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Objective: To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years., Design: We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10-17 years with parental consent., Setting: Retail food outlets in Mississippi and Alabama, USA., Participants: Adults (n 11 311) and adolescents (n 3460)., Results: The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male - female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings., Conclusions: SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.

Objective: We aimed to explore the range of stakeholders' perceptions of the Balance Calories Initiative (BCI), under which the American Beverage Association pledged to decrease per capita US consumption of beverage energy by 20 % by 2025., Design: Semi-structured cross-sectional interviews were conducted in 2017., Setting: Participants were recruited from communities targeted by the BCI (Montgomery, AL; North Mississippi Delta, MS; Eastern Los Angeles, CA).ParticipantsA total of thirty-three parents and thirty-eight youths aged 10-17 years were recruited through youth-serving organizations, street intercept and snowball sampling; sixteen store/restaurant managers were recruited at businesses. Participants were asked about their awareness of the BCI. Parents and youths were asked to 'think aloud' as they viewed BCI messages (e.g. 'Balance What You Eat, Drink, and Do') and managers were asked about beverage marketing., Results: Twelve parents and twenty-four youths had seen BCI messages; only four managers were aware of the BCI. Many parents and youths showed some misunderstanding of BCI messages (e.g. that they should drink more sugar-sweetened beverages (SSB) or they needed to equalize healthy and unhealthy beverage intake). Only one manager had communicated with beverage companies about the BCI., Conclusions: We found mixed comprehension and low awareness of BCI messages in communities targeted by the American Beverage Association for reduced SSB consumption. Industry self-regulation attempts to reduce SSB consumption may have limited effectiveness if stakeholder input is not addressed. Public health practitioners should be aware of the need to address youths' and parents' misunderstandings about SSB consumption, especially in BCI-targeted communities.

We quantified the placement and promotion of beverages in groceries, supermarket and convenience stores in the communities targeted by The Balance Calories Initiative, a campaign launched by the top three American beverage companies to help Americans reduce consumption of sugar from beverages by 20% by 2025. The companies promised to drive interest in low- and no-calorie beverages through promotional efforts such as product placement, featured merchandising, couponing and other incentives, with more intensive efforts in low-income communities in communities in Alabama, Mississippi, and Southern California. We also measured two comparison communities not specifically targeted by The Balance Calories Initiative, observing 69 retail outlets in 5 localities in 2016-2017. We found that sugar-sweetened beverages (SSBs) were the most common beverage in all outlets, and the brands of the companies pledging changes in marketing strategies the most dominant. SSBs were placed in an average of 25 separate locations in groceries vs. 15 for low/no-calorie beverages and 11 for water. No differences were noted between East LA stores observed 2 years after the initiative vs. stores in the North Mississippi Delta, Montgomery or the comparison stores. Given prior evidence that exposure to point-of-sale displays influences purchases, reducing the number and location of displays of SSBs should be considered to reduce SSB consumption., (Copyright © 2018 Elsevier Inc. All rights reserved.)