by Christine Nathe, RDH, MS; Tracy Cagle, RDH, BS; and Milissa Baca, RDH, BS
Americans recently have focused much attention on nutritional habits that affect childhood obesity. Many postulate that the introduction of soft drinks in schools adds to the obesity problem and contributes negatively to the dental health of school children.
Historically, soft drinks can trace their roots to mineral water found in natural springs. In fact, the first marketed soft drinks appeared in the 17th century. However, these carbonated drinks did not achieve great popularity in America until 1832, when John Mathews invented his apparatus for making carbonated water. Amazingly, the consumption of these drinks was considered a healthy practice, and pharmacists started adding medicinal and other flavorful herbs to the beverage.1 In fact, since their creation, soft drinks have become integrated into many aspects of life. Soft drink companies enjoy global popularity; their logos are seen on everything from scoreboards at high school football games to baby bottles.
What is a soft drink?
The average can of soft drink contains 40 grams of sugar, the equivalent of about 10 teaspoons. Soft drinks contain carbonated water, phosphoric and/or citric acid, flavoring, and usually coloring. Soft drinks are 100 percent carbohydrates; they contain no proteins or fats. Simply put, soft drinks are very low in saturated fat and cholesterol, high in sugar, and often contain large amounts caffeine. Tables 1 and 2 give detailed information on the nutritional composition of soft drinks.2
Over the years, the consumption of soft drinks has increased tremendously. Studies have reported that in 1970, each person consumed 22.2 gallons of soft drinks per year. Today, every man, woman, and child consumes approximately 56 gallons per year, or more than one-and-a-half cans per day. This means that more than 14 billion gallons of soda were consumed in the United States alone in 1999.3 In addition, 12-ounce cans of soft drinks increasingly are being replaced by 20-ounce plastic bottles. Americans drinking soft drinks from 20-ounce bottles will surely increase their consumption in this decade.
What are the side effects?
There are many reported side effects to the consumption of soft drinks. These include dental caries, enamel erosion, obesity, nutritional deficiencies, and a possible decrease in milk consumption, potentially resulting in a subsequent risk of osteoporosis and fractures.
According to the Surgeon General’s Oral Health Report, dental caries is the single most common childhood disease. Studies indicate that soft drinks adversely affect enamel erosion by combining with bacteria in the mouth to form acid. Frequent ingestion of these sugar-containing, acidic beverages is a risk factor in the frequency and severity of dental caries.
Another concern related to soft drinks is early childhood caries. Infants and toddlers frequently are given soft drinks in baby bottles and sippy cups. In fact, babies can drink from bottles with soft drink logos imprinted as a decorative advertisement.
Approximately 15 percent of children are overweight, and studies suggest a significant rise in the number of obese children annually. Obese children exhibit an alarming increase in the incidence of type 2 diabetes, high cholesterol, high blood pressure, sleep apnea, orthopedic problems, asthma, and liver disease. Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.4
The increasing consumption of soft drinks, in conjunction with related health issues, supports the need for further research to prevent chronic diseases. Drinking soft drinks often replaces a healthy alternative, such as water or milk. One study reported that children who were in the highest soft drink consumption category consumed less milk and fruit juice compared to those in the lowest consumption category.5 Another study reported a 40 percent decrease in milk consumption when a child frequently consumes soft drinks.
Another controversial issue surrounding soft drinks is concern about the addictive properties of the caffeine, which is found in 70 percent of soft drinks on the market. Soft drink companies that add caffeine report that it enhances the flavor of soft drinks; however, a recent study conducted at John Hopkins University suggested that only 8 percent of adults could differentiate between caffeinated and noncaffeinated cola soft drinks.6
The major soft drink companies spend millions of dollars annually on product promotion. One controversial aspect of these promotional activities is the placement of vending machines in public schools.
Spruill states that in the last decade, schools have become the fastest growing advertising markets for commercial companies.7 Starting in 1995, soft drink companies began advertising in schools with long-term contracts - called “Pouring Rights”8 - in exchange for financial contributions.
Pouring rights are mostly aimed at elementary schools, high schools, and colleges. The contract enables schools to make special purchases for the students, such as computers, books, and physical education equipment. Schools with contracts receive a percentage of the profit from the vending machines and sales at special events. These contracts mandate that the soft drink be present at school events.4 In fact, some contracts restrict teachers and visitors from wearing another soft drink brand’s logo on clothing while on school property. Many times, schools are required to display signage and other promotional materials with the company’s logo on them, in exchange for funding.8
Opposition to pouring rights
Many parental and health-care organizations oppose the presence of soft drink vending machines in the school
environment. Quite logically, the promotion of high-sugar, high-caffeine beverages is in direct conflict with the mission of schools to promote students’ welfare. The school environment should promote healthy eating instead of jeopardizing students’ health. Although many exclusive contracts exist, there is a rising number of schools that are rejecting soft drink company contracts.7
A nationwide survey of vending machines in middle and high schools states that 75 percent of the drinks are of poor nutritional value.9 Moreover, one study suggested that several factors may be associated with soft drink intake in school-age children, most notably taste preferences, soft drink consumption habits of parents and friends, soft drink availability in the home and school, and television viewing.5 Fortunately, the San Francisco board of education has passed a Commercial-Free Schools Act to limit advertising in schools and restrict contracts with soft drink companies. More schools have implemented similar restrictions to soft drink promotion in the school environment.
A statement from the American Academy of Pediatrics urges school officials and parents to become well-informed about the health implications before making a decision to allow soft drink vending machines in schools. Further, a clearly defined, district-wide policy that restricts the sale of soft drinks will safeguard against health problems as a result of overconsumption.10
Few would argue that soft drinks are considered to be unhealthy, and most would agree that there is no reason to increase the potential consumption of soft drinks by children at school. Moreover, soft drink consumption is related to many negative health conditions and diseases, much as cigarette smoking is. Most Americans would not think of installing cigarette machines in schools or advertising cigarettes to children; however, many school officials choose to promote soft drink consumption by making them available to school children and by advertising these products. Given the fact that dental caries is the most common childhood disease and that obesity is on the rise in the United States, the decision to promote soft drinks to school children seems a poor choice.
School officials, parents, and children must be educated about the possible health consequences related to the overconsumption of soft drinks. And even though the public school system may be in need of funding for programs and equipment, the rejection of exclusive beverage contracts from soft drink companies, accompanied by reduced access to these products, will help improve the overall health of school children in America.
1 Bellis M. Introduction to pop - Part 2: the history of soft drinks. Inventors. http://inventors.about.com. 7/11/04.
2 Ron Johnson Engineering, Inc. d.b.a. Nutrition Data.com. 1/10/05.
3 Academy of General Dentistry. Soda Attack. General Dentistry July/August 2004. http://www.agd.org. 1/10/05.
4 Torgan C. Childhood obesity on the rise. NIH Word on Health. National Institutes of Health 2002.
5 Harnack L, Stang J, and Story M. Soft drink consumption among U.S. children and adolescents: nutritional consequences. J am Diet Assoc 1999; 99:436-41.
6 Griffiths RR, Vernotica EM. Is caffeine a flavoring agent in cola soft drinks? Arch Fam Med 2000; 9:727-734.
7 Spruill WT. PDA establishes position statement on cola contracts in schools. Pennsylvania Dental Journal Sept. 2000; 29-32.
8 Nutrition policy profiles: soft drinks contracts in schools 9/28/2002. http://www.preventioninstitute.org/CHI_soda.html.
9 School vending machines “dispensing junk.” CSPI newsroom. http://www.cspinet.org.
10 American Academy of Pediatrics Committee on School Health. Soft drinks in schools. Pediatrics 2004; 113:152-154.
Christine Nathe, RDH, MS, is associate professor and graduate program director at the University of New Mexico, Division of Dental Hygiene and author of Dental Public Health, which can be accessed at www.prenhall.com/nathe. She can be reached at [email protected] or by phone at (505) 272-8147. Tracy Cagle, RDH, BS, and Milissa Duran, RDH, BS, are both former students of the University of New Mexico, Division of Dental Hygiene in Albuquerque, N.M.