Running head: ADDED SUGARS 1

Effects from Drinking Added Sugars

Erica Heaps

Brigham Young University-Idaho

Nursing 433C

Sister Shippen

February 23, 2018

ADDED SUGARS 2

Effects from Drinking Added Sugars

Part 1. Defining the Population

Nutrition is the process of taking in the basic nutrients needed for growth and

development. Proper nutrition is essential for the health of our bodies. Improper nutrition can

negatively affect our health, wellbeing, and weight status or body mass index (BMI) Getting

enough nutrients and calories, but not too much, is important for good health and weight status or

BMI. Consuming too many calories can lead to negative health effects such as obesity. Our

bodies need a certain number of calories depending on a person’s size and growth demands. The

body must do something with the excess calories eaten. Excess calories are turned into storage

in the body, such as fat. There are many added sugars in the food we eat. It can be hard to

consume the right number of calories when what we eat has added sugars.  

Proper nutrition is important because of its effect on weight status. Weight status and a

normal BMI is important because obesity contributes to multiple health problems. The Centers

for Disease Control and Prevention (CDCP) states, “Obesity-related conditions including heart

disease, stroke, type 2 diabetes and certain types of cancer are some of the leading causes of

preventable death” (CDCP, 2017a, para. 1). Even more concerning, for many, is the amount of

money these diseases can cost. The health issues arising from obesity alone can be extremely

costly. The CDCP also states, “The estimated annual medical cost of obesity in the U.S. was

$147 billion U.S. dollars in 2008; the medical costs for people who have obesity were $1,429

higher than those of normal weight” (CDCP, 2017a, para. 1). One way that obesity and

subsequent diseases can be avoided, is through proper nutrition and watching how many calories

we are consuming. It is important to keep in mind how many added sugars are in our daily diets,

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which add to the empty calories being consumed. These empty calories do not add to our needed

nutrition, but only add to our chances of obesity.

This condition, obesity, is a population health concern because obesity is not going away,

and it is becoming more prevalent. From the CDCP, obesity for adults in 1999 occurred in 30.5

percent of the population in the United Stated, and in 2014, obesity rates rose to 37.7 percent.

(CDCP, 2017b)

These numbers are concerning, considering the cost and disease that can accompany obesity.

Even more concerning are the mortality rates associated with obesity. According to the CDCP,

obesity is the leading cause of diabetes, heart disease, stroke, and some types of cancer. Obesity

is a serious concern because it is associated with poorer mental health outcomes, reduced quality

of life, and the leading causes of death in the U.S. and worldwide (CDCP, 2017b, para. 1).

Obesity will continue to be a problem and increase in prevalence unless unhealthy nutritional

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habits are recognized and changed. One unhealthy habit among adults is consuming beverages

full of added sugar. Many adults rely on caffeinated beverages for energy, which are full of

added sugars and empty calories.

Healthy People 2020 Goal

The Healthy People 2020 goal coinciding with this health concern states, “Promote health

and reduce chronic disease risk through the consumption of healthful diets and achievement and

maintenance of healthy body weights.” (Healthy People 2020, 2018). Within this goal is a

specific objective. The objective is to “Reduce consumption of calories from added sugars”

(Healthy People 2020, 2018). Within this specific objective, the recommended baseline is 15.1

percent mean of total daily calorie intake from added sugars for the population aged 2 years and

over in 2005-08 (Healthy People 2020, 2018). From the chart below, it is shown that the total

amount of calories consumed from added sugars is declining.

NWS-17.2 Reduce consumption of calories from added sugarsMean percent of total daily calorie intake from added sugars (age adjusted, 2+ years)

2020 Baseline (year): 15.1 (2005–08) 2020 Target: 9.7 1 Desired Direction: Decrease desired

POPULATIONS 2005-2008 2011-2014 TOTAL 15.1 14.2

(Healthy People 2020, 2018)

Since 2008, the percentage of calorie consumption from added sugar has been going in the right

direction, meaning more people have been reducing their daily calorie intake from added sugars.

Although, there is still a long way to go to reach the Healthy People 2020 goal of 9.7% calories

from added sugars.

Specific Population

The specific population that will be assessed is on-campus male and female students ages

18-24, of all ethnicities, attending Brigham Young University-Idaho (BYU-I). There is a total of

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23,170 on-campus students, including both full-time and part-time students. There are more

females than males (BYU-Idaho, 2017b).

Ethnicity/Race

The most common race at BYU-I is white, making up 85.09% of the population. The

next most common race is Hispanic or Latino, which creates a total of 7.4% according to the Fall

2017 BYU-I official enrollment statistics (BYU-Idaho, 2017c).

  Fall 2017

  Campus

Ethnicity count percent

American Indian/Alaska Native 69 0.32%

Asian/Asian American 240 1.10%

Black/African American 130 0.60%

Hawaiian/Pac Islander 103 0.47%

Hispanic 726 3.33%

Two or more 1,681 7.71%

Unknown 303 1.39%

White 18,564 85.09%

  21,816  (BYU-Idaho, 2017c)

Gender

The graph below shows that among students at BYU-I, there are about 1,000 more female

students than male students. It is interesting how many more females than males there are

attending BYU-I. At all three Institutions, BYU-I, Paul Mitchel, and Evans there are more

females than males.

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(Data USA, 2015)

Community

The city of Rexburg is located in the county of Madison and the state of Idaho. In 2015,

the population, of Rexburg, was estimated to be around 26,723. The median age in Rexburg in

2015 was 22.8 (Data USA, 2015). The community is very college oriented. Where the

community has so many BYUI students between ages 18-24, the younger median age in Rexburg

makes sense.

(Google Maps, 2018)

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The on-campus students attending BYU-I are mainly single. There are 5,676 out of the 23,170

students that are married. There are 79 that have been divorced. Only 3 students have been

widowed (BYU-Idaho, 2017d).

(BYU-Idaho, 2017d)

On top of being a college town, since it has become a four-year university, many families attend

BYU-I. There is a hospital in town as well as pharmacies, clinics, and an on-campus student

health center. Rexburg has many family friendly events, shops, and parks. Porter Park is a very

large and family-oriented park with many things for children to play with, including play

equipment, a carousel, and a free splash pad.

(Water Design Inc, n.d.)

  Fall 2017  Campus

Divorced 79Married 5,676Single 17,412

Widowed 3TOTAL 23,170

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Household Income

The median household income for the city of Rexburg is $25,372. The table below

outlines the household income in Rexburg and shows a comparison to the income of Idaho and

the United States. The median household income, for Rexburg, compared to the rest of the

United States is very low.

(Data USA, 2015)

For those living in Rexburg, females have an average income of $33,388, while males have an

average income of $47,668 (Data USA, 2015). The Gini Index measures statistical dispersion.

In this case, the dispersion being measured is income. For this measure of inequality, using the

Gini Index, a zero would mean perfect equality. The higher the number, the higher the

inequality (Investopedia, 2018). It is interesting that the inequality of income in Rexburg

(measured using the Gini Index) is 0.494, which is higher than the national average.

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Education

The main college or university in Rexburg is Brigham Young University-Idaho. Most

degrees in Rexburg are earned through BYU-I. The most popular associate degree at BYU-I

earned is general studies with 85.6%. The second most popular associate degree is Registered

Nursing at 8%. The most popular Bachelor majors earned are first, General Studies at 10%. The

second most popular degree at 5.56%, is General Business Administration & Management. The

third most popular degree is Exercise Physiology with 5.08% (Data USA, 2015). This

visualization shows the percentage of students graduating with a bachelor’s degree from schools

in Rexburg, ID according to their major (Data USA, 2015).

(Data USA, 2015)

Age Range

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Most of the students at BYU-I are between the ages of 18 to 24. It is a clear majority as

the 18 to 24 age group makes up 85% of the student population at BYU-I. The second largest

age population being 25 to 30 with 13%. Now that BYU-I is a four-year university, the number

of students in the 25 to 30 age range has increased (BYU-Idaho, 2017a).

Fall 2016Campus

Age Level count percent17 and younger 216 1%

18 to 24 19,622 85%25 to 30 2,905 13%

31 to 40 308 1%

41 to 50 85 0%51 to 60 27 0%

61 and older 6 0%unknown 1 0%TOTAL 23,170

(BYU-Idaho, 2017a)

Religious Beliefs

The clear majority of students at BYU-I are members of The Church of Jesus Christ of

Ladder-day Saints (LDS). Across from the south end of BYU-I campus is a temple for the LDS

faith. The next most popular religious affiliation in the Rexburg area, is Roman Catholic, and

then no religious preference (BYU-Idaho, 2017e).

Religious Affiliation of BYU-Idaho Students(2005 - present)

Fall2017

Winter 2018 Spring 2018

Church No. No. No.Baptist 1    Buddhist 1    Christian 10    

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Church of Christ 4    Community of Christ      Coptic Orthodox 1    Hinduism 5    Islam 1    Judaism      LDS 34,953    Lutheran 2    Methodist 3    No Religious Preference 18    Other Religion 2    Preferred LDS (Non LDS) 8    Presbyterian      Protestant 1    Reformed Jew      Roman Catholic 25    Romanian Orthodox 1    Seventh Day Adventist      Sikh      Unidentified 2    TOTAL 35,038    

(BYU-Idaho, 2017e)

Plan

Producing data for this study will include a windshield survey and a 24-hour diet log

questionnaire. The windshield survey will be conducted in the Crossroads food court located in

the Manwaring Center on the BYU-I campus. Students’ food choices will be observed in the

Crossroads at lunchtime. A questionnaire detailing a 24-hour diet log will be conducted with 20

males, and 20 female students partaking in food from the Crossroads. Students will be asked to

give their age and what they have eaten in the past 24-hours. Employees from the Crossroads

food court will be key informants. Two workers will be asked how many students on average

buy sugar-sweetened beverages. Secondary data being collected for this study will come from,

the U.S Department of Health & Human Services website, the Community Commons website, the

World Health Organization website, Data USA website, Center for Disease Control and

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Prevention website, the Food Research & Action Center website, and the Community Health

Rankings and Roadmaps website.

Part 2: Assessment

Primary Data

The primary data collected came from a windshield survey, 40 interview questionnaires,

and a key informant interview All three methods of data collection were conducted on the same

day and at the same location. The collection of data took a total of about 3 hours.

Windshield Survey

The windshield survey was conducted on BYU-I campus in the Crossroads food court,

during lunchtime. The survey began about 1130, when the lunch rush started. The survey

included observing the students who partook of the food being sold on campus, what was being

bought and eaten, and the environment in which they were eating.

Most who came in to eat at the Crossroads were students attending BYU-I. Besides

students, there were a couple of parents and professors. The students between ages 18-24 were

easy to find, as most of the students eating in the food court are between those ages. The

students were most likely single, based on the BYU-I marital status statistics for students, and

from the absence of wedding rings. Most students were eating in couples or groups rather than

by themselves. Individuals sitting by themselves almost always had an electronic device out and

even had head phones on as well. Approaching these individuals was more difficult as they

seemed pre-occupied with their devices. A lot of groups sat doing homework while they ate and

worked in groups. Married students either sat by themselves and/or had their families present,

often with their children.

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Out of all the people in the Crossroads, it appeared that most of the people there came to

buy food provided by the food court. There were some who brought their own food to eat,

however many who brought their own food, would also buy something small like chips, a drink,

or a candy bar. The most popular restaurants that continually had a line of people waiting to

purchase food were the Chick-fil-A, the Chinese restaurant, or the “special of the day.” The food

being ordered from Chick-fil-A included chicken sandwiches, fries, and a soft drink. The food

purchased at the Chinese restaurant included rice or noodle bowls with chicken and vegetables

and a soft drink. The “special of the day” was a double cheese burger with fries and a 20-ounce

fountain soda. Most people in general would include a fountain drink with their meal or add

another kind of sugar-sweetened beverage (SSB). There was a salad bar, as well as yogurt and

fruit available for purchase, but those were purchased less often than SSBs.

The environment in which the people can sit to eat is a large room with many tables. The

one wall is full of very large windows. The ceiling stands very high, and the room is generally

full of people during lunch time. It can be hard to find an empty table even with over 50 tables

and at least 4 chairs to a table. There is a stage with a piano that sits in the center of the room, on

the side with all the windows. No one played the piano during the hours of the windshield

survey, but it is common that un-paid students entertain during the lunch rush. Even without

music and with so many students on their personal electronics, it was quite loud in the large

room. With the many conversations going on, there was a constant hum of noise.

Questionnaire

The questionnaire conducted during the lunch rush included 20 male students and 20

female students, which total 40 BYU-I students. The questionnaire gave the students a chance to

indicate their age, gender, and what they had eaten in the last 24 hours. The students were

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instructed to record food and beverage beginning with their lunch from the day before, until their

current lunch. Some main food choices that were recorded were fruit, vegetable, grain, meat,

dairy, sweet and salty treat, and any sugar sweetened beverages. Students would mark an X for

every serving they had consumed in the appropriate food group.

24 Hour Diet Recall Questionnaire

Please put an X for each serving consumed in the past 24 hours. EX: 2 servings of fruit would show XX

Age Gender Fruit Vegetable Grain Meat/Dairy Sweet/Salty Sugar-Sweetened Beverage

22 M XX X XX XX22 M X XX XXXX X X X21 M X XX XX X20 M XX XXXX XXX XXXXX XX XXX18 M X XX X XX X21 M XX XX X20 M XXX XX XXXX XX XX23 M X XX X XX X24 M XX XX XX XX XX X24 M XX XX XX XXXX X X18 M XX XXX XX XXXX XXXXX XX19 M XXX XXXX XX XX XX X24 M XXX X XX X XXX24 M XX XXX XXX XXXX XXX XX21 M XX X XX XX X X19 M X XXX XX XXXX XX XX18 M XXXX XXX X X XX24 M X XX XX24 M XXX XX XXX X XX XXX22 M X XX XX XXX24 F XXX XXX XXX XXX X XX18 F X XX XX XXX XX20 F XX XXX XX X XX19 F XXX X X X X22 F XX X X X XX18 F XXX XXX XX XXX X21 F XX XX XX X XX19 F XXXXXXX XXXX XXXX X XXX XX

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X19 F XX X X XX XX XX21 F X X X X19 F XX XX XX X25 F X X X18 F X X XX X23 F XX X XX XXX X XX21 F XX XXX X X20 F X X XX X19 F X X X X23 F X XXX X X XXX18 F XX XXX XX X23 F XX X XX XX XXX

The diet questionnaire showed that out of the 20 male students in 24 hours, 24 SSBs were

consumed. Out of those 20 male students, 14 of them drank the 24 SSBs. The other six students

did not drink any SSBs during those 24 hours. Similarly, out of the 20 female students in 24

hours, 21 SSBs were consumed. As for the 20 female students, 12 drank the 21 SSBs. The other

eight female students did not consume any SSBs during those 24 hours.

Key Informant Interviews

The two key informant interviews were conducted during same lunch rush, along with the

windshield survey and questionnaire. The first key informant was a cashier working in the

Crossroads and the second key informant was a shift manager, also working at the Crossroads.

The two were asked the same two questions about students that eat at the Crossroads.

Question number one: How many people on average eat lunch at the Crossroads daily?

Cashier Manager

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“I really haven’t worked here long. It’s hard

to know numbers, but if I had to guess, maybe

1,000.”

“Just during lunch I’m not sure, but we serve

between 4,000 to 5,000 people in a day.”

Question number two: On average, how often do people include a sugar-sweetened beverage in

their meal?

Cashier Manager

“Oh, my goodness, that really is hard to say.

It seems like a lot. I would say half of the

people or maybe even 80 percent.”

“Almost all.”

The key informants were given the same questions. The cashier was not confident giving

numbers out, as she had not worked there very long. The cashier thought a lot about her answers

and took a few minutes to respond to each question. Unlike the cashier, the manager has worked

there over a year and answered the questions in under a minute. The manager knew specific

numbers as she had worked there much longer. Also, as a manager she see the books and

specific numbers for their job.

Secondary Data

Secondary data was gathered from the U.S Department of Health & Human Services

website, the Community Commons website, the World Health Organization website, the Data

USA website, the Center for Disease Control and Prevention website, the Food Research &

Action Center website, and the Community Health Rankings and Roadmaps website. The data

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gathered includes the added sugar consumption trends, daily recommended amount of added

sugars, behaviors that lead to increased added sugar consumption, and food access.

Added Sugar Consumption Trends

According to the CDCP, “In 2011-2014, 5 in 10 adults (49%) drank a sugar-sweetened

beverage on a given day. On average, U.S. adults consume 145 calories from SSBs on a given

day” (CDCP, 2017c, para. 3). From the figure below, the numbers from the Community

Commons website have been suppressed for specific counties, meaning that the percentage of

soda expenditures for Madison county are unavailable. Idaho soda expenditures equal 4.39% of

the total food-at-home expenditures; similarly, the United States soda expenditures equal 4.02%

of the total food-at-home expenditures (Community Commons, IP3 & CARES, 2018).

Soda Expenditures, Percentage of Total Food-At-

Home Expenditures

Idaho (4.39%)

United States (4.02%)

(Community Commons, IP3 & CARES, 2018)

Recommended Amounts

Report Area State Rank

Z-Score (US)

Z-Score (State)

Average Expenditures

(USD)

Percentage of Food-At-

Home Expenditures

Madison County, ID

44 2.09 3.52 suppressed suppressed

Idaho no data

0.56 0 $260.13 4.39%

United States no data

no data

no data

$236.04 4.02%

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It has been recommended that added sugars be decreased in daily diets to lower excess

calories. These recommendations have come from multiple publications. According to the

World Health Organization (WHO), “In both adults and children, WHO recommends reducing

the intake of free sugars to less than 10% of total energy intake” (World Health Organization,

2015, p. 4). It is best if added sugars are decreased over a lifetime. An added recommendation

given by the World Health Organization suggests, “A further reduction of the intake of free

sugars to below 5% of total energy intake” (World Health Organization, 2015, p. 4). The U.S.

Department of Health & Human Resources (HHR) also states that less than 10% of our daily

calories should come from added sugars (U.S. Department of Health & Human Resources,

2017a). HHS suggests that in order to reach this goal, water should replace SSBs (U.S.

Department of Health & Human Resources, 2017b). These percentages, if reached, would mean

that the average calories consumed would drop dramatically. CDCP stated that the average

calories consumed from SSB are 145 (CDCP, 2017c). If we look at a 2000 calorie diet, in order

meet a 5% consumption of added sugars from SSB, there needs to be 45 less calories.

Behaviors that Lead to Increased Consumption

It can be hard to pin-point exactly what drives people to consume sugar sweetened

beverages. The CDCP reports that Americans drink about the same quantity of SSBs away from

home as they do at home. “Calories from SSBs are consumed at home 52% and 48% of calories

from SSBs away from home” (CDCP, 2017, para. 3). Many other factors reported by the CDCP

are contributing factors to increased consumption of SSBs. The CDCP, reported that “Overall, at

least once daily SSB intake was most prevalent among adults aged 18–24 years (CDCP, 2016d,

para. 1). This is significant since the population being assessed is 18-24 years old. According to

CDCP, “Adults and adolescents who smoke, don’t get enough sleep, don’t exercise much, eat

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fast food often and who do not eat fruit regularly are more likely to be frequent consumers of

SSBs” (CDCP, 2017c, para. 4). Many students live very busy lives. They do not sleep or

exercise enough, often eat outside the home, and often eat fast-food. For the population being

examined of BYU-I students ages 18-24, it would be probable that many of these factors are a

part of their lives.

In addition to these behaviors, “SSB intake is higher among males, young adults, non-

Hispanic blacks or Mexican American, or low-income adults.” (CDCP, 2017c, para. 3). Low-

income and poverty is an issue for the 18-24 age group in Rexburg. As noted in the graph

below, it appears that females have a higher rate of poverty than males in Rexburg (Data USA,

2015). Low income contributes to frequent SSB consumption, and the 18-24 age group at BYU-

I lives in poverty.

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(Data USA, 2015)

Food Access

Food access in Rexburg is a health issue according to the Community Health Rankings

and Roadmaps website. This can mean that people struggling to have access to food will go

without or get whatever is available at the time (Community Health Rankings and Roadmaps,

2017). The graph below outlines what the food access statistics are like in Madison County.

From the graph, the food environment index is measured over a year with two types of food

access. First, the low-income individuals in the community who are limited in their access to

healthy foods. Second, is the amount of food insecurity. The food environment index is

measured on a scale of zero to ten. Zero being the worst and ten being the best. In Madison

County, the food environment index is 5.8 (Community Health Rankings and Roadmaps, 2017).

The population of Madison County has nine percent who have limited access to healthy food,

and there is 21 percent of the population struggling with food insecurity. The food insecurity

percentage refers to the amount of the population without access to reliable food (Community

Health Rankings and Roadmaps, 2017).

(Community Health Rankings and Roadmaps, 2017)

In Madison County there is also an issue with food insecurity; almost six percent more of

the people residing in Madison County have food insecurity as compared to the population of

Idaho of and the United States (Community Commons, IP3 & CARES, 2017). This means that

Madison County has more community members struggling to have access to reliable food than

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that of the nation or the state of Idaho. Without reliable food sources, the population consumes

what is available and affordable.

Report Area Total Population

Low Income Population

Low Income Population

with Low Food Access

Percent Low Income

Population with Low Food

Access

Madison County, ID 37,536 21,329 4,661 21.85%

Idaho 1,567,582 640,259 139,643 21.81%

United States 308,745,538 106,758,543 20,221,368 18.94%

(Community Commons, IP3 & CARES, 2018)

The Food Research & Action Center (FRAC) states, “Low-income individuals purchase

cheap, energy-dense foods that are filling – that is, they try to maximize their calories per dollar

in order to stave off hunger” (Food Research & Action Center, 2018, para. 4). Low-income

individuals are more likely to purchase and consume cheap fast food and SSBs. The FRAC

reports, “Low-income communities have greater availability of fast food restaurants, especially

near schools” (Food Research & Action Center, 2018, para. 6). The food at fast food restaurants,

and the Crossroad food court, serve nutrient poor, but energy dense food for relatively low

prices. FRAC also indicates that these foods, may be less expensive and energy-dense, but they

“typically have lower nutritional quality and have been linked to obesity” (Food Research &

Action Center, 2018, para. 4). The students at BYU-I are eating at restaurants serving such foods

and SSBs.

Side Effects from Added Sugars

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SSBs are a major source of added sugars in the diet of U.S. adults and account for

approximately one-third of added sugar consumption. “Among adults, frequent (i.e., at least

once a day) SSB intake is associated with adverse health consequences, including obesity, type 2

diabetes, and cardiovascular disease” (CDCP, 2016, para. 1). Obesity, is just one probable side

effect from consumption of SSBs and their added sugars and calories. “Frequently drinking

sugar-sweetened beverages is associated with weight gain/obesity, type 2 diabetes, heart disease,

kidney diseases, non-alcoholic liver disease, tooth decay and cavities, and gout, a type of

arthritis” (CDCP, 2017c, para. 1). Tooth decay and loss of permanent teeth are associated with

SSB consumptions. From a study on permanent tooth loss from SSB intake found that, “Loss of

one or more permanent teeth due to dental caries or periodontal disease was positively associated

with frequency of SSB intake (Kim, Park, & Lin, 2017). Those consuming SSBs had a higher

chance of losing one to five teeth than those non-SSB consumers (Kim, Park, & Lin, 2017).

Part 3: Data Interpretation

Data Similarities

The first similarity between the between the primary and secondary data is that those in

poverty are more likely to consume SSBs. The second similarity is that the food away from

home is not nutrient dense, but calorie or energy dense and cheaper than nutrient dense foods.

The third and last similarity between the data is that consumption of SSBs is prevalent,

especially for the male gender and young adults.

Data Differences

The differences between the primary and secondary data were hard to find. One thing

that was different was that the students on BYU-I campus have good access to food. There are a

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lot of options as far as food and drink for the students. Another difference is that individuals

with low-incomes are usually buying cheap energy dense foods. One thing that those with low

incomes might consider is that they could be drinking free water instead of spending money on

SSBs. One last difference is that non-Hispanic, blacks and Mexican Americans have a higher

SSB intake, while the main ethnicity at BYU-I with 85.09% is Caucasian.

Population Strengths

One strength of this population is where they live in Rexburg, Idaho. The water in the

area is good to drink right from the tap. If water is not preferred, then there are things that can be

added for flavor such as cucumbers, fruit, or crystal light that have no added sugars and very few

calories. There is a free busing service to the Wal-Mart Supercenter, which enables students to

purchase these for flavoring.

A second strength for this population is their capability and willingness to learn new

things. As BYU-I students learning is a part of their everyday lives. Learning about the

negative, long-term effects that added sugars can have could motivate lifestyle changes.

A third strength that this population has, is that the majority are a part of the LDS faith,

which teaches the Word of Wisdom. The Word of Wisdom teaches about foods and beverages

that should and should not be consumed. The Word of Wisdom teaches further that food should

be consumed in moderation and addictive substance, sugar included, should be avoided.

Population Challenges

The first challenge this population has is the busy schedules that the students face. They

are juggling academics, finances, and social lives. With so many demands in their lives, it is

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easier to buy whatever is cheap, quick, and easy. Another reason SSBs are so popular is their

caffeine content, which helps gives students the energy they need in their busy lives.

A second challenge of this population is that often the way they eat is a habit. It can be

hard to create and keep new habits. The addiction to sugar is worse than the habit. Many people

get headaches when trying to quit drinking SSBs. Along with that, no matter where one goes to

buy cheap quick food, most food has added sugars.

A third challenge of this population is that the environment they live in is very social.

There are many activities going on that provide SSBs and food options full of added sugars.

Food is an essential part of social gatherings and cultural traditions. This creates a difficult

challenge for BYU-I students to want to find other options when that is what everyone is

participating in.

Validating Information

The first bit of significant information that validates the need to decrease consumption of

SSBs are the associated with adverse health effects. Next, the two key informants reported that

80% to almost all students add a SSB to their meal. Lastly, many organizations, like the WHO,

are all recommending that we should be reducing the intake of free sugars to less than 10% of

our total energy intake (World Health Organization, 2015). Reaching such a recommendation

would be difficult with continued consumption of SSBs. A 12 ounce can of Dr. Pepper contains

45 grams added sugars and 180 calories.

Part 4: Population Health Plan

Areas of Improvement

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The first area of improvement or this population would be to carry their own beverage.

Ideally, it would be best to carry a water bottle that can be reused. There are a lot of nice water

bottles, relatively cheap, out there that can be reused for a long time. Some water bottles even

have chambers in them to hold things such as fruit. These chambers make it possible to infuse

plain drinking water with a desired fruit or flavor. Most, if not all, water fountains on campus

include the water bottle dispenser, making filling water bottles quick and easy. This will help

this population already have a drink when they go to school, and when they eat on campus at the

Crossroads Food Court. As students carry their own beverage with them, it will help increase

fluid intake and hopefully reduce the intake of SSBs.

The second area of improvement, for this population, is to become educated on the

beverages available on campus that do not include added sugars. If a water bottle is forgotten at

home or becomes lost, it will be important to know what beverages are available to purchase

without added sugars. There is always the option of just getting a water cup and filling it at the

food court or the many water fountains on campus. If there are only few options for non-SSBs,

then the school should be made aware and this should be rectified. This way, it is not completely

up to the students to always bring their own beverage, but they could have options if they need or

want to buy something.

The third crucial area needed for improvement is education on the effects from drinking

SSBs. The education on SSBs could open the eyes of many people, regarding what the cost of

SSBs have on their health and finances. This could reduce the intake of SSBs in a short amount

of time and be a long-term change for many.

Recommendations

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The first recommendation for the population would be to educate the students to bring

their own meals and beverages to school with them. Two reasons homemade meals would

benefit this population are, first, they may be less tempted to buy food and beverages with added

sugars, and second, the homemade meals cost less. The university has cooking classes that could

help students learn to make healthy meals. Additional food classes could be added, specifically

for cheap, healthy, and quick homemade meal options. These classes could teach students how

to make their own infused water drinks. Bringing their meals with them to campus could reduce

their intake of added sugars and save them money.

A second recommendation would be that the university put up posters around campus

educating students regarding on the benefits of drinking water. The posters could encourage

students and staff to use the drinking fountains on campus. In the food court, additional posters

could point out what options are available without added sugars. The school should work

towards having more beverage options that do not include added sugars or that contain very few.

A third recommendation to help the BYU-I student population, would be to have the

university newspaper, The Scroll, write an article on the effects added sugars can have,

specifically, the added sugars consumed in beverages. The article should include how many

calories from added sugar are recommended during a single day. For perspective, a beverage

with the correct allotment, should be given as an example with nutritional facts. Having this

recommendation come from the university could help drive changes in students’ beverage

choice.

Evaluations

ADDED SUGARS 27

The first evaluation would be to use course evaluations from the new food courses.

These would show if students implemented cooking more at home and if they found the food

courses beneficial. Evaluations give an idea of how well the students are liking the courses. It

would be helpful to know what they like about the classes and what was most beneficial. If the

attendance increases, that would mean that more students are interested in learning how to cook

cheap, quick, and healthy meals.

A second evaluation that will be done would determine if the BYU-I students find that

the posters about water consumption are educational and/or encouraging. Are the posters even

noticed? Do they evoke any feelings of change? The employees working in the Food Court at

BYU-I will be interviewed to see if the students notice the posters or options available to them.

It would be beneficial to know if the students are partaking in more of these non-SSB options

and if they ask for more. If the students are seeing these posters and feel encouraged to drink

more water, then the intake of SSBs could reduce. If employees are seeing more students

partake in these non-SSB options, then there may be a reduction in the consumption of SSBs.

A third evaluation would be done to assess the interest of students by determining how

many newspapers were bought the day the article was published. An email could be sent out to

students using a campus wide email distribution through the university’s, BYU-I, student emails

to take a poll. The poll would evaluate whether they read the article from, The Scroll, and if they

acted upon the information provided. The more newspapers bought and emails responses stating

that students would lower their SSB intake, would prove the newspaper article to be effective.

Reflection

ADDED SUGARS 28

Learning about the effects added sugar can have on an individual has changed my own

eating and drinking habits. I find myself having conversations about how much of what we eat

has added sugars, and what effects those sugars can have on us. The students at BYU-I, ages,

18-24, are working toward their future lives and careers. Their lives, careers, and health could be

negatively affected by their intake of added sugars from SSBs by increasing their chances of

obesity. Unfortunately, these students in Madison county are not immune to the high rate of SSB

consumption according to the key informants working at the food court and from Community

Commons (Community Commons, IP3 & CARES, 2018). The prevalence of obesity is only

increasing for Americans, ages 20 and up. The rate of obesity is almost 38% as of 2014 (CDCP,

2017b). It is in the everyone’s best interest, including these BYU-I students, to substitute the

intake of SSBs with a drink without added sugars, like water. After researching this topic, I have

a stronger desire to substitute my own beverages for water. I believe through my research and

example I could potentially influence others to make positive diet changes. (199)

ADDED SUGARS 29

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