Understanding the health and dietary status of the U.S. Hispanic population is important because Hispanics are the largest racial/ethnic minority group in the United States. As of July 1, 2011, a total of 52 million Hispanic people were living in the United States, constituting 16.7% of the total U.S. population. Furthermore, it is projected that by July 1, 2050, there will be 132.8 million Hispanic people living in the United States (~30% of total U.S. population).¹

The process of adopting the cultural practices of a new dominant cultural group through repeated and continuous exposure, while retaining aspects of one’s culture of origin, is known as acculturation.² Acculturation is a multidimensional process and is affected by various factors, such as generation status, language use, age at immigration, and years living in the United States,² which can be used as proxy measures for acculturation. Dietary acculturation (i.e., dietary changes associated with the migration and cultural change process) is associated with either healthful or unhealthful dietary changes.^2,3 After immigrating to the United States, immigrants with healthier diets in their countries of origin may adopt Western diets that may increase risk for obesity and chronic diseases (e.g., diets low in fruits and vegetables and/or high in added sugars).^3–6 However, as globalization occurs, dietary patterns are changing and with it, assumptions about the healthfulness of the food supply in a person’s country of origin.⁷

Currently in the United States, sugar-sweetened beverages (SSBs) are the largest source of added sugars and a significant contributor of calories in the diet.⁸ The 2010 Dietary Guidelines for Americans defined SSBs as “liquids that are sweetened with various forms of sugars that add calories. These beverages include, but are not limited to, soda, fruit ades and fruit drinks, and sports and energy drinks.”⁹ In addition to poor diet quality,¹⁰ high consumption of SSBs has been associated with adverse health consequences, including obesity,^11–13 type 2 diabetes,^12,14,15 and increased risk for cardiovascular disease,^12,16–18 among adults. Based on the 2009–2010 National Health and Nutrition Examination Survey (NHANES) data, about half of U.S. adults consumed at least one SSB on any given day¹⁹ and SSB intake varied by race/ethnicity.^20,21 For example, compared with non-Hispanic whites, the odds ratio of consuming any SSB per day was 1.39 for Hispanic adults and 1.88 for non-Hispanic black adults.²¹

Because most Hispanics living in the United States are of Mexican origin,¹ recent studies showing their distrust of tap water is relevant to consider in the context of examining SSB consumption. Recent data indicate that Mexico had the highest level of per capita bottled water consumption in the world,²² and Mexican families spend about $140 per year on bottled water.²³ Mexico also had the highest per capita soft drink consumption in the world in 2010.²⁴ Furthermore, Mexican Americans living in the United States report higher SSB intake than non-Hispanic white Americans per national data from 2005–2008.²⁰ This raises an interesting research question on whether the acculturation process is associated with U.S. Hispanics’ current SSB intake. Although a few studies have examined the influence of acculturation on SSB intake among U.S. Hispanic adults,^5,25 none of these studies have used a nationally representative sample. Identifying the extent that Hispanic ethnicity and proxies of acculturation are associated with SSB intake can help public health professionals identify subpopulations that may benefit from tailored intervention approaches aimed at reducing SSB intake. Thus, the purpose of this analysis was to examine the relationship of Hispanic ethnicity and proxies of acculturation with SSB intake among a sample representing the civilian noninstitutionalized U.S. Hispanic and non-Hispanic white adults.

Selected characteristics of survey participants for the overall sample and stratified by Hispanic ethnicity are shown in Table 1. The age and sex of survey participants were somewhat evenly distributed. Approximately 64% of adults were married/domestic partnership, 28.1% were at least college graduate, 65.1% were in a household with an annual family income of <$75,000, 33.8% were living in the South region, and 63.4% were overweight or obese. There were significant differences in SSB in each of the three exposure groups (χ²-test, p ≤ .001; Table 2). The percentage of adults who consumed SSB ≥ 1 time/d was highest among Hispanics who completed the interview in both English and Spanish (74.6%), foreign-born Hispanics (71.1%), and foreign-born Hispanics who had lived in the United States for 10 to <15 years (74.5%) (Table 2).

The odds of drinking SSB > 0 to < 1 time/d was significantly higher among English speaking Hispanics (crude OR = 1.61) and Spanish-speaking Hispanics (crude OR = 2.00) than English-speaking, non-Hispanic whites, as based on the bivariable logistic regression model. However, after controlling for covariates, only the drinking pattern of Spanish-speaking Hispanics remained significant (adjusted OR = 1.78) (Table 3). The odds of drinking SSB > 0 to < 1 time/d was significantly higher among U.S.-born Hispanics (crude OR = 1.85) and foreign-born Hispanics (crude OR = 1.49) than U.S.-born, non-Hispanic whites. However, after controlling for covariates, only the drinking pattern of foreign-born Hispanics remained significant (adjusted OR = 1.30). Regarding years living in the United States among foreign-born Hispanic adults, the odds of drinking SSB > 0 to < 1 time/d was significantly higher among adults who had lived in the United States for 5 to <10 years (crude OR = 3.25) and those who have lived in the United States for 10 to <15 years (crude OR = 2.78) than among those who have lived in the United States for <5 years. After controlling for covariates, the odds of drinking SSB > 0 to < 1 time/d was significantly higher among adults who have lived in the United States for 5 to <10 years (adjusted OR = 3.21) and those who have lived in the United States for ≥15 years (adjusted OR = 2.30) than among those who have lived in the United States for <5 years (Table 3).

The odds of drinking SSB ≥ 1 time/d was significantly higher among English-speaking Hispanics (crude OR = 1.56), Spanish-speaking Hispanics (crude OR = 2.65), and bilingual (English/Spanish) Hispanics (crude OR = 2.15) than among English-speaking, non-Hispanic whites, from the bivariate logistic regression model. However, after controlling for covariates, only the drinking pattern of Spanish-speaking Hispanics remained significant (adjusted OR = 1.65) (Table 3). The odds of drinking SSB ≥ 1 time/d was significantly higher among U.S.-born Hispanics (crude OR = 1.68) and foreign-born Hispanics (crude OR = 1.90) than among U.S.-born, non-Hispanic whites. However, after controlling for covariates, the associations were no longer significant. Regarding years living in the United States among foreign-born Hispanic adults, the odds of drinking SSB ≥ 1 time/d was significantly higher among adults who had lived in the United States for 5 to <10 years (crude OR = 2.76), those who have lived in the United States for 10 to <15 years (crude OR = 3.38), and those who have lived in the United States for ≥15 years (crude OR =2.10) than among those who have lived in the United States for <5 years. After controlling for covariates, these associations persisted. The odds of drinking SSB ≥ 1 time/d was significantly higher among adults who have lived in the United States for 5 to <10 years (adjusted OR = 2.72), those who have lived in the United States for 10 to <15 years (adjusted OR = 2.90), and those who have lived in the United States for ≥15 years (adjusted OR = 2.41) than among those who have lived in the United States for <5 years (Table 3).

Hispanic ethnicity and proxies of acculturation were significantly associated with SSB intake among adults. We found that Spanish-speaking Hispanics (traditionally defined as a less acculturated group) had a 65% higher odds of drinking SSBs daily than English-speaking U.S.-born non-Hispanic whites after controlling for covariates. Since most U.S. Hispanics are of Mexican origin,¹ it is relevant to consider the high consumption of SSBs in Mexico. For example, in 2012, the mean per capita caloric intake from SSBs among Mexican adults was about 269 kcal/d.³² In 2009–2010, the mean caloric intake from SSBs among U.S. adults was 151 kcal/d.¹⁹ Thus, it is not surprising that the Spanish-speaking group was more likely to be daily consumers. In contrast to our findings, one study conducted with 174 low-income Puerto Rican women showed that women who lived in households where English was the primary language spoken had a higher consumption of artificial drinks (e.g., soft drinks), than those living in bilingual (English and Spanish) and Spanish-speaking households.²⁵ Differences in study findings may result from the more limited generalizability of the study by Himmelgreen et al.,²⁵ as it involved limited types of SSBs and a small number of low-income Puerto Rican women living in Connecticut, whereas our study included more types of SSBs and a large, nationally representative sample of Hispanic and non-Hispanic white men and women.

Birthplace of respondents was not significantly associated with daily SSB intake after controlling for covariates in our study. In contrast, Sharkey et al.⁵ reported that 194 U.S.-born Mexican-origin women had significantly higher SSB intake than 405 Mexico-born women (1.9 vs. 1.6 cans or glasses/d, p < .01, based on a χ² test). The discrepancy in findings between studies may result from the more limited generalizability of the study by Sharkey et al.,⁵ as it examined a small number of women of Mexican origin living in Texas, whereas our study included a large, nationally representative sample of Hispanic men and women. In addition, unlike the study of Sharkey et al.,⁵ that limited its analysis to Mexican adults only, our analysis included non-Hispanic whites as the referent group.

After controlling for covariates, our results indicated that foreign-born Hispanics who had lived in the United States for 5 to <10 years, 10 to <15 years, and ≥15 years (more acculturated groups) had 2.7, 2.9, and 2.4 times, respectively, higher odds for drinking SSB daily than foreign-born Hispanics living in the United States for <5 years (less acculturated group). This finding suggests that living in the United States for more years is positively correlated with SSB intake, an interesting finding given the recent beverage sales/intake trends reported in Mexico.^22–24 Consistent with our results, Himmelgreen and colleagues²⁵ reported that the length of time a person lives the United States was significantly associated with a greater consumption of soft drinks among low-income Puerto Rican women.

Hispanics are the largest racial/ethnic minority population in the United States and constituted almost 17% of the total U.S. population in 2011.¹ Additionally, U.S. Hispanic adults have a greater consumption of SSBs and have a higher prevalence of obesity than the non-Hispanic white adults.^20,33 Tailored dietary interventions for Hispanics could consider methods for reaching these subpopulations at highest risk for SSB consumption. To our knowledge, this was the first study to examine the relationship between acculturation and SSB intake among a large, nationally representative sample of U.S. adults. However, this study was subject to limitations. First, the study was cross-sectional; therefore, the directionality of the associations between acculturation and SSB intake could not be determined. Second, the results were subject to potential reporting and recall bias, because NHIS data for sample adults were based on self-reports and recalls on beverage intake during the past month. However, other studies have shown that estimates of beverage intake derived from responses to food-frequency questionnaires were similar to estimates derived from responses to 24-hour dietary recalls or to food records.^34,35 Third, SSB intake was surveyed in terms of frequency. We cannot quantify associations between the volume of SSB intake and the exposure variables of study. Lastly, we used three exposure variables as proxies for acculturation rather than more detailed acculturation indicators, such as an acculturation rating scale,³⁶ because this information was not available in the data set.

In conclusion, this study demonstrates the importance of considering acculturation in the consumption of SSBs. Language of interview and years living in the United States were significantly associated with daily SSB intake after controlling for age, sex, marital status, education level, annual family income, region of residence, and weight status. Our findings indicated that Spanish-speaking Hispanics, as well as those who had lived in the United States for 5 or more years, were more likely to consume SSB daily. Because Hispanic adults are high SSB consumers and have a higher prevalence of obesity than the non-Hispanic white population,^20,33 dietary interventions targeted toward the Hispanic population could consider methods for reaching this subpopulation at highest risk, as identified in our study.