How providing a low-cost water filter pitcher led Latino parents to reduce sugar-sweetened beverages and increase their water intake: explanatory qualitative results from the Water Up!@Home intervention trial

Claudia Santillán-Vázquez, Lucero Hernández, Amanda C Reese, Rosalina Burgos-Gil, Sean D Cleary, Ivonne M Rivera, Joel Gittelsohn, Mark C Edberg, Rafael Monge-Rojas, Uriyoán Colón-Ramos, Claudia Santillán-Vázquez, Lucero Hernández, Amanda C Reese, Rosalina Burgos-Gil, Sean D Cleary, Ivonne M Rivera, Joel Gittelsohn, Mark C Edberg, Rafael Monge-Rojas, Uriyoán Colón-Ramos

Abstract

Objective: This study sought to explain results of the Water Up!@Home randomised controlled trial where low-income parents were randomised to receive an educational intervention +a low-cost water filter pitcher or only the filter. Parents in both groups had reported statistically significant reductions in sugar-sweetened beverages (SSB) and increases in water intake post-intervention.

Design: Qualitative explanatory in-depth interviews analysed thematically and deductively.

Setting: Washington, DC metropolitan area, USA.

Participants: Low-income Latino parents of infants/toddlers who had participated in the Water Up! @Home randomised controlled trial.

Results: The filter-stimulated water consumption in both groups by (1) increasing parents' perception of water safety; (2) acting as a cue to action to drink water; (3) improving the flavour of water (which was linked to perceptions of safety) and (4) increasing the perception that this option was more economical than purchasing bottled water. Safe and palatable drinking water was more accessible and freely available in their homes; participants felt they did not need to ration their water consumption as before. Only intervention participants were able to describe a reduction in SSB intake and described strategies, skills and knowledge gained to reduce SSB intake. Among the comparison group, there was no thematic consensus about changes in SSB or any strategies or skills to reduce SSB intake.

Conclusions: A low-cost water filter facilitated water consumption, which actively (or passively for comparison group) displaced SSB consumption. The findings have implications for understanding and addressing the role of water security on SSB consumption.

Trial registration: ClinicalTrials.gov NCT05159622.

Keywords: Explanatory qualitative interviews; Infants and toddlers; Latino/Hispanic; Sugar-sweetened beverages; Tap water.

References

    1. Hu FB (2013) Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev 14, 606–619.
    1. Charvet A & Huffman FG (2019) Beverage intake and its effect on body weight status among WIC preschool-age children. J Obes 2019, 3032457.
    1. He B, Long W, Li X et al. (2018) Sugar-sweetened beverages consumption positively associated with the risks of obesity and hypertriglyceridemia among children aged 7–18 years in South China. J Atheroscler Thromb 25, 81–89.
    1. Niedfeldt HJ, Beckstead E, Chahalis E et al. (2021) Use of technology to access health information/services and subsequent association with WASH (water access, sanitation, and hygiene) knowledge and behaviors among women with children under 2 years of age in Indonesia: cross-sectional study. JMIR Public Health Surveill 7, e19349.
    1. Roess AA, Jacquier EF, Catellier DJ et al. (2018) Food consumption patterns of infants and toddlers: findings from the feeding infants and toddlers study (FITS) 2016. J Nutr 148, 1525S–1535S.
    1. Demmer E, Cifelli CJ, Houchins JA et al. (2018) Ethnic disparities of beverage consumption in infants and children 0–5 years of age; National Health and Nutrition Examination Survey 2011 to 2014. Nutr J 17, 78.
    1. Thompson IJB, Ritchie LD, Bradshaw PT et al. (2021) Earlier introduction to sugar-sweetened beverages associated with lower diet quality among WIC children at age 3 years. J Nutr Educ Behav 53, 912–920.
    1. Cantoral A, Tellez-Rojo MM, Ettinger AS et al. (2016) Early introduction and cumulative consumption of sugar-sweetened beverages during the pre-school period and risk of obesity at 8–14 years of age. Pediatr Obes 11, 68–74.
    1. Pan L, Li R, Park S et al. (2014) A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years. Pediatrics 134, Suppl. 1, S29–S35.
    1. Dietary Guidelines Advisory Committee (2015) Scientific Report of the 2015 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Washington, DC: US Department of Agriculture, Department of Health and Human Services; available at (accessed December 2018).
    1. Rosinger AY, Bethancourt H & Francis LA (2019) Association of caloric intake from sugar-sweetened beverages with water intake among US children and young adults in the 2011–2016 national health and nutrition examination survey. JAMA Pediatr 173, 602–604.
    1. Vargas-Garcia EJ, Evans CEL, Prestwich A et al. (2017) Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis. Obes Rev 18, 1350–1363.
    1. Vieux F, Maillot M, Rehm CD et al. (2020) Trends in tap and bottled water consumption among children and adults in the United States: analyses of NHANES 2011–2016 data. Nutr J 19, 10.
    1. Drewnowski A, Rehm CD & Constant F (2013) Water and beverage consumption among children age 4–13 years in the United States: analyses of 2005–2010 NHANES data. Nutr J 12, 85.
    1. Onufrak SJ, Park S, Sharkey JR et al. (2014) The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults. Public Health Nutr 17, 179–185.
    1. Pierce G & Gonzalez SA (2016) Mistrust at the tap? Factors contributing to public drinking water mis(perception) across US households. Water Policy 19, 1–12.
    1. Park S, Onufrak S, Patel A et al. (2019) Perceptions of drinking water safety and their associations with plain water intake among US Hispanic adults. J Water Health 17, 587–596.
    1. Hobson WL, Knochel ML, Byington CL et al. (2007) Bottled, filtered, and tap water use in Latino and non-Latino children. Arch Pediatr Adolesc Med 161, 457–461.
    1. Huerta-Saenz L, Irigoyen M, Benavides J et al. (2012) Tap or bottled water: drinking preferences among urban minority children and adolescents. J Community Health 37, 54–58.
    1. Rosinger AY, Patel AI & Weaks F (2022) Examining recent trends in the racial disparity gap in tap water consumption: NHANES 2011–2018. Public Health Nutr 25, 207–213.
    1. Gorelick MH, Gould L, Nimmer M et al. (2011) Perceptions about water and increased use of bottled water in minority children. Arch Pediatr Adolesc Med 165, 928–932.
    1. Rosinger AY (2022) Using water intake dietary recall data to provide a window into US water insecurity. J Nutr 152, 1263–1273.
    1. Barrett N, Colón-Ramos U, Elkins A et al. (2017) Formative research to design a promotional campaign to increase drinking water among Central American Latino youth in an urban area. J Health Commun 22, 459–468.
    1. Colón-Ramos U, Monge-Rojas R, Cremm E et al. (2017) How Latina mothers navigate a ‘food swamp’ to feed their children: a photovoice approach. Public Health Nutr 20(11), 1941–1952.
    1. Fuster M & Colón-Ramos U (2018) Changing places, changing plates? A binational comparison of barriers and facilitators to healthful eating among Central American communities. J Immigr Minor Health 20, 705–710.
    1. Sylvetsky AC, Hoang ST, Visek AJ et al. (2022) Beverage characteristics perceived as healthy among Hispanic and African-American parents of young children. J Acad Nutr Diet 20, 705–710.
    1. Duffy EW, Lott MM, Johnson EJ et al. (2020) Developing a national research agenda to reduce consumption of sugar-sweetened beverages and increase safe water access and consumption among 0–5-year-olds: a mixed methods approach. Public Health Nutr 23, 22–33.
    1. McCarley S, Lopez-Rios M, Burgos Gil R et al. (2021) Using a community-based participatory mixed methods research approach to develop, evaluate, and refine a nutrition intervention to replace sugary drinks with filtered tap water among predominantly Central-American immigrant families with infants and toddlers: the Water Up @Home Pilot evaluation study. Nutrients 13, 2942.
    1. Davison KK, Franckle RL, Lo BK et al. (2021) Infant sugar sweetened beverage and 100 % juice consumption: racial/ethnic differences and links with fathers’ consumption in a longitudinal cohort. Prev Med Rep 22, 101324.
    1. Heyman MB & Abrams SA (2017) Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics 139, e20170967.
    1. Reese AC, Burgos-Gil R, Cleary SD et al. (2022) Use of a water filter at home reduces sugary drink consumption among parents and toddlers in predominantly Hispanic community: results from the Water Up!@ Home intervention trial. J Acad Nutr Diet, S2212-2672(22)00346-X.
    1. Cresswell JW & Plano Clark VL (2011) Designing and Conducting Mixed Methods Research. London: Sage Publications.
    1. Bandura A (1989) Human agency in social cognitive theory. Am Psychol 44, 1175–1184.
    1. Hochbaum G (1958) Public Participation in Medical Screening Programs: A Sociopsychological Study, Public Health Service Publication No 572. Washington, DC: Government Printing Office.
    1. Dixon JK & Dixon JP (2002) An integrative model for environmental health research. Adv Nurs Sci 24, 43–57.
    1. Guest G, Namey E & McKenna K (2016) How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods 29, 3–22.
    1. Triplett R, Chatterjee C, Johnson CK et al. (2019) Perceptions of quality and household water usage: a representative study in Jacksonville, FL. Int Adv Econ Res 25, 195–208.
    1. Colburn AT & Kavouras SA (2021) Tap water consumption and perceptions in United States Latinx adults. Nutrients 13, 2999.
    1. Rosinger AY (2020) Biobehavioral variation in human water needs: how adaptations, early life environments, and the life course affect body water homeostasis. Am J Hum Biol 32, e23338.
    1. Wilson NJ, Montoya T, Lambrinidou Y et al. (2022) From “trust” to “trustworthiness”: retheorizing dynamics of trust, distrust, and water security in North America. Environ Plan E, 1–27.
    1. Young SL, Frongillo EA, Jamaluddine Z et al. (2021) Perspective: the importance of water security for ensuring food security, good nutrition, and well-being. Adv Nutr 12, 1058–1073.
    1. Dibay Moghadam S, Krieger JW & Louden DKN (2020) A systematic review of the effectiveness of promoting water intake to reduce sugar-sweetened beverage consumption. Obes Sci Pract 6, 229–246.
    1. Beck AL, Takayama JI, Halpern-Felsher B et al. (2014) Understanding how Latino parents choose beverages to serve to infants and toddlers. Matern Child Health J 18, 1308–1315.
    1. Ortega-Avila AG, Papadaki A & Jago R (2018) Exploring perceptions of the Mexican sugar-sweetened beverage tax among adolescents in north-west Mexico: a qualitative study. Public Health Nutr 21, 618–626.
    1. Poirier L, Flores L, Rivera I et al. (2021) Feasibility of collaborating with independent Latino-owned restaurants to increase sales of a healthy combo meal. J Public Health Res 11, 2659.
    1. Monge-Rojas R, Vargas-Quesada R, Colón-Ramos U et al. (2022) Dietary intake and sources of added sugars in various food environments in Costa Rican adolescents. Nutrients 14, 959.
    1. Fisberg RM, Leme ACB, Previdelli A et al. (2021) Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutricion y Salud (ELANS). Public Health Nutr 24, 2424–2436.

Source: PubMed

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