Association between the social norm toward sugar sweetened beverages at the county level and the consumption of sugar sweetened beverages among adolescents: A multilevel analysis

Objectives: Multilevel analysis was used to explore the association between county-level social norm toward sugar-sweetened beverages (SSBs) and the consumption of SSBs among adolescents. Methods: This study used data from the Nutrition and Health Survey in Taiwan between 2013 and 2016. Data on 879 adolescents were included in the analysis. Personal attitudes toward SSBs for different age groups were aggregated at the county level as the social norm, respectively. Results: A multilevel logistic regression analysis revealed that the likelihood of SSBs consumption among adolescents increased as the social norm toward SSBs in the county improved (adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI] = 1.11-2.26). In addition, the social norm of young adults (18-24 years) toward SSB living in the same residential areas significantly moderated the association between the county-level social norm of adolescents toward SSBs and the consumption of SSBs among adolescents (aOR = 1.41, 95% CI = 1.10- 1.80). Conclusions: The prevention of overconsumption of SSBs among adolescents may be more effective when the social norm toward SSBs at the county level are considered.