Impact of Dietary Sugar Intake on the Prevalence of Dental Caries in Adolescents: A Qualitative Study of Behavioral, Environmental, and Personal Factors Influencing the Association

Abstract

Background: Dental caries remains one of the most prevalent chronic diseases among adolescents globally and in Pakistan, where prevalence rates frequently exceed 50–70% in school-aged populations. Despite robust epidemiological evidence linking frequent sugar consumption—particularly sugar-sweetened beverages and snacks—to caries development, the subjective motivations, lived experiences, and socio-cultural contexts driving these behaviors remain underexplored. Existing studies are predominantly quantitative, leaving the personal, familial, peer, and environmental dimensions of adolescents’ sugar intake and caries experiences largely unexamined.

Objective:  To generate an in-depth, participant-centered qualitative account of the factors influencing sugar consumption among Pakistani adolescents, their personal and social experiences of dental caries, and their reflections on prevention strategies and conditions that might support reduced intake.

Methods:  A qualitative descriptive design situated within a constructivist-interpretivist epistemological framework was employed. Thirty adolescents aged 12–18 years from urban and peri-urban settings in Pakistan were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted in person or online, audio-recorded, and transcribed verbatim. Data were analyzed using Braun and Clarke’s six-phase reflexive thematic analysis framework. Trustworthiness was established through prolonged engagement, peer debriefing, reflexive memo-writing, and audit trail maintenance. The study was conducted in accordance with COREQ reporting guidelines.

Results: Six themes were identified: cultural and familial normalization of sugar as comfort and reward; peer influence and social bonding through sugary consumption; knowledge–behavior gap and denial of personal risk; economic accessibility and environmental ubiquity of sugary products; lived impact of caries on daily functioning and self-image; and moral residue with conditional orientation toward behavior change.

Conclusion: Adolescent sugar consumption and resultant dental caries in Pakistan are driven by cumulative socio-cultural and environmental factors rather than knowledge deficit alone. Adolescents retain conditional agency for reduction amenable to policy and family-level intervention. Comprehensive approaches—spanning dietary regulation, school-based education, affordable healthy alternatives, and adolescent engagement—are essential to address this phenomenon.