Data source and study sample
This study used data from Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) study, which is a comprehensive longitudinal multicenter community–based cohort study of Hispanic/Latino adults in the United States.30 Between 2008 and 2011, 16,415 U.S. Hispanic/Latino adults were recruited from a random sample of households in four communities (i.e., Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA).
Between 2012 and 2014, SOL Youth recruited 1,465 youth aged 8-16 years whose parent or caregiver was part of HCHS/SOL.31, 32 For these analyses, we included youth with complete and valid SSB consumption data, as well as complete and valid data for family functioning, socio-cultural factors, and demographics. Study questionnaires to collect these data were administered by bilingual staff and in the youth language of preference. We excluded 210 cases due to incomplete data across key study variables. The overarching goal of the SOL-Youth study was to evaluate the influence of youth acculturation, effects of intergenerational influence in acculturation between youth and parents, parenting practices, as well as psychosocial functioning on cardiometabolic risk in Hispanic/Latino youth. 31, 32 SOL-Youth had a cross-sectional design and included children who were assented to participate through voluntarily written informed consent. The study was conducted with approval of the Institutional Review Board at all study institutions, including the HCHS/SOL coordinating center and laboratory.
SSB consumption was measured through two 24-hour dietary recalls from each child, with parental assistance if necessary. The initial dietary recall was conducted in person and the second dietary recall was conducted by telephone within a month of the first assessment. The Nutrition Data System for Research (NDSR) software was used to collect the data and to categorize SSB consumed into the following groups: (a) sugar sweetened beverages; (b) 100% fruit juice; (c) sweetened soft drinks; and (d) sweetened fruit drinks. The average frequency of servings per day (8 fluid ounces) across beverage categories was used as the outcome measure.
Hispanic/Latino youth’ acculturation status was measured using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA).33 Scale scores ranged from 1 to 8. Under the assumption that acculturation itself is a dynamic process and that AHIMSA contains correlated sub-scales, youth were grouped into categories based on their acculturation status: Both Countries Orientation (Integration), United States orientation (Assimilation), orientation to other or neither country (Marginalization or Separation), and Unclassified. This categorical variable was used as grouping variable for descriptive purposes as well as the moderator in the final analytical output.
Hispanic/Latino youth’ acculturative stress was measured using the Acculturative Stress Index34 through three indicators: language conflict, family acculturation conflicts, and discrimination. To denote acculturative stress in our study, we developed a latent construct of acculturative stress composed of the three indicators aforementioned. This approach was used given that it accounts for measurement error, and tests whether these sub-domains represent well the higher construct (acculturative stress). Each indicator used a 5-point scale and, collectively, showed good compatibility to denote acculturative stress as a latent construct (a > 0.61; r > 0.32; b > 0.41).
Hispanic/Latino youths’ family functioning was measured using the 12-item General Functioning subscale of the McMaster Family Assessment Device, which measures overall health of the family.35 Example of statements include: “Planning family activities is difficult because we misunderstand each other;” “We cannot talk to each other about the sadness we feel;” “Making decisions is a problem for our family.” To denote family functioning in our study, the average of all of the items was used. Family functioning scores ranged from 1 to 4, with greater scores indicating poorer family functioning.
Demographic characteristics included as covariates in all models were youth age in years (8-16 years old), youth’ sex (male or female), birthplace (mainland U.S. or outside U.S.), parental educational attainment (less than high school, high School/GED, four-year college or university or more), family income (less than $20,000, $20,000-$50,000, greater than $50,000), and household composition (continuous). The Healthy Eating Index (HEI-2010) was also used as a covariate to represent overall diet quality.36
We used descriptive statistics to summarize demographic characteristics and key study variables (dependent and independent variables). Multi-group path regression models were used to test our study hypotheses using Structural Equation Modelling (SEM). Hispanic/Latino youth’ SSB consumption was used as the dependent variable in all models. Hispanic/Latino youth’ acculturative stress and family functioning were used as independent variables on SSB consumption to test our main hypothesis. Hispanic/Latino youth’ acculturation status was used as the categorical grouping variable. Hispanic/Latino youth’ age and sex were used as covariates in all models. We used 0.05 as the significance level. Model fit was assessed using the root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), and the Comparative Fit Index (CFI).33 In order for our models to attain good fit to the data, the following criteria had to be met: RMSEA (≤0.08), SRMR (≤0.10), and CFI (≥0.90).37 Missing data was handled using listwise deletion. Statistical software STATA 14 was used to perform all analyses while accounting for the complex survey design, sampling weights, and clustered nature of the data.