Obesity is a complex, multifactorial

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1 OBESITY Obesity, sociodemograhic and attitudinal factors associated with sugarsweetened beverage consumtion: Australian evidence Christina M. Pollard, 1,2 Xingqiong Meng, 1,3 Gilly A. Hendrie, 4 Delia Hendrie, 1 Denise Sullivan, 2 Iain S. Pratt, 5 Deborah A. Kerr, 1 Jane A. Scott 1 Obesity is a comlex, multifactorial ublic health roblem. 1 The increase in obesity over the ast 3 years aears to have aralleled increases in the sugarsweetened beverages (SSB) market. The ublic health imlications are large due to the high revalence of both obesity and SSB consumtion. 2 Consumtion of SSB is associated with increased risk of weight gain, fatty liver disease, kidney function, visceral fat and other cardiometabolic roblems in adults and children. 31 The intake of free sugars resent in SSB has also been associated with decreases in the nutrient density of the overall diet 11 and increases in dental caries 12 which, along with the increased risk of weight gain, 13 led the World Health Organization to develo guidelines advising countries to reduce free sugar consumtion to 5 1 of daily energy intake. 14 The colloquial term soft drink in Australia tyically means a nonalcoholic carbonated beverage such as cola, lemonade, tonic or flavoured mineral waters, 15 similar to the terms soda in the US and fizzy drink in the UK. If no adjective such as diet is used, the term generally refers to regular or sugarsweetened soft drink. Multinational beverage comanies market SSB globally; in 28, Australia ranked 1th based on market share. 16 Along with differences in the ingredients used in soft drink roduction, it is likely that there may be cultural variations in consumtion between countries. Therefore, much can be learned from understanding Abstract Objective: To exlore factors associated with sugarsweetened beverage (SSB) consumtion in Australia. Methods: Pooled data from Western Australian (WA) and South Australian (SA) 29 and 212 nutrition monitoring survey series interviews of 2,832 WA and 1,764 SA adults aged 18 to 64 years. Demograhic data were collected and indeendent samles ttest, analysis of variance, multile logistic regression erformed. Results: Obese articiants were more likely to consume SSB than healthy weight articiants (SA: OR=1.77; 95CI ; WA: OR=1.53; ). SA obese articiants consumed more SSB er day (152. ml; ) than healthy weight (8.1 ml; ; <1) and overweight articiants (16.9 ml; 99., 114.8; <1). s were more likely to consume SSB than females (SA: OR 1.8; ; WA: 1.81; ). WA articiants who didn t think about the healthiness of food (4.55; ) and bought meals away from home the day rior (1.55; ) were more likely to consume SSB. SA adults rating their health highest were less likely to consume SSB (.62;.54.72). Conclusions: SSB consumers are more likely to be male, have little interest in health, or have urchased a meal away from home. Imlications: Increasing awareness of the adverse health effects of consumtion may be a first ste in curbing SSB intake. Key words: soft drink, obesity, oulation, association, sugar sweetened beverages consumtion atterns and associations across a range of countries. National dietary surveys are irregularly conducted in Australia and hence dietary data are limited. Analysis of the 1985 and 1995 National Nutrition Survey data showed that SSB contributed to increased energy consumtion in the decade rior to The Australian Health Survey (AHS) reorted that in 21112, onethird of Australian adults (19 years and over) consumed regular and nonnutritively sweetened beverages and flavoured mineral waters on the day rior to the survey, with the oulation mean daily intake of 189 ml. 18 Young adults, 19 3 years, were high soft drink consumers averaging 327 ml er day. 18 Australian state surveys are conducted more regularly and can sulement national data. 19 Overweight and obesity is a key ublic health roblem in Australia, with the revalence increasing from 56 of adults in 1995 to School of Public Health, Curtin University, Western Australia 2. Deartment of Health, Government of Western Australia 3. School of Medicine, Flinders University, South Australia 4. CSIRO Food and Nutrition Flagshi, South Australia 5. Cancer Council Western Australia Corresondence to: Dr Christina Pollard, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845; C.Pollard@curtin.edu.au Submitted: May 215; Revision requested: July 215; Acceted: August 215 The authors have stated they have no conflict of interest. Aust NZ J Public Health. 216; 4:717; doi: / vol. 4 no. 1 Australian and New Zealand Journal of Public Health 71

2 Pollard et al. Article in 211/12. 2 Consumer research is imortant to inform oulationbased interventions such as social marketing camaigns to hel identify riority targets and factors associated with behaviours Aart from industry data suggesting that the beverage market is changing toward healthier otions, there is limited oulationbased evidence available to inform interventions to reduce Australian SSB consumtion. This study aimed to examine the factors associated with SSB consumtion using oulationbased data from crosssectional health monitoring surveys conducted regularly in two states: Western Australia (WA) and South Australia (SA); that together reresent 18 of the Australian oulation (WA 11 and SA 7). 24 A articular focus is on soft drink consumtion and obesity. Methods Western Australia Samle: Data were collected using the WA Deartment of Health s Nutrition Monitor Survey Series (NMSS) that monitors selfreorted attitudes, beliefs and behaviours related to Australian dietary guideline recommendations 17 for adults aged 18 to 64 years. Data were collected using comuterassisted telehone interviews (CATI) during July and August in 29 and 212. Telehone numbers were randomly drawn from the Electronic White Pages (EWP) for WA and stratified according to area of residence. Data were ost adjusted for age, sex and geograhic area of the 211 Estimated Resident Poulation of WA. 25 Details of survey and samling strategies can be found elsewhere. 26 The surveys were aroved by the Deartment of Health in WA and Curtin University s Ethics Committees. Outcome measurements: To cature all SSB available in the market articiants were asked, In total, how many cans, bottles, glasses or cus of regular soft drink (not diet), energy drinks, sorts drinks, flavoured mineral water or vitamin water, did you drink yesterday? ; and to cature the consumtion of artificially sweetened or diet carbonated beverages, articiants were asked How much diet soft drink did you drink yesterday? For the urose of this aer, the term soft drink includes all the SSB listed above, and diet soft drink refers to artificially sweetened carbonated beverages. South Australia Samle: Data were collected using the South Australian Monitoring and Surveillance System (SAMSS) in 29 and 212. SAMSS is a CATI survey that monitors selfreorted trends in diseases, health roblems, risk factors and other health service issues for all ages over time and is managed by Poulation Research and Outcome Studies at the University of Adelaide, for the SA Deartment for Health and Ageing. Interviews are conducted throughout the year, on a minimum of 6 randomly selected eole (adults and children) each month. All households in SA with a telehone connected and the number listed in the EWP are eligible for selection in the samle. The method is described in more detail elsewhere (health. adelaide.edu.au/ros/data/samss/). The data were weighted by age, sex and area of residence to reflect the structure of the SA oulation in the latest 211 Census and the robability of selection in the household. 27 Weighting corrected for disroortionality of the samle with resect to the oulation of interest. The surveys were aroved by the SA Health Human Research Ethics Committee. Outcome measurements: Particiants were asked one question regarding their usual consumtion of soft drinks: On average, how much soft drink do you usually have er day? Because soft drink generally refers to regular or SSB, this question was assumed to be measuring sweetened soft drinks. Consumtion of diet soft drink was not asked in a searate question in the SA survey. Demograhics In both surveys, demograhic data collected were age, gender, education level, household income, emloyment status and residential area. Country of birth was asked in the WA survey. Particiants selfreorted height and weight were collected, from which weight status (body mass index [BMI]) was derived. Weight and height were adjusted to account for ossible reorting bias rior to calculation of BMI. 28 BMI was classified as underweight (BMI<18.5 kg/m 2 ); healthy weight ( kg/m 2 ); overweight ( kg/m 2 ); and obese ( 3 kg/m 2 ). 29 The underweight category was combined with the healthy weight grou for analysis, due to small numbers. In WA, articiants were asked about the attention aid to the health asects of the food they eat, with the otions of ay a lot of attention, take a bit notice or don t really think about it. Particiants were also asked whether they had bought meal(s) from a restaurant, takeaway, lunch bar, canteen or other reared food outlet the day rior to the survey. In the SAMSS, articiants were asked their selfreorted health status on a fiveoint scale of oor, fair, good, very good and excellent. Statistical analysis Descritive statistics reort the roortion of articiants consuming SSB and the tye and amount consumed. SSB consumers were defined as a erson reorting to consume any soft drink on the revious day in the WA survey, or reorting to usually consume any soft drink in the SA survey. In addition, in WA diet soft drink consumers were defined as those reorting to have consumed some diet soft drink on the day revious to the survey. Betweengrou differences were assessed using indeendent samles ttest or analysis of variance, with Bonferroni adjustments. Multile logistic regressions were used to exlore the demograhic and behavioural factors associated with SSB consumtion. Due to the slight differences in the data collected and the way in which exlanatory and outcome measures were recorded, the analysis was conducted searately for each state. All relevant variables (Table 1) were entered into each state s full model but only those with a value <5 were retained in the final model and reorted. Survey module of Stata software version 12. (StataCor LP, College Station, TX) and IBM SPSS Statistics 2 were used for analyses. Results Across 29 and 212, 2,832 and 1,764 ersons articiated in the NMSS and SAMSS surveys, resectively; details are shown in Table 1. On average in WA, 37.2 (95CI ) of articiants were overweight and 22.3 ( ) were obese; in SA 38.4 ( ) were overweight and 27.6 ( ) were obese. In WA on the day rior to the survey, onethird of articiants drank some tye of soft drink; 21.8 drank soft drink, 12.5 drank diet soft drink and 1.4 drank both (Table 2). In SA, 22.6 of articiants usually drank soft drink each day (Table 3). The WA survey found that more females than males consumed diet soft drink (15. [ ] comared to 1 [ ]), see Table 2. Desite 72 Australian and New Zealand Journal of Public Health 216 vol. 4 no. 1

3 Obesity Soft drink consumtion and obesity the different methodology, the quantity of reorted soft drink consumtion was similar in both surveys. Soft drink consumers drank aroximately ml of soft drink er day, which across the oulation was, on average, about ml er erson er day (see Tables 2 and 3). Among diet soft drink consumers, a similar amount was consumed (515 ml, reorted in WA survey only). Multile logistic regression results show that those more likely to consume soft drink were males and eole aged 18 to 44 years. Education and income were not significantly indeendently associated with soft drink consumtion in either state. In SA, overweight and obese eole were more likely to consume soft drink comared to ersons of healthy weight. In WA, only those classified obese were more likely to consume soft drink (Table 4). There was a stewise increase in soft drink consumtion with increasing weight status in SA, see Figure 1(a). The average reorted soft drink consumtion was significantly higher in obese eole (152 ml, [95CI ]) comared to healthy weight (8.1 ml [73.2, 88.2], <1) and overweight eole (16.9 ml [ ], <1). This attern was not observed in WA and no significant difference was found in the amount of soft drink consumed by weight status, see Figure 1(b). The aarent high consumtion among the normal weight/underweight category in the WA samle is likely to be due to the smaller samle size, and the difference is not significant. In WA, males were less likely to consume diet soft drink than females (OR=.58, 95CI.42.79, <1), and overweight and obese eole were more likely to be diet soft drink consumers (1.66 [ ] and 3.33 [2.25.5], resectively, all <5). There was an increase in diet soft drink consumtion with increasing weight status among females in WA. Obese women consumed 76 ml more, on average, (95CI 38114, <1); and overweight females consumed 39 ml more diet soft drink than healthy weight females (95CI 1265; =4). In WA, those articiants who had bought meal(s) away from home on the day rior consumed on average 54 ml more soft drink that day [95CI 288] than those who did not have any meals away from home. SA articiants reorting to be of oor, fair or good health were more likely to be Table 1: Samle demograhics, weight status and selfawareness of health or healthy eating of Nutrition Monitoring Survey: Western Australia and the South Australian Monitoring and Surveillance Survey, 29 & 212. Western Australia South Australia Total a Total b (n=1,284) (n=1,548) (n=2,832) (n=5,634) (n=5,13) (n=1,764) Sex Age grou 1824 years 2534 years 3544 years 4554 years 5564 years 65 years and older Area of residence Metroolitan Remote areas Rural areas Education Less than high school High school Trade/Certificate/Diloma University degree Household income in Australian dollars U to $6, $6,1$1, More than $1, Don t know/unsure/refused Emloyment status Currently not in aid emloyment Currently in aid emloyment Country of birth Australia UK/Ireland Other countries Weight status c Underweight/Healthy weight Overweight Obese Bought meal(s) away from home the day rior No Yes Attention aid to the health asect of the food you eat Pay a lot of attention Take a bit notice Don t really think of Self reorted health Poorfair Good Very goodexcellent , , , , ,871 2, ,7 1, ,121 4,12 1,622 1,722 1,96 1,497 1, ,28 1,46 1, ,7 3, ,629 2, ,47 3,644 1,485 1, ,491 1, ,596 1, ,581 2,26 3, Data not available in survey, a: Percentages were weighted for robability of selection and adjusted by age, sex and geograhic area to the 211 Estimated Resident Poulation of WA. b: Data were weighted by age, sex and area (metroolitan/rural) of residence to reflect the structure of the South Australian oulation in the Census and the robability of selection in the household(27). Weighting corrected for disroortionality of the samle with resect to the oulation of interest. c: Weight Status: Healthy weight (<25 kg/m 2 ); Overweight ( kg/m 2 ); Obese ( 3 kg/m 2 ) vol. 4 no. 1 Australian and New Zealand Journal of Public Health 73

4 Pollard et al. Article Table 2: Prevalence of beverage consumtion and average consumtion among adults, Nutrition Monitoring Survey Series (NMSS), Western Australia, 29 and 212. a Total (95 CI) Proortion of soft drink consumers, b n=2,832 (95 CI) 1824 yr 2534 yr 3544 yr 4554 yr 5564 yr Regular soft drink 21.8 ( ) 15.6 ( ) 27.9 ( ) < ( ) 23.9 ( ) 24.4 ( ) 15.4 ( ) 12.7 ( ) <1 Diet soft drink 12.5 ( ) 15. ( ) 1 ( ) ( ) 9.9 ( ) 12.2 ( ) 13. ( ) 14.4 ( ).52 Either 32.9 ( ) 28.8 ( ) 36.9 ( ) < ( ) 34.2 ( ) 36.5 ( ) 28.4 ( ) 24.2 ( ) <1 Both 1.4 (.9 2.2) 1.8 (1. 3.3) 1. (.5 2.1) (.7 8.) 1.9 (.8 4.1) 1 (.4 2.1) 1.4 (.7 2.9).6 (.2 1.5).35 Amount consumed (among consumers) c Mean (95 CI) Mean (95 CI) Mean (95 CI) value d Mean (95 CI) Mean (95 CI) Mean (95 CI) Mean (95 CI) Mean (95 CI) value e Regular soft drink (ml), 55 ( ) 432 ( ) 577 ( ) <1 645 ( ) 554 ( ) 511 (44 582) 415 ( ) * 423 (37 476) * <1 n=486 Diet soft drink (ml), n= ( ) 458 ( ) 574 ( ) ( ) 626 (448 83) 569 ( ) 492 ( ) 436 ( ) 8 Total (had either or both) (ml), n= ( ) 477 (446 58) 67 ( ) <1 63 ( ) 626 ( ) 543 (484 62) 476 ( ) 438 ( ) <1 Amount consumed (among all articiants), n=2,832 Regular soft drink (ml) 12 (15 135) 71 (58 85) 168 (14 196) <1 227 ( ) 14 (11 179) 128 (99 156) 67 (52 82) * 55 (42 67) * <1 Diet soft drink (ml) 66 (54 78) 68 (57 79) 63 (42 84) (18 54) 85 (42 128) 72 (51 94) 71 (56 86) * 52 (39 65) 2 Total (ml) 186 (167 24) 14 ( ) 231 ( ) <1 263 ( ) 225 (169 28) 2 ( ) 138 ( ) 17 (9 124) <1 a: Estimates were weighted for robability of selection and adjusted by age, sex and geograhic area to the 211 Estimated Resident Poulation of WA b: A soft drink consumer is defined as a erson who reorted to consume some (greater than zero) soft drink on the revious day c: values were derived from designbased Pearson chisquare test d: values were derived from adjusted Wald test e: values were derived from Bonferroniadjusted Wald test * Values were significantly different from age grou of 1824 yr at <1 level. Table 3: Prevalence of soft drink consumtion and average consumtion among adults, South Australian Monitoring and Surveillance Survey (SAMSS), 29 & 212. a Total (95 CI) (95 CI) 1824 yr 2534 yr 3544 yr 4554 yr 5564 yr 65+ yr Usual soft drink 22.6 ( ) 17.3 ( ) 28.2 ( ) < ( ) 3.6 ( ) 26.9 ( ) 22.4 ( ) ) 11.4 ( ) <1 consumers b Mean (95 CI) Mean (95 CI) value d Mean (95 CI) Mean (95 CI) Mean (95 CI) Mean (95 CI) Mean (95 CI) Mean (95 CI) value e Amount consumed (among consumers only n=2435) Soft drink (ml) 491(477 54) 434( ) 527(58 546) <1 445( ) 525( ) * 499( ) 525( ) 496( ) 397( ) <1 Amount consumed (among all articiants n=1764) Soft drink (ml) 111(16 116) 75(7 81) 148(14 157) <1 142( ) 161( ) 134( ) 118(15 13) 85(73 98) * 45(39 52)* <1 a: The data were weighted by age, sex and area (metroolitan/rural) of residence to reflect the structure of the SA oulation in the latest 211 Census and the robability of selection in the household(27). Weighting corrected for disroortionality of the samle with resect to the oulation of interest. b: A soft drink consumer is defined as a erson who reorted to usually consume some (greater than zero) soft drink each day c: values were derived from designbased Pearson chisquare test. d: values were derived from indeendent samles ttest e: values were derived from Bonferroniadjusted Analysis of Variance * Values were significantly different from age grou of 1824 yr at 1 level. Figure 1: Regular soft drink consumtion among males and females adults by weight status grous, (a) South Australian Monitoring and Surveillance Survey (SAMSS), and (b) Nutrition Monitoring Survey Series (NMSS), Western Australia, 29 & 212. Soft drink consumtion (in ml) (a) South Australia Regular soft drink consumtion (in ml) (b) Western Australia Underweight and normal weight Overweight Body weight status Obese Underweight and normal weight Overweight Body weight status Obese 74 Australian and New Zealand Journal of Public Health 216 vol. 4 no. 1

5 Obesity Soft drink consumtion and obesity regular soft drink consumers (Table 4) and consume more soft drink (data not shown), than those of very good or excellent health. In WA, articiants who aid less attention to the healthiness of their food were about five times more likely (4.55 [ ], <1) to be soft drink consumers than those who reorted aying a lot of attention to the healthiness of their food. Discussion SSB consumtion was associated with obesity in WA and SA is consistent with research from Australia and other countries. 3 In this study, the mean daily intake of SSB by those who consume it rovides an additional 9 kilojoules or 215 calories er day. In 21, Cook et al. 31 asserted that the additional mean daily energy increase of 3 4 (equivalent to 35 kilojoules er day) of Australian adults between 1983 and 1995 would be exected to result in significant body weight increases over time if there were no comensatory increases in energy exenditure. As well, in Australia, the rising consumtion of SSB was noted to have contributed significantly to the energy increase over that time. 31 In addition to energy intake, half a litre of SSB would contribute an estimated 55 grams of free sugar, exceeding the WHO recommendation to restrict free sugars to 25 to 5 grams er day for those who drink SSB, even without considering the free sugars from other foods. SSB consumtion atterns were remarkably similar in both states, with of adults consuming an average of around half a litre er day of soft drink, equating to ml er erson er day over the oulation. Also, the findings are remarkably consistent with the results of a 211 survey of 38,978 adults aged 18 years or older in six US states which reorted that 23.9 of adults drank sugary drinks at least once a day. 32 Demograhic factors associated with consumtion were also similar, with males and younger adults more likely to consume SSB in both Australian states and in the US research. Dietary intake data from the US NHANES reort that young adults have the highest consumtion of soft drink among oulation age grous and there are similar sociodemograhic differences in consumtion atterns among consumers. 33 Diet soft drink consumtion (WA only) was additional to SSB consumtion and increased the roortion of articiants consuming any soft drink to onethird. Those drinking Table 4: Factors associated with selfreorted soft drink consumtion among adults, Nutrition Monitoring Survey Series (NMSS), Western Australia, and the South Australian Monitoring and Surveillance Survey (SAMSS), 29 & 212. Western Australia South Australia Gender Age (years) years and older Weight Status d Healthy weight (<25 kg/m 2 ) Overweight ( kg/m 2 ) Obese ( 3 kg/m2) Attention aid to the health asect of the food you eat Pay a lot of attention Take a bit notice Don t really think of Had meal(s) away from home the day rior to the survey No Yes Selfreorted health Poorfair Good Very goodexcellent diet soft drink consumed a similar amount to SSB consumers (515 ml comared to 55 ml, resectively). This finding is consistent with revious WA research 34 and the AHS 24hour dietary recall, which reorted 33 of Australian adults aged 19 years and over consumed soft drinks and flavoured mineral water. 35 The Australian Beverage Industry reorts a decrease in sales of SSB and an increase in sales of nonsugarsweetened carbonated soft drink and water between 1997 and 26. A review of Australian grocery sales of waterbased beverages between 1997 and 211 showed that the category is undergoing a fundamental shift from sugarsweetened to nonsugar beverages. 36 This current study and the AHS find that about onethird of soft drink consumers select diet roducts, and consumtion is an either/or choice. Areciation of the healthiness of diet was associated with reduced soft drink Regular soft drink consumer, yes (n=2,823) Soft drink consumer, yes (n=2,435) 1.8 ( ) c 1.81 ( ) c.64 ( ).71 ( ).39 (.24.64) c.35 (.21.59) c.99 ( ) 1.53 ( ) a 1.73 ( ) c 4.55 ( ) c.84 (.71.99) a.67 (.57.8) c.47 (.39.56) c.34 (.28.42) c.22 (.18.27) c 1.18 ( ) b 1.77 ( ) c 1.55 ( ) b a <.5; b <.1; c <.1. Results are odds ratio and 95 confidence interval from multile logistic regression models. note: Only significant variables were included in the logistic regression models d Weight Status: Healthy weight (<25 kg/m2); Overweight ( kg/m2); Obese ( 3 kg/m2) consumtion in the current study. Park et al. 37 reorted that US adults aged over 18 years who said they did not know that soft drink consumtion contributed to weight gain were more likely to consume soft drink. The authors recommended nutrition education for those with the lowest knowledge: adults with less education, men and minority grous. 37 These findings suggest that increasing the awareness of the adverse health effects of consumtion may be a first ste in curbing SSB intake. 38 Eating a meal away from home increased the odds of consuming soft drink among WA adults. An association between eating at fast food restaurants and higher intake of SSB was reorted in the US. 39 Households buying SSB were less likely to adhere to a rudent dietary attern and were more likely to consume a ready to eat/fast food attern. 4 Similarly, young adults atronising burger and fries restaurants more than three times a week.79 (.68.91) b.62 (.54.72) c 216 vol. 4 no. 1 Australian and New Zealand Journal of Public Health 75

6 Pollard et al. Article consumed an additional serve of SSB er day comared to those using them less than once a week. 39 Although SSB consumtion was associated with takeaway meals in this current study, further Australian research is needed to investigate other distribution channels. In the US, most bottled SSB are sold in suermarkets (5) comared to food service/drinking laces (2), convenience stores/gas stations (12) and vending machines (11). 41 SSB advertisements and sonsorshis aear to target younger eole. 42 Restricting SSB advertising and timing health romotion interventions to corresond with the exected eaks in consumtion has the otential to reduce SSB consumtion. The authors recommend health romotion interventions targeting younger adults, articularly males. Those consuming SSB were more likely to be overweight or obese. Although the SSB industry emhasises its role in romoting healthier drinks as a strategy to reduce obesity, the diet soft drink advertising in this current study reresented only 1 2 of the total advertising send. Diet soft drink consumers were more likely to be obese, which likely reflects reverse causality. Previous research suggests that when adults relace SSB with diet drinks, they make few other changes to their diet, indicating nutrition education is needed. 43 A limitation of the current study is that social desirability to reort lower soft drink consumtion is otentially more revalent in females, which may account for some of the gender differences observed. Also, the data resented here is selfreorted and crosssectional, so causality cannot be inferred. There are otential confounders which have not been described in this study, including total energy intake. It is ossible that the articiants with higher consumtion of SSB also had higher energy intake and therefore would have excess weight. Nevertheless, the similarity in findings in the two different states and with studies using different dietary collection methods increases the lausibility and generalisability of the results. Researchers and olicy makers acknowledge the need to modify the system and environmental drivers of obesity. 1,44,45 Policy actions to reduce noncommunicable chronic diseases and obesity, include banning SSB in schools, taxation of SSB and regulation of beverage marketing and romotion. 46,47 A number of countries have imlemented strategies to increase the comarative rice of SSB relative to other more nutritious beverages and there is evidence that younger eole are generally more sensitive to rice elasticity. 48 For almost a decade, the Australian Government has been considering a range of ublic health interventions to try to reduce SSB consumtion across the oulation, but none has been systematically imlemented. 49,5 Further research is required to exlore the economic imact of current and rojected consumtion atterns for Australia to rovide evidence for otential fiscal and regulatory interventions. In summary, SSB consumtion was associated with increased revalence of obesity, and SSB consumers were more likely to be: younger; males; have urchased a meal away from home on the day rior to the survey; or have oorer selfreorted health status than those who did not consume SSB. Those with little interest in the health asects of the food they ate were more likely to consume SSB, suggesting that increasing the general community awareness of and interest in the adverse health effects of SSB may be a first ste in changing social norms to curb soft drink intake. Acknowledgements Western Australia: The Nutrition Monitoring Survey Series is owned and funded by the Deartment of Health in Western Australia. Healthway, the Western Australian Health Promotion Foundation, funded Curtin University to assist the translation of research into ractice through the Food Law, Policy and Communications to Imrove Public Health Project. We thank Janette Lewis and Claire Pulker for assisting with the final manuscrit rearation. South Australia: The data is owned by South Australian Health and collected by Poulation Research and Outcome Studies (PROS), within The University of Adelaide. SA Health rovided funding to establish the Physical Activity and Nutrition Observatory: Research and Monitoring Alliance (PANORAMA). CSIRO received funding from PANORAMA to assist in nutritionrelated rojects. References 1. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity andemic: Shaed by global drivers and local environments. Lancet. 211;378(9793): Pereira MA. The ossible role of sugarsweetened beverages in obesity etiology: A review of the evidence. Int J Obes. 26;3:S28S Malik VS, Hu FB. Sugarsweetened beverages and health: Where does the evidence stand? Am J Clin Nutr. 211;94(5): Malik VS, Pokin BM, Bray GA, Desres JP, Hu FB. 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