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Hutelin Z, Ahrens M, Baugh ME, Oster ME, Hanlon AL, DiFeliceantonio AG. Creation and validation of a NOVA scored picture set to evaluate ultra-processed foods. Appetite 2024; 198:107358. [PMID: 38621591 PMCID: PMC11092385 DOI: 10.1016/j.appet.2024.107358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
There has been a rapid shift in the modern food environment towards increased processing in foods consumed in the United States (US) and globally. The NOVA system (not an acronym) for classifying food on degree of processing currently has the most empirical support. Consumption of foods in the NOVA 4 category, ultra-processed foods (UPF), is a risk factor for a host of poor health outcomes including heart disease, stroke, and cancer. Despite these poor health outcomes, UPF make up 58% of calories consumed in the US. Methodologies for assessing the reinforcing and rewarding properties of these foods are necessary tools. The Becker-DeGroot-Marschak auction paradigm (BDM) is a well validated tool for measuring value and is amenable to neuromonitoring environments. To allow for the testing of hypotheses based on level of food processing, we present a picture set of 14 UPF and 14 minimally-processed foods (MPF) matched on visual properties, food characteristics (fat, carbohydrate, cost, etc.), and rated perceptual properties. Further, we report our scoring of these foods using the NOVA classification system and provide additional data from credentialed nutrition professionals and on inter-rater reliability using NOVA, a critique of the system. Finally, we provide all pictures, data, and code used to create this picture set as a tool for researchers.
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Affiliation(s)
- Zach Hutelin
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, United States; Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, United States.
| | - Monica Ahrens
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, United States
| | | | - Mary E Oster
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, United States
| | - Alexandra L Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, United States
| | - Alexandra G DiFeliceantonio
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, United States; Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
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Chung A, Hatzikiriakidis K, Martino F, Skouteris H. Characterising Parent-Appeal Marketing on Foods for Children: A Scoping Review. Curr Nutr Rep 2024:10.1007/s13668-024-00559-3. [PMID: 38935250 DOI: 10.1007/s13668-024-00559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW This scoping review examines current evidence on parent-appeal marketing on the front-of-pack of food products for children and the impacts on parents' perceptions, intentions, and behaviours. RECENT FINDINGS Thirteen relevant studies were identified. Marketing features on packages of foods for children that appealed to parents include health claims, nutrition claims, non-nutrient claims such as 'natural', healthy-looking product images, images of healthy ingredients, and celebrity endorsements. At the same time, parents were wary of front-of-pack marketing and find it confusing, deceptive, and misleading. Child-appeal marketing features such as cartoon characters and bright colours gave parents the perception that products were unhealthy. Overall, this scoping review offers important insights into the types of front-of-pack marketing that appeal to parents and offers an inventory of parent-appeal marketing features. These findings support the design and implementation of policies that aim to reduce commercial influences on children's diets through stronger regulation of marketing of foods for children.
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Affiliation(s)
- Alexandra Chung
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia.
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Florentine Martino
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Warwick Business School, Warwick University, Coventry, United Kingdom
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Noonan RJ. What Are the Roots of the Nation's Poor Health and Widening Health Inequalities? Rethinking Economic Growth for a Fairer and Healthier Future. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241259241. [PMID: 38889922 DOI: 10.1177/2752535x241259241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Health inequalities are differences in health between groups in society. Despite them being preventable they persist on a grand scale. At the beginning of 2024, the Institute of Health Equity revealed in their report titled: Health Inequalities, Lives Cut Short, that health inequalities caused 1 million early deaths in England over the past decade. While the number of studies on the prevalence of health inequalities in the UK has burgeoned, limited emphasis has been given to exploring the factors contributing to these (widening) health inequalities. In this commentary article I will describe how the Government's relentless pursuit of economic growth and their failure to implement the necessary regulatory policies to mitigate against the insecurity and health effects neoliberal free market capitalism (referred to as capitalism herein) causes in pursuit of innovation, productivity and growth (economic dynamism) is one key driver underpinning this social injustice. I contend that if the priority really is to tackle health inequalities and ensure health for all then there is an imperative need to move beyond regulation alone to mitigate the worst effects of capitalist production; the goal of the economy has to change to fully restore the balance between economic growth and public health.
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Affiliation(s)
- Robert J Noonan
- Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
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van der Bend DLM, Beunke TA, Shrewsbury VA, Bucher T, van Kleef E. My feed is what I eat? A qualitative study on adolescents' awareness and appreciation of food marketing on social media. J Hum Nutr Diet 2024. [PMID: 38856698 DOI: 10.1111/jhn.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Adolescents spend much of their time online and hence are exposed to a lot of non-core (energy-dense, nutrient-poor) social media food marketing (SMFM). This may influence their dietary choices and health. This present study aimed to investigate adolescents' perceptions towards SMFM; that is, their recognition and appreciation of SMFM. METHODS Semi-structured one-on-one interviews were conducted with Dutch adolescents aged 13-16 years (n = 16), on Skype. Examples of food promotions on Instagram, Snapchat, TikTok and YouTube were discussed with adolescents. RESULTS Adolescents' reasons for recognising and appreciating or liking SMFM were often related to the level of product integration. Factors that determined participants' recognition of SMFM included product focus (e.g., brand or product prominence), sponsorship disclosure, type of content (paid, influencer and peer-generated content) and promotional strategy (e.g., discounts, promotional texts, layout). Participants' appreciation of SMFM was determined by the format of a post (image, video, text, pop-up), trustworthiness of the source (brand, celebrity, friend/peer), type of product promoted (core, non-core) and appearance or layout of a post (e.g., professionalism, appeal). CONCLUSIONS The present study contributes to the ongoing debate on how to increase adolescents' resilience to commercial messages that promote non-core foods. Adolescents mostly enjoy watching non-core video content from peers or influencers and do not perceive this as food marketing. It is recommended that future studies investigate the effects of earned social media marketing formats (i.e., unpaid peer and influencer endorsements) promoting non-core foods on adolescents' dietary intake, and how they can be made more critical towards such types of SMFM.
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Affiliation(s)
- Daphne L M van der Bend
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Department of Social Sciences, Marketing and Consumer Behaviour Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Tjamke A Beunke
- Department of Social Sciences, Marketing and Consumer Behaviour Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
| | - Tamara Bucher
- School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Ourimbah, NSW, Australia
| | - Ellen van Kleef
- Department of Social Sciences, Marketing and Consumer Behaviour Group, Wageningen University & Research, Wageningen, The Netherlands
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Jindarattanaporn N, Kelly B, Punpuing S, Phulkerd S. Development of a questionnaire for assessing the impact of children's food marketing exposure on diet-related outcomes. BMJ Nutr Prev Health 2024; 7:174-182. [PMID: 38966107 PMCID: PMC11221310 DOI: 10.1136/bmjnph-2024-000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/14/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction The Government of Thailand has drafted legislation to protect children from the harmful impact of unhealthy food (including beverages) marketing. Local evidence on Thai children's exposure to, and the impact of, this marketing is necessary to, first, support the adoption of this Law and, second, to contribute to assessing policy implementation and effectiveness. This study aimed to develop and validate a questionnaire for examining Thai children's exposure to unhealthy food marketing and its impact on diet-related outcomes. Materials and methods To design the questionnaire, we first conceptualised the range of impacts of unhealthy food marketing on children's diet-related outcomes based on published frameworks. These outcomes related to food brand loyalty, preference, purchase and consumption. We conducted a literature review to gather related questions used in earlier surveys to assess these outcomes. Using these questions, we assessed content validity with five experts. Face validity and reliability were assessed for 32 children. Validity was assessed using Content Validity Index (CVI) and Kappa statistics. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC). Results We identified 15 survey questions that had been used to assess the outcomes of interest. The CVI of all questions was 1.0, indicating perfect agreement with each question's relevance by the experts. Most questions were perceived to be easy to read and comprehend, suggesting face validity. Cronbach's alpha and ICC of all questions were both 0.75, demonstrating internal consistency across responses to questions about, separately, brand loyalty, preferences, purchase and consumption. Conclusion The final 15-item questionnaire provides a valid and reliable survey instrument for measuring the impact of unhealthy food marketing on children's diet-related outcomes. This instrument will be useful for gathering local evidence on the need for policy reform to protect children from unhealthy food marketing in Thailand. The instrument also provides a cost-effective approach for generating evidence in other jurisdictions to propel policy actions. This is a pilot study and the validity and reliability needs further testing after a larger-scale roll-out.
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Affiliation(s)
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Backholer K, Huse O, Brooks R, Martino F, Chung A, Zorbas C, Driessen C, Sartori A, Browne J. The rise and fall of the Queensland Government policy to restrict unhealthy food and alcohol advertising on publicly owned assets. Aust N Z J Public Health 2024; 48:100148. [PMID: 38839474 DOI: 10.1016/j.anzjph.2024.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE To examine the strategies employed by opponents of the Queensland Government's policy to restrict unhealthy food and alcohol advertising on publicly owned assets and identify which of the opposing arguments appeared to influence the policy outcomes. METHODS Retrospective qualitative policy analysis case study informed by the Policy Dystopia Model of corporate political activity. We used qualitative content analysis to examine data from stakeholder submissions to the 'Advertising content on Queensland Government advertising spaces' policies (v1 and 2), and Minister for Health's diaries. RESULTS Stakeholders from the food, beverage, alcohol and advertising industries and several not-for-profit health organisations opposed the policy. Industry actors used discursive strategies, coalition management (including co-option of not-for-profit health organisations), information management and direct involvement with policy makers to communicate their arguments against the policy. The second version of the policy was weaker regarding scope and key policy provisions, reflecting the arguments of industry actors. CONCLUSIONS Influence from industries with a clear conflict of interest should be minimised throughout policy development to ensure public health is prioritised over corporate gain. IMPLICATIONS FOR PUBLIC HEALTH Our findings can support other jurisdictions to prepare for industry opposition when designing policies to restrict unhealthy food and alcohol marketing.
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Affiliation(s)
- Kathryn Backholer
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia.
| | - Oliver Huse
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Ruby Brooks
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Florentine Martino
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina Zorbas
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Christine Driessen
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | | | - Jennifer Browne
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
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Brooks R, Backholer K, Kite J. Covert marketing of quick-service restaurants via news media in Australia: A content analysis. Aust N Z J Public Health 2024; 48:100150. [PMID: 38839475 DOI: 10.1016/j.anzjph.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE To determine the extent and nature of news media coverage generated from press releases made by top-selling quick-service restaurants in Australia. METHODS We conducted a content analysis of press releases made between July 2021 and June 2022 by the five largest quick-service restaurant brands in Australia by brand share, including coding their main subject. We then conducted a content analysis of news media coverage related to the press releases, including coding its slant towards the brand. RESULTS Among 52 press releases, new food products (27% of press releases; all unhealthy foods) and corporate social responsibility activities (25%) were the most promoted subjects. For 62% of press releases, at least one news media item was identified. Among the 86 identified news media items, most related to press releases promoting new food products (45% of news media items) or corporate social responsibility activities (21%). News media items overwhelmingly had a slant favourable to the relevant brand (93%). CONCLUSIONS Press releases by top-selling quick-service restaurant brands in Australia commonly generate news media coverage that promotes such brands and their predominantly unhealthy products. IMPLICATIONS FOR PUBLIC HEALTH Policies restricting unhealthy food marketing should consider brand-generated news media coverage.
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Affiliation(s)
- Ruby Brooks
- Sydney School of Public Health, University of Sydney, Australia; Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Australia.
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Australia
| | - James Kite
- Sydney School of Public Health, University of Sydney, Australia
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Pellegrino F, Tan M, Richonnet C, Reinert R, Bucher Della Torre S, Chatelan A. What Is the Nutritional Quality of Pre-Packed Foods Marketed to Children in Food Stores? A Survey in Switzerland. Nutrients 2024; 16:1656. [PMID: 38892589 PMCID: PMC11175003 DOI: 10.3390/nu16111656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Food marketing targeting children influences their choices and dietary habits, and mainly promotes food high in fat, sugar, and salt as well as ultra-processed food. The aim of this study was to assess the nutritional quality of food and beverages marketed to children over the age of 3 and available on the Swiss market. Products with at least one marketing technique targeting children on the packaging were selected from five food store chains. Three criteria to assess nutritional quality were used: (1) nutritional composition (using the Nutri-Score), (2) degree of processing (NOVA classification), and (3) compliance with the World Health Organization (WHO) Nutrient Profile Model (NPM). A total of 735 products were found and analyzed. The most common marketing techniques used were childish names/fonts (46.9%), special characters (39.6%), and children's drawings (31.3%). Most products had a Nutri-Score of D or E (58.0%) and were ultra-processed (91.8%). Only 10.2% of products displayed the Nutri-Score. The least processed products generally had a better Nutri-Score (p < 0.001). Most products (92.8%) did not meet the criteria of the WHO NPM. Products that met the WHO NPM criteria, organic products, and products with a nutritional claim generally had a better Nutri-Score and were less processed (ps < 0.05). Pre-packaged foods and beverages marketed to children in the Swiss market were mostly of poor nutritional quality. Public health measures should be adopted to improve the nutritional quality of foods marketed to children in Switzerland and restrict the marketing of unhealthy foods to children.
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Affiliation(s)
- Fabien Pellegrino
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Celine Richonnet
- Club Européen des Diététiciens de l’Enfance (CEDE), Esplanade, 17-7800 Ath, Belgium
| | - Raphaël Reinert
- Federal Food Safety and Veterinary Office, Schwarzenburgstrasse 155, 3003 Bern, Switzerland
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland
| | - Angeline Chatelan
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland
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Minaker LM, Menko P, Olona D. Development and testing of two tools to assess point-of-sale food and beverage marketing to children in restaurants. Public Health Nutr 2024; 27:e128. [PMID: 38705591 PMCID: PMC11112432 DOI: 10.1017/s1368980024000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To describe the development and testing of two assessment tools designed to assess exterior (including drive-thru) and interior food and beverage marketing in restaurants with a focus on marketing to children and teens. DESIGN A scoping review on restaurant marketing to children was undertaken, followed by expert and government consultations to produce a draft assessment tool. The draft tool was mounted online and further refined into two separate tools: the Canadian Marketing Assessment Tool for Restaurants (CMAT-R) and the CMAT-Photo Coding Tool (CMAT-PCT). The tools were tested to assess inter-rater reliability using Cohen's Kappa and per cent agreement for dichotomous variables, and intra-class correlation coefficients (ICCs) for continuous or rank-order variables. SETTING Waterloo, Ontario, Canada. PARTICIPANTS Restaurants of all types were assessed using the CMAT-R (n 57), and thirty randomly selected photos were coded using the CMAT-PCT. RESULTS The CMAT-R collected data on general promotions and restaurant features, drive-thru features, the children's menu and the dollar/value menu. The CMAT-PCT collected data on advertisement features, features considered appealing to children and teens, and characters. The inter-rater reliability of the CMAT-R tool was strong (mean per cent agreement was 92·4 %, mean Cohen's κ = 0·82 for all dichotomous variables and mean ICC = 0·961 for continuous/count variables). The mean per cent agreement for the CMAT-PCT across items was 97·3 %, and mean Cohen's κ across items was 0·91, indicating very strong inter-rater reliability. CONCLUSIONS The tools assess restaurant food and beverage marketing. Both showed high inter-rater reliability and can be adapted to better suit other contexts.
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Affiliation(s)
- Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Patrycia Menko
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Olona
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Harris JL, Taillie LS. More than a Nuisance: Implications of Food Marketing for Public Health Efforts to Curb Childhood Obesity. Annu Rev Public Health 2024; 45:213-233. [PMID: 38109516 DOI: 10.1146/annurev-publhealth-090419-102616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Fifteen years ago, public health experts urged industry, governments, and advocates to take action to dramatically improve the unhealthy food-marketing environment surrounding children in order to address the global childhood obesity crisis. Since then, research has confirmed that food marketing to children has far-reaching negative effects on their diets and health, takes advantage of adolescent vulnerabilities, and contributes to health disparities. In addition, digital marketing has profoundly changed young people's engagement with brands. Moreover, reliance on industry self-regulation as a solution has proven ineffective. Government-led policies have been more successful, but they remain limited in scope and challenging to adopt and implement. New approaches are necessary to increase public and policy maker awareness that food marketing is more than a nuisance, that it threatens the long-term health of children and adolescents worldwide, and that meaningful governmental action is urgently required to curtail industry's negative impact on young people's well-being.
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Affiliation(s)
- Jennifer L Harris
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut, USA;
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Boyland E, Spanakis P, O'Reilly C, Christiansen P. Associations between everyday exposure to food marketing and hunger and food craving in adults: An ecological momentary assessment study. Appetite 2024; 196:107241. [PMID: 38307297 DOI: 10.1016/j.appet.2024.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
Food marketing in television and digital media negatively affects appetitive sensations and eating behaviour in children, but effects are less well understood for outdoor food advertising and adults. This research used Ecological Momentary Assessment (EMA) to explore associations between exposures to food advertising in various contexts (television, digital, outdoors) and adults' hunger and craving for highly advertised food categories. Over one week, participants provided ratings of cravings for types of food (fast food, soft drinks, snacks/confectionery, other) and hunger on a smartphone app up to six times per day when they saw a food advertisement (reactive assessment) and at random intervals (random assessment). Fifty-four participants (70.4 % female; 21.24 ± 3.84 years) provided 1223 assessments (24.7 % reactive, 75.3 % random). Data were analysed in R using multilevel multivariable linear regression models. Participants reported feeling hungrier (X2(1) = 5.85, p = .016, ΔAIC = 3.9) and having stronger cravings (X2(1) = 20.64, p < .001, ΔAIC = 318.6) after seeing food advertisements vs. random assessments. This was driven by greater hunger following television advertising exposure vs. random assessments (β = 1.58, SE = 0.61, p = .010, 95 %CIs 0.38 to 2.78), food advertising via digital devices or outdoors was not associated with hunger. Participants experienced stronger craving after seeing a food advertisement on television (β = 0.52, SE = 0.19, p = .006, 95 %CIs 0.15 to 0.89), outdoors (β = 0.39, SE = 0.12, p < .001, 95 % CIs 0.16 to 0.62) and in digital media (β = 0.36, SE = 0.14, p = .012, 95 % CIs 0.08 to 0.64), vs. random assessments. Cravings were (largely) specific to the advertised food category. EMA can be effective for assessing food marketing associations in adults. The current study provides evidence that food marketing is associated with hunger and craving in adults, which may, with replication, have implications for public health policy.
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Affiliation(s)
- Emma Boyland
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Panagiotis Spanakis
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Connor O'Reilly
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Paul Christiansen
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
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12
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Agarwal A, Esmaeel SE, Alrawili RA, Alanazi FB, Alanazi E, Alhazimi AF. Perception and Impact of Food and Beverage Marketing on Children's Eating Behaviors and Associated Health Issues. Cureus 2024; 16:e61210. [PMID: 38939281 PMCID: PMC11208888 DOI: 10.7759/cureus.61210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Children are more susceptible to food and beverage marketing than adults, but little is known about the specific effects of marketing through the media most used by children. This study aims to discover variables that can help inform childhood obesity prevention strategies. Our findings indicate an association between food advertisements and children's consumption, evidencing a need for the concerned authorities to create strict guidelines that consider the nutritional value of advertised foods. This study aims to study the attitudes and practices of children related to their preference for unhealthy meals due to food marketing and their association with childhood obesity. METHODOLOGY A cross-sectional study of randomly selected guardians of children who were screened for obesity. A structured questionnaire was given to the children's parents. RESULTS The study found that most of the participants' children prefer fast food (291, 78.0%), eat healthy meals (287, 76.9%), and eat fruits and vegetables every day (198, 53.1%). Furthermore, most participants (340, 91.2%) indicated that they were aware of unhealthy diets, and 105 (28.2%) said their children were overweight. Most participants (326, 87.4%) also indicated that watching television (TV) was associated with eating high-calorie foods. CONCLUSIONS There is strong evidence that children exposed to food marketing develop attitudes about and choose unlimited healthy food and unhealthy foods, which negatively impacts their health. It is recommended that future research employs a wide range of methodologies to study contemporaneous marketing strategies.
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Affiliation(s)
- Anshoo Agarwal
- Department of Pathology, Faculty of Medicine, Northern Border University, Arar, SAU
| | - Safya E Esmaeel
- Department of Physiology, Northern Border University, Arar, SAU
| | | | - Fai B Alanazi
- Department of Medicine, Northern Border University, Arar, SAU
| | - Eman Alanazi
- Department of Medicine, Northern Border University, Arar, SAU
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Nuss T, Chen YJM, Scully M, Hickey K, Martin J, Morley B. Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products. Health Promot J Austr 2024; 35:332-339. [PMID: 37286359 DOI: 10.1002/hpja.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
ISSUE ADDRESSED This study assessed Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products. METHODS An online survey was undertaken by Australian adults aged 18-64 recruited via two national panels in December 2019 (N = 2044). RESULTS Most respondents (69%) agreed the Government should protect children from unhealthy food and drink marketing and advertising broadly. Those who agreed most commonly indicated children should be protected up to age 16 (34%) or 18 (24%). There was widespread support for government actions to stop unhealthy food and drink marketing on digital platforms (e.g., internet sites) (68%-69%) and various digital marketing techniques (e.g., advertising by brands on social media) (56%-71%). A total ban on targeting unhealthy food and drink marketing to children online received the highest level of support (76%). Most respondents (81%) disagreed unhealthy food and drink companies should be able to collect children's personal information for marketing purposes. Support for examined actions was generally higher among older adults, more educated adults and more frequent internet users, lower among males, and similar between parents and non-parents. CONCLUSIONS There is public perception that the government is responsible for protecting children, well into adolescence, from unhealthy food and drink marketing broadly. Widespread public support extends to specific actions to reduce children's exposure to digital marketing of unhealthy food and drink products. SO WHAT?: Implementation of policies to protect children from digital marketing of unhealthy food and drink products would be well received by the Australian public.
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Affiliation(s)
- Tegan Nuss
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Yan Jun Michelle Chen
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | | | - Jane Martin
- Food For Health Alliance, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
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Balderas-Arteaga N, Mendez K, Gonzalez-Rocha A, Pacheco-Miranda S, Bonvecchio A, Denova-Gutiérrez E. Healthy lifestyle interventions within the curriculum in school-age children: systematic review and meta-analysis. Health Promot Int 2024; 39:daae020. [PMID: 38470184 DOI: 10.1093/heapro/daae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Childhood obesity is a major public health challenge. Previous research has identified the impact of school-based interventions for preventing and treating obesity; we hypothesized that when curricular changes are integrated, results could be exponentiated. This study aimed to systematically review and conduct a meta-analysis of the published literature analyzing information about school-based interventions inserted in the curriculum. The Cochrane Handbook methodology was followed. An electronic search was conducted in five databases, with a specific design strategy per database. Randomized controlled trials or quasi-experimental studies of children with nutrition and physical activity (PA) interventions inserted into the school curricula were included. The risk of bias was assessed with the Risk of Bias tool. The mean differences were pooled using a fixed-effects model for the meta-analysis. The certainty of the evidence was evaluated according to the guidelines of the Grading of the Recommendations, Assessment, Development, and Evaluations working group (Protocol ID: CRD42021270557). After the screening and selection process, 12 studies were included. The interventions identified, based on the school curricula, include classroom activities and homework, among others. A meta-analysis with five intervention groups presented an overall mean difference of -0.14 body mass index (BMI) Z-score (95% CI: -0.25, -0.03) after this intervention with high certainty of the evidence. This systematic review and meta-analysis suggest that nutrition and PA lessons inserted into the curricula and supported with additional activities (i.e. homework, workshops, etc.) could increase nutrition knowledge and improve attitudes toward fruit, vegetables, and water consumption, and BMI Z-score reduction.
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Affiliation(s)
- Nydia Balderas-Arteaga
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Kenia Mendez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Alejandra Gonzalez-Rocha
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Selene Pacheco-Miranda
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Anabelle Bonvecchio
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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15
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Henney AE, Gillespie CS, Alam U, Hydes TJ, Boyland E, Cuthbertson DJ. Ultra-processed food and non-communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature. Obes Rev 2024; 25:e13682. [PMID: 38204299 DOI: 10.1111/obr.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
The social and economic constructs of the United Kingdom (UK) provide a fertile food environment for the dramatic expansion in the ultra-processed food (UPF) market, driving increased UPF consumption. This has coincided with the significant increase in the incidence and prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and cancer, with an inherent impact on morbidity and mortality. Our review aims to assess the current epidemiological and public health trends in the United Kingdom, specifically examining consumption of UPFs and subsequent development of NCDs, summarizing existing meta-analytical and experimental approaches. First, we address important socioeconomic and psychosocial domains that may contribute to increased availability and consumption of UPF. Additionally, we explore the putative mechanistic basis for the association between UPFs and NCDs: partly attributable to their energy density, the macro- and micronutrient composition (including high refined carbohydrate, saturated, and trans fats composition, in addition to low fiber and protein content), and artificially engineered additives and other compounds that adversely affect health in inadequately researched pathophysiological pathways. This review highlights the importance of promoting minimally processed diets to both clinical and political decision makers.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Theresa J Hydes
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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Ares G, De Rosso S, Mueller C, Philippe K, Pickard A, Nicklaus S, van Kleef E, Varela P. Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets. Nutr Rev 2024; 82:536-552. [PMID: 37339527 PMCID: PMC10925906 DOI: 10.1093/nutrit/nuad072] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.
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Affiliation(s)
- Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay
| | - Sofia De Rosso
- Centre des Sciences du Goût et de l’Alimentation, Centre National de la Recherche Scientifique, Institut National de la Recherche Agronomique, Institut Agro, Université de Bourgogne, Dijon, France
| | - Carina Mueller
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Kaat Philippe
- Centre des Sciences du Goût et de l’Alimentation, Centre National de la Recherche Scientifique, Institut National de la Recherche Agronomique, Institut Agro, Université de Bourgogne, Dijon, France
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
| | - Abigail Pickard
- Center for Food and Hospitality Research, Cognitive Science, Institut Paul Bocuse Research Center, Lyon, France
- Laboratoire d’Etude de l’Apprentissage et du Développement–Centre National de la Recherche Scientifique UMR5022, University of Burgundy, Dijon, France
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Sophie Nicklaus
- Centre des Sciences du Goût et de l’Alimentation, Centre National de la Recherche Scientifique, Institut National de la Recherche Agronomique, Institut Agro, Université de Bourgogne, Dijon, France
| | - Ellen van Kleef
- Marketing and Consumer Behaviour Group, Wageningen University and Research, Wageningen, the Netherlands
| | - Paula Varela
- Nofima AS, Ås, Norway
- Department of Chemistry, Biotechnology and Food Science, The Norwegian University of Life Science, Ås, Norway
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17
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Ares G, Antúnez L, Alcaire F, Natero V, Otterbring T. Is this advertisement designed to appeal to you? Adolescents' views about Instagram advertisements promoting ultra-processed products. Public Health Nutr 2024; 27:e96. [PMID: 38449441 PMCID: PMC10993065 DOI: 10.1017/s1368980024000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents. DESIGN Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding. SETTING One private secondary school and two after-school clubs. PARTICIPANTS Convenience sample of 105 Uruguayan adolescents aged 11-17 years. RESULTS Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products. CONCLUSIONS This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.
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Affiliation(s)
- Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando,
Facultad de Química, Universidad de la República, By Pass de
Rutas 8 y 101 s/n, Pando, Montevideo, Uruguay
- Centro de Investigación Básica en Psicología, Facultad de Psicología,
Universidad de la República, Tristán Narvaja 1674,
Montevideo, Uruguay
| | - Lucía Antúnez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando,
Facultad de Química, Universidad de la República, By Pass de
Rutas 8 y 101 s/n, Pando, Montevideo, Uruguay
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando,
Facultad de Química, Universidad de la República, By Pass de
Rutas 8 y 101 s/n, Pando, Montevideo, Uruguay
| | - Virginia Natero
- Escuela de Nutrición, Universidad de la
República, Montevideo, Uruguay
| | - Tobias Otterbring
- School of Business and Law, Department of Management,
University of Agder, Universitetsveien 17,
Kristiansand, Norway
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18
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Royo-Bordonada MÁ, Cavero-Esponera C, Romero-Fernández MM, González-Díaz C, Ordaz Castillo E. Differences in children's exposure to television advertising of unhealthy foods and beverages in Spain by socio-economic level. BMC Public Health 2024; 24:739. [PMID: 38454414 PMCID: PMC10921598 DOI: 10.1186/s12889-023-17410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. METHODS Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. RESULTS The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). CONCLUSION Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television.
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Affiliation(s)
- Miguel Ángel Royo-Bordonada
- National School of Public Health, Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, 28029, Spain
| | - Cristina Cavero-Esponera
- Department of Preventive Medicine and Public Health, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, 28003, Spain.
- Doctoral Program in Biomedical Sciences and Public Health, International Doctorate Program, National University of Distance Education (UNED), Madrid, 28015, Spain.
| | - María Mar Romero-Fernández
- Puertollano Integrated Care Management. Health Service of Castilla-La Mancha, Unit of Teaching and Research, Santa Bárbara Hospital, Castilla-La Mancha, Spain
| | | | - Elena Ordaz Castillo
- National School of Public Health, Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, 28029, Spain
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Rivera JA, Colchero MA, Pérez-Ferrer C, Barquera S. Perspective: Mexico's Experience in Building a Toolkit for Obesity and Noncommunicable Diseases Prevention. Adv Nutr 2024; 15:100180. [PMID: 38246349 PMCID: PMC10877686 DOI: 10.1016/j.advnut.2024.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Noncommunicable diseases (NCDs) are a leading cause of death and disability worldwide, with a higher risk of death in low- and middle-income countries. Diet and excess weight are risk factors for NCDs. In Mexico, the prevalence of overweight and obesity increased dramatically in the last 30 y and is among the highest in the world. To address this public health problem, governments and public health professionals have several policy instruments available. In this study, we present the policy instruments currently approved in Mexico, which include fiscal, informational, and authoritative tools that aim to improve the food environment and promote healthy behaviors (taxes, school food guidelines, front-of-pack labeling, marketing regulations, and dietary guidelines). These types of interventions are important in regions like Latin America, where social inequities and poor access to information are common, and individual healthy choices are often limited. These interventions target the environments in which individuals live, study, work, and seek entertainment, while limiting access to unhealthy choices and offering information to promote healthy alternatives. The Mexican experience in design, implementation, and evaluation of policies to improve the food environment can be useful for other low- and middle-income countries facing similar challenges.
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Affiliation(s)
- Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Mónica Arantxa Colchero
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Carolina Pérez-Ferrer
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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20
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Jindarattanaporn N, Phulkerd S, Chamratrithirong A, Soottipong Gray R, Pattaravanich U, Loyfah N, Thapsuwan S, Thongcharoenchupong N. How an agreement with restriction of unhealthy food marketing and sodium taxation influenced high fat, salt or sugar (HFSS) food consumption. BMC Public Health 2024; 24:586. [PMID: 38395859 PMCID: PMC10885404 DOI: 10.1186/s12889-024-18069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Food taxation and food marketing policy are very cost-effectiveness to improve healthy diets among children. The objective of this study was to investigate the socio-demographic characteristics of Thais and attitude towards on policy unhealthy food marketing restriction and sodium taxation which influence high fat, sodium, and sugar (FHSS) food eating. METHODS The data were obtained from the 2021 Health Behavior of Population Survey, four-stage sampling method of the Thai people, aged 15 years and above, using a offline survey application-assisted face-to-face interview. Logistic Regression were used to analyze the explanatory variables on agreement and HFSS food intake. RESULTS Almost half (48.4%) of samples disagreed with sodium taxation, and 42.7% of the samples disagreed with food marketing restriction. Most (99.6%) of Thai respondents consumed HFSS food, including sugar sweetened beverages (SSB). Gender, age, education, income, BMI, and health status were associated with agreement with food marketing restriction policy and sodium taxation policy. There is no association between agreement with policy on sodium taxation and food marketing and HFSS food consumption. CONCLUSION Nearly half of Thais indicated that they disagreed with policy on food marketing restriction and sodium taxation. Therefore, understanding and awareness of the two policies among Thais should be further investigated in order to develop better policy communication for increased public understanding and engagement.
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Affiliation(s)
- Nongnuch Jindarattanaporn
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand.
| | - Aphichat Chamratrithirong
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
| | - Rossarin Soottipong Gray
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
| | - Umaporn Pattaravanich
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
| | - Nutnicha Loyfah
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
| | - Sasinee Thapsuwan
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
| | - Natjera Thongcharoenchupong
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand
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21
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Maksi SJ, Keller KL, Dardis F, Vecchi M, Freeman J, Evans RK, Boyland E, Masterson TD. The food and beverage cues in digital marketing model: special considerations of social media, gaming, and livestreaming environments for food marketing and eating behavior research. Front Nutr 2024; 10:1325265. [PMID: 38384857 PMCID: PMC10880034 DOI: 10.3389/fnut.2023.1325265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 02/23/2024] Open
Abstract
Digital marketing to children, teens, and adults contributes to substantial exposure to cues and persuasive messages that drive the overconsumption of energy dense foods and sugary beverages. Previous food marketing research has focused on traditional media, but less is known about how marketing techniques translate within digital platforms, such as social media, livestreaming, and gaming. Building upon previous theories and models, we propose a new model entitled food and beverage cues in digital marketing (FBCDM). The FBCDM model specifies key marking elements and marketing integration strategies that are common on digital platforms and are hypothesized to enhance the effects of advertising and incentive sensitization process. FBCDM also categorizes measurable outcomes into three domains that include brand, food, and social outcomes. Additionally, repeated marketing exposure and the resulting outcomes are hypothesized to have long term consequences related to consumer markets, consumption behavior, culture, and health. We include a discussion of what is currently known about digital marketing exposure within the outcome domains, and we highlight gaps in research including the long-term consequences of digital marketing exposure. The FBCDM model provides a conceptual framework to guide future research to examine the digital marketing of food and beverages to children and adolescents in order to inform government and industry policies that restrict the aggressive marketing of products associated with obesity and adverse diet related outcomes.
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Affiliation(s)
- Sara J. Maksi
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Kathleen L. Keller
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Frank Dardis
- Department of Advertising and Public Relations, The Pennsylvania State University, University Park, PA, United States
| | - Martina Vecchi
- Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, University Park, PA, United States
| | - Jason Freeman
- Department of Advertising, School of Communications, Brigham Young University, Provo, UT, United States
| | - Rebecca K. Evans
- Department of Psychology, The University of Liverpool, Liverpool, United Kingdom
| | - Emma Boyland
- Department of Psychology, The University of Liverpool, Liverpool, United Kingdom
| | - Travis D. Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
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22
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Amson A, Pauzé E, Ramsay T, Welch V, Hamid JS, Lee J, Olstad DL, Mah C, Raine K, Potvin Kent M. Examining gender differences in adolescent exposure to food and beverage marketing through go-along interviews. Appetite 2024; 193:107153. [PMID: 38072086 DOI: 10.1016/j.appet.2023.107153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/17/2023] [Accepted: 12/04/2023] [Indexed: 01/01/2024]
Abstract
This study explores how adolescents engage with unhealthy food and beverage marketing in online settings, from a gender perspective. Employing an online ethnography approach and using go-along interviews, we explored the experiences of adolescent boys and girls aged 13-17 as they navigated their online experiences with digital food and beverage marketing. Notable themes emerged, including the identification of predatory actions by food companies, the role of protective factors such as family, and the influence of social media influencers in shaping adolescent dietary preferences. Importantly, this research unearthed gender disparities in the participants' responses. Girls, in particular, exhibited a heightened awareness of the protective role played by their families, emphasized the influence of color in marketing strategies, recognized the significance of gender in marketing, and reported exposure to alcohol advertisements-findings that boys less frequently echoed. The study underscores the importance of adolescence as a critical phase in development, during which food companies target these impressionable individuals, driven by their independence and potential for brand loyalty. Moreover, it highlights the potential avenue of gender-specific marketing, offering valuable insights into the gendered dimensions of adolescents' food marketing experiences. By examining the interplay between digital food marketing and gender, this research addresses a critical gap in the literature, shedding light on how gender influences adolescents' perceptions, responses, and behaviors in the context of food marketing strategies. These findings have the potential to inform adolescents of the marketing techniques that target them and guide policymakers in developing and implementing evidence-based regulations aimed at safeguarding adolescents from exposure to unhealthy food marketing.
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Affiliation(s)
- A Amson
- Interdisciplinary School of Health Sciences, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada
| | - E Pauzé
- Interdisciplinary School of Health Sciences, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada
| | - T Ramsay
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - V Welch
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - J S Hamid
- Department of Mathematics and Statistics, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada
| | - J Lee
- Cumming School of Medicine - Department of Community Health Sciences & Cardiac Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - D L Olstad
- Cumming School of Medicine - Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - C Mah
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building 2nd Floor 2A01, Office 2A03, 5850 College Street, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - K Raine
- Center for Health Promotion Studies, School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - M Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
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23
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Bassi S, Bahl D, Gopal S, Sethi V, Backholer K, Gavaravarapu SM, Babu GR, Ghosh-Jerath S, Bhatia N, Aneja K, Kataria I, Mishra P, De Wagt A, Arora M. Are advertising policies affirmative in restricting the marketing of foods high in fat, salt and sugar (HFSS) in India?: evidence from SWOT Analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100315. [PMID: 38361596 PMCID: PMC10866952 DOI: 10.1016/j.lansea.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 02/17/2024]
Abstract
The regulatory Indian environment for advertising high fat, salt, and sugar (HFSS) foods and non-alcoholic beverages, on various media was reviewed. Identified national-level policies were categorised as mandatory or self-regulatory based on legal content. For each mandatory regulation, Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was undertaken to determine how existing policies could be strengthened to safeguard children from unhealthy food advertisements. Thirteen policies (nine mandatory; four self-regulatory) relevant to advertising in India were identified. Of the nine mandatory policies, Guidelines for Prevention of Misleading Advertisements and Endorsements for Misleading Advertisements, 2022, is the only policy that restricts HFSS food advertisements to children across all media. There are key shortfalls, including limited scope of 'child-targeted' advertisements and lack of criteria to define HFSS foods. A robust regulatory framework is needed to protect children from HFSS food marketing, not just what is 'directed' at them, with clear evidence-based food classification criteria.
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Affiliation(s)
| | | | | | - Vani Sethi
- UNICEF, Regional Office for South Asia, Kathmandu, Nepal
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - Giridhara R. Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | | | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
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24
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Sanders T, Noetel M, Parker P, Del Pozo Cruz B, Biddle S, Ronto R, Hulteen R, Parker R, Thomas G, De Cocker K, Salmon J, Hesketh K, Weeks N, Arnott H, Devine E, Vasconcellos R, Pagano R, Sherson J, Conigrave J, Lonsdale C. An umbrella review of the benefits and risks associated with youths' interactions with electronic screens. Nat Hum Behav 2024; 8:82-99. [PMID: 37957284 DOI: 10.1038/s41562-023-01712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/01/2023] [Indexed: 11/15/2023]
Abstract
The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.
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Affiliation(s)
- Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia.
| | - Michael Noetel
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Philip Parker
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Borja Del Pozo Cruz
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physical Education, Faculty of Education, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Faculty of Sport and Health Scienchresholds for statistical credibilites, University of Jyväskylä, Jyväskylä, Finland
| | - Rimante Ronto
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Ryan Hulteen
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Rhiannon Parker
- The Centre for Social Impact, University of New South Wales, Sydney, New South Wales, Australia
| | - George Thomas
- The Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Katrien De Cocker
- Department of Movement and Sport Science, Ghent University, Ghent, Belgium
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Kylie Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nicole Weeks
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Hugh Arnott
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Emma Devine
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, New South Wales, Australia
| | - Roberta Vasconcellos
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Rebecca Pagano
- School of Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Jamie Sherson
- School of Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - James Conigrave
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
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25
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Boyland E, Maden M, Coates AE, Masterson TD, Alblas MC, Bruce AS, Roberts CA. Food and non-alcoholic beverage marketing in children and adults: A systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Obes Rev 2024; 25:e13643. [PMID: 37766661 DOI: 10.1111/obr.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/12/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
Food marketing impacts the food behaviors of children and adults, but the underpinning neural mechanisms are poorly understood. This systematic review and meta-analysis pooled evidence from neuroimaging studies of exposure to food marketing stimuli (vs. control) on brain activations in children and adults to clarify regions associated with responding. Databases were searched for articles published to March 2022. Inclusion criteria included human functional magnetic resonance imaging (fMRI) studies employing a contrast between a food marketing stimulus and a non-food/non-exposure control, published in English in a peer-reviewed journal, reporting whole brain (not Region of Interest [ROI] only) co-ordinates. Eleven studies met inclusion criteria, of which eight were included in the quantitative synthesis (Activation Likelihood Estimation [ALE] meta-analysis). Food marketing exposures (vs. controls) produced greater activation in two clusters lying across the middle occipital gyrus, lingual gyrus, and cuneus (cluster 1), and the postcentral gyrus, precentral gyrus, and the inferior parietal lobule/supramarginal gyrus (cluster 2). Brain responses to food marketing are most consistently observed in areas relating to visual processing, attention, sensorimotor activity, and emotional processing. Subgroup analyses (e.g., adults vs. children) were not possible because of the paucity of data, and sensitivity analyses highlighted some instability in the clusters; therefore, conclusions remain tentative pending further research.
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Affiliation(s)
- Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Anna E Coates
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Travis D Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, Pennsylvania, USA
| | - Monique C Alblas
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda S Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas, USA
| | - Carl A Roberts
- Department of Psychology, University of Liverpool, Liverpool, UK
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26
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Engel E, Gell S, Heiss R, Karsay K. Social media influencers and adolescents' health: A scoping review of the research field. Soc Sci Med 2024; 340:116387. [PMID: 38039770 DOI: 10.1016/j.socscimed.2023.116387] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/29/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
Social media influencers (SMIs) have become an important source of health information for adolescents. However, the lack of expertise and commercial interests of SMIs pose challenges for adolescent health. To gain a better understanding of these challenges, this scoping review aimed to synthesize existing research on the role of SMIs in adolescent health. Using the PRISMA-ScR approach, we conducted a comprehensive search of eight databases and screened articles based on predefined criteria. The final sample included 51 articles published between 2012 and 2022. Results revealed inconsistent definitions and classifications of SMIs. The most common topics included appearance, nutrition, and substance use, while mental and sexual health topics were underrepresented. The ability of SMIs to establish trustworthy relationships with their followers was highlighted in the reviewed studies, shedding light on potential benefits and challenges for adolescent health. However, most studies focused on the negative roles of SMIs, such as the promotion of unrealistic body images, unhealthy diets, substance use, and inaccurate diagnosis and treatment advice. In addition, inappropriate advertising of unhealthy products (e.g., junk food, tobacco products and alcohol) was identified as a major challenge. The reviewed studies identified stricter regulation and improved social media and health literacy as important avenues for policy action. Less attention was given to the potential positive impact of SMIs and how to effectively include them in health promotion campaigns. In addition, the majority of studies were conducted in the Global North and relied on quantitative approaches, resulting in a lack of representation of minority populations and male adolescents.
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Affiliation(s)
- Elena Engel
- University of Vienna, Department of Communication, Kolingasse 14-16, 1070 Vienna, Austria; MCI | The Entrepreneurial School©, Center for Social & Health Innovation, Universitätsstraße 15, 6020, Innsbruck, Austria.
| | - Sascha Gell
- University of Vienna, Department of Communication, Kolingasse 14-16, 1070 Vienna, Austria; MCI | The Entrepreneurial School©, Center for Social & Health Innovation, Universitätsstraße 15, 6020, Innsbruck, Austria.
| | - Raffael Heiss
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation, Universitätsstraße 15, 6020, Innsbruck, Austria.
| | - Kathrin Karsay
- University of Vienna, Department of Communication, Kolingasse 14-16, 1070 Vienna, Austria.
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27
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Watson WL, Torkel S, Kat M, Hughes C. How healthy are Australian lunch box snacks with child-directed marketing? Health Promot J Austr 2024; 35:220-224. [PMID: 36941803 DOI: 10.1002/hpja.718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/18/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
ISSUE ADDRESSED The diets of Australian children, including their lunch boxes have a disproportionate amount of discretionary foods. Packaged snacks have marketing directed to both children and parents. METHODS Packaged school lunch box snacks were identified on supermarket websites. Nutrition information and child-directed and parent-directed marketing on the package were analysed. The "healthiness" of products was analysed using the Health Star Rating (HSR) (presently on packaging in Australia), two criteria designed for assessing food suitable for marketing to children (the Australian Health Council and the World Health Organization Western Pacific region) and Chilean criteria (used for broad food regulation). RESULTS The average HSR of the 135 products was 2.2% and 79% had a HSR <3.5. About 39% of products had child-directed marketing. Child-directed marketing would be removed from 89% sweet snacks, and 91% savoury snacks if products with a HSR <3.5 were not allowed to carry that marketing. This is less than the proportion not allowed using criteria from Chile (100%), World Health Organization Western Pacific Region (99%) and the Australian Health Council (93%). CONCLUSIONS A policy that disallows marketing tactics on unhealthy food based on any of the criteria studied would remove most of both child-directed and parent-directed marketing on packaged lunch box snacks. SO WHAT?: Removing child-directed marketing from unhealthy products would help parents when shopping and contribute to addressing the high proportion of discretionary foods eaten by children at school. Child-directed marketing on packaging should be a part of comprehensive regulation to protect children from the marketing of unhealthy foods.
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Affiliation(s)
- Wendy L Watson
- Cancer Prevention and Advocacy Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, New South Wales, Australia
| | - Sophia Torkel
- Nutrition and Dietetics Group, School of Life and Environmental Science, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Martha Kat
- Nutrition and Dietetics Group, School of Life and Environmental Science, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Clare Hughes
- Cancer Prevention and Advocacy Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, New South Wales, Australia
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28
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Dunford EK, Kelly B, Jones A. Could Google Help Curb Online Advertising of Unhealthy Foods to U.S. Children? Am J Prev Med 2024; 66:64-72. [PMID: 37737788 DOI: 10.1016/j.amepre.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION In 2020, Google took voluntary action to restrict food and beverage advertising through its online channels in the European Union/United Kingdom using Google's own nutrient profiling model to identify products eligible to be marketed to children through its Google Display Network. The objective of this study was to evaluate the potential impact of the Google policy, if applied to the U.S. market, on restricting online advertising of the top-selling packaged foods and beverages in the U.S. METHODS The top 25 U.S. food and beverage manufacturers were identified. Nutrient data for products from these manufacturers were sourced from Label Insight (a Nielsen IQ company) in 2021. Each product was examined against four nutrient profiling models: the Google nutrient profiling model, the WHO Europe nutrient profiling model, the Pan American Health Organization nutrient profiling model, and the Chilean government nutrient profiling model. RESULTS Under Google's nutrient profiling model, 18% of 14,188 products were eligible to be advertised to children, representing $44 billion in revenue for the top 25 U.S. manufacturers of the >$240 billion generated annually. The Google nutrient profiling model permitted the most products to be advertised to children of all four nutrient profiling models examined. CONCLUSIONS U.S. children engage extensively with online media. In place of government regulation, the Google advertising policy and related nutrient profiling model would limit online advertising of the most unhealthful products to children, if the policy were to be applied to the U.S. market. The effectiveness of the policy would be strengthened by refining the Google nutrient profiling model to better align with nutrient profiling models developed by authoritative health agencies, including the WHO.
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Affiliation(s)
- Elizabeth K Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong Australia, Wollongong, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia
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29
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Mediano Stoltze F, Correa T, Corvalán Aguilar CL, Taillie LS, Reyes M, Dillman Carpentier FR. Beverage industry TV advertising shifts after a stepwise mandatory food marketing restriction: achievements and challenges with regulating the food marketing environment. Public Health Nutr 2023; 27:e26. [PMID: 38148176 PMCID: PMC10830373 DOI: 10.1017/s1368980023002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Sugar-sweetened beverages (SSB) are heavily advertised globally, and SSB consumption is linked to increased health risk. To reduce unhealthy food marketing, Chile implemented a regulation for products classified as high in energies, sugar, saturated fat or sodium, starting with a 2016 ban on child-targeted advertising of these products and adding a 06.00-22.00 daytime advertising ban in 2019. This study assesses changes in television advertising prevalence of ready-to-drink beverages, including and beyond SSB, to analyse how the beverage industry shifted its marketing strategies across Chile's implementation phases. DESIGN Beverage advertisements were recorded during two randomly constructed weeks in April-May of 2016 (pre-implementation) through 2019 (daytime ban). Ad products were classified as 'high-in' or 'non-high-in' according to regulation nutrient thresholds. Ads were analysed for their programme placement and marketing content. SETTING Chile. RESULTS From pre-regulation to daytime ban, child-targeted, daytime and total ads decreased by 51·8 percentage points (p.p.), 51·5 p.p. and 61·8 p.p. for high-in products and increased by 62·9 p.p., 54·9 p.p. and 61·8 p.p. for non-high-in products (Ps < 0·001). Additionally, total ready-to-drink beverage ads increased by 5·4 p.p. and brand-only ads (no product shown) by 7 p.p. CONCLUSIONS After the regulation implementation, 'high-in' ads fell significantly, but 'non-high-in' ads rose and continued using strategies targeting children and being aired during daytime. Given research showing that advertising one product can increase preferences for a different product from that same brand and product categories, broader food marketing regulation approaches may be needed to protect children from the harmful effects of food marketing.
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Affiliation(s)
- Fernanda Mediano Stoltze
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Teresa Correa
- School of Communication, Diego Portales University, Santiago, Chile
| | | | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Marcela Reyes
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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30
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Kelly B, Boyland E, Tatlow-Golden M, Christiansen P. Testing a conceptual Hierarchy of Effects model of food marketing exposure and associations with children and adolescents' diet-related outcomes. Public Health Nutr 2023; 27:e10. [PMID: 38058182 PMCID: PMC10830363 DOI: 10.1017/s1368980023002616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Children's exposure to unhealthy food marketing contributes to poor diets by influencing the foods that children like, request, buy and consume. This study aimed to use confirmatory mediational analyses to test a hypothetical model of marketing effects, to better understand the mechanisms behind food marketing's impacts on children. DESIGN Children responded to a cross-sectional online survey about their attitudes towards, and purchase and consumption behaviours of, ten frequently promoted food/beverage brands and their media use. Structural equation modelling tested a priori potential pathways for the effects of food marketing exposure on children's diets. PARTICIPANTS 10-16-year-old children (n 400). SETTING Australia. RESULTS There was a significant positive correlation between children's commercial screen media use and their attitudes towards brands (related to perceived social norms) and their brand purchasing behaviours, including their own purchases and requests to parents. The use of strategies to avoid advertising in commercial screen media reduced but did not remove the association between media use and brand purchases. Other brand exposures (on clothing, outdoor advertising, sponsorships) had a positive association with children's perceived social norms about brands and their brand purchases and requests. Non-commercial screen media use was not associated with any brand-related outcomes. CONCLUSIONS Commercial screen media use and other brand exposures were strongly positively associated with children's perceptions and purchasing behaviours of frequently marketed food/beverages. Regulations to restrict children's exposures to food marketing on-screen and through other media are required to reduce the effect of marketing exposure on children's food purchasing behaviours.
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Affiliation(s)
- Bridget Kelly
- Early Start, School of Health & Society, University of Wollongong, Wollongong, NSW2522, Australia
| | - Emma Boyland
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Mimi Tatlow-Golden
- School of Education, Childhood, Youth and Sport, The Open University, Milton Keynes, UK
| | - Paul Christiansen
- Institute of Population Health, University of Liverpool, Liverpool, UK
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31
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Mulligan C, Remedios L, Ramsay T, Pauzé E, Bagnato M, Potvin Kent M. The impact of characters like Tony the Tiger and other child-targeted techniques used in food and beverage marketing. Front Nutr 2023; 10:1287473. [PMID: 38115882 PMCID: PMC10728630 DOI: 10.3389/fnut.2023.1287473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Food marketing's impact is a function of exposure and power, both of which contribute to children's poor diet quality and obesity risk. Children's exposure to food marketing is well documented, however, few studies have assessed the impact of specific persuasive marketing techniques or aspects of 'power' on children. Methods This study administered an online survey to 1,341 Canadian children (9-12 years) aiming to determine the impact of: (1) child-targeted vs. adult-targeted marketing, and (2) licensed characters vs. spokes characters on children's food preferences and behavioral intentions. Participants were randomized to a single condition in each survey part and viewed 3 static food advertisements displaying the features of that condition (e.g., child-targeted advertising or licensed characters), and answered 3 Likert-scale (5-point) questions after each exposure. For each condition within each research question, there were four outcome variables related to the impact of marketing on children: food preference, purchase intent, pester power, and total impact. ANOVA tested the difference in impact (Likert scores) between conditions overall and for each outcome, with Bonferroni post-hoc tests where necessary. Results A greater average total impact was observed among children exposed to child-targeted ads (mean Likert score 3.36) vs. adult-targeted ads (mean score 2.75; p < 0.001) or no marketing (mean score 2.81; p < 0.001). Children exposed to ads featuring spokes characters had a higher average total impact (mean score 3.98) vs. licensed characters (mean score 3.80; p < 0.001) and the control (i.e., no characters) (mean score 3.19; p < 0.001), and the total impact of licensed characters was greater than that of no characters. Similar trends were observed for all other outcomes. Discussion Overall, this study showed that child-targeted ads and those using characters - especially spokes characters - have a strong overall impact on children's food preferences, purchase intents, and pester power, and support the implementation of comprehensive marketing restrictions to protect children.
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Affiliation(s)
- Christine Mulligan
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lauren Remedios
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tim Ramsay
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elise Pauzé
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Mariangela Bagnato
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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32
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Kontsevaya AV, Imaeva AE, Balanova YA, Breda JJ, Wickramasinghe K, Jewell JM, Abdrakhmanova S, Polupanov AG, Bagci Bosi T, Ergüder T, Drapkina OM, Boyland EJ. Children's exposure to television advertising of unhealthy foods and beverages across four countries of WHO European Region. Public Health Nutr 2023; 26:s32-s40. [PMID: 36912113 PMCID: PMC10801364 DOI: 10.1017/s1368980023000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/02/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To compare the frequency and healthfulness of foods being advertised to children and adolescents in four countries of WHO European region. DESIGN Cross-sectional quantitative study, guided by an adapted version of the WHO protocol. All recorded food advertisements were categorised by categories and as either 'permitted' or 'not permitted' for advertising to children in accordance with WHO Regional Office for Europe Nutrient Profile Model. SETTINGS Four countries: Russia, Turkey, Kazakhstan and Kyrgyzstan. PARTICIPANTS TV channels most popular among children and adolescents. RESULTS Analysis included 70 d of TV broadcasting for all channels, during which time there were 28 399 advertisements. The mean number of advertisements per hour varied from eleven in Turkey and Kazakhstan to eight and two in Russia and Kyrgyzstan. In all countries, the majority of the food and beverages advertised should not be permitted for advertising to children according to the WHO Nutrient Profile Model. The mean number of non-permitted food and beverage advertisements per hour was high in Turkey and Kazakhstan (8·8 and 8·5 ads) compared with Russia (5·1) and Kyrgyzstan (1·9). Turkey was the only country where nutritional information was fully available, and no values were missing that prevented coding for some product categories. CONCLUSIONS Results revealed that children and adolescents in four countries are exposed to a considerable volume of food and beverage advertisements, including sugary products on broadcast television. As such, policymakers should consider protecting youth by developing regulations to restrict these marketing activities within media popular with children.
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Affiliation(s)
- Anna V Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Asiia E Imaeva
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Department of Epidemiology of Chronic Non-Communicable Diseases, Moscow, Russia
| | - Yulia A Balanova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Department of Epidemiology of Chronic Non-Communicable Diseases, Moscow, Russia
| | - João J Breda
- World Health Organization, Regional Office for Europe, Moscow, Russia
| | | | - Jo Martin Jewell
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Shynar Abdrakhmanova
- National Center of Public Health under the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Andrew G Polupanov
- National Center for Cardiology and Therapy named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Tulay Bagci Bosi
- Hacettepe University, Department of Public Health, School of Medicine, Ankara, Turkey
| | - Toker Ergüder
- World Health Organization, Country Office in Turkey, Ankara, Turkey
| | - Oksana M Drapkina
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Emma J Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
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Thow AM, Phulkerd S, Ngqangashe Y, Ravuvu A, Zaruba L, Huckel Schneider C, Collin J, Schram A, Friel S. Protecting children from unhealthy food marketing: a comparative policy analysis in Australia, Fiji and Thailand. Health Promot Int 2023; 38:daad136. [PMID: 38011397 PMCID: PMC10681351 DOI: 10.1093/heapro/daad136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Restrictions on marketing of unhealthy foods and beverages to children is a globally recommended policy measure to improve diets and health. The aim of the analysis was to identify opportunities to enable policy learning and shift beliefs of relevant actors, to engender policy progress on restrictions on marketing of unhealthy foods to children. We drew on the Advocacy Coalition Framework to thematically analyse data from qualitative policy interviews conducted Australia (n = 24), Fiji (n = 10) and Thailand (n = 20). In all three countries two clear and opposing advocacy coalitions were evident within the policy subsystem related to regulation of unhealthy food marketing, which we termed the 'strengthen regulation' and 'minimal/self regulation' coalitions. Contributors to policy stasis on this issue were identified as tensions between public health and economic objectives of government, and limited formal and informal spaces for productive dialogue. The analysis also identified opportunities for policy learning that could enable policy progress on restrictions on marketing of unhealthy foods to children as: taking an incremental approach to policy change, defining permitted (rather than restricted) foods, investing in new public health expertise related to emerging marketing approaches and scaling up of monitoring of impacts. The insights from this study are likely to be relevant to many countries seeking to strengthen regulation of marketing to children, in response to recent global recommendations.
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Affiliation(s)
- Anne Marie Thow
- Faculty of Medicine and Health, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Phutthamonthon, Nakhon Pathom, Thailand
| | - Yandisa Ngqangashe
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra, ACT, 2600, Australia
| | - Amerita Ravuvu
- Non-Communicable Disease (NCD) Prevention and Control Programme, Public Health Division, Pacific Community (SPC), Private Mail Bag, Suva, Fiji
| | | | - Carmen Huckel Schneider
- Faculty of Medicine and Health, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Ashley Schram
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra, ACT, 2600, Australia
| | - Sharon Friel
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra, ACT, 2600, Australia
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Evans RK, Christiansen P, Finlay A, Jones A, Maden M, Boyland E. A systematic review and meta-analysis of the effect of digital game-based or influencer food and non-alcoholic beverage marketing on children and adolescents: Exploring hierarchy of effects outcomes. Obes Rev 2023; 24:e13630. [PMID: 37608618 DOI: 10.1111/obr.13630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
Videogame livestreaming platforms are an emerging form of digital media, popular with young people, where users watch gaming influencers play videogames. Food and non-alcoholic beverage (hereafter: food) brands have a substantial presence on these platforms, yet no studies have examined the impact of this food marketing on young people. This systematic review and meta-analysis examined the evidence (quantitative or mixed-method) for a relationship between exposure to digital game-based or influencer food marketing, and food-related (brand awareness, attitudes, preferences, purchase, and consumption), and post-consumption (weight, body mass index [BMI], and dental caries) outcomes in young people (≤18 years). Twenty-three databases were searched in March 2021. Twenty-two studies met the inclusion criteria, of which 20 were included in the quantitative synthesis. Meta-analyses indicated food marketing was associated with more positive attitudes and greater preferences (OR = 1.74, p < 0.001 [95%CI: 1.355, 2.232]), and increased consumption (SMD = 0.37, p < 0.001 [95%CI: 0.219, 0.529]). Narrative synthesis indicated that food marketing may increase brand awareness but not pester intent, although data were limited. Evidence suggests that there is a relationship between exposure to food marketing via influencers and digital gaming media, and several food-related outcomes. This is the first quantitative synthesis to demonstrate these relationships; this work has implications for food marketing policy.
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Affiliation(s)
- Rebecca K Evans
- Department of Psychology, The University of Liverpool, Liverpool, UK
| | - Paul Christiansen
- Department of Psychology, The University of Liverpool, Liverpool, UK
| | - Amy Finlay
- Department of Psychology, The University of Liverpool, Liverpool, UK
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, Institute of Population Health, The University of Liverpool, Liverpool, UK
| | - Emma Boyland
- Department of Psychology, The University of Liverpool, Liverpool, UK
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Chung A, Myers J, Skouteris H, Backholer K. Front-of-pack marketing on infant and toddler foods: Targeting children and their caregivers. Aust N Z J Public Health 2023; 47:100101. [PMID: 38030442 DOI: 10.1016/j.anzjph.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To identify and quantify child- and caregiver-appeal on front-of-pack marketing on infant and toddler foods in the Australian food supply. METHODS Content analysis of the presence and type of front-of-pack marketing techniques displayed on the front-of-pack of infant and toddler foods (for children aged up to 36 months) available in Australia's two major supermarkets' online stores. RESULTS Infant and toddler foods are promoted by up to 15 unique marketing techniques on the front-of-pack with an average of eight unique features per pack. A majority of food packages included marketing techniques targeting children, and all food packages included marketing techniques targeting caregivers, most commonly promoting health and nutrition. CONCLUSIONS Infant and toddler food packages are saturated with front-of-pack marketing features that target children and caregivers. To adequately protect young children's diets from the harmful influence of food marketing, and to promote the development of optimal feeding behaviours, government-led controls of all marketing intended to influence children's diets are required. In the context of marketing infant and toddler foods, this includes regulation of front-of-pack marketing techniques targeted to children and their caregivers. IMPLICATIONS FOR PUBLIC HEALTH Comprehensive government-led food marketing controls are required to protect children's diets from the harmful influence of marketing. The scope of these controls must include all unhealthy food marketing that children are exposed to and all other forms of unhealthy food marketing intended to influence children's diets.
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Affiliation(s)
- Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Judith Myers
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Kathryn Backholer
- Global Centre for Physical Activity and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
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Grummon AH, Petimar J, Moran AJ, Anderson E, Lurie P, John S, Rimm EB, Thorndike AN. Effects of in-store marketing on food and beverage purchases: a longitudinal study of households with children. Public Health Nutr 2023; 27:e4. [PMID: 38037704 PMCID: PMC10830370 DOI: 10.1017/s1368980023002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Most food retailers display foods in prominent locations as a marketing strategy (i.e. 'placement promotions'). We examined the extent to which households with children change their food and beverage purchases in response to these promotions. DESIGN We analysed a novel dataset of all products promoted in two supermarkets from 2016 to 2017, including promotion dates and locations (e.g. aisle endcaps and front registers). We linked promotions to all purchases from the supermarkets from 2016 to 2017 by a cohort of households with children. We calculated the number of weekly promotions in each of thirteen food and beverage groups (e.g. bread; candy) and used fixed effects regressions to estimate associations between number of weekly promotions and households' weekly food purchases, overall and by Supplemental Nutrition Assistance Program (SNAP) participation. SETTING Two large supermarkets in Maine, USA. PARTICIPANTS Eight hundred and twenty-one households with children. RESULTS Most promotions (74 %) were for less healthy foods. The most promoted food groups were sweet and salty snacks (mean = 131·0 promotions/week), baked goods (mean = 68·2) and sugar-sweetened beverages (mean = 41·6). Households generally did not change their food group purchases during weeks when they were exposed to more promotions for those groups, except that a 1-sd increase in endcap candy promotions (about 1 promotion/week) was associated with $0·19/week (about 14·5 %) increase in candy purchases among SNAP nonparticipants (adjusted P < 0·001). CONCLUSIONS In-store placement promotions for food groups were generally not associated with purchases of promoted food groups, perhaps because exposure to unhealthy food marketing was consistently high. Substantial changes to in-store food marketing may be needed to promote healthier purchases.
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Affiliation(s)
- Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA94304, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, USA
| | - Alyssa J Moran
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Anderson
- Department of Population Health Management, Cambridge Health Alliance, Cambridge, USA
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, USA
| | - Sara John
- Center for Science in the Public Interest, Washington, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Vandevijvere S, De Pauw R, Djojosoeparto S, Gorasso V, Guariguata L, Løvhaug AL, Mialon M, Van Dam I, von Philipsborn P. Upstream Determinants of Overweight and Obesity in Europe. Curr Obes Rep 2023; 12:417-428. [PMID: 37594616 DOI: 10.1007/s13679-023-00524-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants. RECENT FINDINGS Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.
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Affiliation(s)
- Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sanne Djojosoeparto
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Leonor Guariguata
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | | | - Iris Van Dam
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Peter von Philipsborn
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Munich, Germany
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Putra IGNE, Daly M, Sutin A, Steptoe A, Robinson E. The psychological legacy of past obesity and early mortality: evidence from two longitudinal studies. BMC Med 2023; 21:448. [PMID: 37974151 PMCID: PMC10655273 DOI: 10.1186/s12916-023-03148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND We test a novel 'weight scarring' hypothesis which suggests that past obesity is associated with impairments in current psychological well-being and this increases risk of negative physical health outcomes associated with obesity. Across two nationally representative studies, we tested whether past obesity is associated with current psychological outcomes and whether these psychological outcomes explain the association between past obesity and subsequent early mortality. METHODS Data were from the National Health and Nutrition Examination Survey (NHANES) (n = 29,047) and the Health and Retirement Study (HRS) (n = 11,998). Past obesity was defined based on maximum lifetime weight in NHANES and the highest weight from past study waves in the HRS. Across both studies, current depressive symptoms were analysed. A set of 10 additional well-being measures were combined to produce an 'index of impaired well-being' in HRS. Subsequent all-cause mortality was examined using National Deaths Index records in NHANES and household interviews in HRS. Linear or logistic regression, Cox proportional hazard regression, and causal mediation models were used. RESULTS We found that past obesity was associated with greater current depressive symptoms after controlling for current weight status and in analyses limited to those who were no longer classified as having obesity in NHANES (β = 0.17; 95% CI: 0.13, 0.22) and HRS (β = 0.20; 95% CI: 0.08, 0.31). In HRS, past obesity was also associated with a range of current negative psychological outcomes, including an index of impaired psychological well-being (β = 0.16; 95% CI: 0.05, 0.27). Past obesity was associated with a higher risk of early mortality in both NHANES and HRS (HR = 1.31; 95% CI: 1.16, 1.48 and HR = 1.34; 95% CI: 1.20, 1.50, respectively). Depressive symptoms explained 6% (95% CI: 0.01, 0.10) and 5% (95% CI: 0.01, 0.09) of the association between past obesity and premature mortality in NHANES and HRS, respectively. Impaired psychological well-being partly mediated the association between past obesity and premature mortality by 10% (95% CI: 0.04, 0.16) in HRS. CONCLUSIONS Our findings suggest that there may be a psychological legacy of past obesity that is associated with raised mortality risk. Ensuring people with obesity receive psychological support even after experiencing weight loss may be important.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- Department of Psychology, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Michael Daly
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Angelina Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, USA
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, UK
| | - Eric Robinson
- Department of Psychology, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Lianbiaklal S, Rehman V. Revisiting 42 Years of literature on food marketing to children: A morphological analysis. Appetite 2023; 190:106989. [PMID: 37524244 DOI: 10.1016/j.appet.2023.106989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Despite the preventive measures taken by the WHO, childhood obesity is still on the rise and is expected to increase by 100% between 2020 and 2035. Food marketing continues to permeate children's environments in numerous ways and influence the food behaviour of children, thus significantly contributing to the rise of obesity. Studies suggest that the literature on the effects of food marketing on children is complex and multidimensional. To fully understand these effects, a comprehensive and systematic approach is required. Nonetheless, existing reviews have focused only on specific aspects and have not comprehensively covered the literature on food marketing to children. Therefore, this review aims to navigate potential research gaps in the existing literature through a comprehensive examination of the literature by using morphological analysis (MA) methodology, the first time in this domain. Using PRISMA, 202 papers were considered eligible for inclusion and further analysed using MA. The articles were categorised into three dimensions to develop the MA framework: Stimuli (Food well-being), Organism, and Response, and 34 variants. The review has presented future research prospects by identifying at least 218 research gaps. With these findings, researchers can further explore the gaps and develop new research questions that could foster an understanding of the multifarious literature. Moreover, these findings can also provide marketers and practitioners with a better comprehension of the current state of the literature and develop more effective strategies for responsible marketing practices and policies.
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Affiliation(s)
- S Lianbiaklal
- Department of Management Studies, Indian Institute of Technology Madras, India.
| | - Varisha Rehman
- Department of Management Studies, Indian Institute of Technology Madras, India.
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40
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Ares G, Natero V, Gugliucci V, Machín L, Alcaire F, de León C, Otterbring T. Health-Washing of Ultraprocessed Products on Instagram: Prevalence and Strategies in an Emerging Market. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:815-822. [PMID: 37777932 DOI: 10.1016/j.jneb.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To evaluate the prevalence of health-related cues as part of the digital marketing of ultraprocessed foods on Instagram among food companies in Uruguay. METHODS Cross-sectional exploratory study. All content posted by 118 Instagram accounts of companies promoting ultraprocessed foods in Uruguay over 6 months (from August 2020 to February 2021) was retrieved. The content of 1,893 Instagram posts was coded considering visual and textual cues conveying health-related associations. The number and percentage of posts, including cues within each category and theme, were calculated. RESULTS More than half of all posts contained at least 1 visual or textual cue conveying health-related associations. Three main themes emerged: i) product composition, ii) healthy lifestyle, and iii) health and health benefits. The prevalence of health-related cues differed dramatically across product categories, ranging from 100% to 1.5%. CONCLUSIONS AND IMPLICATIONS Health-washing constitutes an integral part of the digital marketing of ultraprocessed foods on Instagram in Uruguay. The inclusion of health-related cues can potentially undermine public health efforts targeted at reducing consumption of these foods. These findings suggest that strict and comprehensive regulations on the digital marketing of such products are needed in policies promoting healthy eating habits globally.
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Affiliation(s)
- Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Uruguay; Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay.
| | - Virginia Natero
- Departamento de Alimentos, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Vanessa Gugliucci
- Espacio Interdisciplinario, Universidad de la República, Montevideo, Uruguay
| | - Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Florencia Alcaire
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Uruguay
| | | | - Tobias Otterbring
- School of Business and Law, Department of Management, University of Agder, Kristiansand, Norway; Institute of Retail Economics, Stockholm, Sweden
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Petticrew M, Glover RE, Volmink J, Blanchard L, Cott É, Knai C, Maani N, Thomas J, Tompson A, van Schalkwyk MCI, Welch V. The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses. Syst Rev 2023; 12:165. [PMID: 37710334 PMCID: PMC10503085 DOI: 10.1186/s13643-023-02323-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The field of the commercial determinants of health (CDOH) refers to the commercial products, pathways and practices that may affect health. The field is growing rapidly, as evidenced by the WHO programme on the economic and commercial determinants of health and a rise in researcher and funder interest. Systematic reviews (SRs) and evidence synthesis more generally will be crucial tools in the evolution of CDOH as a field. Such reviews can draw on existing methodological guidance, though there are areas where existing methods are likely to differ, and there is no overarching guidance on the conduct of CDOH-focussed systematic reviews, or guidance on the specific methodological and conceptual challenges. METHODS/RESULTS CODES provides guidance on the conduct of systematic reviews focussed on CDOH, from shaping the review question with input from stakeholders, to disseminating the review. Existing guidance was used to identify key stages and to provide a structure for the guidance. The writing group included experience in systematic reviews and other forms of evidence synthesis, and in equity and CDOH research (both primary research and systematic reviews). CONCLUSIONS This guidance highlights the special methodological and other considerations for CDOH reviews, including equity considerations, and pointers to areas for future methodological and guideline development. It should contribute to the reliability and utility of CDOH reviews and help stimulate the production of reviews in this growing field.
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Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK.
| | - Rebecca E Glover
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK
| | - Jimmy Volmink
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Cécile Knai
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - James Thomas
- UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK
| | - Alice Tompson
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK
| | | | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
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42
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Boyland E. Is it ethical to advertise unhealthy foods to children? Proc Nutr Soc 2023; 82:234-240. [PMID: 36606537 DOI: 10.1017/s0029665123000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- E Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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43
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Bagnato M, Roy-Gagnon MH, Vanderlee L, White C, Hammond D, Potvin Kent M. The impact of fast food marketing on brand preferences and fast food intake of youth aged 10-17 across six countries. BMC Public Health 2023; 23:1436. [PMID: 37501119 PMCID: PMC10373354 DOI: 10.1186/s12889-023-16158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Consumption of fast food, which is associated with poor diet, weight gain and the development of noncommunicable diseases, is high amongst youth. Fast food marketing, a modifiable determinant of excess weight and obesity, affects youth's food-related behaviours. This study aimed to examine the relationship between exposure to fast food marketing and the fast food brand preferences and intake amongst youth aged 10-17 across six countries. METHODS Data from 9,695 youth respondents living in Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States (US) were analyzed from the 2019 International Food Policy Study (IFPS) Youth Survey. Survey measures assessed exposure to fast food marketing and brand-specific marketing, and preference for these brands and fast food intake. Regression models adjusted for age, sex, income adequacy and ethnicity were used to examine the associations. RESULTS Exposure to fast food marketing was positively associated with brand preferences and intake consistently across most countries. Overall, preference for McDonald's (OR:1.97; 95% CI:1.52, 2.56), KFC (OR:1.61; 95% CI:1.24, 2.09) and Subway (OR:1.73; 95% CI:1.34, 2.24) were highest when exposed to general fast food marketing ≥ 2x/week compared to never. Preference for McDonald's (OR:2.32; 95% CI:1.92, 2.79), KFC (OR:2.28; 95% CI:1.95, 2.68) and Subway (OR:2.75; 95% CI:2.32, 3.27) were also higher when exposed to marketing for each brand compared to not. Fast food intake was highest in Chile (IRR:1.90; 95% CI:1.45, 2.48), the UK (IRR:1.40; 95% CI:1.20, 1.63), Canada (IRR:1.32; 95% CI:1.19, 1.48), Mexico (IRR:1.26; 95% CI:1.05, 1.53) and the US (IRR:1.21; 95% CI:1.05, 1.41) when exposed to general fast food marketing ≥ 2x/week compared to never and was higher across most countries when exposed to brand-specific marketing compared to not. Respondents classified as ethnic minorities were more likely to report consuming fast food than ethnic majorities, and females were less likely to report consuming fast food than males. CONCLUSIONS Exposure to fast food marketing is consistently and positively associated with brand preferences and fast food intake in all six countries. Our results highlight the need for strict government regulation to reduce exposure of unhealthy food marketing to youth in all six countries.
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Affiliation(s)
- Mariangela Bagnato
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, Santé Et Société (Centre NUTRISS), and Institut Sur La Nutrition Et Les Aliments Fonctionnels (INAF), Université Laval, Quebec City, Canada
| | - Christine White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
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Prescott SL, D’Adamo CR, Holton KF, Ortiz S, Overby N, Logan AC. Beyond Plants: The Ultra-Processing of Global Diets Is Harming the Health of People, Places, and Planet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6461. [PMID: 37569002 PMCID: PMC10419141 DOI: 10.3390/ijerph20156461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Global food systems are a central issue for personal and planetary health in the Anthropocene. One aspect of major concern is the dramatic global spread of ultra-processed convenience foods in the last 75 years, which is linked with the rising human burden of disease and growing sustainability and environmental health challenges. However, there are also calls to radically transform global food systems, from animal to plant-derived protein sources, which may have unintended consequences. Commercial entities have moved toward this "great plant transition" with vigor. Whether motivated by profit or genuine environmental concern, this effort has facilitated the emergence of novel ultra-processed "plant-based" commercial products devoid of nutrients and fiber, and sometimes inclusive of high sugar, industrial fats, and synthetic additives. These and other ingredients combined into "plant-based" foods are often assumed to be healthy and lower in calorie content. However, the available evidence indicates that many of these products can potentially compromise health at all scales-of people, places, and planet. In this viewpoint, we summarize and reflect on the evidence and discussions presented at the Nova Network planetary health meeting on the "Future of Food", which had a particular focus on the encroachment of ultra-processed foods into the global food supply, including the plant-sourced animal protein alternatives (and the collective of ingredients therein) that are finding their way into global fast-food chains. We contend that while there has been much uncritical media attention given to the environmental impact of protein and macronutrient sources-meat vs. novel soy/pea protein burgers, etc.-the impact of the heavy industrial processing on both human and environmental health is significant but often overlooked, including effects on cognition and mental health. This calls for a more nuanced discourse that considers these complexities and refocuses priorities and value systems towards mutualistic solutions, with co-benefits for individuals, local communities, and global ecology.
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Affiliation(s)
- Susan L. Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Christopher R. D’Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kathleen F. Holton
- Departments of Health Studies and Neuroscience, Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA;
| | - Selena Ortiz
- Department of Health Policy and Administration, The Pennsylvania State University, State College, PA 16802, USA;
| | - Nina Overby
- Department of Nutrition and Public Health, Centre for Lifecourse Nutrition, University of Agder, 4630 Kristiansand, Norway;
| | - Alan C. Logan
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
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45
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Long JW, Masters B, Sajjadi P, Simons C, Masterson TD. The development of an immersive mixed-reality application to improve the ecological validity of eating and sensory behavior research. Front Nutr 2023; 10:1170311. [PMID: 37538924 PMCID: PMC10395832 DOI: 10.3389/fnut.2023.1170311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction The modern eating environment has been implicated as a driving force of the obesity epidemic. Mixed reality applications may improve traditional methodological assessments of eating behavior by improving the ecological validity of the laboratory setting. Methods Research experts evaluated the utility and ecological validity of a mixed reality application that allowed immersion within virtual environments through utilizing the passthrough cameras of the head mounted display to view and interact with real foods. An initial evaluation was conducted that involved three virtual environments: a traditional laboratory booth, a non-textured restaurant, and a full-textured restaurant. The feedback from the initial evaluation was used to create a new virtual restaurant environment and a subsequent evaluation was conducted. Results Nearly all research experts suggested adding social cues such as people and background noise to create a more authentic and ecologically valid experience. The experts scored the new virtual restaurant environment to be more acceptable than eating or conducting research in a sensory booth but scored lower when compared to conducting research in a real-world restaurant setting. Discussion The results of this evaluation suggest that mixed reality applications may be a new methodology to assess environmental influences of eating behavior and may be a promising direction for eating behavior and sensory science research.
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Affiliation(s)
- John W. Long
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Bart Masters
- The Center for Immersive Experiences, The Pennsylvania State University, University Park, PA, United States
| | - Pejman Sajjadi
- Department of Software Engineering and Game Development, Kennesaw State University, Marietta, GA, United States
| | - Christopher Simons
- Department of Food Science and Technology, The Ohio State University, Columbus, OH, United States
| | - Travis D. Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
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46
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Nicholson E, Kelly B. Establishing the Minimum Media Time Sample Required to Obtain Reliable Estimates of Children's Digital Media Food Marketing Exposures. Curr Dev Nutr 2023; 7:100092. [PMID: 37213717 PMCID: PMC10196768 DOI: 10.1016/j.cdnut.2023.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023] Open
Abstract
Background The ubiquitous nature of food marketing on digital media likely has a profound effect on children's food preferences and intake. Monitoring children's exposure to digital marketing is necessary to raise awareness of the issue, inform policy development, and evaluate policy implementation and effect. Objectives This study aimed to establish whether smaller time samples (less time and/or fewer days captured) would provide robust estimates of children's usual exposures to food marketing. Methods Using an existing data set of children's digital marketing exposures, which captured children's total screen use over 3 d, a reliability assessment was performed. Results A subsample of 30% of children's usual screen time was found to provide reliable estimates of digital food marketing exposure compared with the full sample (intraclass correlation coefficient: 0.885; Cronbach α: 0.884). There was no difference in the rates of marketing (exposures/h) between weekdays and weekend days. Conclusions These findings enable researchers to reduce the time and resource constraints that have previously restricted this type of monitoring research. The reduced media time sample will further lessen participant burden.
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47
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Dillman Carpentier FR, Mediano Stoltze F, Reyes M, Taillie LS, Corvalán C, Correa T. Restricting child-directed ads is effective, but adding a time-based ban is better: evaluating a multi-phase regulation to protect children from unhealthy food marketing on television. Int J Behav Nutr Phys Act 2023; 20:62. [PMID: 37231508 DOI: 10.1186/s12966-023-01454-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND As childhood obesity rates continue to rise, health organizations have called for regulations that protect children from exposure to unhealthy food marketing. In this study, we evaluate the impact of child-based versus time-based restrictions of "high-in" food and beverage advertising in Chile, which first restricted the placement of "high-in" advertisements (ads) in television attracting children and the use of child-directed content in high-in ads and, second, banned high-in ads from 6am-10pm. "High-in" refers to products above regulation-defined thresholds in energy, saturated fats, sugars, and/or sodium. High-in advertising prevalence and children's exposure to high-in advertising are assessed. METHODS We analyzed a random stratified sample of advertising from two constructed weeks of television at pre-regulation (2016), after Phase 1 child-based advertising restrictions (2017, 2018), and after the Phase 2 addition of a 6am-10pm high-in advertising ban (2019). High-in ad prevalence in post-regulation years were compared to prior years to assess changes in prevalence. We also analyzed television ratings data for the 4-12 year-old child audience to estimate children's ad exposure. RESULTS Compared to pre-regulation, high-in ads decreased after Phase 1 (2017) by 42% across television (41% between 6am-10pm, 44% from 10pm-12am) and 29% in programs attracting children (P < 0.01). High-in ads further decreased after Phase 2, reaching a 64% drop from pre-regulation across television (66% between 6am-10pm, 56% from 10pm-12am) and a 77% drop in programs attracting children (P < 0.01). High-in ads with child-directed ad content also dropped across television in Phase 1 (by 41%) and Phase 2 (by 67%), compared to pre-regulation (P < 0.01). Except for high-in ads from 10pm-12am, decreases in high-in ads between Phase 1 (2018) and Phase 2 were significant (P < 0.01). Children's high-in ad exposure decreased by 57% after Phase 1 and by 73% after Phase 2 (P < 0.001), compared to pre-regulation. CONCLUSIONS Chile's regulation most effectively reduced children's exposure to unhealthy food marketing with combined child-based and time-based restrictions. Challenges remain with compliance and limits in the regulation, as high-in ads were not eliminated from television. Yet, having a 6am-10pm ban is clearly critical for maximizing the design and implementation of policies that protect children from unhealthy food marketing.
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Affiliation(s)
| | - Fernanda Mediano Stoltze
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, 27599, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Marcela Reyes
- Institute of Nutrition and Food Technology, University of Chile, Santiago, 7830490, Chile
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27516, USA
- Department of Nutrition, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599-7400, USA
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, 7830490, Chile
| | - Teresa Correa
- School of Communication, Diego Portales University, Santiago, 8370067, Chile.
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48
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Olstad DL, Boyland E. Towards effective restriction of unhealthy food marketing to children: unlocking the potential of artificial intelligence. Int J Behav Nutr Phys Act 2023; 20:61. [PMID: 37231444 DOI: 10.1186/s12966-023-01458-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
The World Health Organization recommends that member states enact policies to limit unhealthy food marketing to children. Chile enacted relatively stringent laws that restrict unhealthy food marketing to children in two phases, beginning in 2016. Dillman-Carpentier and colleagues examined the incremental effectiveness of the first and second phases of Chile's policy in limiting children's exposure to unhealthy food marketing on television relative to pre-policy. Banning advertisements for all 'high-in' products (i.e., those that exceeded thresholds for energy, saturated fats, sugars and/or sodium) during the daytime (phase 2) was more effective in reducing children's exposure to unhealthy food marketing on television than only banning 'high-in' marketing during programs with large child audiences (phase 1). These findings underscore the importance of implementing comprehensive policies that reduce children's exposure to all marketing for unhealthy foods-not simply that which targets them directly-to better protect them from its negative impacts. However, although policies in Chile and other nations have reduced children's exposure to unhealthy food marketing in broadcast media, it is not clear whether such policies have meaningfully reduced children's overall food marketing exposures. This is partly due to the challenges of studying children's digital food marketing exposures, which are an increasingly important source of unhealthy food marketing. To address these methodologic gaps, several research teams are developing artificial intelligence (AI)-enabled systems to assess food marketing to children on digital media and support efforts to monitor compliance with policies that restrict this marketing. These and other AI systems will be essential to comprehensively and systematically study and monitor food marketing to children on digital media internationally and at scale.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, Liverpool, L69 7ZA, UK
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49
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Luna Pinzon A, Stronks K, Emke H, van den Eynde E, Altenburg T, Dijkstra SC, Renders CM, Hermans R, Busch V, Chinapaw MJM, Kremers SPJ, Waterlander W. Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective. Front Public Health 2023; 11:1128316. [PMID: 37304107 PMCID: PMC10248031 DOI: 10.3389/fpubh.2023.1128316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction and Methods To develop an understanding of the dynamics driving obesity-related behaviours in adolescents, we conducted systems-based analysis on a causal loop diagram (CLD) created from a multi-actor perspective, including academic researchers, adolescents and local stakeholders. Results The CLD contained 121 factors and 31 feedback loops. We identified six subsystems with their goals: (1) interaction between adolescents and the food environment, with profit maximisation as goal, (2) interaction between adolescents and the physical activity environment, with utility maximisation of outdoor spaces as goal, (3) interaction between adolescents and the online environment, with profit maximisation from technology use as goal, (4) interaction between adolescents, parenting and the wider socioeconomic environment, with a goal focused on individual parental responsibility, (5) interaction between healthcare professionals and families, with the goal resulting in treating obesity as an isolated problem, and (6) transition from childhood to adolescence, with the goal centring around adolescents' susceptibility to an environment that stimulates obesity-related behaviours. Discussion Analysis showed that inclusion of the researchers' and stakeholders' perspectives contributed to an understanding of how the system structure of an environment works. Integration of the adolescents' perspective enriched insights on how adolescents interact with that environment. The analysis further showed that the dynamics driving obesity-related behaviours are geared towards further reinforcing such behaviours.
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Affiliation(s)
- Angie Luna Pinzon
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Karien Stronks
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Helga Emke
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Emma van den Eynde
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - S. Coosje Dijkstra
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carry M. Renders
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Roel Hermans
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Mai J. M. Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
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50
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Evans R, Christiansen P, Masterson T, Pollack C, Albadri S, Boyland E. Recall of food marketing on videogame livestreaming platforms: Associations with adolescent diet-related behaviours and health. Appetite 2023; 186:106584. [PMID: 37127245 DOI: 10.1016/j.appet.2023.106584] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/24/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023]
Abstract
Digital media has become an integral part of adolescents' lives. Mirroring this trend, food and non-alcoholic beverage (hereafter: food) brands increasingly promote products in digital media to maximise reach with young consumers. Videogame livestreaming platforms, where individuals can broadcast or watch streamed videogame footage, are a growing form of digital media. The top three platforms (market share by hours watched) are Twitch (72%), YouTube Gaming (13%), and Facebook Gaming Live (9%), with a combined 34.6 billion hours watched in 2021. These platforms represent a hybridisation of two popular digital trends amongst teenagers: viewing online video content and playing videogames. On these platforms, gaming influencers promote food brands and products, with energy drinks and fast-food restaurants representing the most frequently promoted categories. Evidence suggests that food marketing via Twitch is associated with food craving, purchasing and consumption in adults. Yet, despite the evident teenage appeal and prevalence of food marketing on these platforms, research is yet to explore its associations with adolescent eating behaviour. Adolescents (n = 490, Mage = 16.81, 30.2% female) completed an online cross-sectional questionnaire exploring their recall of food marketing on the top three videogame livestreaming platforms, and relevant behavioural (purchase, consumption) and health (Body Mass Index) outcomes. Structural equation modelling was used to explore hierarchical relationships between the key variables. Results showed that recall of unhealthy food marketing on these platforms was significantly associated with purchase and consumption of marketed food categories. Attitudes towards unhealthy foods mediated this relationship. Findings are the first to demonstrate the relationships between unhealthy food marketing via videogame livestreaming platforms and adolescent eating behaviours, which has implications for the design of policies to restrict digital food marketing to young people.
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Affiliation(s)
- Rebecca Evans
- Department of Psychology, The University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Paul Christiansen
- Department of Psychology, The University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Travis Masterson
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, 226 Henderson, University Park, PA, 16802, USA
| | - Catherine Pollack
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Sondos Albadri
- School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, UK
| | - Emma Boyland
- Department of Psychology, The University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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