Exploring the feasibility of school based interventions to reduce sugar sweetened beverage consumption in India

The increased consumption of Sugar and Sweetened Beverages (SSBs) is one of the most important reasons for obesity and overweight, dental caries and Type II diabetes. The consumption of SSBs is rapidly increasing among children and adolescents especially in developing countries. This is an important public health issue as majority of the population in developing countries is very young. Governmental bodies around the world are taking increasing action to address the availability of soft drinks in schools through increased taxation on soft drinks or banning their sale in schools. However, the evidence around effects of restricting availability or increasing taxes on SSBs on their consumption and health is still unclear and emerging, it is likely that these actions are being driven by the belief that high-calorie, nutrient-poor drinks no longer have a place in schools, and, moreover, that schools are an appropriate starting point to reduce total consumption of SSBs among youth. In the absence of robust evidence, an intervention cannot be delivered to test the effectiveness of various fiscal policies in reducing SSB consumption among youth. This study will test the acceptability and feasibility of a fiscal intervention delivered through schools to reduce SSB consumption among children and adolescents.

Sugar-sweetened beverage (SSB) consumption is established as a major risk factor for overweight and obesity, as well as an array of cardio-metabolic conditions, especially type 2 diabetes and dental caries. SSB consumption is particularly popular in school going children. In the past few decades, sources of energy intake among youth have shifted toward greater consumption of sugar-sweetened beverages (SSBs), such as soda, sports drinks, and high calorie fruit drinks. This shift has important public health implications given that SSB consumption has been associated with youth obesity and weight gain, which have several physical and psychosocial consequences. This becomes a very serious problem especially for Low and middle Income Countries (LMICs) which are demographically very young. In certain countries including India national taxation policies have been introduced to promote healthy diet such as a tax on sugary soft drinks but these policies have focussed primarily on soda while not taxing other SSBs. As an alternative to a national tax policy, there is the option of implementing pricing policy at a more local level through a settings approach. Some schools have also taken voluntary action restricting the sales of soda but have left out other SSBs and have shown a mixed bag of results providing no clear evidence on the best set of interventions which can lead to reduction in SSB consumption among youth. The development, implementation and evaluation of a fiscal and policy intervention to reduce SSB consumption amongst school going children is a complex and challenging task. Before a full scale randomised controlled trial can be undertaken detailed preliminary research is needed. This study therefore proposes to undertake a two-phased investigation to inform and test the acceptability and feasibility of a SSB fiscal and policy intervention delivered in the setting of recognised non-aided public schools of New Delhi.

Sugar-sweetened beverage (SSB) consumption is established as a major risk factor for overweight and obesity, as well as an array of cardio-metabolic conditions, especially type 2 diabetes and dental caries. SSB consumption is particularly rising in school going children. The variation of policies on soft drink availability and taxation presents an opportunity to examine the effects of various policy options, especially with regard to the effects of different levels of restrictions in schools. Such research could help identify policies that are most likely to succeed, information that is currently lacking for obesity and other NCD prevention in general. No study from India and very few from other LMICs have studied the effect of increased taxation or banning of sales of SSBs in schools on consumption among children and adolescents. This study is innovative as we would adopt a mixed methods approach to guide our intervention. The qualitative approach will help us to undertake an in-depth analysis on who is affected, what factors are involved, do individuals react or respond differently. Immediate academic beneficiaries will be the named Indian researchers who are likely to exploit this to set up their own independent research teams, and become more involved in designing and implementing complex intervention to answer some of the very difficult questions. The Indian researchers will get an opportunity to work in a multi-disciplinary team which will aid in building their research acumen by learning from the experience of UK based experts. The global public health community will also be benefited as the study will help pave the way to stimulate similar research work in other countries of the world and contribute to the global evidence. The proposed project may lead in the longer term to the development of new upstream interventions to reduce the burden of obesity and other chronic diseases, enhancing quality of life worldwide. We believe that the time scales for the benefits to be realised are not too distant. In the academic context, impact will be within the time frame of the grant proposal. All our research staff are in place, allowing us to progress at a fast pace. The research and professional skills that the staff on this project will develop are very broad. Other than being involved in high profile and cross-discipline research through an India-UK consortium, staff will also be trained in project management and communicating their science in the broadest sense, providing them with transferable skills beyond pure academic research. The research outputs will be communicated to the academic community through traditional scientific communication routes including high-profile peer-reviewed publications and international scientific conferences. All applicants will also actively engage in efforts to promote the public understanding of the science underlying the proposed project. We see the potential direct and indirect impacts of this study as considerable, particularly in terms of its relevance to current and future policy initiatives in India and other low and middle income countries. It will be a key role for each of the investigators to focus on ensuring this impact occurs. It will be an on-going agenda item for all group meetings. The press office will be regularly updated, and items for dissemination will be strategically considered to maximise impacts. The research team on this grant have considerable experience of maximising the impact of their research. We have very strong linkages with the federal government and many international organizations. We will use this platform to stimulate wider interest on this topic and the importance of undertaking policy relevant research. Context specific communication materials for the websites, newsletters, brochures, and events will be produced with the goal of promulgating the research findings and their impact towards a healthier, sustainable and an equitable future.