Health-related perceptions and drinking motives as actionable targets for precision prevention of high sugar-sweetened beverage intake among Chinese adolescents

ObjectiveTo quantify the contribution of modifiable individual risk factors (MIRFs)—particularly health-related perceptions and drinking motives—to high sugar-sweetened beverage (SSB) intake among adolescents, and to evaluate their relevance as actionable targets for precision-oriented prevention.MethodsA school-based survey was conducted among 1,466 Chinese junior high school students to assess SSB consumption and related individual-level factors. Multivariable logistic regression was used to identify factors associated with high SSB intake. To illustrate the practical value of these modifiable factors for identifying and targeting high-risk individuals, a population-based risk stratification approach was applied and evaluated using internal and external datasets. Model performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC), calibration curves, and decision curve analysis (DCA).ResultsFour MIRFs—drinking SSBs as water (OR = 13.00, 95% CI: 7.33–23.07, R2 = 11.12%), belief in no health effects [“Yes”: OR = 10.61(4.82–23.34); “Unsure”: OR = 2.37 (1.21–4.62); R2 = 4.99%], a strong desire to consume SSBs (OR = 2.45, 1.49–4.02, R2 = 1.91%), and drinking due to boredom (OR = 2.27, 1.25–4.13, R2 = 1.00%)—were strongly associated with high SSB intake (p < 0.05), collectively accounting for 71.1% of the model-explained variance. The full model demonstrated good discrimination, with AUCs of 0.858 in the training set, 0.736 in the internal validation set, and 0.751 in the external validation set, along with satisfactory calibration. A simplified model including only these MIRFs showed comparable net benefit in DCA, supporting their potential utility for efficient screening and risk stratification.ConclusionHealth-related perceptions and non-physiological drinking motives are key modifiable correlates of high SSB intake among adolescents. An MIRF-based screening and targeting approach may support precision prevention strategies and more efficient allocation of intervention resources in school- and community-based public health programs.