A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting and Intervention Design
2.2. Intervention Components: School Health Nurse Consultation and Home-Use Materials
2.3. Qualitative Interviews: Recruitment, Data Material and Analysis
3. Results
3.1. Interviews and Participant Characteristics
3.2. Social Aspects of and Practices around Sweet Treats
3.2.1. ‘Family Treats’: Creating Family Time with Sugar-Rich Foods and Drinks
“Friday sweets are simply a tradition. It has just always been that way, so that would be hard to change. Whether they get an ice cream on a Tuesday or a Wednesday or not at all, that, I think, would not be very important to them. But the Friday sweets are really—it is kind of sacred”,Mother to boy at school A.
“You look forward to all those things, or at least [name of the child] does, to arrange it nicely and have a good and cosy time with it”,mother to boy at school D.
“We have simply declared: “now it is limited to Friday sweets, and that is it”, and he seems to take it quite well”,mother to boy at school A.
3.2.2. Strategies for Behavioural Changes in Relation to ‘Family Treats’
“We have rules that at least on weekdays there are no sweets”,father to girl at school C.
“I am glad we have cut back on the intake on Fridays compared to earlier, where it was a huge pile of sweets and then a stomach ache the next day”,mother to girl at school D.
“Now we have Friday fruits. The kids chip in what fruits we should buy and then they have something a little extra, like cream biscuits or a pancake or something like that, but we always have fruits and something sweet, but it is never sweets”,mother to girl at school C.
3.2.3. ‘Everyday Treats’: Sugar-Rich Snacks and Soft Drinks Linked to the Everyday
“I used to prepare a snack platter for him in the afternoon. I guess it was more sweet things than fruit and vegetables. It could be a small bowl with crisps, some chocolate or a chocolate bar. Or it could be a fruit stick”,mother to boy at school B.
“We drink a lot of milk, they have water at school and in kindergarten, and then they can have one glass of cordial for dinner. Well, that is how we do it in our family, right?”,mother to girl at school A.
3.2.4. Strategies for Behavioural Changes in Relation to ‘Everyday Treats’
“I give it more thought now what I put in his lunch pack. I have swopped some of the spreads. He really likes chocolate spread, but now he rather gets fruit cuts, or fruit sticks instead of Kinder milk slices”,mother to boy at school B.
“Typically, there was a packet of biscuits in the drawer and that was what the kids wanted when they got home from school. They got two-three-four biscuits according to their appetite. Now we realize the amount of sugar in those biscuits and we are happy to have that knowledge”,mother to girl at school C.
“We do know that cordial contains sugar, but then you read it and it is a kind of an eye-opener […] Now cordial is only served on weekends”,mother to girl at school D.
“We limit the amount of unhealthy food when we shop for groceries and serve something else. Afternoon snack are bell pepper and fruit instead of fruit sticks, biscuits and the like”,mother to boy at school A.
“Perhaps we have gotten a little better in preparing veggie snacks and between meals and not necessarily use granola bars or ice cream as our go-to solution. Simply getting these carrot and celery sticks cut (laugh) so that you can serve them in time”,mother to boy at school C.
“The afternoon meal is healthier, but that is also linked to my parental energy level; if I am tired the servings drop in quality, but in general, meals have improved”,mother to girl at school C.
“I have a guilty pleasure: soda and energy drink. That is my weakness […] And energy drink is the worst; that is really something you should not introduce your children to, right? It makes me think: ‘Wow! My kids should definitely not have energy drink’”,mother to girl at school A.
“My husband is very fond of soda. He is crazy about real Coke [with sugar] and we have decided that it does not work! We need to stop that, because [name of child] started to grow fond of it too. It was right there, as an alternative [to water] on the dinner table. So we have cut out soda and cordial completely during the week”,mother to boy at school A.
“That is our biggest change: Water on weekdays!”,mother to girl at school D.
“It became clear that there were some things that relatively easy could be swopped with other things”,father to boy at school C.
3.2.5. ‘Socialized Treats’: Sugar-Rich Foods and Drinks as a Cultural Norm
“I was shocked how little control I have over what my child eats during the day […] I mean we can have a healthy balance [with a limited amount of sweet foods and drinks] at home. But then it is a week with a lot of activities: Baking cake in the after school club, and birthdays in class where friends bring Kinder surprise eggs”,mother to boy at school A.
“Now it is Fastelavn [Danish Carnival tradition in February] and I think it is exaggerated: They have a bun with icing and cream, and cocoa and sweets. Apparently, they need it all. And at birthday celebrations they wallow in sweets again—and cake and the like. In fact, it is more the things that I cannot change that I think should be cut down”,mother to girl at school A.
“I have used quite some time clearing it all out. The girls have several very ‘generous relatives’ [sarcastic voice], my aunt for example, every year she arrange this Easter hunt, and I mean it is an enormous bag with chocolate eggs”,mother to girl at school A.
“The hardest thing right now is Grandma. It is really…[sigh]. When they are at grandma’s place they are spoiled. Preferably with sodas and sweets”,mother to girl at school A.
3.2.6. Strategies for Behavioural Changes in Relation to ‘Socialized Treats’
“I mean we are not the kind of parents that tell our kids: “You are not allowed to eat the treats offered at school”, or tell our parents that they should not serve cake when the grandchildren are visiting. There are other considerations to take into account—both in relation to our kids but also family and friends. Concerns that overrule the guidelines [from the project]”,father to boy at school C.
“I pay more attention to what my parents offer to the girls, and I have asked them to cut down. I have been more outspoken, than before, because I think they exaggerate the treats. Earlier I have been thinking: “We are not there that often, it will be okay,” but this time I raised it and explained that they should not have all kinds of sweets and treats, when we are visiting”,mother to girl at school B.
3.3. Barriers for Behavioural Changes
3.3.1. Culturally Codified Practices and Social Concerns as Barriers to Change
“It has been a little less strict, because it is the holidays. I mean, that is when they should feel that you have some extra fun together. The holidays are where you should try to relax and have a good time together”,mother to boy at school A.
“I mean, why are we so strict (laughs) compared to her classmates and what they have in their lunch packs. We talk about why it is this way, because obviously she finds it extremely annoying […] because if she has to explain in class why she is not allowed, e.g., Kinder milk slice or whatever. Then it is easier for her to say: ‘Well, in our family we think it is like sweets, and we only have sweets on Fridays or at special occasions’”,mother to girl at school B.
3.3.2. When Parents’ Own Habits Inhibit Behavioural Change
“I drink water all day at work, and when I get home, I just have to have something else, and then it is a bit difficult to say: “No, you cannot have soda, but mom can”, right?”,mother to boy at school B.
“In our family, we think sugar-free cordial for dinner is okay […] We as parents have a different definition [than the project’s] of what counts as sugar and what does not count as sugar. We don’t include sugar-free soft drinks in the ‘sugar account’. We don’t deem it to be sugar”,mother to girl at school C.
“But it is also because I have chocolate spread myself, and you know… perhaps I should not, but I like it for breakfast. Then obviously, she wants it too, that is fair enough”,mother to girl at school A.
“I enjoy giving them small treats. Or perhaps not treats but something nice. Sweet biscuits for example, well in fact it often turns out to be some kind of lousy carbohydrates that I have put in […] I think it is because I myself like to have something yummy after my sandwiches”,mother to girl at school C.
3.3.3. Parents with Disparate Views and Perceptions of Healthy Habits
“They cannot bring small cinnamon rolls and stuff like that […] Fruit sticks, raisins and the like is okay. And they can also bring granola bars, I know they are not particularly… but he gets them quite often. When I do the lunch pack I skip them, but I know my husband gives them (laugh). We are not totally aligned, when it comes to food”,mother to boy at school A.
“He is convinced that we are quite well off, I think we could do better (laugh). That said, I do not want to always be the super strict one, but it is always him buying McDonald’s. It is always him that offers an ice cream after dinner. It is never Mom […] my husband is very fond of easy solutions”,mother to boy at school A.
“It is entirely me who is responsible for this hustle and bustle of health in our family, [name of husband] he drinks coke and eats crisps”,mother to boy at school B.
3.3.4. Lack of Skill and Knowledge as a Barrier to Reductions
“I can on a daily basis be confused, what is this? It says that it is apple, but I mean it is not an apple. It is shaped as an astronaut, and honestly, I have no clue what it is”,father to girl at school C.
3.3.5. Lack of Motivation
“I was surprised that there was an issue [with sweet foods and drinks], because he is so thin […] he is clearly both small and skinny, so it was hard to believe that he had too much sweets. I mean, I did understand what she was saying, but to go so far as to say that he had too much. I mean, you cannot tell from looking at him”,mother to boy at school B.
“When I look at him—I mean his is skinny-skinny. There is not one gram of fat on his body. Therefore, I have not been overly engaged. You know, there are some foods I have replaced, but not a lot”,mother to boy at school A.
3.3.6. Lack of Parental Resources and Prioritization
“We are not there yet. We still need to focus and cannot wriggle out of the risk for backslide. Especially if our mental energy is drained”,father to girl at school C.
“The main aim here is to change some routines in our everyday life, but we did not really have ‘an everyday life’, at least not as it used to be [laughter]. That might have made it a bit harder”,mother to boy at school C.
“I also think it depends what kind of family you have. If we only had one or two children, it would not have been so challenging for us, because then we would have had the resources and would have been able to stick to it. But now… when the daily hustle and bustle takes over and you get more and more busy, you know, which battles do we choose”,father to boy at school D.
“I am too exhausted for such things. I need to walk him through the mandatory stuff [curriculum] because he is at home. And he is not having the same input and stimulation that he used to have when he was attending school and the after school club. It is sheer hard work to home-school him”,mother to boy at school A.
“I think perhaps that I could have put in more effort. But then… at the same time I think that the time simply was not there. There has just been too much going on”,mother to boy at school A.
3.4. Approaches to Behavioural Change and New Habits
“Sometimes she exceeds the four servings over the course of a weekend. She does”,mother to girl at school B.
“My aim has not been to stick strictly to four servings. It has been close to four servings and should one or two more be added without our influence, then that is okay”,mother to girl at school C.
“Then you count the different servings and such. That would be too formalized and rigid in my opinion”,mother to boy at school A.
“It has been a wake-up call, and we have greater awareness, but the guidelines are so strict that we did not aim to adopt them (laughter)”,father to boy at school C.
“We have used it in assessing quantities and to estimate “what is actually sweet?”. As in, what should be counted in. After all, sweet treats are not just sweets. It is also dried fruits and cakes and—yes, we have used it in that way, rather than: “How many servings does she get a week?””,Mother to girl at school B
4. Discussion
4.1. Easily Adoptable Reduction Strategies Requiring Less Effort Were the Most Likely to Be Implemented
4.2. Cultural Events and Social Concerns
4.3. Reduction Strategies and Barriers to Behavioural Change
4.4. Strengths and Limitations
4.5. Considerations on Research Needs and Future Initiatives
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Population Interviewees, n = 24 | |
---|---|
Sex of participating child; n (%) | |
Girls | 14 (58%) |
Boys | 10 (42%) |
Interviewees; n (%) | |
Mother | 18 (75%) |
Father | 1 (4%) |
Both parents | 5 (21%) |
Highest parental education; n (%) | |
Basic school (<12 y) | 3 (13%) |
Upper secondary school (12 y) | 0 (0%) |
Vocational education (13 y, practical) | 7 (29%) |
Short higher (13–14 y) | 4 (17%) |
Medium higher (15–16 y) | 5 (21%) |
Long higher (≥17 y) | 5 (21%) |
Themes | Subthemes |
---|---|
Sweet treats in social relations | Sweet treats from grandparents |
Sweet treats from close relatives | |
Sweet treats served at social occasions | |
Behavioural strategies for reductions | Substitution strategies |
Strategies on portion size reductions | |
Strategies reducing serving frequency | |
Strategies reducing availability and accessibility | |
Barriers to reduction strategies | Culturally codified practices, social concerns |
Parents’ personal preferences | |
Parents having disparate views on health | |
Lack of motivation | |
Lack of skill and knowledge | |
Lack of parental resources | |
Reported behavioural changes | Sugar-rich drinks |
Sweet afternoon snacks | |
Lunch packs | |
Family weekend and holiday habits | |
Other practices |
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Christensen, B.J.; Bestle, S.M.S.; Trolle, E.; Biltoft-Jensen, A.P.; Matthiessen, J.; Lassen, A.D. A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions. Int. J. Environ. Res. Public Health 2022, 19, 11647. https://doi.org/10.3390/ijerph191811647
Christensen BJ, Bestle SMS, Trolle E, Biltoft-Jensen AP, Matthiessen J, Lassen AD. A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions. International Journal of Environmental Research and Public Health. 2022; 19(18):11647. https://doi.org/10.3390/ijerph191811647
Chicago/Turabian StyleChristensen, Bodil Just, Sidse Marie Sidenius Bestle, Ellen Trolle, Anja Pia Biltoft-Jensen, Jeppe Matthiessen, and Anne Dahl Lassen. 2022. "A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions" International Journal of Environmental Research and Public Health 19, no. 18: 11647. https://doi.org/10.3390/ijerph191811647