State-Level Differences in Sugar-Sweetened Beverage Consumption by Income Among Children Aged 1–5 Years, United States, 2021–2023

BACKGROUND: Sugar-sweetened beverage (SSB) consumption among young children can be associated with obesity and other adverse health outcomes. Consumption varies by socioeconomic factors such as household income and geographic region, although how these factors might jointly affect SSB consumption is unknown. We evaluated state-level associations between income-to-poverty ratio (IPR) and SSB consumption among children aged 1-5 years in the United States. METHODS: We conducted a pooled cross-sectional study of 55,399 children aged 1-5 years using 2021-2023 National Survey of Children's Health data. We estimated the prevalence of SSB consumption ≥4 times per week by household IPR (<130%, 130%-349%, ≥350%) and state. Multivariable logistic regression evaluated the association between IPR and SSB consumption after adjusting for age, sex, and race and ethnicity. RESULTS: Nationally, 21.1% (95% confidence interval [CI]: 20.2%-21.9%) of children consumed SSBs ≥4 times per week, and this varied significantly by IPR (<130%: 33.1% [95% CI: 30.7%-35.6%], 130%-349%: 22.4% [95% CI: 21.0%-23.9%], ≥350%: 12.1% [95% CI: 11.2%-13.0%]). Substantial geographic variation was observed; SSB consumption ranged from 8.6% (95% CI: 6.4%-11.3%) in Vermont to 33.7% (95% CI: 28.9%-38.8%) in Mississippi. In multivariable models, children from households with a lower IPR (<130% compared with ≥350%) had significantly higher SSB consumption for most states, although the magnitude of this association differed by state. CONCLUSIONS: To reduce SSB consumption among young children, findings highlight the need for potential interventions tailored to the needs of those residing in low-income households.