Expenditure on Paid-for Gambling Advertising During the National COVID-19 'Lockdowns': An Observational Study of Media Monitoring Data from the United Kingdom

Changes in gambling advertising during national COVID-19 'lockdowns', when stay-at-home rules restricted participation in certain gambling activities, provides important context to variance in gambling behaviour during these periods. This study describes expenditure on paid-for gambling advertising during three national lockdowns, compares expenditure to pre-pandemic estimates, and compares changes in expenditure by subsector. Data come from an observational study of weekly expenditure on paid-for gambling advertising in the United Kingdom (n = 135 weeks; beginning 2019 to mid-2021), focusing on three COVID-19 lockdowns: (1) March-May 2020; (2) November-December 2020; and (3) January-March 2021. We descriptively analysed how total advertising expenditure in each lockdown (£GBP, inflation-adjusted) compared to the same time points in 2019, both overall and by subsector (bookmakers, lotteries, online bingo, online casino and poker, gaming, pools, mobile content). Gambling advertising expenditure during lockdown one was 38.5% lower than 2019 (£43.5 million[m] vs. £70.7 m, respectively), with decreases across all subsectors (range: -81.7% [bookmakers] to -2.8% [online bingo]). Total advertising expenditure in lockdown two was 49.3% higher than 2019 (£51.7 m vs. £34.6 m), with increases for 5/7 subsectors (range: -31.6% [mobile content] to + 103.8% [bookmakers]). In lockdown three, advertising expenditure was 5.9% higher than 2019 (£91.2 m vs. £86.1 m), with increases for 4/7 subsectors (range: -92.4% [pools] to + 49.2% [mobile content]). Reductions in advertising expenditure in lockdown one are congruent with self-reported reductions in overall gambling also observed during this period. Further research is needed to determine whether increased advertising expenditure in lockdowns two and three correlates with increased gambling, overall and for specific subsectors.

How do Gambling Providers Use the Social Network Twitter in Germany? An Explorative Mixed-Methods Topic Modeling Approach

This study examines the social media activities of gambling providers in Germany, focusing on the platform Twitter. A collection of 34.151 tweets from 13 Twitter accounts was made, representing casinos, sports betting, state lotteries, social lotteries and lottery brokers. We apply an explorative mixed-methods approach, integrating a summative content analysis together with a semi-supervised guided topic modeling approach, to analyse frequency, number of followers, interaction and content of Twitter messages, and work out differences among the individual providers. The results show that Twitter does not seem to be particularly important for gambling providers who are active in Germany. Regarding outreach, frequency of tweets and interaction, Twitter plays a much smaller role than, for example, in the UK. The potential for Twitter to be an advertising, marketing and interaction channel has not yet been fully exploited, which would make it a perfect moment for developing an appropriate regulatory framework. Overall, the results of semi-supervised topic modeling show that providers most often use informative content (news) and combine it with other, usually less neutral content. It is alarming that many providers make little or no use of Responsible Gambling messages. Even though the activities are presently on a low level, they contribute to the normalization of gambling, setting incentives for increasing gambling participation. Children and youth form a large segment of Twitter users. Potential harm can arise especially for this group because of the lack of enforcement of any age limit.

Is it ethical to advertise unhealthy foods to children?

The marketing of foods and non-alcoholic beverages (hereafter: food) high in fats, salt and/or sugar (HFSS) has been strongly implicated in the rising levels of childhood obesity worldwide. Multiple ethical concerns arise from the practice of exposing children to such marketing and efforts to monitor and restrict it through regulatory policies. There is considerable evidence that exposure to powerful food marketing messages affects children's food behaviours in ways that are detrimental to good dietary health. Children are particularly vulnerable to being exploited and deceived by food marketing messages based on their cognitive and developmental immaturity. HFSS food marketing also affects numerous child rights enshrined within the UN Convention on the Rights of the Child (of which the UK is a signatory) including the right to the enjoyment of the highest attainable standard of health. The debate has become somewhat polarised between the public health community's evidence-based assertion that all marketing is inherently exploitative and the rebuttal from food and marketing industry stakeholders that provided the marketing is 'accurate and truthful' and there is no ethical need to regulate. This polarisation is reflected in the complexity of policymaking decisions regarding the rationale for mandatory government-led policies or industry self-regulation. There are also ethical considerations inherent in the monitoring of children's food marketing exposure, particularly in the digital sphere, by researchers for the purposes of informing policy design, scope and implementation. This review paper will explore the latest evidence on these issues and consider the implications for public health research, policy, and practice.

Different ways… same message? Road safety-targeted communication strategies in Spain over 62 years (1960-2021)

Among the most generalised preventive measures against traffic crashes, advertisements and broadcast campaigns in the media have stood out over the last six decades. The core aim of this paper is to describe the evolution of the subject matter and typology of road safety-related advertisements used in Spain during 62 years (1960-2021). Thus, this paper assesses their role in reducing road fatalities, while keeping in mind the potential effect of the many other road safety-related preventive measures carried out in the country during this period. The results of this study allow us to target five key time periods, all of them with clear particular communication strategies to be differentiated, using specific types of advertisements and informative, persuasive, emotional, and humorous techniques (among others) to reach the audience. Additionally, some key practical implications and guidelines are provided.

'Come and get a taste of normal': Advertising, consumerism and the Coronavirus pandemic

The coronavirus disease (COVID-19) pandemic continues to present unique challenges to governments and organisations around the world, but one sector has incorporated COVID-19 into its core mission with relative ease: advertisers have acknowledged the pandemic while continuing to draw on notions of 'normality' to activate our desire to consume. As the UK's series of lockdowns have come to an end, we look back over more than a year of unusual advertising and consider how the pandemic has changed approaches to marketing and the shape of consumer culture in ways connected to ideas about what constitutes 'normal' life. Discussions of the relationship between the pandemic and consumerism have included critiques of the prioritising of profit over people, and conceptualisations of Coronavirus as a brand itself, but the politics of notions of 'normality' promoted by consumer culture demand closer consideration. This article complements existing studies and debates by examining the tensions, contradictions and morally neutral positions revealed by the advertising response to the coronavirus disease pandemic. Through an analysis of UK advertising campaigns launched during and with reference to the pandemic, this work explores key themes and strategies, including their connection to power dynamics concerning race, gender, class and capitalism. We suggest advertising during crises may offer the opportunity to critique larger dynamics and trends of consumerism, including narrow notions of the defining features of 'everyday' life.

Exposure to alcohol advertising and alcohol consumption among children and early teenagers in South Africa

BACKGROUND

There is a paucity of information on alcohol adverts on alcohol consumption among early teenagers. The study aimed to examine the association between exposure to alcohol adverts and alcohol consumption.

METHODS

A sample of 3833 early teenagers aged 12-14 years were extracted from the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey (SABSSM) 2017. Participants answered questions related to their exposure to alcohol adverts across television, Poster/billboard, events, and social media. Alcohol consumption was assessed on ever consumed alcohol and in the previous 12 months. Information on demographic characteristics was collected. Descriptive and inferential statistics were used to process the data.

RESULT

Exposure to alcohol adverts increases from 5.2% for Events to 77.0% on television. All alcohol media of adverts were associated with alcohol consumption by age. The results mirror studies that demonstrated that exposure to alcohol advertisements was associated with alcohol consumption.

CONCLUSION

The association between alcohol consumption, exposure to alcohol adverts, and demographic characteristics need the urgent attention of policymakers and interventionists. The focus of action should be on protecting these early teenagers from exposure to media of adverts and risk background factors.

Reducing Student Exposure to Digital Food and Beverage Marketing: Policy and Practice Recommendations

Digital marketing of unhealthy foods and beverages to children and adolescents is pervasive, highly effective, undermines healthy eating, and contributes to health inequities. Expanded use of electronic devices and remote learning during the COVID-19 pandemic has increased the urgency for policy interventions to limit digital food marketing in schools and on school-issued devices. The US Department of Agriculture provides little guidance to schools for how to address digital food marketing. Federal and state privacy protections for children are inadequate. Considering these policy gaps, state and local education authorities can incorporate strategies to reduce digital food marketing into school policies for: content filtering on school networks and on school-issued devices; digital instructional materials; student-owned device use during lunch; and school use of social media to communicate with parents and students. Model policy language is provided. These policy approaches can leverage existing policy mechanisms to address digital food marketing from a variety of sources.

Complexity of Data Displays in Prescription Drug Advertisements for Healthcare Providers

BACKGROUND

Healthcare providers (HCPs) often encounter clinical trial results in the form of data displays in prescription drug promotions. Information conveyed in data displays vary in their presentation and complexity. This study describes characteristics of data displays in prescription drug advertising targeted to HCPs.

METHODS

This study characterized the content of 140 data displays in 98 unique print advertisements from 2009 to present and identified in AdPharm, an online database of pharmaceutical advertisements. Two reviewers independently coded the advertisements for characteristics (κ = 0.85) including complexity, format, and quality.

RESULTS

About one-third (32%) of the advertisements contained multiple data displays (range 2 to 6) and 44% showed clinical data from oncology trials; other disease domains were mental and behavioral health (14%), rheumatology and autoimmune disorders (8%), endocrinology (7%), cardiology (6%), infectious disease (6%), pulmonology and allergy (4%), and others (< 2% each). About one-half (51%) of displays were classified as "simple" which included "pseudographs" and basic tables or charts. "Complex" displays appeared as survival curves, line graphs, or bar graphs with complex features. Most complex displays included a comparator drug (90%), plain language restatement of the key finding (93%) and disclosure statements (91%) with additional study details, although their placement varied. Complex displays were of high quality, according to our selected indicators; our analysis found no data distortion or errors.

CONCLUSION

Data displays in prescription drug advertising are often highly complex. Future research assessing understanding of data displays and the potentially beneficial effect of disclosures and other features is warranted.

Is exposure to pharmaceutical direct-to-consumer advertising for heart disease and diabetes associated with physical activity and dietary behavior?

CONTEXT

Scholars have suggested that direct-to-consumer advertising (DTCA) of prescription drugs may discourage or encourage changes in lifestyle to improve health. The current paper informs this debate by examining associations between estimated exposure to DTCA for drugs focused on heart disease/cholesterol and diabetes and self-reported exercise and consumption of a variety of unhealthy foods (candy, sugary drinks, alcohol, and fast food).

METHODS

We estimated exposure to DTCA by combining data from Kantar Media Intelligence (Kantar) on televised pharmaceutical DTCA airings in the U.S. from January 2003 to August 2016 (n = 7,696,851 airings) with thirteen years of data from the Simmons National Consumer Survey (Simmons), a mailed survey on television viewing patterns. We estimated associations between exposure to advertising (both overall and for advertisements with specific content) and self-reported physical activity and dietary behavior using Simmons data from January 2004 to December 2016 (n = 288,483 respondents from n = 157,621 unique households in the U.S.). Our analysis controls for many potential confounders including respondent demographics, temporal trends, and program placement to account for purposeful ad targeting to higher-risk adults.

FINDINGS

Higher estimated exposure to DTCA for heart disease and diabetes drugs were not consistently associated with meaningful differences in the frequency of engaging in regular physical activity. Greater estimated exposure to DTCA for both diseases were, linked to small but consistently higher volume of consumption of candy, sugar-sweetened beverages, alcohol, and fast food. Specific DTCA message content about diet and exercise explained very little of the observed association between overall DTCA exposure volume and study outcomes.

CONCLUSIONS

Many Americans were regularly exposed to pharmaceutical DTCA for heart disease and diabetes from 2003 to 2016. Widespread exposure to such DTCA is associated with higher levels (though small in magnitude) of consuming alcohol, fast food, candy, and sugar-sweetened beverages.

Exploring global trends and future directions in advertising research: A focus on consumer behavior

This study aims to select the physiological and neurophysiological studies utilized in advertising and to address the fragmented comprehension of consumers' mental responses to advertising held by marketers and advertisers. To fill the gap, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was employed to select relevant articles, and bibliometric analysis was conducted to determine global trends and advancements in advertising and neuromarketing. The study selected and analyzed forty-one papers from the Web of Science (WoS) database from 2009-2020. The results indicated that Spain, particularly the Complutense University of Madrid, was the most productive country and institution, respectively, with 11 and 3 articles. The journal Frontiers in Psychology was the most prolific, with eight articles. The article "Neuromarketing: The New Science of Consumer Behavior" had the most citations (152 T.Cs). Additionally, the researchers discovered that the inferior frontal and middle temporal gyri were associated with pleasant and unpleasant emotions, respectively, while the right superior temporal and right middle frontal gyrus was connected to high and low arousal. Furthermore, the right prefrontal cortex (PFC) and left PFC were linked to withdrawal and approach behaviors. In terms of the reward system, the ventral striatum played a critical role, while the orbitofrontal cortex and ventromedial PFC were connected to perception. As far as we know, this is the first paper that focused on the global academic trends and developments of neurophysiological and physiological instruments used in advertising in the new millennium, emphasizing the significance of intrinsic and extrinsic emotional processes, endogenous and exogenous attentional processes, memory, reward, motivational attitude, and perception in advertising campaigns.

Nicotine-related content in English language ENDS advertisements in the US: 2018-2020

There is no standard way to communicate to consumers how much nicotine is present in electronic nicotine delivery systems (ENDS). This study assessed the inclusion of nicotine-related content, including nicotine strength, in a sample of English language ENDS advertisements that appeared in consumer and business-to-business outlets in the US during 2018-2020. The sample, provided by a media surveillance company, included ads from television, radio, newspapers, magazines (consumer and business-to-business), online platforms, outdoor/billboards, and direct-to-consumer emails. We coded for the presence of nicotine-related content (excluding FDA-required warnings) including nicotine strength presentation, such as mg, mg/ml and percent. The sample included 2966 unique ads, of which 33% (n = 979) featured nicotine-related content. The proportion of ads in the entire sample with nicotine-related content differed by manufacturer/retailer. Ads for Logic e-cigarettes had the highest proportion of nicotine content (62%, n = 258), while ads for JUUL and Vapor4Life had the lowest proportion (13.0% (n = 95) and 19.8% (n = 65), respectively). The proportion of ads with nicotine-related content also differed by media outlet: B2B magazines: 64.8% (n = 68); emails: 41% (n = 529); consumer magazines: 30.4% (n = 41); online: 25.3% (n = 227); television: 20% (n = 6); radio: 19.1% (n = 89); and outdoor (0%, n = 0). Across the sample of ads, 15% reported nicotine strength in mg or mg/ml (n = 444), and 9% reported nicotine strength in percent (n = 260). Most ENDS ads do not include nicotine-related content. There is substantial variation in presentation of nicotine strength, which may present challenges for consumer understanding of absolute and relative nicotine-related content.

Gender bias in antidepressant direct-to-consumer pharmaceutical advertising

BACKGROUND

Direct to consumer pharmaceutical advertising (DTCPA) may have significant impacts on public perception of diseases and treatments. Our objective was to examine whether DTCPA for antidepressants disproportionately portray and hence target women in the United States.

METHODS

DTCPA for branded medications for depression, psoriasis and diabetes were analyzed to determine the gender of the main "patient" portrayed, as well as the content of the disease depiction.

RESULTS

DTCPA for antidepressants included only women in 82% of ads, only men in 10.1% of ads, and both genders in 7.8% of ads. There were significantly higher representations of women versus men in DTCPA for antidepressants (82%) compared to either psoriasis (50.4%) or diabetes (37.6%) medications. These differences remained statistically significant even after adjusting for gender disparities in disease prevalence.

CONCLUSIONS

Antidepressant DTCPA in the United States disproportionately target women. There are potential adverse consequences for both women and men resulting from unequal representations in DTCPA for antidepressant medications.

Effectiveness of Regulatory Policies on Online/Digital/Internet-Mediated Alcohol Marketing: a Systematic Review

BACKGROUND

The rapid growth of social networking sites and video sharing platforms has created an opportunity for the alcohol industry to employ advanced advertising and marketing approaches to target their audiences, increasingly blurring the lines between commercial marketing and user-generated content, which poses a challenge for effective regulation.

METHODS

We conducted a systematic search through three peer-reviewed journal databases (WoS, PubMed, Scopus). Studies were included if published in English, after 2004, and assessed statutory regulation or voluntary industry codes, enacted by an EU or nation's governmental agency or private entity, and with the intent to restrict digital alcohol advertising. In addition, we conducted a manual search of gray literature.

RESULTS

A total of 4690 records were identified. After duplicate removal and full-text assessment, 14 articles were examined. Our findings indicate that children and adolescents may often be exposed to alcohol advertisements on social media and websites due to industry's self-regulatory age-affirmation systems being largely ineffective at preventing under-aged access. Cases of self-regulatory violations by the alcohol industry, and increasingly innovative 'gray-area' advertising approaches have also been noted. Additionally, research illustrates a lack of developed statutory restrictions of digital alcohol advertising and instead continued reliance on voluntary industry self-regulation.

CONCLUSIONS

There is a substantial need for further research to examine the effectiveness of digital alcohol advertising restrictions in social media, websites and image/video sharing platforms. Moreover, there is a necessity for countries to develop comprehensive statutory frameworks, which would effectively restrict and monitor rapidly advancing digital alcohol advertising practices on new digital media.

Compliance of orthodontic practice websites with ethical, legal and regulatory advertising obligations

BACKGROUND AND OBJECTIVES

The aim of the study was to investigate the degree to which the websites of orthodontists in Australia comply with the regulatory frameworks regarding healthcare advertising.

METHOD

The websites of orthodontist practices in Australia were assessed against Section 133 of the National Law and the Australian Health Practitioner Regulation Agency (AHPRA)'s guidelines pertaining to the advertising of regulated health services. Website content was assessed in relation to 5 domains regarding the provision of false and misleading information, the use of offers and inducement without clear terms and conditions, the use of patient testimonials, the creation of unrealistic expectation of benefit and the encouragement of the indiscriminate and unnecessary use of health services.

RESULTS

The websites of 166 orthodontist practices and 304 orthodontists satisfying inclusion/exclusion criteria were evaluated. Intra-rater agreement was high, ranging from 0.91 to 0.97. Most websites (80.7%) contravened the Law in one or more domains. The mean number of non-compliant domains per website was 2.2 (95% CI: 1.96 to 2.46). Information that was likely to create unrealistic expectations of orthodontic treatment (74.1%) was the domain most frequently breached with clinical information that only discussed the benefits of treatments contained in 64.5% of websites. Named commercial products were contained within 88.6% of the websites with links to commercial product manufacturers provided by 36.7%.

CONCLUSIONS

Compliance of orthodontist practices in Australia with ethical, legal and regulatory advertising requirements is lacking. Orthodontists must exercise greater diligence in ensuring that the ethical requirements of preserving patient safety are not jeopardised by the advertising of their healthcare services.

Using Marketing Frameworks to Predict the Effects of E-Cigarette Commercials on Youth

Purpose

This investigation applied the Product Life Cycle (PLC) and Product Evolutionary Cycle (PEC) frameworks to the nicotine and tobacco market to predict the impact of television commercials for electronic cigarettes (e-cigarettes) on youth.

Design/methodology/approach

Surveys were administered over a three-year period to 417 alternative high school students from southern California who had never used e-cigarettes, cigarettes, or cigars at the baseline. Covariate-adjusted logistic regression causal mediation models were employed to test competing hypotheses from the PLC and PEC frameworks.

Findings

Results support a refined version of the PEC framework where e-cigarette commercials increase the odds of e-cigarette use, which leads to subsequent use of competing products including cigarettes and cigars.

Originality

Regulations in the United States that permit television commercials for e-cigarettes but restrict the promotion of cigarettes and cigars have created an opportunity to study product adoption among youth consumers when one product has a strategic marketing advantage.

Practical implications

This investigation demonstrates the utility of frameworks that conceptualize youth-oriented marketing as a two-part process in which potential customers are first convinced to adopt a behavior and then enticed to use a specific product to enact the behavior.

Social implications

Rising rates of nicotine and tobacco product use among youth may be partially attributable to e-cigarette commercials.

A scoping review of empirical research on prescription drug promotion

BACKGROUND

Pharmaceutical spending on prescription drug promotion is considerable, and exposure to advertising can influence demand and behavior. The U.S. Food and Drug Administration (FDA) provides industry guidance to help ensure that communications to consumers and health care providers about prescription drug promotion are truthful, balanced, and accurately communicated. As empirical research has accelerated on this topic in the past decade, an understanding of the current landscape of the science will help inform future research.

OBJECTIVES

Using systematic methods, this rigorous scoping review of the literature over the past decade (2012-2021) (1) examined the extent to which prescription drug promotion has been empirically investigated with consumers, patients, and health care providers; (2) examined the extent to which content and features of prescription drug promotion have been empirically investigated; and (3) identified themes across the literature to better understand the current landscape of prescription drug promotion.

METHODS

Databases searched include PubMed, Web of Science, CINAHL, APA PsycInfo, Business Source Corporate, Communication Source, Cochrane Library, and ClinicalTrials.gov for original research published in English from January 1, 2012, through November 10, 2021, using terms related to direct-to-consumer advertising, prescription drugs, and outcomes of interest (e.g., attitudes, perceptions, intentions, behaviors).

RESULTS

Of 804 screened references, 151 studies addressed the first research question, and 40 studies addressed the second. The most common theme across the body of evidence focused on testing of features and content in prescription drug promotional materials (84), followed by studies examining attitudes, perceptions, and behaviors toward prescription drug promotion more generally (43). Some (27) studies focused on targeted populations, such as patients, the elderly, non-English speaking people or individuals of a non-white race/ethnicity. Twenty-four studies assessed influence of exposure to prescription drug promotion on actual clinical outcomes, while 11 studies examined emerging technologies around prescription drug promotion. Seven studies evaluated the extent to which prescription drug promotion complied with existing guidelines and requirements.

CONCLUSIONS

Findings from this scoping review suggest there has been an increase in the number of empirical studies conducted on prescription drug promotion over the past decade. Potential areas that warrant further study include examination of emerging technologies, an expanded focus on targeted populations, and construct measurement.

Advertising and general dental practice: how compliant are practice websites in Australia with legal requirements?

BACKGROUND

The Australian Health Practitioner Regulation Agency (AHPRA) requires general dental practitioners (GDPs) to agree to regulatory advertising guidelines on initial registration and annual renewal. The aim of this study was to determine the compliance of GDPs websites to these requirements.

METHODS

A representative sample of GDPs websites from each state and territory in Australia was based on the total AHPRA registrant distribution. Assessment of compliance was used across five domains consisting of 17 criteria related to AHPRA's advertising of regulated health services guidelines, as well as section 133 of the National Law. Inter-rater reliability was estimated using Fleiss's Kappa.

RESULTS

One hundred and ninety-two GDPs websites were reviewed with 85% non-compliant with at least one of the legal and regulatory requirements relating to advertising. Of these websites, 52% displayed false and misleading information, 12.8% had offers and inducement without clear terms and conditions, 11.5% used written testimonials, 33.9% created unrealistic expectation of benefit and 39.6% encouraged indiscriminate and unnecessary use of health services.

CONCLUSIONS

More than 85% of GDP websites in Australia did not comply with legal and regulatory requirements related to advertising. A multi-stakeholder approach involving AHPRA, professional dental bodies and dental registrants is necessary to improve compliance.

An Eye Tracking Investigation of Young People's Gaze Behaviour to Gambling and Non-Gambling Moving Adverts

INTRODUCTION

Data from several areas of public health (e.g., harmful alcohol and tobacco) are consistent with the assertion that children's exposure to advertising strategies increases intention to consume such products. Most studies have measured self-rated impact of gambling advertising using questionnaires. Given that gambling advertisements come in different forms such as print media/television advertising and contain variable content, it is difficult to understand using subjective measures which aspects of the gambling advertisements increase craving and desire to trigger a gambling session. In the present study, we applied a novel data-driven methodology that directly tracks eye movements to reveal attentional biases towards gambling adverts and promotions by examining differences in young people's eye gaze behaviour when watching gambling and non-gambling (control) moving adverts.

METHOD

A total of 98 (16-18 years old) children who self-identify as having a low or high craving to gambling watched gambling and non-gambling (control) television adverts, while their eye movements were recorded.

RESULTS

The results show that the data-driven method can isolate video clips that best distinguish people on the low-high craving spectrum, reveal the type of each video clip with the largest group differences, and accurately predict young people's gambling craving on the basis of eye movement patterns.

CONCLUSION

Our findings demonstrate that young people's craving for gambling can be predicted based on their eye movements to video clips of gambling advertisements and that certain features of gambling advertisements may be more appealing to some group of viewers, particularly those with high craving for gambling.

Modern pied pipers: Child social media influencers and junk food on YouTube: A study from Germany

Kid influencers (under the age of 13) have profiles on social media platforms and create content to generate views and engagements. To reach young consumers, food companies are increasingly using kid influencers, perceived as highly trustworthy among children of the same age, to promote their (high-calorie) food products. Exposure to such content can lead to an increase in calorie intake. Therefore, this study aimed to identify which foods and beverages are featured in the videos of the four kid influencer channels most popular in Germany and, if possible, which Nutri-Score category these products receive. Of each channel, 50 of the most popular and 50 of the newest videos were analyzed regarding the food and beverage products and brands appearing in the video and the thumbnail. To analyze the number of appearances, each product was categorized as to whether it was branded or unbranded. Where possible, the Nutri-Score was then calculated for each product that appeared. Within the total video sample (N = 373), food and/or beverages appeared in almost 70% of the videos, of which 220 were branded and 178 were unbranded products. Due to incomplete nutrition labels of branded products, only 146 branded products could be analyzed, from which 66% received the worst Nutri-Score categories D and E. The unbranded foods were evaluated using products as similar as possible, of which the majority received Nutri-Score A. The most common brands included McDonald's, Kinder, and Coca-Cola, and the most frequent product categories were chocolate, candy, soft drinks, and fruit. The high number of high-calorie products in the videos shows that kid influencers might be regarded as a risk factor when it comes to childhood obesity.

What is the evidence that advertising policies could have an impact on gambling-related harms? A systematic umbrella review of the literature

OBJECTIVE

To summarise the evidence on the impacts of gambling-related advertising that could lead to gambling-related harm, including impacts on vulnerable individuals and inequalities in the distribution of harms.

STUDY DESIGN

An umbrella review of studies investigating the impact of gambling advertising.

METHODS

A review was undertaken of systematic reviews of qualitative, quantitative and mixed method studies reporting outcomes associated with gambling advertising and marketing. The search strategy included database searches (Web of Science, PsycInfo) and website searches. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews 2.

RESULTS

1024 papers were identified by database searches. Eight systematic reviews, including 74 unique studies, met inclusion criteria. Included studies, using quantitative and qualitative methods, consistently support the existence of a causal relationship between exposure to advertising of gambling products/brands and more positive attitudes to gambling, greater intentions to gamble and increased gambling activity at both individual and population level. There is evidence of a 'dose-response' effect; greater advertising exposure increases participation which leads to a greater risk of harm. There was more evidence for the impact on children and young people and for those already at risk from current gambling activity with those most vulnerable more likely to be influenced.

CONCLUSION

Gambling advertising restrictions could reduce overall harm and mitigate the impact of advertising on gambling-related inequalities. Public health harm prevention strategies should include policies which limit exposure to advertising, particularly among children and vulnerable groups.

An analysis of operating strategy for a video live streaming platform: advertisement, advertorial, and donation

Video live streaming services have reached every corner of the world through the influence of COVID-19. In this study, the business model of a video live streaming platform is examined under a structure in which both a streamer and a platform provider simultaneously have an incentive alignment and a payoff conflict. On the one hand, the streaming platform relies on the efforts of streamers to strengthen its market share; on the other hand, streamers can employ influencer marketing to construct their own additional revenue from commercials, which can affect the sales from the advertisements operated by the platform. In addition, the platform provider can reward talented streamers for their remarkable performance by sharing the subscription revenue with them; however, the adoption of a built-in reward system is perplexing because the platform can levy a commission fee from the money donated to streamers. Combining these practical points, our results indicate that advertorials can still be largely expanded by streamers mastering marketing skills, even if there is high substitution in ad services. In addition, the practice of charging a commission fee from the built-in reward system but sharing the subscription revenue with outstanding streamers can benefit the streaming platform, and their donation loss will be compensated by a higher revenue-sharing ratio.

A digital divide in the COVID-19 pandemic: information exchange among older Medicare beneficiaries and stakeholders during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic resulted in unprecedented challenges for older adults. Medicare enrollment was already an overwhelming process for a high fraction of older adults pre-pandemic. Therefore, the purpose of this qualitative study was to gain understanding from community organizations and stakeholders about their pre-pandemic and during-pandemic experiences while adapting to continue offering insurance advice to seniors, what resources are available to seniors, and what needs to be done to help seniors make higher quality insurance choices in the Medicare program. In addition, we wanted to explore how the COVID-19 pandemic may have changed the ways that these stakeholders interacted with Medicare beneficiaries.

METHODS

We employed a qualitative strategy to gain a deep understanding of the challenges that these organizations may have faced while offering advice/counseling to older adults. We accomplished this by interviewing a group of 30 stakeholders from different states.

RESULTS

Every stakeholder mentioned that some older adults have difficulty making Medicare decisions, and 16 stakeholders mentioned that their system is complex and/or overwhelming for older adults. Twenty-three stakeholders mentioned that Medicare beneficiaries are often confused about Medicare, and this is more noticeable among new enrollees. With the onset of the pandemic, 22 of these organizations mentioned that they had to move to a virtual model in order to assist beneficiaries, especially at the beginning of the pandemic. However, older adults seeking advice/meetings have a strong preference for in-person meetings even during the pandemic. Given that the majority of the beneficiaries that these stakeholders serve may not have access to technology, it was difficult for some of them to smoothly transition to a virtual environment. With Medicare counseling moving to virtual or telephone methods, stakeholders discussed that many beneficiaries had difficulty utilizing these options in a variety of ways.

CONCLUSIONS

Findings from our interviews with stakeholders provided information regarding experiences providing Medicare counseling pre- and during-COVID-19 pandemic. Some of the barriers faced by older adults included a complex and overwhelming system, a strong preference for in-person meetings among beneficiaries, challenges with technology, and an increased risk of information overload and misinformation. While bias may exist within the study and sample, given that technology-savvy beneficiaries may not seek help from organizations our study participants work in, they show how the current Medicare system may impact vulnerable older adults who may need support with access to high-speed internet and digital literacy.

Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019

BACKGROUND

The World Health Organization (WHO) recommends that countries implement fiscal policies to reduce the health impacts of sugary drinks. Few studies have fully examined the responses of industry to these policies, and whether they support or undermine health benefits of sugary drinks taxes. We aimed to explore the changes that sugary drinks companies may make to their marketing, and underlying decision-making processes, in response to such a tax.

METHODS

Following introduction of the UK Soft Drinks Industry Levy (SDIL) in 2018, we undertook one-to-one semi-structured interviews with UK stakeholders with experience of the strategic decision-making or marketing of soft drinks companies. We purposively recruited interviewees using seed and snowball sampling. We conducted telephone interviews with 6 representatives from each of industry, academia and civil society (total n=18), which were transcribed verbatim and thematically analysed. Four transcripts were double-coded, three were excluded from initial coding to allow comparison; and findings were checked by interviewees.

RESULTS

Themes were organised into a theoretical framework that reveals a cyclical, iterative and ongoing process of soft drinks company marketing decision-making, which was accelerated by the SDIL. Decisions about marketing affect a product's position, or niche, in the market and were primarily intended to maintain profits. A product's position is enacted through various marketing activities including reformulation and price variation, and non-marketing activities like lobbying. A soft drinks company's selection of marketing activities appeared to be influenced by their internal context, such as brand strength, and external context, such as consumer trends and policy. For example, a company with low brand strength and an awareness of trends for reducing sugar consumption may be more likely to reformulate to lower-sugar alternatives.

CONCLUSION

The theoretical framework suggests that marketing responses following the SDIL were coordinated and context-dependent, potentially explaining observed heterogeneity in responses across the industry.

Exposure to gambling promotions and gambling behaviours in Australian secondary school students

Background

Young people's gambling behaviours are associated with a range of individual, interpersonal and community factors. This study explored the association between exposure to types of gambling advertising and promotions and adolescent gambling behaviours.

Methods

Students from two states answered gambling questions as part of the 2017 Australian Secondary Students' Alcohol and Drug (ASSAD) Survey. Students reported gambling behaviours (gambling in the last month, types of gambling activities), exposure to gambling promotions during the last 30 days (e.g. ads for gambling on TV, online, live studio crosses), and were assessed for problem gambling. Principal Component Analysis suggested four groups of gambling promotion exposure. Logistic regression analyses examined the association between gambling promotion exposure and student gambling, engagement in hard gambling activities in the last month, and problem or at risk gambling, controlling for a range of student characteristics.

Results

Most students (81%) had been exposed to some form of gambling promotion or advertisement in the last month, most commonly TV, social media and sporting event advertisements. Exposure to online gambling ads (including websites, pop-ups on websites, and social media) in the last month was significantly associated with gambling in the last month, and being classified as an at risk or problem gambler; but not with participating in hard gambling activities. After adjusting for exposure to gambling advertising across categories, no other advertising exposure types were associated with adolescent gambling behaviours.

Conclusions

Study findings point to the need to impose restrictions on gambling advertisements and promotions, particularly those presented online.

Towards a regulation of food advertising?

For 20 years the UK Government has recognised that food advertising plays a part in food choices and hence diets of the population, particularly for children. In 2007 the UK brought in regulations to stop the advertising of less healthy foods on television (TV) during child-specific programming. Less healthy foods were defined using the 2004/2005 nutrient profiling model (NPM) as products high in saturated fat, salt and sugar (HFSS). Evaluations showed that children were still seeing and being affected by the adverts for less healthy foods. To try to mitigate childhood obesity, in 2018, the UK Government announced its intention to consult on further restrictions on the advertising of HFSS products on TV and online. Two years later, the intention to implement a 9pm advertising ban on TV and a further consultation on restricting online advertising of HFSS products was announced. New legislative controls on the advertising of HFSS foods are expected to be brought into legislation in the UK in January 2024. In the present paper, the history of advertising restrictions in the UK and the evidence informing them is reviewed. There will also be a reflection on where further actions might be needed in due course.