Underlying Drivers of Water and Sugary Drink Consumption in Puerto Rico

Strategic Insights -

Research conducted by George Washington University in collaboration with various stakeholders in Puerto Rico has shed light on the relationship between water hardship and consumption of sugar-sweetened beverages (SSBs). The study aimed to develop a shared understanding of the drivers of water and SSB consumption in Puerto Rico, where residents have experienced water hardship. The research employed a participatory system dynamics modeling approach, engaging stakeholders from public service, commercial sector, civil groups, and parents to conceptualize water and SSB consumption as outcomes of interconnected subsystems shaped by distrust in government.

Key Takeaways:

  • The study found that communities experiencing water hardship tend to consume more SSBs, and the underlying mechanisms are not well understood.
  • Stakeholders in Puerto Rico identified distrust in government as a key driver of water and SSB consumption, with fear of contaminants in tap and bottled water discouraging water consumption and indirectly increasing SSB intake.
  • Aggressive marketing reinforced habitual SSB consumption across generations, and stakeholders conceptualized water and SSB consumption as outcomes of two interconnected subsystems.
  • The study identified three leverage points in Puerto Rico: leveraging water infrastructure funding, providing water quality data in real-time, and coordinating counter-marketing campaigns targeting SSBs paired with drinking water promotion.
  • Participants agreed that water would not become a viable alternative to SSBs if water insecurity were not addressed first.
  • The research employed a participatory approach, bringing together stakeholders from diverse sectors to encourage them to look beyond individual behaviors of interest.
  • The study was conducted through a Group Model Building workshop in January 2023 and a parent group discussion in April 2023, involving 28 stakeholders from public service, commercial sector, civil groups, and parents.
  • The research has been peer-reviewed and published in the Journal of the Academy of Nutrition and Dietetics.

Statistics:

  • 7 stakeholders from public service participate in the Group Model Building workshop
  • 3 stakeholders from the commercial sector participate in the Group Model Building workshop
  • 13 stakeholders from civil groups participate in the Group Model Building workshop
  • 5 stakeholders from parents participate in the Group Model Building workshop
  • 28 stakeholders participated in the Group Model Building workshop in total
  • 2 interconnected subsystems were conceptualized by stakeholders to understand water and SSB consumption in Puerto Rico
  • 3 leverage points were identified by stakeholders in Puerto Rico to address water and SSB consumption

Sources:

  • Underlying Drivers of Water and Sugary Drink Consumption in Puerto Rico: A Qualitative Participatory System Dynamics Modeling Map. Journal of the Academy of Nutrition and Dietetics, 2025.
  • Elsevier Science Inc, Ste 800, 230 Park Ave, New York, NY 10169, USA. (Elsevier - www.elsevier.com; Journal of the Academy of Nutrition and Dietetics - www.journals.elsevier.com/journal-of-the-academy-of-nutrition-and-dietetics/)
  • Uriyoan Colon-Ramos, Dept. of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.