High Carbonated Soft Drink Intake is Associated with Health Risk Behavior and Poor Mental Health among School-Going Adolescents in Six Southeast Asian Countries

Carbonated soft drink (CSD) intake has been associated with various risk behaviors in adolescents in high-income countries, but there is lack of evidence of this association in cross-nationally representative samples of school adolescents in low- and middle-income countries. This study aimed to assess the association between CSD intake, health risk behavior, and poor mental health behavior among school-going adolescents in six Southeast Asian countries. Cross-sectional national "Global School-Based Student Health Survey (GSHS)" data from 36173 school-going adolescents from Bangladesh, Indonesia, Laos, Philippines, Thailand, and Timor-Leste were analyzed. Results indicate that across all six Southeast Asian countries, in the past 30 days 23.9% of study participants had consumed no CSD, 38.8% had consumed CSD <once/day, 19.9% once a day and 17.5% ≥ two times/day. In the final adjusted logistic regression model CSD intake was associated with increased odds of having been attacked, having sustained an injury, being in a physical fight, being bullied, school truancy, tobacco use, alcohol use, and lifetime drunkenness. In addition, the consumption of CSD ≥two times/day was associated with increased odds of ever used cannabis and ever used amphetamine. Higher intake of CSD was positively associated with a history of loneliness, anxiety, suicide ideation, suicide planning, and suicide attempts. CSD intake in low- and middle-income countries is associated with several health risk behaviors and poor mental health that are similar to those observed in high-income countries.