HLTH 6413 Module 3 Intervention Evaluation Paper Example

Matching the Remedy to the Barrier: Evaluating Five Interventions to Cut Sugary Drinks Among Families in a Kentucky Mountain County

Student Name

American College of Education

HLTH6413: Fundamentals in Health Education

Module 3 Assignment

Instructor Name

March 16, 2026

Introduction

The first two modules linked the heavy soda, sweet tea and energy drink habits of families in a composite Kentucky mountain county to habit and taste, caffeine for long commutes, hospitality customs, low soda prices, doubts about the safety of tap and well water and rules and budgets that do little to change what is sold or served, and concluded that programs should aim at confidence, barriers and the environment rather than knowledge alone. This paper evaluates five interventions that address those barriers. Each is judged on four criteria: the strength of the evidence, how directly it addresses the county's barriers, whether the county could carry it out and whether it would reach the families with the greatest need.

The Barriers to Be Overcome

Four barriers stand out from the earlier analysis. The first is the availability of sugary drinks at home, where most consumption happens and where habits are learned. The second is the lack of a trusted, cheap alternative, since many parents distrust tap and well water while bottled water is pricier than soda. The third is social custom, the expectation that sugary drinks will be offered at gatherings and given to children as treats. The fourth is price, which favors soda in local stores. An intervention that addresses none of these, such as a poster campaign on sugar content, is excluded from the evaluation.

Evaluation Criteria

Evidence is judged by study design and certainty, drawing where possible on systematic reviews. Fit is judged by how many of the four barriers an intervention addresses and how directly. Feasibility considers cost, staffing, partners and whether the county has authority to act. Equity asks whether low-income families, families on wells and families far from the county seat would benefit, or whether the intervention would mostly help those already best placed to change.

Intervention 1: School Water Promotion

In a cluster-randomized trial in 32 elementary schools in socially deprived areas of two German cities, installing water fountains and teaching four classroom lessons on water raised children's water intake by 1.1 glasses a day and reduced the risk of overweight by 31% compared with control schools, although it did not change juice or soft drink consumption (Muckelbauer et al., 2009). The Cochrane review of environmental interventions rated the evidence that school water availability reduces sugary drink intake as very low certainty (von Philipsborn et al., 2019). For the county, the approach fits the barrier of trusted water only if the water is trusted: nearly two in five young people nationally doubt that school fountains are clean and safe (Onufrak et al., 2014). Chilled filtered bottle-filling stations, with posted test results, would address that concern. Feasibility is good, since the district can fund stations through facility budgets, and equity is strong because every child attends school. The weakness is that the intervention reaches children at school, while most sugary drinks are consumed at home.

Intervention 2: Home Beverage Delivery

The Cochrane review judged with moderate certainty that stocking the home with more low-calorie drinks reduced sugary drink intake and high-certainty evidence that it reduced body weight among adolescents with overweight and high baseline intake (von Philipsborn et al., 2019). The best-known trial randomized 224 adolescents with overweight or obesity who regularly drank sugary drinks; the intervention group received home deliveries of water and noncaloric drinks for a year, and their sugary drink intake fell to nearly zero, with significant differences in body mass index and weight at one year that were not sustained at two years after deliveries stopped (Ebbeling et al., 2012). This intervention addresses the home availability barrier directly and, if deliveries include water, the alternative barrier too. Its drawbacks are cost and sustainability, and its effect faded when support ended. For the county, a time-limited delivery of bottled or filtered water paired with coaching could start new habits, but it would need a plan for what replaces it.

Intervention 3: Community Campaigns

The Cochrane review found moderate-certainty evidence that multicomponent community campaigns focused on sugary drinks were associated with decreased sales (von Philipsborn et al., 2019). Such campaigns combine media, events, work with stores and organizations and changes in what is served at community settings. In the county, a campaign could work through churches, schools, youth sports leagues and the extension office, changing what is served at suppers and ballgames and giving families social permission to offer water. This intervention addresses the social custom barrier better than any other and supports the others. Its evidence comes largely from sales data rather than individual intake, and it needs sustained local leadership.

Intervention 4: Price Measures

Price increases on sugary drinks are associated with decreased sales, with moderate certainty in the Cochrane review (von Philipsborn et al., 2019), which excluded taxes as a separate topic. The best-known local example is the one-cent-per-ounce tax that Berkeley, California, introduced in 2015; surveys in low-income Berkeley neighborhoods found a 21% fall in sugary drink consumption after the tax began, while consumption rose 4% in two comparison cities, and water intake rose more in Berkeley as well (Falbe et al., 2016). A tax addresses the price barrier directly, but a county in Kentucky lacks the authority to levy one, and the idea would face strong opposition. More feasible price measures include discounts on water at participating stores and removing sugary drinks from price promotions at events the county or schools control. Price measures fit the problem well but fit the county's political authority poorly.

Intervention 5: Water Testing and Filters

No trial in the evaluated literature tests free water testing and filters as a way to reduce sugary drinks, but the logic follows from the determinants. Distrust of tap water is associated with lower water intake among some groups (Onufrak et al., 2012), and in the county survey 41% of parents would not let children drink tap water. Offering free well and tap testing through the health department, sharing results in plain language and providing filter pitchers or faucet filters to families whose water is safe but distrusted, or bottled water and referral to families whose water is not, addresses the alternative barrier at its root. The intervention is feasible, since the health department already tests wells, and it is equitable, reaching rural families on wells first. Its effect on sugary drink intake would need to be evaluated.

Comparing the Five

On evidence, home beverage availability and community campaigns rank highest, followed by price measures, with school water promotion and water testing lower. On fit, community campaigns address the most barriers, while water testing and home delivery address the alternative and home availability barriers directly. On feasibility, school water stations, water testing and community campaigns are within the county's reach; taxes are not, and delivery is costly. On equity, water testing and school water stations reach families with the greatest need most reliably. No single intervention addresses every barrier well.

Recommendation

The evaluation supports a combination: a community campaign working through churches, schools and sports leagues as the backbone; water testing and filters to make home water trusted; filtered bottle-filling stations in schools with posted test results; a short period of home water delivery and coaching for families with high intake; and voluntary price measures at events the county and schools control. The combination addresses all four barriers and stays within the county's authority. Module 4 will examine the ethical issues such a program raises, and Module 6 will develop it into a full proposal.

Conclusion

Evaluating interventions against local barriers, rather than choosing the best-known option, shows that the strongest evidence does not always match the county's situation. Home availability and community campaigns have good evidence; water trust is the barrier most particular to the coalfields, and addressing it may be the key that makes the other interventions work.

References

Ebbeling, C. B., Feldman, H. A., Chomitz, V. R., Antonelli, T. A., Gortmaker, S. L., Osganian, S. K., & Ludwig, D. S. (2012). A randomized trial of sugar-sweetened beverages and adolescent body weight. New England Journal of Medicine, 367(15), 1407-1416. https://doi.org/10.1056/NEJMoa1203388

Falbe, J., Thompson, H. R., Becker, C. M., Rojas, N., McCulloch, C. E., & Madsen, K. A. (2016). Impact of the Berkeley excise tax on sugar-sweetened beverage consumption. American Journal of Public Health, 106(10), 1865-1871. https://doi.org/10.2105/AJPH.2016.303362

Muckelbauer, R., Libuda, L., Clausen, K., Toschke, A. M., Reinehr, T., & Kersting, M. (2009). Promotion and provision of drinking water in schools for overweight prevention: Randomized, controlled cluster trial. Pediatrics, 123(4), e661-e667. https://doi.org/10.1542/peds.2008-2186

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

von Philipsborn, P., Stratil, J. M., Burns, J., Busert, L. K., Pfadenhauer, L. M., Polus, S., Holzapfel, C., Hauner, H., & Rehfuess, E. (2019). Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database of Systematic Reviews, Article CD012292. https://doi.org/10.1002/14651858.CD012292.pub2