Digital Interventions Targeting Sugar-Sweetened Beverage and Energy Drink Consumption in Adolescents: A Promising but Fragmented Field
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe manuscript addresses an important and timely topic, namely the role of digital interventions in changing the consumption of sugar-sweetened and energy drinks among adolescents. The study is well aligned with current public health concerns and falls within the scope of the Beverages study. The introduction provides a solid and comprehensive context, clearly highlighting the relevance of beverage consumption among adolescents and the potential of digital approaches. The manuscript is also well structured, and the tables summarizing the included studies and the analytical framework are particularly useful.
The paper provides a valuable descriptive and analytical overview of the existing literature, highlighting the predominance of findings on sugar-sweetened beverages and the relative lack of attention paid to energy drink consumption. Identifying this imbalance is a significant contribution and supports the authors’ conclusion that the field remains fragmented.
However, several aspects should be improved to strengthen the scientific rigor and clarity of the manuscript.
First, the methodological approach requires further clarification. Although the search strategy and selection process are described, the study does not follow a clearly defined systematic review framework (e.g., PRISMA) and no formal assessment of study quality or risk of bias is reported. Including at least a brief justification for the chosen approach and clarifying whether this work should be considered a systematic, purposive, or narrative review would improve transparency. In addition, discussing the implications of not conducting a formal quality assessment would strengthen the methodological section.
Second, the inclusion of heterogeneous study types (e.g., protocols, secondary analyses, and developmental studies) should be justified and discussed more explicitly. While this approach is acceptable for mapping a fragmented field, it limits the ability to draw conclusions about the effectiveness of the intervention. This limitation is acknowledged but could be more clearly integrated into the interpretation of the results.
Third, while the analytical framework proposed by the authors is a strength of the manuscript, its added value could be further emphasized. Specifically, the authors could clarify how this framework advances existing approaches or how it could be applied in future research or intervention design.
Fourth, the discussion could be expanded to provide more concrete implications for practice and policy. Although the manuscript identifies important gaps (e.g., limited focus on energy drinks, lack of social media-based interventions), it would benefit from more explicit recommendations for designing effective digital interventions targeting adolescent drinking.
Finally, while the manuscript is generally well-written, some sections could benefit from minor improvements in clarity and conciseness, particularly where sentences are long and complex.
Overall, the manuscript represents a relevant and well-structured contribution to the field. With minor revisions aimed at improving methodological transparency and strengthening the discussion, the paper would provide a valuable reference for researchers and practitioners working on digital interventions in adolescent health.
Author Response
Comment 1:
The manuscript addresses an important and timely topic, namely the role of digital interventions in changing the consumption of sugar-sweetened and energy drinks among adolescents. The study is well aligned with current public health concerns and falls within the scope of the Beverages study. The introduction provides a solid and comprehensive context, clearly highlighting the relevance of beverage consumption among adolescents and the potential of digital approaches. The manuscript is also well structured, and the tables summarizing the included studies and the analytical framework are particularly useful. The paper provides a valuable descriptive and analytical overview of the existing literature, highlighting the predominance of findings on sugar-sweetened beverages and the relative lack of attention paid to energy drink consumption. Identifying this imbalance is a significant contribution and supports the authors’ conclusion that the field remains fragmented.
Response 1:
I sincerely thank the reviewer for this positive assessment of my manuscript and for recognizing the relevance of the topic, the structure of the paper, and the value of the analytical framework and the summary tables.
Comment 2:
First, the methodological approach requires further clarification. Although the search strategy and selection process are described, the study does not follow a clearly defined systematic review framework (e.g., PRISMA) and no formal assessment of study quality or risk of bias is reported. Including at least a brief justification for the chosen approach and clarifying whether this work should be considered a systematic, purposive, or narrative review would improve transparency. In addition, discussing the implications of not conducting a formal quality assessment would strengthen the methodological section.
Response 2:
I thank the reviewer for this important comment. In response, I revised the Materials and Methods section to clarify the methodological positioning of the study. In Section 2.1, I now explicitly define the study as a structured analytical review rather than a systematic review of intervention effectiveness. I also clarify that the aim was to identify, characterize, and interpret how digital interventions targeting beverage-related behaviors among adolescents have been designed, delivered, and assessed. In Section 2.6, I further specify that the findings were synthesized narratively and analytically, and I now explicitly state that no formal quality appraisal or risk of bias assessment was performed, along with the rationale for this choice and its implications for interpreting the findings.
Comment 3:
Second, the inclusion of heterogeneous study types (e.g., protocols, secondary analyses, and developmental studies) should be justified and discussed more explicitly in the Methods section. While this approach is acceptable for mapping a fragmented field, it limits the ability to draw conclusions about the effectiveness of the intervention. This limitation is acknowledged but could be more clearly integrated into the interpretation of the results.
Response 3:
I agree and have revised the manuscript accordingly. In Section 2.5, I now clarify that the inclusion of protocols, developmental studies, and secondary analyses was intentional and consistent with the aim of mapping and analytically classifying an emerging and fragmented field. In Section 5 (Limitations), I now state more explicitly that this broader inclusion strategy, while useful for capturing how the field is conceptualized and operationalized, limits the extent to which firm conclusions can be drawn regarding intervention efficacy.
Comment 4:
Third, while the analytical framework proposed by the authors is a strength of the manuscript, its added value could be further emphasized. Specifically, the authors could clarify how this framework advances existing approaches or how it could be applied in future research or intervention design.
Response 4:
I thank the reviewer for this suggestion. I have revised the manuscript to make the contribution of the analytical framework more explicit. In Section 2.5, I clarify that the framework was developed to support structured comparisons across heterogeneous studies. In the Discussion, I added a paragraph emphasizing that the framework helps distinguish between beverage-specific and beverage-inclusive interventions, direct and embedded beverage outcomes, and different ecological levels of delivery. I also note that the framework may support future intervention design, reporting, and evidence synthesis.
Comment 5:
Fourth, the discussion could be expanded to provide more concrete implications for practice and policy. Although the manuscript identifies important gaps (e.g., limited focus on energy drinks, lack of social media-based interventions), it would benefit from more explicit recommendations for designing effective digital interventions targeting adolescent drinking.
Response 5:
I appreciate this comment and expanded the Discussion accordingly. The revised text now provides more concrete implications for future intervention development, including the potential relevance of brief learning modules, self-monitoring, interactive challenges, label-reading activities, myth correction approaches, media literacy elements, and links to school and family environments. The discussion of the implementation context was also strengthened by emphasizing the role of schools, families, peer influence, and adolescents’ digital exposure to beverage-related content. In addition, a more explicit policy-oriented statement regarding the integration of digital beverage interventions into broader school health promotion strategies and public health efforts addressing adolescents’ digital food environments has been included.
Comment 6:
Finally, while the manuscript is generally well-written, some sections could benefit from minor improvements in clarity and conciseness, particularly where sentences are long and complex.
Response 6:
I agree and have revised the manuscript to improve its clarity, conciseness, and readability. Particular attention was given to the Methods, Discussion, Limitations, and Conclusions sections of the manuscript. The manuscript was also revised for consistency with US English.
Comment 7:
Overall, the manuscript represents a relevant and well-structured contribution to the field. With minor revisions aimed at improving methodological transparency and strengthening the discussion, the paper would provide a valuable reference for researchers and practitioners working on digital interventions in adolescent health.
Response 7:
I thank the reviewer for this constructive evaluation. I have carefully revised the manuscript in line with all suggestions and hope that the revised version satisfactorily addresses the reviewer’s concerns.
Reviewer 2 Report
Comments and Suggestions for AuthorsThis manuscript reviews literature on digital (app and web-based) interventions for sugar-sweetened beverage and energy drink consumption in adolescents. The author reports the search strategy and the characteristics of studies around which she has organized the literature. The search appears to have been competently executed and the results, including the organization of the set of articles reviewed, although not earth-shattering, may be of value to investigators interested in planning or investigating such interventions. The writing is particularly lucid.
I have a few minor suggestions:
- In the paragraph on lines, even if Reference 21 is being cited to support all statements in the paragraph, it would be helpful to have at least one more 21 earlier in the paragraph (e.g., at the end of the sentence that says digital interventions have shown promise).
- In Section 2.4, it would probably be helpful to readers to have more detail about how the initially discovered 300+ records were reduced to 22 (i.e., more specific information about the inclusion and exclusion criteria for these studies).
- On line 263, Figure X should say Figure 1.
- It is not really clear what is added in Section 3.3 that was not or could not be in Section 3. 1.
- In the sentences on lines 310-314: There should be a period after “attention”. Then, “particularly” should start a new sentence, there should be a comma after the set of references, and “future” should be the end of the sentence revised to start with “particularly”.
- It seems that there is room in this area for studies that compare strategies/interventions;
Author Response
Comment 1:
This manuscript reviews literature on digital (app and web-based) interventions for sugar-sweetened beverage and energy drink consumption in adolescents. The author reports the search strategy and the characteristics of studies around which she has organized the literature. The search appears to have been competently executed and the results, including the organization of the set of articles reviewed, although not earth-shattering, may be of value to investigators interested in planning or investigating such interventions. The writing is particularly lucid.
Response 1:
I sincerely thank the reviewer for this thoughtful and positive assessment of my manuscript. I appreciate the recognition of the clarity of writing, organization of the literature, and potential value of the paper for researchers interested in planning and evaluating digital beverage-related interventions in adolescents.
Comment 2:
In the paragraph on lines, even if Reference 21 is being cited to support all statements in the paragraph, it would be helpful to have at least one more 21 earlier in the paragraph (e.g., at the end of the sentence that says digital interventions have shown promise).
Response 2:
I thank the reviewer for this helpful suggestion. I have revised the paragraph accordingly and added the citation to Reference 21 earlier in the paragraph, immediately after the statement that digital interventions have shown promise in adolescent health promotion.
Comment 3:
In Section 2.4, it would probably be helpful to readers to have more detail about how the initially discovered 300+ records were reduced to 22 (i.e., more specific information about the inclusion and exclusion criteria for these studies).
Response 3:
I appreciate this comment and agree that additional details would be helpful. I have revised Section 2.4 to clarify the study selection process and to make the reduction from the initial set of records to the final 22 included studies easier for readers to follow. I also made the link with the eligibility criteria in Section 2.3, more explicit.
Comment 4:
On line 263, Figure X should say Figure 1.
Response 4:
I thank the reviewer for noticing this error. This has been corrected.
Comment 5:
It is not really clear what is added in Section 3.3 that was not or could not be in Section 3.1.
Response 5:
I appreciate this observation. In response, I have revised the text to clarify the distinct purpose of Section 3.3. Whereas Section 3.1 provides a descriptive summary of the included studies, Section 3.3 more explicitly presents the cross-cutting analytical classification of the interventions using the author-developed framework. I have revised the wording to clarify this distinction for the reader.
Comment 6:
In the sentences on lines 310-314: There should be a period after “attention”. Then, “particularly” should start a new sentence, there should be a comma after the set of references, and “future” should be the end of the sentence revised to start with “particularly”.
Response 6:
I thank the reviewer for this careful reading. I have revised these sentences to improve punctuation, sentence structure, and readability.
Comment 7:
It seems that there is room in this area for studies that compare strategies/interventions;
Response 7:
I agree with the reviewer. I have revised the Discussion section to make this point more explicit and now note that future research would benefit from studies directly comparing intervention strategies, components, and delivery approaches to identify which configurations appear most promising for modifying beverage-related behaviors in adolescents.
Reviewer 3 Report
Comments and Suggestions for AuthorsThis study is a review of digital interventions targeting sugar-sweetend beverages and energy drinks, and I find its focus and novelty excellent. However, I would appreciate it if you could consider adding results from the following perspectives, as this would be helpful for subsequent researchers and readers.
- Is it possible to develop indicators that visualize the intervention effect, such as the combined effect size?
- If you have any guidelines on how much a sugar-sweetend beverages intake needs to be altered through intervention to bring about changes in health indicators, please include them in any section of your discussion or analysis.
- There is no consistency in the way references are presented. For example, references 12 and 13 are the same source, but they are written differently; the way references are presented is inconsistent.
Author Response
Comment 1:
This study is a review of digital interventions targeting sugar-sweetend beverages and energy drinks, and I find its focus and novelty excellent. However, I would appreciate it if you could consider adding results from the following perspectives, as this would be helpful for subsequent researchers and readers.
Response 1:
I sincerely thank the reviewer for this positive assessment of the manuscript and for recognizing the relevance and novelty of its focus. I also appreciate these constructive suggestions, which helped me further improve the clarity and usefulness of this paper.
Comment 2:
Is it possible to develop indicators that visualize the intervention effect, such as the combined effect size?
Response 2:
I thank the reviewer for this important suggestion. However, I did not calculate a combined effect size because the included studies were highly heterogeneous in terms of study design, intervention format, outcome definitions, and the measurement and reporting of beverage-related outcomes. In addition, the review included not only completed intervention studies but also protocols, developmental studies, and secondary analyses. For these reasons, a formal quantitative synthesis would not have been methodologically appropriate for this study.
To address this point, I have strengthened the methodological clarification in the revised manuscript, particularly in Sections 2.1 and 2.6, where I have explicitly stated that the study was designed as a structured analytical review and that the findings were synthesized narratively and analytically rather than through formal meta-analytic procedures. I also further clarified in the Limitations section that the heterogeneity of the available literature limits the direct comparability across studies and restricts firm conclusions regarding intervention effectiveness.
Comment 3:
If you have any guidelines on how much a sugar-sweetend beverages intake needs to be altered through intervention to bring about changes in health indicators, please include them in any section of your discussion or analysis.
Response 3:
I appreciate this thoughtful suggestion. Although the present review was not designed to derive a quantitative threshold of sugar-sweetened beverage reduction from the included studies, I added a brief statement in the Discussion to better contextualize the health relevance of reducing free sugars and sugar-sweetened beverage intake, drawing on broader guideline-based evidence. Simultaneously, I avoided presenting a specific intervention threshold, as the included studies were too heterogeneous in terms of intervention targets, duration, beverage outcomes, and health-related endpoints to support a reliable dose–response conclusion within the scope of the present review.
Comment 4:
There is no consistency in the way references are presented. For example, references 12 and 13 are the same source, but they are written differently; the way references are presented is inconsistent.
Response 4:
I thank the reviewer for pointing this out. I use EndNote to manage the references, and during the revision process, the formatting style may occasionally shift while changes are being introduced. I have reviewed the reference list again to improve consistency throughout the manuscript.
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThe manuscript has been improved compared to the previous version. Considering the novelty of the research topic, I feel that the maximum possible amount of information has been included. The references are also consistent, but there seem to be some omissions, such as the use of an abbreviation for the journal name in reference 2 (Am J Clin Nutr). Please check it again.
