. Participants were shown 6 beverage advertisements (SSB and non-SSB) modified to obscure brand name and randomly selected from a library of 46 television and online ads from the top-spending non-alcoholic beverage brands in the adolescent market segment as tracked by an advertising analysis company. Ads for telecommunications products served as a negative control. Receptivity was a composite score of recognizing, liking, and correctly identifying the brand for a displayed ad, later categorized as low, moderate, and high. Weekly SSB servings were measured with a modified BEVQ15 quantitative food frequency questionnaire and modeled using negative binomial regression. Perceived SSB harm (4 levels: "no harm" to "a lot") was modeled using ordered logistic regression. Modeling included multiple imputation for missing covariates, school-level clustering, and adjustment for presumed confounders (gender, age, screen time, etc.).
Results: In co-variate adjusted models, greater beverage advertisement receptivity was associated with higher SSB intake (ratio of SSB servings, moderate vs. low receptivity: 1.16 [95%CI 1.02, 1.32]; high vs. low receptivity: 1.47 [95%CI 1.02, 2.12]) and with lower perceived SSB harm (odds ratio, moderate vs. low receptivity: 0.68 [95%CI 0.59, 0.80]; high vs. low receptivity: 0.79 [95%CI 0.49, 1.27]). Greater receptivity to telecommunication advertisements was not associated with either SSB intake or perceived harm. Perceived SSB harm was inversely associated with SSB intake.
Conclusions: Beverage advertisement receptivity was associated with less perceived harm and greater SSB consumption among adolescents. Strategies targeting adolescents, such as SSB marketing restrictions or counter-marketing campaigns, could reduce their SSB consumption and improve health.