Associations Between Sugar-Sweetened Beverage Consumption and Fast-Food Restaurant Frequency Among Adolescents and Their Friends

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To assess associations between adolescents and their friends with regard to sugar-sweetened beverage (SSB)/diet soda intake and fast-food (FF) restaurant visits.


Population-based, cross-sectional survey study with direct measures from friends.


Twenty Minneapolis/St Paul schools during 2009–2010.


Adolescents (n = 2,043; mean age, 14.2 ± 1.9 years; 46.2% female; 80% non-white).

Main Outcome Measures:

Adolescent SSB/diet soda intake and FF visits.


Generalized estimating equation logistic models were used to examine associations between adolescents' SSB/diet soda intake and FF visits and similar behaviors in nominated friends (friend groups and best friends). School-level (middle vs high school) interactions were assessed.


Significant associations were found between adolescents and friends behaviors for each of the beverages assessed (P < .05), but they varied by friendship type and school level. Five of 6 models of FF visits (including all FF visits) were significantly associated (P < .05) among adolescents and their friends. Significant interactions by school level were present among adolescents' and friends' FF visits, with associations generally for high school participants compared with middle school participants (P < .05).

Conclusions and Implications:

Findings suggest that for many beverages and FF restaurant types, friends' behaviors are associated, especially FF visits for older adolescents. Nutrition education efforts may benefit by integrating knowledge of the impact of adolescents' friends on FF visits.

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