[A high-risk combination: obesity, food brands, minors and challenges on YouTube]

OBJECTIVE

To identify high-risk content in food advertising that combines obesogenic features with a highly emotionally engaging format.

METHOD

Comparison of 304 videos (47hours and 41minutes) from 13 food brand channels (traditional advertising) and from 15 child YouTuber channels (endorsement and influence) posted in 2019. Exploratory content analysis of variables describing the communication style of the "challenges" format.

RESULTS

Challenges are the most common type of content (53.3%; n=162), with a greater prevalence on child YouTuber channels (59%; n=131) than on brand channels (41%; n=31).

CONCLUSIONS

Content created by consumers is not covered by current audiovisual communication legislation. Increased control of these practices is urgently needed, in terms of legislation, self-regulation and codes of ethics. Creativity, enjoyment or mere entertainment is not a sufficient argument for the persuasive promotion of behaviors that endanger the physical health of children.

Bullshit in a network structure: the two-sided influence of self-generated signals

In today's social network age, information flowing in networks does not derive solely from external sources; people in the network also independently generate signals. These self-generated signals may not be deliberate lies, but they may not bear any relationship with the truth, either. Following the philosopher Harry G. Frankfurt, we refer to such self-generated signals as bullshit. We present an information diffusion model that allows nodes which hold no value to spread information, capturing the diffusion of bullshit information. The presence of self-generated signals (i.e., bullshit) increases the amount of information available for transmission in the network. However, participants in the spread process respond to the existence of such self-generated information by receiving data from internal sources with caution. These two contradictory forces-the increase in information transmission on the one hand, and in suspicion on the other-result in a two-sided effect of bullshit on the total spread time. We first take a numerical approach, simulating our model on Watts-Strogatz networks and building a decision tree to characterize the effects of bullshit given different network structures. We find that increasing the rate of self-generated information may have either a monotonic or non-monotonic effect on the rumor spread time, depending on the network structure and rate of non-self-generated internal communications. Then, taking an analytical approach, we analyze the spread behavior for cliques, and identify the conditions for monotonic behavior in a 2-clique network.

The extent and nature of television food advertising to children and adolescents in the Russian Federation

OBJECTIVE

To assess the frequency, healthfulness and promotional techniques of television food advertising to children and adolescents in the Russian Federation.

DESIGN

A cross-sectional study was conducted to monitor food and beverage television advertising. For the five most popular TV channels among children and adolescents, TV broadcasts were recorded for two weekdays and two weekends (320 h) during March-May 2017. Recordings were screened for advertisements. Food advertisements were categorised by food categories and as either 'permitted' or 'not permitted' for advertising to children in accordance with World Health Organization Regional Office for Europe Nutrient Profile Model (NPM), and promotional techniques in advertisements were recorded.

RESULTS

Overall, 11 678 advertisements were coded. Across all channels, food and drink (19·2 %) were the most frequently advertised product type. The most common food categories advertised were beverages (except juices, milk drinks and energy drinks) (24·1 %); yoghurts and other dairy foods (15 %); and chocolate and confectionery (12·3 %). A majority (64·2 %) of food and drink products advertised should not be permitted for advertising to children according to the NPM. The most frequently used persuasive appeals in the food advertisements were low price (15·4 %), product novelty (11·8 %) and enjoyment (10·0 %).

CONCLUSIONS

Children and adolescents in the Russian Federation are likely exposed to a substantial number of unhealthy food advertisements. There is a need to consider policies to restrict children's exposure to unhealthy food advertising on television in the Russian Federation.

A prospective community engagement initiative to improve clinical research participation in patients with peripheral artery disease

Objective:

Patients diagnosed with peripheral artery disease are difficult to recruit into clinical trials. However, there is currently no high-quality, patient-centered information explaining why peripheral artery disease patients choose to participate or not participate in clinical research studies.

Methods:

The current study was a prospective community engagement initiative that specifically asked patients with and without peripheral artery disease: (1) what motivates them to participate in clinical research studies, (2) their willingness to participate in different research procedures, (3) the barriers to participation, (4) preferences about study design, and (5) demographic and disease-related factors influencing participation. Data were gathered through focus groups (n = 19, participants aged 55–79 years) and mailed questionnaires (n = 438, respondents aged 18–85 years).

Results:

More than half of the respondents stated that they would be willing to participate in a study during evening or weekend time slots. Peripheral artery disease patients (n = 45) were more willing than those without peripheral artery disease (n = 360) to participate in drug infusion studies (48% versus 18%, p < 0.001) and trials of investigational drugs (44% versus 21%, p < 0.001). Motivating factors and barriers to participation were largely consistent with previous studies.

Conclusion:

Adults in our geographic region are interested in participating in clinical research studies related to their health; they would like their doctor to tell them what studies they qualify for and they prefer to receive a one-page advertisement that has color pictures of the research procedures. Peripheral artery disease patients are more willing than those without peripheral artery disease to participate in drug infusion studies, trials of investigational drugs, microneurography, and spinal/epidural infusions.

eSubmission of Promotional Labeling and Advertising Materials via the eCTD FDA Gateway : The Time Has Come for Advertising and Promotion to Submit in Module One

In June 2019, the Food and Drug Administration (FDA) issued its final Guidance on submission of advertising and promotional materials to the Office of Prescription Drug Promotion (OPDP) in eCTD format through the electronic gateway. Our goal was to put in place a stepwise plan and clear process to submit these materials in advance of June 2021 when electronic submissions become mandatory. The first step was to test every submission type and every possible iteration, therefore, as issues arose, problems could be easily addressed and resolved. This helped build confidence and achieve a level of comfort in preparing for the first eSubmission. To accomplish this, testing was performed through the gateway including: Form FDA 2253 (and accompanying promotional materials), advisory comments (launch and non-launch), enforcement actions, multiproduct submissions (grouped and ungrouped), and information request responses. The second step was to obtain internal alignment between involved functional areas to pilot a single brand. Finally, after a successful pilot program, eCTD submissions were expanded across all other brands. This paper discusses the stepwise approach taken, considerations for electronic submissions and results for improved efficiencies and cost savings. Implementing a well, laid-out plan, and starting the conversion early, allowed us to be thoughtful in our approach. The steps taken, and the successful outcomes achieved, demonstrate that there is no reason to wait for submitting promotional materials via the FDA gateway.

Ultra-processed food and beverage advertising on Brazilian television by International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support benchmark

OBJECTIVE

To analyse the extent and nature of food and beverage advertising on the three major Brazilian free-to-air television (TV) channels.

DESIGN

Cross-sectional study. A protocol developed for the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support was applied for data collection. A total of 432 h of TV programming was recorded from 06.00 to 24.00 hours, for eight non-consecutive and randomly selected days, in April 2018. All TV advertisements (ads) were analysed, and food-related ads were classified according to the NOVA classification system. Descriptive analyses were used to describe the number and type of ads, food categories and the distribution of ads throughout the day and time of the day.

SETTING

The three most popular free-to-air channels on Brazilian TV.

PARTICIPANTS

The study did not involve human subjects.

RESULTS

In total, 14·2 % (n 1156 out of 7991) of ads were food related (858 were specific food items). Approximately 91 % of food items ads included ultra-processed food (UPF) products. The top three most promoted products were soft drinks, alcoholic beverages and fast-food meals. Alcoholic beverage ads were more frequently broadcast in the evening.

CONCLUSION

The high risk of exposure of the Brazilian population to UPF ads should be considered a public health concern given the impact of unhealthy food advertising on people's food choices and health.

An assessment of violent imagery in advertisements on city buses in Manhattan, New York City

Background: Violence or violent imagery, defined as any image that conveys an imminent physical or existential threat to person(s), property, or society, with or without weaponry, is often featured in advertising. However, the effects of exposure (sporadic or chronic) to such imagery are not fully understood. The objective of this study was to describe the prevalence and types of violence portrayed in advertising on public buses in New York City (NYC).

Methods: In this cross-sectional study, from April to July 2019, researchers catalogued and coded the print advertising images present on the passenger entry side of all Metropolitan Transit Authority (MTA) bus lines in Manhattan to determine whether images of violence or violent acts were present. Unlike images of alcohol and tobacco products (banned from MTA property in 2017 and 1992, respectively), there are no similar restrictions on violence or violent imagery.

Results: A total of 23 out of 136 (17%) observed advertisements included images of violence and/or actual or imminent violent acts. One hundred percent of images involving violence were embedded in advertisements for mass media/entertainment purposes often featuring well known and favorably regarded actors and entertainment personalities or companies.

Conclusion: People of all ages and backgrounds are passively exposed to bus advertisements in a variety of settings. This study contributes to the literature regarding the extent to which the public is passively exposed to violent advertising. Additional study is required to further understand the link between violent imagery and attitudes toward/tolerance of violence.

Impact of alcohol marketing on drinkers with Alcohol use disorders seeking treatment: a mixed-method study protocol

Background

The marketing of alcohol influences patterns of alcohol consumption. Existing studies have focused, for the most part, on adolescents and the links between exposure to marketing and alcohol initiation. In France, the Evin law, a French exception, was set up in 1991 with the aim of regulating this exposure to marketing, but since 2009 it has been severely compromised. Alcohol consumption causes severe damage, which may be seenfrom 1 standard unit per day and mostly among adults who are regular users of alcohol. In this at-risk population, studies analysing the impact of marketing are sparse.

The specific objectives include (i) the evaluation of the perception of alcohol marketing by patients with an AUD (ii) gaining understanding of the links between alcohol marketing and patients with AUD behaviours (iii) the development of alcohol demarketing strategy in patients receiving AUD coaching.

Methods

Our main objective isto evaluate the impact of marketing on a population with an AUD. The methodology was in 4 steps: step 1 is a pre-test (N = 100) selecting type of alcohol consumed and type of marketing stimuli identified by patients aged 18 + with an AUD. Step 2 is a qualitative study (N = 20), with in-depth interview, to understand links between alcohol marketing and patients with AUD behaviours. Step 3 is a quantitative study(N = 600) to confirm these links and the impact of alcohol marketing on patients with AUD behaviours. Step 4 is an interventional step, including and testing the impact of demarketing intervention on patients with AUD while using the results of the three first steps (N = 120).

Discussion

This study will contribute to a better definition of the impact of alcohol marketing on patients with AUD and will enable identification of the determinants of this impact. These data will inform the development of interventions that take into account demarketingstrategies on patients under AUD management.

Trial registration

The Trial registrationregistration number is NCT03876132, and it was registered on the 15th march 2019.

Examining the frequency and nature of gambling marketing in televised broadcasts of professional sporting events in the United Kingdom

OBJECTIVE

Gambling operators in the United Kingdom have introduced a voluntary ban on adverts broadcast during televised sport before 21:00 (the 'whistle-to-whistle' ban). To inform debates around the potential effectiveness of this ban, we examine the frequency and nature of gambling marketing in televised broadcasts across professional sporting events.

STUDY DESIGN

Frequency analysis of verbal and visual gambling marketing references during television broadcasts of football (n = 5), tennis, Formula 1, boxing and rugby union (each n = 1) from 2018.

METHODS

For each gambling reference, we coded: whether it appeared in-play or out-of-play; location (e.g. pitch-side advertising); format (e.g. branded merchandise); duration (s); number of identical references visible simultaneously; brand; and presence of age restriction or harm-reduction messages.

RESULTS

Boxing contained the most gambling references, on average, per broadcast minute (4.70 references), followed by football (2.75), rugby union (0.55) and tennis (0.11). Formula 1 contained no gambling references. In boxing, references most frequently appeared within the area-of-play. For football and rugby union, references most frequently appeared around the pitch border or within the area-of-play (e.g. branded shirts). Only a small minority of references were for adverts during commercial breaks that would be subject to the whistle-to-whistle ban (e.g. 2% of references in football). Less than 1% of references in boxing and only 3% of references in football contained age restriction or harm-reduction messages.

CONCLUSIONS

As gambling sponsorship extends much beyond adverts in commercial breaks, the 'whistle-to-whistle' ban will have limited effect on gambling exposure. Gambling sponsorship activities rarely contain harm-reduction messages.

Relationship between trait suggestibility and eating-related behaviors in overweight and obesity

Differences in trait suggestibility among those with obesity may help explain differential responses to weight-loss interventions. Ubiquitous advertising of unhealthy foods, weight-loss products that are not evidence-based, and myths regarding weight loss could be particularly sabotaging in individuals with high levels of suggestibility, with or at risk of developing obesity. This study explored relationships between suggestibility, body mass index (BMI), and self-reported eating-related behaviors that vary among those with obesity. A sample of ethnically diverse adults (N = 73) with a BMI ≥25 completed the Short Suggestibility Scale (SSS), Palatable Eating Motives Scale (PEMS), Binge Eating Scale (BES), Dutch Eating Behavior Questionnaire-Restraint (DEBQ-R), and Barratt Impulsiveness Scale (BIS). Impulsiveness was controlled in analyses due to its strong association with suggestibility. Analyses revealed that BMI was not related to SSS scores, consistent with studies using hypnotic-suggestibility scales. However, SSS scores were positively associated with eating caloric food more frequently for Reward, Social, and Conformity motives, and with greater actual dieting behavior, and binge eating. Suggestibility was not related to eating for Coping motives or effort to diet. If supported by future replications, knowledge of these associations could potentially help inform and tailor weight-loss interventions to protect those that may be most susceptible to adopting invalid messages and products.

A cross-sectional study of website claims related to diagnoses and treatment of non-musculoskeletal conditions

BACKGROUND

The Danish Authorisation Act sets out the chiropractic scope of practice. Under this legislation the scope of practice is diagnostics, prevention and treatment of biomechanical disorders of the spine, pelvis and extremities. Despite this and an international movement toward a scientifically active, evidence-based profession with a focus on treatment of musculoskeletal disorders, a large proportion of chiropractors still offer treatment of non-musculoskeletal disorders. This study aimed to investigate the content and characteristics of website claims by chiropractors in Denmark on non-musculoskeletal conditions and to assess whether these were aligned with the Danish Authorisation Act of the chiropractic scope of practice.

METHODS

In this cross-sectional study data on a representative sample were collected from chiropractic clinic websites in Denmark. Information on non-musculoskeletal conditions from the websites was categorised. For each non-musculoskeletal condition, it was noted whether a clarifying explanation justifying the presence of the diagnosis was available and what it said. These explanations were assessed and categorised according to agreement or disagreement with the chiropractic scope of practice as defined by the Danish Authorisation Act. In addition, data on geographic location, clinic size, reimbursement coverage, country of education and special clinical focus (children, athletes, etc) were collected. Differences in characteristics of the clinics and the frequency of reporting non-musculoskeletal conditions were tested using Pearson's chi-squared or Fisher's exact test.

RESULTS

A geographically stratified, random sample of 139 (57%) websites was included from chiropractic clinics in Denmark. In total, 36 (26%) of the sampled websites mentioned conditions of non-musculoskeletal origin that was not accompanied by a clarifying explanation in agreement with the chiropractic scope of practice. A positive association between advertising infant or children's care and advertising treatment for non-musculoskeletal disorders (without adequate explanation) was observed.

CONCLUSIONS

A total of 36 (26%) of the sampled chiropractic websites in Denmark mentioned diagnoses or symptoms of non-musculoskeletal origin on their websites without presenting an adequate clarifying explanation in agreement with the chiropractic scope of practice as defined by the Danish Authorisation Act. This could be misleading for patients seeking care for non-musculoskeletal conditions and consequently lead to inappropriate treatment.

Nutritional quality of foods and non-alcoholic beverages advertised on Brazilian free-to-air television: a cross-sectional study

BACKGROUND

Evidence shows that foods marketed on television are often low-nutrient-dense foods associated with poor nutritional diet quality, obesity and non-communicable diseases. However, little research has been undertaken in Brazil around this issue. This study assessed the nutritional profile of foods and non-alcoholic beverages advertised on Brazilian television by applying the Pan American Health Organization (PAHO) and the World Health Organization (WHO/Europe) nutrient profiling models.

METHODS

Cross-sectional study based on the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) protocol. A total of 432 h on the three major Brazilian free-to-air TV channels was recorded from April 1st to 30th 2018. Recordings were done for eight non-consecutive and randomly selected days from 6 am to 12 am (midnight). All food-related ads were coded using a systematic approach and classified according to the PAHO and the WHO/Europe nutrient profile models as "eligible"/"not eligible" for marketing restrictions. Absolute and relative frequencies were used to describe absolute numbers and proportions of food and beverage advertisements. The nutritional profile of foods was compared by day, time of the day and types of TV program. For each advertisement, the parent company of promoted food products, supermarkets and restaurants was identified.

RESULTS

A total of 1610 food and beverage ads were broadcast, representing 18.1% of the total ads shown on selected channels. Over 80.0% of all foods and beverages advertised on Brazilian TV channels did not meet the PAHO and the WHO/Europe nutritional quality standards and were considered eligible for marketing restrictions. The proportion of unhealthy food ads was significantly higher on weekends, in the afternoon, and during soap operas programming. Altogether, 10 transnational and local food and beverage companies, two large international fast food chains and two of Brazil's largest supermarket retailers accounted for almost 90% of all unhealthy food ads shown.

CONCLUSIONS

The findings of the present study indicate a high exposure of the Brazilian population to unhealthy food marketing and an inefficient enforcement of existing regulations. Further research to monitor population exposure to unhealthy food marketing and understand the policy inertia that is preventing policy progress, is highly recommended.

Marijuana Promotion Online: an Investigation of Dispensary Practices

Marijuana product advertising will become more common, as the use of medical and/or recreational marijuana becomes increasingly legal in the USA. In this study, we investigate the marketing tactics being used on marijuana dispensary websites in the USA that could influence substance use behaviors. One hundred dispensary websites were randomly selected from 10 states that allowed the legal use of medical or recreational marijuana and had at least 10 operational dispensaries. Three dispensaries were excluded due to non-functioning websites, leaving a sample of 97 dispensaries. Content analysis was conducted on these dispensaries' websites, with the primary areas of focus including website age verification, marijuana effects, warnings, and promotional tactics. Among the 97 dispensaries, 75% did not include age verification. Roughly 30% offered online ordering and 21% offered delivery services. Sixty-seven percent made health claims pertaining to medical conditions that could be treated by their marijuana products, with moderate or conclusive evidence to support their claims. Less than half of the dispensaries (45%) advised consumers of possible side effects, and only 18% included warnings about contraindications. Nearly half (44%) offered reduced prices or coupons, 19% offered "buy one get one free" offers, and 16% provided giveaways or free samples. Our findings indicate that marijuana dispensary websites are easily accessible to youth. In addition, only a small amount of the websites advised consumers about possible side effects or contraindications. This study suggests the need for surveillance of marijuana commercialization and online advertising especially in the context of state policy reforms.

[Representation of the image of the minor in the publicity circulated via the Internet]

INTRODUCTION

The representation of the minor in advertisements is a topic that is scarcely studied and reflected in the bibliography, in social paediatrics as well as audio-visual communication. The aim of the present study is to describe how the minor is represented in the publicity that is conveyed through the internet, and whether or not that representation is adequate.

MATERIAL AND METHODS

An analysis was made of all the advertisements in which minors appeared during a period of two months, on three days a week, on the most visited web pages in Spain. The evaluation on how the minor was represented was carried out with an evaluation tool, constructed by the authors, based on European and Spanish legislation, which showed a high concordance between evaluators. A descriptive analysis was performed on the categorical variables, and the inter-dependent relationship was established between them using the chi-squared test.

RESULTS

A total of 173 advertisements were identified in which at least one minor appeared, which was generally represented solo (63.5%), in a natural environment (36.9%) and of school age (44.5%). The web pages of the "general press" are those that most frequently show advertisement in which minors are represented, through the use of banners (82%). In the majority of cases the inadequate use of the figure of the minor takes place using tactical representation, and not just strategic.

CONCLUSIONS

The image of the minor in the publicity that is conveyed via the most visited web pages in Spain is inadequate in 3 of every 3 advertisements. This misuse of the minor is usually seen in as unjustifiably strategic, and favouring non-positive values or that they favour situations of inequality.

Griffiths M. A Content Analysis of Gambling Operators' Twitter Accounts at the Start of the English Premier League Football Season

The use of social media is now an established strategy to engage and maintain customer loyalty. The purpose of the present study was to examine the Twitter accounts of ten of the largest online sports betting operators in the UK to determine what marketing strategies were employed. More specifically, this study analyzed 3375 tweets posted by the operators during the opening weekend of the 2018-2019 English Premier League football season using a content analysis methodology. The results demonstrated that multiple strategies, including hashtags, were used to link gambling operator tweets with major sporting events, and the use of numerous promotional campaigns. Notably, over 90% of the tweets contained no responsible gambling information. The quantity and content of social media posts underline the need for a review of the current advertising regulations in the UK. Further research should examine how exposure to sports betting social media marketing influences gambling behavior.

Cannabis advertising, promotion and branding: Differences in consumer exposure between 'legal' and 'illegal' markets in Canada and the US

Relatively little evidence exists on the impact of exposure to cannabis marketing, including potential differences between 'legal' and 'illegal' cannabis markets. The current study examined cannabis advertisement exposure and brand awareness across three jurisdictions: (i) all Canadian provinces immediately prior to legalization, (ii) US states that had not legalized non-medical cannabis (US 'illegal' states) as of August 2018, and (iii) US states that had legalized non-medical cannabis (US 'legal' states). Data are from Wave 1 of the International Cannabis Policy Study, an online survey conducted from August 27-October 7, 2018. The current sample (n = 26,710) included respondents from Canada (n = 9840), US illegal states (n = 9578), and US legal states (n = 7292). Regression models were fitted to examine cannabis advertisement exposure and brand awareness. Exposure to cannabis advertising and brand awareness differed across jurisdictions. Respondents in US legal states were more likely to report noticing advertisements, while those in Canada were more likely to report higher brand recall. Across jurisdictions, social media was cited among the most frequent channels from which cannabis advertisements were noticed in the past month. Higher rates of advertisement awareness and brand recall were also associated with greater frequency of cannabis use and self-reported proximity to cannabis retail stores. Results from this study indicate that advertisement exposure was higher in legal cannabis markets, although brand awareness for cannabis products was low across all jurisdictions. The findings reflect the relative novelty of legalized cannabis markets and provide a benchmark for evaluating the impact of cannabis advertising as legal markets become established.

Bi-objective design of household E-waste collection with public advertising and competition from informal sectors

The rapid expansion of technology, coupled with the falling prices of electronic products and their fast obsolescence, has resulted in a rapidly-growing amount of e-waste worldwide. Because of adverse effects on environment and public health, more and more countries and regions have begun to establish and operate public e-waste collection systems. In many developing countries, the low level of environmental awareness and the existence of informal sectors present obstacles to the success of such collection systems. This paper proposes to design a household e-waste collection network and launch a corresponding public service advertising campaign to counteract the informal recycling markets. The proposed mixed integer nonlinear program maximizes the amount of collected e-waste and minimizes overall costs of developing the network and its advertising campaign. A decomposition-based, multi-objective metaheuristic was developed to obtain the Pareto frontier. A case study based on the e-waste collection system in Changsha, China contextualizes the problem and developed methodology. Experiment results show that the cost of network construction and public advertising must be carefully balanced for limited budgets. The impact of residents' environmental awareness is also important to the collection effect. From a methodology perspective, this paper uses the Pareto analysis approach to study the design of household e-waste collection networks, with a supporting public service announcement campaign, in the presence of informal recycling markets. This paper also offers a policy design decision support tool to help regulators determine most workable policies that will balance the trade-offs between the two objectives.

How Age and Disclosures of Sponsored Influencer Videos Affect Adolescents' Knowledge of Persuasion and Persuasion

This study examines the effects of age (early versus middle adolescence) combined with the content of disclosures for sponsoring in online influencer videos on adolescents’ knowledge of persuasion and on persuasion. An experiment was conducted among a sample of 406 adolescents (167 early adolescents aged 12–14 years, mean age 12.85, SD = 0.14, 53% female; and 239 middle adolescents, aged 15–16 years, mean age 14.36, SD = 0.13, 59% female). The results show that early adolescents need extensive information (disclosure of advertising and of its intent) to activate their knowledge of persuasion regarding sponsored influencer videos, whereas middle adolescents’ knowledge of persuasion is activated by disclosure of advertising alone. This indicates that early adolescents’ knowledge of persuasion is less well developed and that their information processing is more limited than that of middle adolescents. Moreover, only middle adolescents showed more negative brand and influencer attitudes in response to the disclosure. Interestingly, purchase intention remains unaffected by the disclosure for all adolescents. These findings add to the research on adolescence as they show that adolescents’ responses to influencer marketing are a function of their developmental stage in combination with disclosure content. As such, this study has implications for theory on persuasion among adolescents and for regulations aiming to empower adolescents to deal with online sponsored influencer videos.

How to meet reuse and preparation for reuse targets? Shape advertising strategies but be aware of "social washing"

Preparation for reuse (PfR) is a fundamental waste management practice that is second only to prevention in the waste hierarchy. The paper, building on advertising literature, investigates how to leverage the pro-social nature of this option for giving products that have become waste a second life. To examine how advertising strategies based on emotional, functional or combined stimuli can be used to increase intention to buy these items, we carried out an experiment on 507 actual visitors a PfR items shop run by a social cooperative in Northern Italy. We found that, depending on consumers' social involvement, both emotional and functional stimuli based on the social impact of preparation for reuse tend to outperform functional stimuli and have a positive impact on brand attitudes by shaping attitudes to advertisements. Purchasing behaviour has a positive impact on attitudes toward the PfR organization and moderates the effect of emotional and combines stimuli on attitudes toward the advertisement. Since emotional stimuli can be freely used by both legitimated and opportunistic companies, the former should seek to preserve their value proposition by making it easier for consumers to recognise actually trustworthy organizations. This is possible combining the use of advertisements with the development of solid customer relationships. To this end, awareness campaigns, closer relationships with stakeholders and third-party verifiable standards and certifications should be considered to reduce the risk of "social washing" in the current second-hand market context.

Impact of direct-to-consumer drug advertising during the Super Bowl on drug utilization

BACKGROUND

Direct-to-consumer advertising (DTCA) of prescription drugs impacts patients' requests for medications, and clinician prescribing. However, the impact of DTCA during the Super Bowl has not been previously described.

OBJECTIVE

Evaluate the impact of prescription drug DTCA during the Super Bowl on drug utilization using 2014-2016 Medicare data.

METHODS

Efinaconazole was advertised during Super Bowls XLIX (02/01/2015) and L (02/07/2016). The number of prescriptions for efinaconazole and for a comparator drug, tavaborole, were calculated in 31-day intervals from July 2014-December 2016. Interrupted time-series analysis models were created to test changes in trends of prescriptions for efinaconazole and tavaborole.

RESULTS

Following Super Bowl XLIX, the number of prescriptions per 100,000 Medicare beneficiaries increased by 91% for efinaconazole, and 275% for tavaborole. After Super Bowl L, the number of prescriptions increased significantly for efinaconazole (p-value<0.001), but not for tavaborole (p = 0.70). Interrupted time-series analyses estimated that, in the absence of DTCA during Super Bowl XLIX, prescriptions for efinaconazole would have increased by 40%, instead of the observed 91%. For tavaborole, prescriptions would have increased by 90% instead of 275%.

CONCLUSIONS

DTCA during the Super Bowl resulted in sharp increases in utilization of the prescription drug advertised, which supports further regulation of DTCA.

Evaluating the impact of Chile's marketing regulation of unhealthy foods and beverages: pre-school and adolescent children's changes in exposure to food advertising on television

OBJECTIVE

To evaluate the effects of Chile's 2016 regulation restricting child-directed marketing of products high in energy, saturated fats, sodium and sugars on reducing children's exposure to 'high-in' television food advertising.

DESIGN

Television use by pre-schoolers and adolescents was assessed via surveys in the months prior to implementation and a year after implementation. Hours and channels of television use were linked with the amount of high-in food advertising observed in corresponding content analyses of food advertisements (ads) from popular broadcast and cable channels to estimate changes in exposure to food ads from these channels.

SETTING

Middle-lower and lower-income neighbourhoods in Santiago, Chile.

PARTICIPANTS

Pre-schoolers (n 879; mothers reporting) and adolescents (n 753; self-reporting).

RESULTS

Pre-schoolers' and adolescents' exposure to high-in food advertising in total decreased significantly by an average of 44 and 58 %, respectively. Exposure to high-in food advertising with child-directed appeals, such as cartoon characters, decreased by 35 and 52 % for pre-schoolers and adolescents, respectively. Decreases were more pronounced for children who viewed more television. Products high in sugars were the most prevalent among the high-in ads seen by children after implementation.

CONCLUSIONS

Following Chile's 2016 child-directed marketing regulation, children's exposure to high-in food advertising on popular broadcast and cable television decreased significantly but was not eliminated from their viewing. Later stages of the regulation are expected to eliminate the majority of children's exposure to high-in food advertising from television.

Does e-cigarette advertising encourage adult smokers to quit?

We provide the first causal evidence on whether e-cigarette advertising on television and in magazines encourages adult smokers to quit. We find the answer to be yes for TV advertising but no for magazine advertising. Our results indicate that a policy banning TV advertising of e-cigs would have reduced the number of smokers who quit in the recent past by approximately 3%. If the FDA were not considering regulations and mandates, e-cig ads might have reached the number of nicotine replacement therapy TV ads during that period. That would have increased the number of smokers who quit by around 10%.

Interest in inducements: A psychophysiological study on sports betting advertising

Recent research has shown an association between the viewing of wagering advertising, which often presents inducements to gamble, and maladaptive sports-betting behaviours; however, the mechanism/s underlying the development of the intention to gamble remains relatively understudied. Eye-tracking and tonic electrodermal activity was recorded from 59 participants (including 49 regular gamblers and 10 non-gamblers), while they watched a series of advertisements. Following each advertisement, participants were asked to rate how likely they would be to take up the offer presented, therein. The number of fixations placed on each offer differed according to the type of inducement shown (p < .001), with reduced risk and cash back inducements being looked at more often than better odds and bonus bet inducements by all groups. Increased electrodermal activity while viewing the advertisements was associated with greater severity of gambling-related harm (p < .001), as well as greater ratings of desire for most advertisements. Rating of desire was, likewise, positively associated with gambling-related harm (p < .001). These results may suggest that, while the offers in gambling advertisements may be looked at by most viewers, unless there an attendant increase in arousal, it is quite unlikely that these inducements will elicit a desire to gamble. For individuals already at risk of gambling problems, exposure to these advertisements, especially those offering what is perceived to be safer betting options that minimise financial losses, may exacerbate existing harms. Such information may prove useful in guiding industry practice, government regulations, therapeutic interventions, and future research on this topic.

Vaccine-related advertising in the Facebook Ad Archive

BACKGROUND

In 2018, Facebook introduced Ad Archive as a platform to improve transparency in advertisements related to politics and "issues of national importance." Vaccine-related Facebook advertising is publicly available for the first time. After measles outbreaks in the US brought renewed attention to the possible role of Facebook advertising in the spread of vaccine-related misinformation, Facebook announced steps to limit vaccine-related misinformation. This study serves as a baseline of advertising before new policies went into effect.

METHODS

Using the keyword 'vaccine', we searched Ad Archive on December 13, 2018 and again on February 22, 2019. We exported data for 505 advertisements. A team of annotators sorted advertisements by content: pro-vaccine, anti-vaccine, not relevant. We also conducted a thematic analysis of major advertising themes. We ran Mann-Whitney U tests to compare ad performance metrics.

RESULTS

309 advertisements were included in analysis with 163 (53%) pro-vaccine advertisements and 145 (47%) anti-vaccine advertisements. Despite a similar number of advertisements, the median number of ads per buyer was significantly higher for anti-vaccine ads. First time buyers are less likely to complete disclosure information and risk ad removal. Thematically, anti-vaccine advertising messages are relatively uniform and emphasize vaccine harms (55%). In contrast, pro-vaccine advertisements come from a diverse set of buyers (83 unique) with varied goals including promoting vaccination (49%), vaccine related philanthropy (15%), and vaccine related policy (14%).

CONCLUSIONS

A small set of anti-vaccine advertisement buyers have leveraged Facebook advertisements to reach targeted audiences. By deeming all vaccine-related content an issue of "national importance," Facebook has further the politicized vaccines. The implementation of a blanket disclosure policy also limits which ads can successfully run on Facebook. Improving transparency and limiting misinformation should not be separate goals. Public health communication efforts should consider the potential impact on Facebook users' vaccine attitudes and behaviors.

Density of outdoor advertising of consumable products in NYC by neighborhood poverty level

BACKGROUND

To determine if outdoor advertising density for non-alcoholic drinks, food, tobacco products, and alcohol, is associated with neighborhood poverty or other Census-level characteristics in New York City (NYC).

METHODS

From June - July of 2015, photographs were taken of all street-level, stationary outdoor advertising (posters, stickers, decals, etc.) for consumable products in a sample of 953 NYC retail-dense street segments. Density of product images was analyzed by neighborhood poverty level and other characteristics using multivariate negative-binomial regression.

RESULTS

A total of 16,305 discrete advertisements displaying 50,673 product images were photographed. Total product image prevalence relative to retail density was not significantly higher in high- vs. low-poverty neighborhoods, as hypothesized (OR: 1.31; 95% CI: 0.98, 1.77). However, total product image prevalence was higher in neighborhoods with a higher percentage of Black residents (OR: 1.08; 95% CI: 1.04, 1.12), and for sugary drinks in areas with a higher percentage of adults with

CONCLUSIONS

Product images were abundant throughout NYC's retail-dense areas, with marginally greater prevalence by some Census-level demographics, irrespective of the content displayed.

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Key Words

• Advertising
• Chronic disease
• Retail environment
• Tobacco control
• Urban

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MESH Headings

• Adult
• Advertising/methods
• Advertising/statistics & numerical data
• Black or African American/statistics & numerical data
• Alcoholic Beverages
• Beverages
• Censuses
• Female
• Food
• Humans
• Male
• New York City/epidemiology
• Poverty/statistics & numerical data
• Residence Characteristics/statistics & numerical data
• Tobacco Products

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Grants

• U58 DP005956 NCCDPHP CDC HHS
• 6 NU58DP005956-03 CDC HHS
• Centers for Disease Control and Prevention

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