{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:13:29Z","timestamp":1779257609531,"version":"3.51.4"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sugar-sweetened beverage (SSB) consumption among children represents a significant risk factor for health problems, including obesity and dental caries. Children aged 8\u202f~\u202f9\u202fyears 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\u2014encompassing individual, interpersonal, environmental, and awareness of health labeling\u2014and children\u2019s SSB consumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2019 SSB consumption was significantly predicted by caregivers\u2019 SSB consumption (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.378), peer influence (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.254), home SSB storage (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.230), caregivers\u2019 rewards (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.096), teachers\u2019 rewards (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.081), and students\u2019 attitudes (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.148), all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05. Students\u2019 attitudes were positively influenced by awareness of health labeling (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.778), students\u2019 knowledge level (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.427), and caregivers\u2019 attitudes (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.183), all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001. Health education courses positively predicted students\u2019 knowledge level (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.188,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Caregivers\u2019 SSB consumption was positively associated with convenience store access (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.148,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and home SSB storage (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.106,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Significant indirect effects were observed via students\u2019 attitudes and caregivers\u2019 SSB consumption. The model explained 35.2% of the variance in students\u2019 SSB consumption.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2019s SSB consumption and promote healthy behavioral patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1817212","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:44:51Z","timestamp":1779255891000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"14","author":[{"given":"Lulu","family":"Meng","sequence":"first","affiliation":[{"name":"Office of Research and Teaching Administration, Beijing Center for Disease Prevention and Control","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjia","family":"Li","sequence":"additional","affiliation":[{"name":"Xingtai Xindu District Center for Disease Control and Prevention","place":["Xingtai, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiran","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyu","family":"Liang","sequence":"additional","affiliation":[{"name":"School of Public Health, Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manning","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liyu","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of Nutrition and Food Hygiene, Beijing Center for Disease Prevention and Control","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruoxiang","family":"Cao","sequence":"additional","affiliation":[{"name":"Office of Research and Teaching Administration, Beijing Center for Disease Prevention and Control","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.7762\/cnr.2015.4.1.9","article-title":"Association of Sugar-Sweetened Beverage Intake during infancy with dental caries in 6-year-olds","volume":"4","author":"Park","year":"2015","journal-title":"Clin Nutr Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1467-789X.2007.00389.x","article-title":"A short history of beverages and how our body treats them","volume":"9","author":"Wolf","year":"2008","journal-title":"Obes Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.2337\/dc10-1079","article-title":"Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis","volume":"33","author":"Malik","year":"2010","journal-title":"Diabetes Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2113","DOI":"10.1161\/CIRCULATIONAHA.118.037401","article-title":"Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in US adults","volume":"139","author":"Malik","year":"2019","journal-title":"Circulation"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e014883","DOI":"10.1161\/JAHA.119.014883","article-title":"Sugar-sweetened beverage intake and cardiovascular disease risk in the California teachers study","volume":"9","author":"Pacheco","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"ref6","volume-title":"Dietary Guidelines for Americans [EB\/OL]. 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