HLTH 6413 Module 1 Lifestyle Determinants Research Paper Example

Two Liters Cheaper Than Water: Social, Political, Economic and Personal Determinants of Sugary Drink Consumption in Families of an Eastern Kentucky Coalfield County

Student Name

American College of Education

HLTH6413: Fundamentals in Health Education

Module 1 Assignment

Instructor Name

March 2, 2026

Introduction

In the grocery aisles of a composite county in the eastern Kentucky coalfields, a two-liter bottle of store-brand soda often costs less than a gallon of bottled water, and in many homes the tap water is not trusted. Parents buy soda, sweet tea, fruit drinks and energy drinks by the case, and children as young as two drink them daily. The county health department's school health educator has been asked to lead a response, and a response depends on understanding why families make this choice. This paper researches the determinants of sugary drink consumption in the county's families, organized into four groups that the course emphasizes: personal, social, economic and political. It draws on national surveillance, research in Appalachia and a 2025 county parent survey completed by 312 parents of children in the county's four elementary schools.

The Lifestyle Choice and Its Stakes

Sugar-sweetened beverages include regular soda, fruit drinks, sports and energy drinks and sweetened tea and coffee. Frequent consumption is linked to excess weight, type 2 diabetes, cardiovascular disease and dental caries. Nationally, intake has fallen substantially: analysis of National Health and Nutrition Examination Survey data found that average daily energy from these drinks among Americans aged two and older fell from 183.9 kilocalories in 2003-2004 to 95.0 in 2015-2016, with declines in every age group (Marriott et al., 2019). The decline has not been even. In the county survey, 58% of parents said their child drank at least one sugary drink every day, and 34% said their child drank three or more. Parents reported similar habits of their own. The county's rates of childhood obesity and adult diabetes are well above state averages, and dentists at the county's federally qualified health center describe severe tooth decay in young children as routine.

A Frame for the Determinants

In the ecological perspective, individual traits, relationships, organizations, communities and public policy all bear on behavior at the same time (McLeroy et al., 1988). The four groups of determinants in this paper map onto those levels. Personal factors sit at the individual level; social factors at the levels of relationships and community; economic factors at the community and organizational levels; and political factors at the policy level. Organizing the evidence this way prevents a common error, treating sugary drinks as a matter of individual willpower when most of the forces behind them sit outside the individual.

Personal Determinants

Taste and habit come first. Parents in the survey most often said their families drank soda because they liked it and had always had it in the house. Caffeine is a second personal factor: many adults in the county commute an hour or more each way to jobs in regional towns, and energy drinks and soda keep them alert on mountain roads. Age matters as well. In a study of 150 adults in one rural Appalachian Kentucky county, those aged 22 to 38 drank an average of 329.2 kilocalories a day from sugary drinks, compared with 157.0 among those aged 39 to 54 and 134.6 among those 55 and older, and younger adults drank far more sweetened fruit drinks and energy drinks (Norman-Burgdolf et al., 2021). Because younger adults are the parents of young children, their habits shape what children learn to drink. Knowledge is a weaker determinant than one might expect: most parents surveyed knew soda was unhealthy but did not count fruit drinks or sweet tea as sugary.

Social Determinants

Sugary drinks are woven into social life. Sweet tea and soda are offered to guests as a matter of hospitality, served at church suppers, funeral dinners and ballgames and handed to children as treats by grandparents who care for them while parents work. Several parents described a sense that refusing a child a soda at a family gathering would seem stingy or judgmental. Peer habits among teenagers, especially energy drinks before school and sports, add another layer. These social patterns mean that a family trying to cut back must do so against the grain of the people around them.

Economic Determinants

Price and access shape choices strongly in a county where many families live on low incomes. The county has two full-service grocery stores, both in the county seat, and many families shop at dollar stores and gas stations closer to home. In a price check at eight stores, the health department found that store-brand soda sold for less per ounce than bottled water in six. Sugary drinks are also shelf-stable, easy to buy in bulk and heavily promoted with multipack discounts. When money is tight, a drink that is cheap, filling and liked by the children is an understandable choice.

Water Access and Trust

A determinant particular to the coalfields is distrust of water. Many rural households rely on wells, and residents have long memories of contamination from mining, boil-water notices and aging water systems. Nationally, 13.0% of adults disagreed that their local tap water was safe and 26.4% agreed that bottled water was safer than tap water, and among Hispanic adults distrust of tap water was associated with twice the odds of drinking a sugary drink every day (Onufrak et al., 2012). Among youth, nearly one in five disagreed that their tap water was safe and nearly two in five disagreed that school water fountains were clean and safe (Onufrak et al., 2014). In the county survey, 41% of parents said they would not let their children drink water from the tap at home. When water is distrusted and bottled water costs more than soda, the healthy choice becomes the expensive one.

Political Determinants

Policy shapes the beverage environment in several ways. Federal nutrition standards for foods and beverages sold in schools limit what can be sold during the school day, so the drinks children consume at school come mostly from home or from events after hours, such as concession stands. The Supplemental Nutrition Assistance Program, used by many county families, permits the purchase of sugary drinks, a policy debated nationally but unchanged in Kentucky. The county has no local beverage tax and no policy on beverages sold on county property. Aging public water systems and slow investment in rural water infrastructure are also political determinants, since they sustain the distrust described above.

How the Determinants Interact

The determinants reinforce one another. Economic pressure makes cheap drinks attractive; distrust of water removes the obvious alternative; social customs make sugary drinks a sign of care; personal habits formed in childhood carry into adulthood and are passed to the next generation; and policy leaves most of these conditions untouched. Families with the least income face the strongest combination, since they are more likely to rely on wells, to shop at convenience stores and to use benefits that permit sugary drink purchases.

Implications for Health Education

The research suggests that education focused on knowledge alone will have limited effect, since most parents already know soda is unhealthy. Education should correct specific gaps, such as the sugar content of fruit drinks and sweet tea, but the larger opportunities lie in making water trusted, available and appealing, working with churches and schools on the drinks served at gatherings and addressing the price environment. The following modules will examine the theories and principles of health education that fit this problem, evaluate interventions for overcoming its barriers, consider the ethical issues it raises and propose a research-based intervention.

Conclusion

Sugary drink consumption in this county is a lifestyle choice shaped far more by circumstances than by preference alone. Taste, caffeine and habit matter, but so do hospitality customs, prices, distrust of water and the policies that govern benefits, schools and water systems. Understanding these determinants is the foundation for health education that families will find realistic.

References

Marriott, B. P., Hunt, K. J., Malek, A. M., & Newman, J. C. (2019). Trends in intake of energy and total sugar from sugar-sweetened beverages in the United States among children and adults, NHANES 2003-2016. Nutrients, 11(9), Article 2004. https://doi.org/10.3390/nu11092004

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401

Norman-Burgdolf, H., DeWitt, E., Cardarelli, K. M., Gillespie, R., Slone, S., & Gustafson, A. (2021). Sugar-sweetened beverage consumption among adults in rural Appalachia. Preventive Medicine Reports, 24, Article 101642. https://doi.org/10.1016/j.pmedr.2021.101642

Onufrak, S. J., Park, S., Sharkey, J. R., & Sherry, B. (2012). The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults. Public Health Nutrition, 17(1), 179-185. https://doi.org/10.1017/S1368980012004600

Onufrak, S. J., Park, S., Sharkey, J. R., Merlo, C., Dean, W. R., & Sherry, B. (2014). Perceptions of tap water and school water fountains and association with intake of plain water and sugar-sweetened beverages. Journal of School Health, 84(3), 195-204. https://doi.org/10.1111/josh.12138