Factors Associated With Water Consumption Among Adolescents in Quebec

Main Article Content

Joannie Delisle-Martel
https://orcid.org/0009-0004-2367-1461
Dominique Beaulieu
https://orcid.org/0009-0000-9312-7593
Lydi-Anne Vézina-Im
https://orcid.org/0000-0001-9769-9847
Stéphane Turcotte
https://orcid.org/0000-0001-6031-4958
Anne-Frédérique Turcotte
https://orcid.org/0000-0002-0799-8411
Valérie Labbé
Lily Lessard
https://orcid.org/0000-0001-7581-4576
Mariane Gingras

Abstract

Introduction: Water is a healthy alternative to sugar-sweetened beverages (SSB) consumption.
 
Objective: Identify psychosocial factors associated with water consumption among adolescents from Quebec (Canada).
 
Method: Data collection took place in 12 regions of Quebec (March-July 2023). A total of 218 French-speaking adolescents (82.1% between 14 and 16 years; 55.5% girls) completed an online questionnaire based on the Reasoned Action Approach. Water and SSB consumption was measured using a validated French version of the Beverage Questionnaire.
 
Results: Adolescents reported consuming an average of 1591.4 ml of water and 283.3 ml of SSB per day. The intention to make water the drink of choice every day was significantly associated with the behavior of consuming more than 1000 ml of water per day (OR: 1.96; 95% CI: 1.17-3.25). Self-identity (β = 0.43; p <0.0001), perceived behavioral control (β = 0.30; p <0.0001), affective attitude (β = 0.16; p = 0.0033) and descriptive norm (β = 0.15; p = 0.0007) explained 73% of the variance in intention.
 
Discussion and Conclusion: This study highlights avenues for interventions aimed at promoting water as the drink of choice to replace SSB intake among young Quebecers. The results will be useful for nurses and other stakeholders in public health, schools, and clinical settings to better understand what influences adolescents to drink water to promote healthy hydration habits and, consequently, favor health.

Article Details

How to Cite
Delisle-Martel, J., Beaulieu, D., Vézina-Im, L.-A., Turcotte, S., Turcotte, A.-F., Labbé, V., … Gingras, M. (2025). Factors Associated With Water Consumption Among Adolescents in Quebec. Science of Nursing and Health Practices. https://doi.org/10.62212/snahp.152
Section
Empirical research articles

References

Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.

http://dx.doi.org/10.1016/0749-5978(91)90020-T

Armfield, J. M., Spencer, A. J., Roberts-Thomson, K. F. et Plastow, K. (2013). Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children. American journal of public health, 103(3), 494–500. https://doi.org/10.2105/AJPH.2012.300889

Barrett, N., Colón-Ramos, U., Elkins, A., Rivera, I., Evans, W. D. et Edberg, M. (2017). Formative Research to Design a Promotional Campaign to Increase Drinking Water among Central American Latino Youth in an Urban Area. Journal of health communication, 22(6), 459–468. https://doi.org/10.1080/10810730.2017.1303557

Beaulieu, D., Vézina-Im, L.-A., Simard, D. et Boucher, D. (2018). Beliefs of Adolescents on Sugar-Sweetened Beverages Abstinence: A Reasoned Action Approach Elicitation Study. Science of Nursing and Health Practices / Science infirmière et pratiques en santé, 1(1), 1–12. https://doi.org/10.31770/2561-7516.1002

Beaulieu, D., Vézina-Im, L. A., Turcotte, S., Guillaumie, L., Boucher, D., Douville, F. et Simard, D. (2020). Correlates of sugar-sweetened beverages consumption among adolescents. Public health nutrition, 23(12), 2145–2154. https://doi.org/10.1017/S1368980019005147

Bleich, S. N. et Vercammen, K. A. (2018). The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC obesity, 5, 6. https://doi.org/10.1186/s40608-017-0178-9

Bogart, L. M., Babey, S. H., Patel, A. I., Wang, P. et Schuster, M. A. (2016). Lunchtime School Water Availability and Water Consumption Among California Adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 58(1), 98–103. https://doi.org/10.1016/j.jadohealth.2015.09.007

Camirand, H., Conus, F., Davison, A., Dupont, K., Gonzalez-Sicilia, D., Joubert, K. et Niyibizi, J. (2023, mai). Enquête québécoise sur la santé de la population 2020-2021. Québec. Institut de la statistique du Québec. https://statistique.quebec.ca/fr/fichier/enquete-quebecoise-sante-population-2020-2021.pdf

Centers for Disease Control and Prevention. (2011). Beverage consumption among high school students --- United States, 2010. Morbidity and Mortality Weekly Report, 60(23), 778–780. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6023a2.htm

Cradock, A. L., Everett Jones, S. et Merlo, C. (2019). Examining differences in the implementation of school water-quality practices and water-access policies by school demographic characteristics. Preventive medicine reports, 14, 100823. https://doi.org/10.1016/j.pmedr.2019.100823

Drapeau, V., Laramée, C., Lafreniere, J., Trottier, C., Brochu, C., Robitaille, J., Lamarche, B. et Lemieux, S. (2024). Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent’s population. Nutrition journal, 23(1), 66. https://doi.org/10.1186/s12937-024-00954-0

Duncan, M. J., Belita, E., Amores, A., Riazi, N. A., Carsley, S., Vanderloo, L. M., Carson, V., Chaput, J. P., Faulkner, G., Leatherdale, S. T. et Patte, K. A. (2024). Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity. BMC nutrition, 10(1), 27. https://doi.org/10.1186/s40795-024-00831-3

Dupont, D., Adamowicz, W. L. et Krupnick, A. (2010). Differences in water consumption choices in Canada: the role of socio-demographics, experiences, and perceptions of health risks. Journal of water and health, 8(4), 671–686. https://doi.org/10.2166/wh.2010.143

Fishbein, M. et Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. Psychology Press.

Fortin, M.-F. et Gagnon, J. (2022). Fondements et étapes du processus de recherche : méthodes quantitatives et qualitatives (4e éd.). Chenelière éducation.

Franken, S. C. M., Smit, C. R., de Leeuw, R. N. H., van Woudenberg, T. J., Burk, W. J., Bevelander, K. E. et Buijzen, M. (2023). Understanding the behavioral determinants of adolescents’ water consumption: A cross-country comparative study. Dialogues in health, 2, 100101. https://doi.org/10.1016/j.dialog.2023.100101

Gagné, C. et Godin, G. (2012). La mesure des variables théoriques et des comportements. Dans G. Godin (dir.), Les comportements dans le domaine de la santé : comprendre pour mieux intervenir (p. 231-292). Les Presses de l’Université de Montréal.

Gouvernement du Canada. (2025, 26 février). https://guide-alimentaire.canada.ca/fr/

Gowland-Ella, J., Batchelor, S., David, M., Lewis, P. et Kajons, N. (2023). The outcomes of Thirsty? Choose Water! Determining the effects of a behavioural and an environmental intervention on water and sugar sweetened beverage consumption in adolescents: A randomised controlled trial. Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals, 34(2), 410–419. https://doi.org/10.1002/hpja.623

Hill, C. E., MacDougall, C. R., Riebl, S. K., Savla, J., Hedrick, V. E. et Davy, B. M. (2017). Evaluation of the Relative Validity and Test-Retest Reliability of a 15-Item Beverage Intake Questionnaire in Children and Adolescents. Journal of the Academy of Nutrition and Dietetics, 117(11), 1757–1766.e5. https://doi.org/10.1016/j.jand.2017.05.011

Huerta-Saenz, L., Irigoyen, M., Benavides, J. et Mendoza, M. (2012). Tap or bottled water: drinking preferences among urban minority children and adolescents. Journal of community health, 37(1), 54–58. https://doi.org/10.1007/s10900-011-9415-1

Institut national de santé publique du Québec. (2019, 16 mai). Milieux ruraux et urbains : Quelles différences de santé au Québec? Gouvernement du Québec. https://www.inspq.qc.ca/santescope/milieux-ruraux-urbains

International Agency for Research on Cancer. (2018). Absence of excess body fatness. IARC Working Group on the Evaluation of Cancer-Preventive Interventions, 16, 1–646. http://publications.iarc.fr/570.

Jones, A. Q., Dewey, C. E., Doré, K., Majowicz, S. E., McEwen, S. A., David, W. T., Eric, M., Carr, D. J. et Henson, S. J. (2006). Public perceptions of drinking water: a postal survey of residents with private water supplies. BMC public health, 6, 94. https://doi.org/10.1186/1471-2458-6-94

Jones, A. C., Kirkpatrick, S. I. et Hammond, D. (2019). Beverage consumption and energy intake among Canadians: analyses of 2004 and 2015 national dietary intake data. Nutrition journal, 18(1), 60. https://doi.org/10.1186/s12937-019-0488-5

Lin, Y., Zhang, N., Zhang, J., Lu, J., Liu, S. et Ma, G. (2024). Seasonality Affects Fluid Intake Behaviors among Young Adults in Hebei, China. Nutrients, 16(11), 1542. https://doi.org/10.3390/nu16111542

Malik, V. S. et Hu, F. B. (2019). Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence. Nutrients, 11(8), 1840. https://doi.org/10.3390/nu11081840

Marshall, T. A., Curtis, A. M., Cavanaugh, J. E., Warren, J. J. et Levy, S. M. (2021). Beverage Intakes and Toothbrushing During Childhood Are Associated With Caries at Age 17 Years. Journal of the Academy of Nutrition and Dietetics, 121(2), 253–260. https://doi.org/10.1016/j.jand.2020.08.087

Martin, C. et Arcand, L. (2005). Guide à l’intention du milieu scolaire et de ses partenaires : pour la réussite éducative, la santé et le bien-être des jeunes. Gouvernement du Québec. https://www.education.gouv.qc.ca/fileadmin/site_web/documents/dpse/adaptation_serv_compl/EcoleSante_GuideIntenMilieuScolPartenaires_f.pdf

McEachan, R., Taylor, N., Harrison, R., Lawton, R., Gardner, P. et Conner, M. (2016). Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 50(4), 592–612. https://doi.org/10.1007/s12160-016-9798-4

Merlo, C. L., Jones, S. E., Michael, S. L., Chen, T. J., Sliwa, S. A., Lee, S. H., Brener, N. D., Lee, S. M. et Park, S. (2020). Dietary and Physical Activity Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019. Morbidity and Mortality Weekly Report Suppl, 69(1), 64–76. https://doi.org/10.15585/mmwr.su6901a8

Michie, S., van Stralen, M. M. et West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science : IS, 6, 42. https://doi.org/10.1186/1748-5908-6-42

Muckelbauer, R., Gortmaker, S. L., Libuda, L., Kersting, M., Clausen, K., Adelberger, B. et Müller-Nordhorn, J. (2016). Changes in water and sugar-containing beverage consumption and body weight outcomes in children. The British journal of nutrition, 115(11), 2057–2066. https://doi.org/10.1017/S0007114516001136

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

Organisation mondiale de la Santé (OMS). (‎2018)‎. Soyez malin : buvez de l’eau! Un guide destiné aux directeurs des établissements scolaires pour limiter la vente et la commercialisation des boissons sucrées en milieu scolaire. Bureau régional de l’OMS pour le Pacifique occidental. https://iris.who.int/handle/10665/274110.

Park, S., Onufrak, S. J., Cradock, A. L., Hecht, C., Patel, A., Chevinsky, J. R. et Blanck, H. M. (2022). Factors Related to Water Filter Use for Drinking Tap Water at Home and Its Association With Consuming Plain Water and Sugar-Sweetened Beverages Among U.S. Adults. American journal of health promotion : AJHP, 36(5), 813–822. https://doi.org/10.1177/08901171211073304

Park, S., Sherry, B., O’Toole, T. et Huang, Y. (2011). Factors associated with low drinking water intake among adolescents: the Florida Youth Physical Activity and Nutrition Survey, 2007. Journal of the American Dietetic Association, 111(8), 1211–1217. https://doi.org/10.1016/j.jada.2011.05.006

Patel, A. I., Bogart, L. M., Klein, D. J., Burt Cowgill, Uyeda, K. E., Hawes-Dawson, J. et Schuster, M. A. (2014). Middle school student attitudes about school drinking fountains and water intake. Academic pediatrics, 14(5), 471–477. https://doi.org/10.1016/j.acap.2014.05.010

Patel, A. I. et Hampton, K. E. (2011). Encouraging consumption of water in school and child care settings: access, challenges, and strategies for improvement. American journal of public health, 101(8), 1370–1379. https://doi.org/10.2105/AJPH.2011.300142

Pica, L. A., Traoré, I., Bernèche, F., Laprise, P., Cazale, L., Camirand, H., Berthelot, M., Plante N. et Institut de la statistique du Québec. (2012). L’Enquête québécoise sur la santé des jeunes du secondaire 2010-2011. Le visage des jeunes d’aujourd’hui : leur santé physique et leurs habitudes de vie, Tome 1. Institut de la statistique du Québec. https://statistique.quebec.ca/fr/fichier/enquete-quebecoise-sur-la-sante-des-jeunes-du-secondaire-2010-2011-le-visage-des-jeunes-d-aujourdhui-leur-sante-physique-et-leurs-habitudes-de-vie-tome-1.pdf

Plante C., Blanchet C. et Rochette L. (2020). La consommation des Autres aliments et des boissons chez les Québécois. Collection : Regard sur l’alimentation des Québécois. Numéro 4. Institut national de santé publique du Québec. https://www.inspq.qc.ca/sites/default/files/publications/2634_consommation_autres_aliments_boissons.pdf

Riebl, S. K., Estabrooks, P. A., Dunsmore, J. C., Savla, J., Frisard, M. I., Dietrich, A. M., Peng, Y., Zhang, X. et Davy, B. M. (2015). A systematic literature review and meta-analysis: The Theory of Planned Behavior's application to understand and predict nutrition-related behaviors in youth. Eating behaviors, 18, 160–178. https://doi.org/10.1016/j.eatbeh.2015.05.016

Rise, J., Sheeran, P. et Hukkelberg, S. (2010). The role of self-identity in the theory of planned behavior: A meta-analysis. Journal of Applied Social Psychology, 40(5), 1085–1105. https://doi.org/10.1111/j.1559-1816.2010.00611.x

Rosinger, A. Y., Herrick, K. A., Wutich, A. Y., Yoder, J. S. et Ogden, C. L. (2018). Disparities in plain, tap and bottled water consumption among US adults: National Health and Nutrition Examination Survey (NHANES) 2007-2014. Public health nutrition, 21(8), 1455–1464. https://doi.org/10.1017/S1368980017004050

Roussel-Ouellet, J., Beaulieu, D., Vézina-Im, L. A., Turcotte, S., Labbé, V. et Bouchard, D. (2022). Psychosocial Correlates of Recreational Screen Time among Adolescents. International journal of environmental research and public health, 19(24), 16719. https://doi.org/10.3390/ijerph192416719

Samson, A. et Trudel C. (2019, 14 mars). Plan d’action pour réduire la consommation de boissons sucrées et promouvoir l’eau (publication no 18-289-04W). Gouvernement du Québec. https://publications.msss.gouv.qc.ca/msss/fichiers/2018/18-289-04W.pdf

Santina, T., Godin, G., Gagné, C. et Guillaumie, L. (2017). Psychosocial determinants of physical activity at school among Lebanese children: An application of the planned behavior theory. Journal of physical education and sport, 17(1), 171–181.

SAS Institute Inc. (2023). SAS (version 9,4) [logiciel]. https://www.sas.com/fr_ca/home.html

Slotnick, M. J., Wolfson, J. A. et Leung, C. W. (2023). Tap water perceptions and water filter use vary with socio-demographic characteristics and are associated with water and sugar-sweetened beverage consumption in university students. Public health nutrition, 26(11), 2288–2293. https://doi.org/10.1017/S1368980023001659

Smit, C. R., de Leeuw, R. N., Bevelander, K. E., Burk, W. J., Buijs, L., van Woudenberg, T. J. et Buijzen, M. (2021). Promoting water consumption among children: a three-arm cluster randomised controlled trial testing a social network intervention. Public health nutrition, 24(8), 2324–2336. https://doi.org/10.1017/S1368980020004802

Traoré, I., Simard, M. et Julien, D. (2024). Enquête québécoise sur la santé des jeunes du secondaire. Résultats de la troisième édition – 2022-2023. Institut de la statistique du Québec. https://statistique.quebec.ca/fr/fichier/enquete-quebecoise-sante-jeunes-secondaire-2022-2023.pdf

Vézina-Im, L. A. et Beaulieu, D. (2019). Determinants and Interventions to Promote Water Consumption Among Adolescents: a Review of the Recent Literature. Current nutrition reports, 8(2), 129–144. https://doi.org/10.1007/s13668-019-0275-0

Vézina-Im, L. A., Beaulieu, D., Turcotte, S., Savard, C., Lemieux, S., Boucher, D., Gallani, M. C. et Paquette, M. C. (2023). Validation d’un questionnaire mesurant la consommation de boissons sucrées, jus et eau auprès d’adolescents francophones. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en diététique : une publication des Diététistes du Canada, 84(3), 141–148. https://doi.org/10.3148/cjdpr-2023-002

Vézina-Im, L. A., Beaulieu, D., Turcotte, S., Turcotte, A. F., Delisle-Martel, J., Labbé, V., Lessard, L. et Gingras, M. (2024). Association between Beverage Consumption and Sleep Quality in Adolescents. Nutrients, 16(2), 285. https://doi.org/10.3390/nu16020285.

Vézina-Im, L. A., Beaulieu, D., Turcotte, S., Turcotte, A. F., Lessard, L., Delisle-Martel, J., Boucher, D., Labbé, V. et Gingras, M. (2024). Individual and environmental correlates of tap water consumption among adolescents in Canada. Appetite, 202, 107645. https://doi.org/10.1016/j.appet.2024.107645

von Haeften, I., Fishbein, M., Kasprzyk, D. et Montano, D. (2001). Analyzing data to obtain information to design targeted interventions. Psychology, Health & Medicine, 6(2), 151–164. https://doi.org/10.1080/13548500125076

Vos, M. B., Kaar, J. L., Welsh, J. A., Van Horn, L. V., Feig, D. I., Anderson, C. A. M., Patel, M. J., Cruz Munos, J., Krebs, N. F., Xanthakos, S. A., Johnson, R. K. et American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Functional Genomics and Translational Biology; and Council on Hypertension (2017). Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. Circulation, 135(19), e1017–e1034. https://doi.org/10.1161/CIR.0000000000000439

Welsh, J. A., Sharma, A., Abramson, J. L., Vaccarino, V., Gillespie, C. et Vos, M. B. (2010). Caloric sweetener consumption and dyslipidemia among US adults. JAMA, 303(15), 1490–1497. https://doi.org/10.1001/jama.2010.449

Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt, R. et Hu, F. B. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA internal medicine, 174(4), 516–524. https://doi.org/10.1001/jamainternmed.2013.13563

Zheng, M., Rangan, A., Olsen, N. J., Andersen, L. B., Wedderkopp, N., Kristensen, P., Grøntved, A., Ried-Larsen, M., Lempert, S. M., Allman-Farinelli, M. et Heitmann, B. L. (2015). Substituting sugar-sweetened beverages with water or milk is inversely associated with body fatness development from childhood to adolescence. Nutrition (Burbank, Los Angeles County, Calif.), 31(1), 38–44. https://doi.org/10.1016/j.nut.2014.04.017

Most read articles by the same author(s)