Project Summary: The intake of sugar-sweetened beverages (SSB, e.g., soda/pop, sweet tea, sports and
energy drinks, fruit drinks) is disproportionately high in Appalachia, including among adolescents whose intake
is more than double the national average and more than four times the recommended daily amount. There are
strong and consistent scientific data and systematic reviews documenting relationships among high SSB
consumption and numerous chronic health conditions such obesity, some types of obesity-related cancers,
diabetes, cardiovascular disease, and dental erosion and decay. Reaching adolescents with behaviorally-
focused health programs where they spend the majority of their time, at school, shows promise. However,
engaging caregivers who serve as their child’s most influential role model as well as the gatekeeper for the
home environment may be equally as important in changing adolescents’ SSB behaviors. Finally, there is a
great need to understand how to support schools and teachers to deliver and maintain evidence-based health
education programs, especially among rural schools. Thus, the overarching goal of this proposal is to work in
partnership with Appalachian middle schools to implement and evaluate Kids SIPsmartER. Kids SIPsmartER is
a 6-month, school-based, behavior and health literacy curriculum aimed at improving SSB behaviors among
middle school students. The program also integrates a two-way short service message (SMS) strategy to
engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is
grounded by the Theory of Planned Behavior as well as health literacy, media literacy, numeracy, and public
health literacy concepts. In our proposed cluster-randomized controlled trial, we target 12 middle schools in
medically underserved Appalachian counties in southwest Virginia. Our study is guided by the RE-AIM (reach,
adoption, effectiveness, implementation, and maintenance) framework and is a type 1 hybrid design. The
primary aim is to assess changes in SSB behaviors at 7-months among 7th grade students at schools receiving
Kids SIPsmartER, as compared to control schools. We will also evaluate changes in secondary student
outcomes (e.g., BMI, quality of life, theory-related variables), changes in caregiver outcomes (e.g., SSB
behaviors, home SSB environment), and 19-month maintenance of outcomes. The reach and
representativeness of Kids SIPsmartER will be assessed. Furthermore, we will use a mixed-methods approach
with interviews, surveys, observation, and process evaluation strategies to determine the degree to which
teachers implement Kids SIPsmartER as intended and the potential for institutionalization within the schools.
The long-term goal of this health promotion and prevention line of research is to establish an effective,
scalable, and sustainable multi-level strategy to improve SSB behaviors and reduce SSB-related health
inequities and chronic conditions (e.g. obesity, cancer, type II diabetes, heart disease, dental caries) in rural
Appalachia.
