The effects of food advertising on food-related behaviours and perceptions in adults: A review

An environmental scan of food and drink advertising on public transport around Adelaide schools

ISSUE ADDRESSED

Children and adolescents are particularly receptive to cues from food and drink advertising. Several policies recommend restricting unhealthy or discretionary ('junk') food advertising on government infrastructure such as public transport. Prior research in New South Wales (NSW) and Western Australia (WA) reveals a high proportion of discretionary food advertising outdoors and on public transport. The aim of this study was to identify the landscape of food and drink advertising on public transport assets around Adelaide schools.

METHODS

An environmental scan of food and drink advertising on public transport assets within 500 m of 65 Adelaide schools was conducted. The Council of Australian Governments Health Council's interim guide was used to categorise advertisements as 'suitable' or 'unsuitable' for promotion.

RESULTS

Almost four in every five food and drink advertisements on public-transport assets observed around Adelaide schools included discretionary food or drink, and therefore were categorised as unsuitable for promotion. Advertisements on bus exteriors were more likely to promote discretionary foods, compared with bus shelters.

CONCLUSIONS

This proportion of 'unhealthy' food advertising was comparable to previous research conducted in WA and NSW. SO WHAT?: In light of historic state/territory actions such as the ACT preventing discretionary food advertising on public transport, these findings should prompt a review and discussion of the suitability of food and drink promotion on government-owned South Australian transport and their associated assets.

The Role of Social Media Advertisement and Physical Activity on Eating Behaviors among the General Population in Saudi Arabia

Over the past few decades, people in Saudi Arabia have become less inclined to adopt active lifestyles and healthy eating habits due to the increasing use of digital technologies such as social media. The objective of this online-based cross-sectional study was to assess the role of social media food advertisements and physical activity on eating behaviors among the general population in Saudi Arabia (n = 471). Data were collected through a structured questionnaire, which consisted of four parts: (i) sociodemographic information, (ii) attitude towards social media, (iii) eating behaviors-related information, and (iv) exposure to and engagement with social media advertisements. The study's outcome variable, eating behaviors (healthy vs. unhealthy), was assessed using the following question: "Are you on a healthy diet (such as a balanced diet, keto, or low carb)?" A multiple binary logistic regression analysis was performed to investigate the factors that influence unhealthy eating behaviors. Approximately 79.6% of the participants had unhealthy eating behaviors. Participants who were not involved in daily physical activity were more likely to have unhealthy eating behaviors compared to their counterparts (adjusted odds ratio, AOR = 4.86). Participants who watched food ads on social media channels 1-3 times a week (AOR = 2.58) or daily (AOR = 3.49) were more likely to have unhealthy eating behaviors than their counterparts. Participants whose appetite to try foods increases always (AOR = 1.42) or usually (AOR = 2.88) after viewing ads on social media were more likely to have unhealthy eating behaviors. These findings suggest that policymakers should take immediate action to regulate food advertising policy to promote a healthy food environment across the country. Saudis should be encouraged to engage in more physical activity, which could support the maintenance of healthy eating patterns and lifestyles.

A randomized controlled trial to test the effects of displaying the Nutri-Score in food advertising on consumer perceptions and intentions to purchase and consume

BACKGROUND

Some research shows that advertising for high-fat, sugar, or salt (HFSS) products is contributing to a shift in consumer preferences toward products of poor nutritional quality, leading to unhealthy nutritional intakes that increase the risk of obesity and chronic diseases. A strategy of displaying simple and understandable nutritional information (like the front-of-pack nutrition label Nutri-Score) in food messages could be an aid to help guide consumers' choice towards healthier products.

METHODS

A randomized controlled experiment was conducted on 27,085 participants randomly assigned to two experimental conditions or a control condition. In both experimental conditions (independent variable: advertising messages with vs. without the Nutri-Score), participants were exposed to advertisements for diversified food products with contrasting nutritional quality and belonging to nine different food categories. Participants were then asked questions about their perception, affective evaluation, and intentions to purchase and consume the products. In the control condition, they were not exposed to the advertisements.

RESULTS

Overall, interaction effects between the two variables (1) the messages with vs. without the Nutri-Score and (2) the nutritional quality of products, were significant for all dependent variables, with effect sizes between large and medium. Overall, the better the products' nutritional quality, the more positive their perceptions, affective evaluations, and intentions to buy and consume them. When the Nutri-score was displayed in advertising messages (vs. when it was not), perceptions, affective evaluation, and behavioral intentions: (1) became more positive for products of good nutritional quality (Nutri-score A and B), (2) became more negative for products of poor nutritional quality (Nutri-score D and E), (3) changed little or not at all for products of intermediate nutritional quality (Nutri-Score C).

CONCLUSIONS

This research is the first in the literature to demonstrate that displaying the Nutri-Score in advertising messages assists consumers in directing their choices towards healthier foods. Regulations mandating the display of the Nutri-Score in food advertising could be an effective public health measure.

Do Primary Health Professionals in Brazil Have a Misperception about Food? The Role of Food Literacy as a Positive Predictor

Risk perception is socially constructed; psychological elements control people's reactions to a hazard, and even health professionals may have difficulty determining what healthy food is. This work aimed to measure food literacy and food risk perceptions among primary healthcare professionals in a Brazilian city. In the first phase, 280 health professionals working in primary care in Rio Claro, Brazil, were studied. The Short Food Literacy Questionnaire (SFLQ-Br) and scales of risk and benefit perception of 50 foods were used. In the second phase, 20 professionals were interviewed to investigate the responses to different foods observed in the first phase. In this second phase, 16 users of the health system were also enrolled to understand their perceptions and how the nutrition messages conveyed by the health team reached them. Professionals scored an average of 34.5 on food literacy (for which there is a maximum score of 52). They showed difficulty with dietary guidelines and their interpretation. Food's risk and benefit perception were generally consistent with the recommendations of the Food Guide for the Brazilian Population. However, some processed foods or those with no proven health benefits were considered healthy by the study participants, indicating a biased perception (e.g., gelatin, processed turkey breast, cream crackers, and cereal bars). Less misperception was observed when food literacy was higher, which positively predicted risk perception. The reasons for identifying benefits of these foods ranged from the false impression that they are natural and nutritious foods to the comparative claim that they are better for health than similar foods. The results indicate the need to educate health professionals based on current references to avoid bias in population counseling.

Seattle's sweetened beverage tax implementation and changes in interior marketing displays

Policymakers aim sugar-sweetened beverage (SSB) taxes at decreasing SSB consumption; however, little is known about their impact on beverage marketing in the retail environment. We assessed changes in interior marketing displays within large food stores before and after the implementation of Seattle's SSB tax. We used Poisson difference-in-difference (DID) models to estimate whether presence and variety of interior beverage marketing displays in Seattle changed from before to after the tax compared to displays in non-taxed comparison area stores, overall, and by beverage type. We found no significant changes in overall SSB or non-SSB interior marketing displays in Seattle versus the comparison area. There was less of an increase in displays for diet soda (DID 0.79, 90% CI 0.65, 0.97), and more of an increase in displays for diet energy drinks (DID 1.78, 90% CI 1.03, 3.09) in Seattle versus comparison area. There was mixed evidence that stores changed interior marketing displays in response to the SSB tax.

Digital Marketing and Fast-Food Intake in the UAE: The Role of Firm-Generated Content among Adult Consumers

In the contemporary digital marketing context, this study aimed to investigate the influence of firm-generated content and social media advertising on fast-food consumption patterns among the adult population. Utilizing a questionnaire distributed to customers of a restaurant in Fujairah, United Arab Emirates, convenience sampling was employed. The findings underscored a significant positive relationship between firm-generated content and social media engagement, as well as between the latter and online shopping behavior. However, it was determined that word of mouth did not significantly moderate the relationship between attitudes towards social media advertisements and fast-food consumption patterns. From a theoretical perspective, these results enrich the understanding of how digital dynamics shape consumer behavior in specific contexts. Practically speaking, they prompt a critical reflection on the ethics of marketing in promoting products potentially detrimental to health, urging both companies and policymakers to reconsider their strategies and regulations, respectively.

Breaking down silos: the multifaceted nature of obesity and the future of weight management

The continued global increase in the prevalence of obesity prompted a meeting at the Royal Society of London investigating causal mechanisms of the disease, 'Causes of obesity: theories, conjectures, and evidence' in October 2022. Evidence presented indicates areas of obesity science where there have been advancements, including an increased understanding of biological and physiological processes of weight gain and maintenance, yet it is clear there is still debate on the relative contribution of plausible causes of the modern obesity epidemic. Consensus was reached that obesity is not a reflection of diminished willpower, but rather the confluence of multiple, complex factors. As such, addressing obesity requires multifactorial prevention and treatment strategies. The accumulated evidence suggests that a continued focus primarily on individual-level contributors will be suboptimal in promoting weight management at the population level. Here, we consider individual biological and physiological processes within the broader context of sociodemographic and sociocultural exposures as well as environmental changes to optimize research priorities and public health efforts. This requires a consideration of a systems-level approach that efficiently addresses both systemic and group-specific environmental determinants, including psychosocial factors, that often serve as a barrier to otherwise efficacious prevention and treatment options. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'.

The conceptualisation and operationalisation of 'marketing' in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis

BACKGROUND

Extensive public health research reports the nature, scope and effects of various marketing activities used by food and drinks companies to support the sale of their products. Such literature informs the regulation of food marketing that encourages unhealthy eating behaviours and poor diet-related health outcomes. However, it is not clear whether this literature consistently conceptualises and applies marketing, which could in turn influence the approach and efficacy of policies to regulate food marketing. We aimed to understand the conceptualisation and operationalisation of marketing in public health research of food marketing, eventually focusing on the conceptualisation of integrated marketing.

METHODS

We conducted a review of reviews that drew on scoping review methods and applied principles of critical interpretive synthesis. Five databases of peer-reviewed literature and websites of relevant organisations were searched in June - August 2020. Articles were screened against inclusion criteria to identify reviews examining food marketing in a health context. Informative text segments from included articles were coded using NVivo. Codes were grouped into synthetic constructs and a synthesising argument.

RESULTS

After screening against inclusion criteria, 60 publications were eligible for inclusion. Informative text segments from 24 publications were coded, after which no new codes were identified. Our synthesising argument was that the understanding of integrated marketing appeared inconsistent across publications, such as by differences in use of underlying conceptual frameworks and in the application of terms such as marketing strategy and tactics.

CONCLUSIONS

Using our synthesising argument, we suggest ways to improve the future study of food marketing in public health research, for example by using in-depth case studies to understand the integrated operation and effect of multi-component marketing strategies. Improving conceptual clarity in the study of food marketing in public health research has the potential to inform policy that is more reflective of the true nature of marketing, and thus more effective in combating food marketing effects and protecting public health.

PROTOCOL REGISTRATION

The review protocol was made publicly available on Open Science Framework prior to the start of the study (DOI: https://doi.org/10.17605/OSF.IO/VSJCW ).

A Scoping Review of Observational Studies on Food and Beverage Advertising on Social Media: A Public Health Perspective

Popular social media platforms have been actively used by ultra-processed food companies to promote their products. Being exposed to this type of advertising increases the consumption of unhealthy foods and the risk of developing obesity and other non-communicable diseases (NCDs). Thus, monitoring commercial content on social media is a core public health practice. We aimed to characterize the methods used for monitoring food advertising on social media and summarize the investigated advertising strategies via a scoping review of observational studies. This study is reported according to the MOOSE Statement, and its protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration nº. CRD42020187740). Out of the 6093 citations retrieved, 26 met our eligibility criteria. The studies were published from 2014 to 2021, mostly after 2018. They focused on Australia, Facebook, strategies aimed at children and adolescents, and advertising practices of ultra-processed food companies. We grouped strategies in eight classes: post features (n = 18); connectivity and engagement (n = 18); economic advantages, gifts, or competitions (n = 14); claims (n = 14); promotional characters (n = 12); brand in evidence (n = 8); corporate social responsibility or philanthropy (n = 7); and COVID-19 (n = 3). We found similarities in the investigation of strategies regardless of the type of social media. Our findings can contribute to the designing of tools for monitoring studies and regulatory mechanisms to restrict the exposure of food advertising.

Naturally green, irrationally lean: How background scenery affects calorie judgments

Extant research has found that the addition of vegetables to a meal induces a "health halo," thereby lowering the perceived calorie content of the entire dish. We investigated whether environmental stimuli that convey naturalness could trigger such a halo effect. Specifically, we tested whether meals accompanied by a natural, as opposed to an urban, background scenery were estimated to be lower in their calorie content and whether this effect was moderated by the perceived healthiness of the food alternatives. In a mixed (between-within-subjects) design experiment, 200 participants estimated the calorie content and rated the healthiness of 18 complex meals presented against either a natural or an urban background. Our results showed no main effect of the food rating background. However, there was a negative relationship between inferred food healthiness and the estimated calorie content of the meals. In addition, we found a significant interaction between food rating background and inferred healthiness of the evaluated food alternatives. Specifically, when participants evaluated meals against a natural background, they rated relatively unhealthy food alternatives as lower in calories than when they evaluated such alternatives against an urban background. Overall, our results highlight the moderating role of perceived food healthiness in studying the effects of environmental cues on consumers' calorie judgments.

Determinants of Food Choices among Adults (20-40 Years Old) Residing in Delhi, India

Background

India has seen a rise in consumption of foods high in fat, sugar, and salt that increases risk of diet-related noncommunicable diseases. Information on the drivers that determine food choices among adults will provide insights for policymakers to promote healthier food selection.

Objective

This study assessed the determinants of food choices among adults in India.

Methods

A cross-sectional study with a nonprobability purposive sampling technique in which adults were selected from residential colonies belonging to the 4 geographic zones of the city Delhi, India. Data was collected using a mixed methods approach on a total of 589 adults (20-40 y) belonging to upper-middle-income and high-income groups. Data was analyzed by the principal component analysis, chi-squared test, and logistic regression with a level of significance set at P value of < 0.05.

Results

Most influential factors of food choices were brand (30%), nutritive value (22%), and taste (20%). The 3 factors that emerged from principal component analysis that determine food choices among adults were "individual," "social," and "food quality/wholesomeness." Focus group discussions also showed that the majority of participants were influenced by the "brand," "nutritive value," and "taste" of the food product while making food choices. Food choices were influenced by the company the person was eating food with, i.e., family members or friends. The cost of the food product was also an important driver of food choices among younger adults.

Conclusion

Public health policy should utilize the determinants of food choices to bring about changes in the food environment by increasing the availability of healthier yet tasty food, bearing the cost in mind.

Global case study of digital marketing on social media by a top soda brand

The Big Soda segment is central in modern food systems, and they invest heavily in digital marketing, but little is known about it. We aimed to analyze the digital marketing on Facebook of the soda brand with a major worldwide reach. Countries were described in terms of soda brand presence and popularity on Facebook according to countries' socio-demographic index (SDI) and the market share of soda brand (%MS). From 149 countries, 57.0% had soda brand's Facebook page among the top five in the number of followers within the beverage segment. Among them, digital marketing was described by the number of the page followers, the number of posts, and the number of interactions (likes, comments and shares) that each post received by Facebook users. Also, we analyzed the characteristics, and the use of marketing strategies on posts in a random sample of 10% (n = 1217) of all posts. We found that soda brand's popularity on Facebook was higher among countries with higher SDI and higher %MS. Also, the number of users that engaged with soda brand's posts was higher among countries with lower SDI and higher brand's %MS. The brand's posts focus on young adults, display of brand's products and glorification of its attributes. Other identified features include sport-related thematic and appeals to socialization and healthy eating. In addition, posts' characteristics differed with countries' characteristics. Soda brand digital marketing varies according to countries' characterization and maintains the brand position on the global marketing of beverages.

A scoping review of outdoor food marketing: exposure, power and impacts on eating behaviour and health

BACKGROUND

There is convincing evidence that unhealthy food marketing is extensive on television and in digital media, uses powerful persuasive techniques, and impacts dietary choices and consumption, particularly in children. It is less clear whether this is also the case for outdoor food marketing. This review (i) identifies common criteria used to define outdoor food marketing, (ii) summarises research methodologies used, (iii) identifies available evidence on the exposure, power (i.e. persuasive creative strategies within marketing) and impact of outdoor food marketing on behaviour and health and (iv) identifies knowledge gaps and directions for future research.

METHODS

A systematic search was conducted of Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL, PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and a number of grey literature sources. Titles and abstracts were screened by one researcher. Relevant full texts were independently checked by two researchers against eligibility criteria.

RESULTS

Fifty-three studies were conducted across twenty-one countries. The majority of studies (n = 39) were conducted in high-income countries. All measured the extent of exposure to outdoor food marketing, twelve also assessed power and three measured impact on behavioural or health outcomes. Criteria used to define outdoor food marketing and methodologies adopted were highly variable across studies. Almost a quarter of advertisements across all studies were for food (mean of 22.1%) and the majority of advertised foods were unhealthy (mean of 63%). The evidence on differences in exposure by SES is heterogenous, which makes it difficult to draw conclusions, however the research suggests that ethnic minority groups have a higher likelihood of exposure to food marketing outdoors. The most frequent persuasive creative strategies were premium offers and use of characters. There was limited evidence on the relationship between exposure to outdoor food marketing and eating behaviour or health outcomes.

CONCLUSIONS

This review highlights the extent of unhealthy outdoor food marketing globally and the powerful methods used within this marketing. There is a need for consistency in defining and measuring outdoor food marketing to enable comparison across time and place. Future research should attempt to measure direct impacts on behaviour and health.

A content analysis of the aims, strategies, and effects of food and nonalcoholic drink advertising based on advertising industry case studies

Background

Placing limitations on advertising of food and nonalcoholic drinks to children is an effective strategy in addressing childhood obesity. The industry maintains that further restrictions are unnecessary.

Aims

To ascertain whether the advertising campaigns were successful according to the industry evaluations and more specifically the effects of marketing on children.

Materials & Methods

A total of 117 case studies (1980-2016) published by the advertising industry which evaluate the effects of advertising campaigns were reviewed. This industry data source had been previously used to analyze the effects of alcohol advertising campaigns. The nutrition profile of the products was assessed by applying the World Health Organisation Nutrition Profile model designed to restrict the marketing of foods and beverages to children.

Results

The food and drink industry advertising campaigns target specific consumers including children, use several persuasive marketing techniques (utilizing celebrities and gamification), often position unhealthy products as healthy, and lead to increased sales of the advertised product with good returns on investment. The health-related claims made, and aspects of the campaigns related to the marketing of the products to children are summarized.

Discussion

Our analysis of food and non-alcoholic drinks case studies aligns with similar analyses of tobacco and alcohol advertising.

Conclusion

This analysis, based on internal industry data, presents important evidence on the effects of advertising on consumption-related outcomes and the mechanisms by which they are achieved.

Use of persuasive strategies in food advertising on television and on social media in Brazil

We analyzed the use of persuasive advertising strategies by 18 food brands on TV and Facebook, Instagram, and YouTube in Brazil in April 2018. Advertising strategies were investigated from three groups: power of advertising strategies (n = 10) (e.g., use of licensed character, celebrities, awards, etc), use of the prize offering (n = 9) (e.g., pay 2 take 3 or more, gifts or collectable, limited edition, etc), and use of brand benefit claims (n = 8) (e.g., messages that exalt sensory-based characteristics such as flavor, taste, aroma and recommend how to use/consume the product, etc). Almost 90% of the brands were ultra-processed foods producers and they carried 52 ads on TV and 194 posts on social media platforms. A higher frequency of the strategy ‘cartoon/company owned character’ was found on TV ads (19.2%; p < 0.0001) in comparison to social media platforms (0% on the three platforms) while the presence of ‘famous sportsperson/team’ prevailed on YouTube (41.4%) in comparison to TV (19.2%), Facebook (10.9%) and Instagram (9.1%), p < 0.0001. On YouTube ads, the claims ‘sensory-based characteristics’ (86.2%), ‘suggested use’ (51.7%), and ‘emotive claims’ (31.0%) were more commonly seen in comparison to the other media, while the claims about ‘new brand developments’ (23.1%), ‘price’ (9.6%) and ‘suggesting to children and the whole family to use the advertised product’ (21.1%) prevailed on TV. Ultra-processed food brands are the main food companies that advertise on Brazilian TV and social media and the message transmitted by these brands varies in each media according to the advertising strategies that are used.

Incidental exposure to hedonic and healthy food features affects food preferences one day later

Memories acquired incidentally from exposure to food information in the environment may often become active to later affect food preferences. Because conscious use of these memories is not requested or required, these incidental learning effects constitute a form of indirect memory. In an experiment using a novel food preference paradigm (n = 617), we found that brief incidental exposure to hedonic versus healthy food features indirectly affected food preferences a day later, explaining approximately 10% of the variance in preferences for tasty versus healthy foods. It follows that brief incidental exposure to food information can affect food preferences indirectly for at least a day. When hedonic and health exposure were each compared to a no-exposure baseline, a general effect of hedonic exposure emerged across individuals, whereas health exposure only affected food preferences for high-BMI individuals. This pattern suggests that focusing attention on hedonic food features engages common affective processes across the general population, whereas focusing attention on healthy food features engages eating restraint goals associated with high BMI. Additionally, incidental exposure to food features primarily changed preferences for infrequently consumed foods, having less impact on habitually consumed foods. These findings offer insight into how hedonic information in the obesogenic food environment contributes to unhealthy eating behavior that leads to overweight and obesity. These findings further motivate the development of interventions that counteract the effects of exposure to hedonic food information and that broaden the effects of exposure to healthy food information.

Japanese newspaper advertisements for dietary supplements before and after COVID-19: a content analysis

OBJECTIVES

Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread.

DESIGN

Content analysis.

PARTICIPANTS

We analysed advertisements for dietary supplements in two major Japanese newspapers in February-July 2019 and February-July 2020. Our analysis covered 2167 advertisements.

RESULTS

The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as 'defence' and 'prevent' were used to promote the preventive effect.

CONCLUSIONS

False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers.

The Effect of a Serious Health Game on Children's Eating Behavior: Cluster-Randomized Controlled Trial

Background

Currently, children’s dietary intake patterns do not meet prescribed dietary guidelines. Consequently, childhood obesity is one of the most serious health concerns. Therefore, innovative methods need to be developed and tested in order to effectively improve the dietary intake of children. Teaching children how to cope with the overwhelming number of unhealthy food cues could be conducted effectively by serious health games.

Objective

The main aim of this study was to examine the effect of a serious health computer game on young children’s eating behavior and attitudes toward healthy and unhealthy foods.

Methods

A cluster-randomized controlled trial with a between-group design was conducted (n=157; 8-12 years), wherein children played a game that promoted a healthy lifestyle or attended regular classes and did not play a game (control). The game was designed in collaboration with researchers and pilot-tested among a group of children repeatedly before conducting the experiment. After 1 week of playing, attitudes toward food snacks and actual intake (children could eat ad libitum from fruits or energy-dense snacks) was assessed.

Results

The results showed that playing a serious health game did not have an effect on attitude toward fruits or energy-dense snacks or on the intake of fruits or less energy-dense snacks. Additional Bayesian analyses supported these findings.

Conclusions

Serious health games are increasingly considered to be a potential effective intervention when it comes to behavior change. The results of the current study stress the importance of tailoring serious health games in order to be effective, because no effect was found on attitude or eating behavior.

Trial Registration

ClinicalTrials.gov NCT05025995; https://tinyurl.com/mdd7wrjd

Abusive advertising of food and drink products on Brazilian television

In Brazil, any advertising strategies that take advantage of the child's judgment or induce consumers to make harmful health choices are considered abusive. However, the efficacy of restrictions on their use on television (TV) food advertising remains poorly understood. This study analysed the extent and nature of abusive techniques according to national regulations and patterns in their use in food-related ads. Cross-sectional studyrecorded the programming of the three most popular TV channels (6 am-12 am), during eight non-consecutive days, in April 2018. Data collection was based on the INFORMAS protocol and two national regulations. Descriptive analyses were used to describe the types of food ads and abusive techniques used in ultra-processed products (UPP) ads. Principal component analysis was applied to identify patterns of abusive marketing techniques and to relate them to specific food groups. More than 90% of food ads included at least one UPP. Overall, 10.1% of UPP ads targeted children and 57.7% used some kind of abusive technique directed to children and adolescents. Most ads contained messages inducing harmful health choices did not present adequate and clear information about the product and contained more than one type of abusive technique. Four out of five patterns in the use of abusive techniques in UPP ads were specifically directed to children, and fast-food meals were associated with three out of five patterns. The high abusiveness of food advertising in UPP ads should be considered a public health concern given their impact on children's food choices and health.

Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice

Background

Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action.

Methods

This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories.

Results

Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%.

Conclusions

Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01481-8.

A Content Analysis of Video Advertisements for Dietary Supplements in Japan

Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of video advertisements for dietary supplements and described the content of advertisements with high numbers and frequent views. We analyzed 82 video advertisements on YouTube that promoted fat-reduction effects. We extracted 22 themes and classified them into 10 categories. The categories with the highest numbers of advertisements were “Exemption” (i.e., consuming the product frees the audience from refraining from binge eating) (20 ads, 24.4%) and “Health Concerns” (i.e., the product intake solves the health concerns of the audience) (19 ads, 23.2%). These advertisements may stimulate negative audience attitudes toward appropriate health behaviors. The category with the most frequent views was “Lifestyle” (i.e., adding product intake to a healthy lifestyle) (3,035,298 views). “Lifestyle” advertisements portray physical activity in a positive light and may promote appropriate health behaviors in the audience. We discuss the possible effects of the advertisements on audiences and consider issues for future research and practice.

Effects of Advertising: A Qualitative Analysis of Young Adults' Engagement with Social Media About Food

Young adults are constantly exposed to energy-dense, nutrient-poor food and beverages, particularly through advertising. Exposure can influence poor food choices and negatively impact health. This study aimed to understand young adults' attitudes and experiences associated with food-related advertisements, particularly on social media. This qualitative analysis involved n = 166 Australian 18 to 24-year-olds who were involved in a four-week online conversation on different areas relating to health, social media, and eating. Inductive thematic analysis was utilised on two forums on the recall and perceptions of food-related advertisements. Young adults commonly mentioned aspects of the marketing mix (promotion, product, price, and place) in food advertisements. Participants were more readily able to recall energy-dense, nutrient-poor food advertisements compared to healthy food-related advertisements. Digital advertisements were often discussed alongside the use of ad-blockers and algorithms which tailored their social media viewing to what they like. Participants felt constant exposure to unhealthy food advertisements hindered their ability to realise healthy eating behaviours and created feelings of guilt. This current analysis highlights the need to provide an advertising environment that appropriately motivates healthy eating and a food environment that allows healthy food to be the affordable and convenient option.

Sugary drink advertising expenditure across Australian media channels 2016-2018

OBJECTIVE

The aim of this study was to describe advertising expenditure for sugary drinks compared with alternative cold non-alcoholic beverages (artificially sweetened beverages, plain water, plain milk) between 2016 and 2018 across Australian media channels.

METHODS

Monthly estimates of advertising expenditure for non-alcoholic beverages were obtained from Nielsen Media and aggregated by product type and media.

RESULTS

Total sugary drink advertising expenditure between 2016 and 2018 ($129.5M) significantly exceeded expenditure on artificially sweetened drinks ($23.26M), plain water ($14.27M), and plain milk ($31.30M). Television and out-of-home advertising accounted for the largest share of sugary drink advertising (45%, 35%). Expenditure on out-of-home advertising was more heavily dominated by sugary drinks (75%) than advertising in all media combined (65%). Sugary drink advertising peaked in warmer months and was lowest in August. Soft drinks (26%), flavoured milks (24%) and energy drinks (21%) accounted for the majority of sugary drink advertising.

CONCLUSIONS

Cold non-alcoholic beverage advertising in Australian media is dominated by the advertising of sugary drinks. Implications for public health: Restricting unhealthy beverage advertising on television and out-of-home media may be most effective initially. However, comprehensive restrictions capturing a broader range of media and settings would be optimal to prevent displacement and limit advertising reach and exposure.

Breakfast Food Advertisements in Mediterranean Countries: Products' Sugar Content in the Adverts from 2015 to 2019

Although Spain was considered to be the healthiest country in the world in 2019, some studies reported that Mediterranean diet (MD) adherence, especially for breakfast, is low among children in Mediterranean countries, where child obesity is increasing alarmingly. This study correlated longitudinally the sugar content of breakfast products with advertising strategies. The research design applied quantitative analysis to compile the advertising data from 2015 to 2019 for all media, qualitative analysis of the content, and the use of popular characters to promote the food purchase. Additionally, a nutritional analysis was used to determine the products’ sugar content. The results were analyzed according to the target they were aimed at (adults or children). Results showed that the Spanish food industry promoted unhealthy products for breakfast, especially those targeted to children, with very high sugar content. To improve the childhood obesity rate in Spain, greater involvement from the food industry is needed. The reformulation of breakfast products must be a priority along with additional sugar reduction strategies so as not to lose adherence to MD in younger generations. More nutrition education is necessary among children, especially on balanced breakfast consumption, a basic meal that helps children to concentrate better in class during the morning.

How Is Functional Food Advertising Understood? An Approximation in University Students

In functional food advertising, messages are not always easily understandable for the target audience. Current European legislation, enforced through Regulation 1924/2006, specifies that such messages should be clear and precise so as not to mislead the consumer. The objective of this study was to observe consumers' understanding of messages in functional food advertisements. The methodology used was a self-administered survey filled out by 191 students enrolled in a Degree in Advertising and Public Relations at the University of Alicante (Spain). The results suggest that a large number of students do not know what functional food is and obtain information about these products mainly from labelling/packaging. The major means of communication through which they learn about health benefits via advertising is the internet, followed by television. Most respondents indicated that they understood related advertisements and found it helpful to be given additional information on health benefits. Worthy of note, the greater their level of understanding of the messages, the higher their level of distrust of advertising messages, which they considered to be deceptive or misleading.

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

OBJECTIVE

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

DESIGN

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

SETTING

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

PARTICIPANTS

The study did not involve human subjects.

RESULTS

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

CONCLUSION

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

Changes in Beverage Marketing at Stores Following the Oakland Sugar-Sweetened Beverage Tax

INTRODUCTION

In July 2017, Oakland, California implemented a 1 cent/ounce sugar-sweetened beverage tax. This study examined changes in store marketing practices-advertising and price promotions-for sugar-sweetened beverages, artificially sweetened beverages, and unsweetened beverages following the introduction of the tax.

METHODS

The study employed a quasi-experimental research design and included Oakland as the intervention site and Sacramento, California as a comparison site. Based on data collected pretax (May-June 2017), 6 months post-tax (January 2018), and 12 months post-tax (June 2018) at 249 stores across the 2 sites, exterior and interior advertising for 4 taxed sugar-sweetened beverage subtypes and 6 untaxed artificially sweetened and unsweetened beverage subtypes, as well as price promotions for 59 specific taxed products and 69 untaxed products were examined. In 2019, difference-in-differences logistic regressions estimated pre-post changes in Oakland relative to Sacramento.

RESULTS

At 6 months post-tax, the odds of sugar-sweetened beverage price promotions fell 50% in Oakland but only 22% in Sacramento. Price promotions for regular soda in particular declined in Oakland post-tax, by 47% at 6 months and 39% at 12 months (versus no change in Sacramento). Moreover, the odds of artificially sweetened beverage price promotions fell by a similar magnitude as sugar-sweetened beverages in Oakland, 55% at 6 months and 53% at 12 months, which differed significantly from Sacramento. No significant post-tax changes were found in sugar-sweetened or artificially sweetened beverage exterior or interior advertising.

CONCLUSIONS

Rather than increasing marketing, retailers and manufacturers may have tried to offset revenue losses by reducing price promotions for sugar-sweetened beverages, particularly regular soda, and artificially sweetened beverages.

The impact of inappropriate food advertising on consumer behavior

The impact of food advertising on consumer behavior is a matter of concern to psychologists, marketers, economists and the general public alike. It is well known that the consumer is not rational, and all the time does not carefully evaluate all available alternatives before purchase. There exist many stimuli influencing consumer behavior, which refers to the study of buying tendencies of consumers. There are several stages a consumer goes through before he finally picks up products available in the market. Various factors, be it cultural, social, personal or psychological, influence the buying decision of individuals. Submitted paper deals with the impact of inappropriate advertising on consumer behavior, namely the purchase of food. Related research was conducted at Department of Marketing and Trade, FEM SUA in Nitra, based on a questionnaire survey with a sample of 702 respondents from the Slovak Republic. We have used two research methods: Chi Square contingency test and Kolmogorov - Smirnov test. Obtained results proved that 38% of respondents have a personal experience with inappropriate food advertising and most respondents considered inappropriate food advertising as a deceptive, misleading and manipulative one. It was confirmed that the perception of inappropriate food advertising is not dependent on the age of the respondents and respondents do not avoid buying food previously seen in inappropriate advertising. They take into consideration more important characteristics and features of the food products such as quality, price, taste etc.

The impact of elevated body mass on brain responses during appetitive prediction error in postpartum women

Repeated exposure to highly palatable foods and elevated weight promote: 1) insensitivity to punishment in striatal regions and, 2) increased willingness to work for food. We hypothesized that BMI would be positively associated with negative prediction error BOLD response in the occipital cortex. Additionally, we postulated that food reinforcement value would be negatively associated with negative prediction error BOLD response in the orbital frontal cortex and amygdala. Postpartum women (n = 47; BMI = 25.5 ± 5.1) were 'trained' to associate specific cues paired to either a highly palatable milkshake or a sub-palatable milkshake. We then violated these cue-taste pairings in 40% of the trials by showing a palatable cue followed by the sub-palatable taste (negative prediction error). Contrary to our hypotheses, during negative prediction error (mismatched cue-taste) versus matched palatable cue-taste, women showed increased BOLD response in the central operculum (pFWE = 0.002; k = 1680; MNI: -57, -7,14) and postcentral gyrus (pFWE = 0.006, k = 1219; MNI: 62, -8,18). When comparing the matched sub-palatable cue-taste to the negative prediction error trials, BOLD response increased in the postcentral gyrus (r = -0.60, pFWE = 0.008), putamen (r = -0.55, pFWE = 0.02), and insula (r = -0.50, pFWE = 0.01). Similarly, viewing the palatable cue vs sub-palatable cue was related to BOLD response in the putamen (pFWE = 0.025, k = 53; MNI: -20, 6, -8) and the insula (pFWE = 0.04, k = 19, MNI:38, -12, -6). Neither BMI at 6-month postpartum nor food reinforcement value was related to BOLD response. The insula and putamen appear to encode for visual food cue processing, and the gustatory and somatosensory cortices appear to encode negative prediction errors. Differential response in the somatosensory cortex to the matched cue-taste pairs to negative prediction error may indicate that a palatable cue may dull aversive qualities in the stimulus.

Ultra-processed food product brands on Facebook pages: highly accessed by Brazilians through their marketing techniques

Objective

To analyse the content and extent of marketing of ultra-processed food products (UPP) and their brand pages on Facebook, which are highly accessed by Brazilians.

Design

Descriptive.

Setting

Sixteen UPP brand pages on Facebook were selected from 250 pages that were the most liked by Brazilians in October 2015.

Subjects

We analysed the frequency of ‘likes’ and members ‘talking about’ each one of the pages, in addition to fifteen marketing techniques used in the previous year (September 2014 to October 2015). The number of posts, likes, ‘shares’ and ‘commentaries’, and the mean number of likes, shares and commentaries per post, were collected for one month, from 23 September to 23 October 2015.

Results

The two most liked pages were: Coke® (93 673 979 likes) and McDonald’s® (59 749 819 likes). Regarding the number of people talking about the pages, McDonald’s led with 555 891 commentaries, followed by Coke (287 274), Burger King® (246 148) and Kibon® (244 523). All pages used marketing techniques, which included photos, user conversations, presence of brand elements and links. Videos were observed on 93·8 % of the pages; promotions on 68·8 %; and celebrities on 62·5 %. In one month, Garoto®, Outback® and Coke were brands that published more than one post per day. Kibon achieved the highest ratio of likes per post (285 845·50) and Burger King had the highest mean shares per post (10 083·93), including commentaries per post (7958·13).

Conclusions

UPP marketing is extensively used on Facebook pages and is highly accessed by Brazilians, with UPP companies employing a diversity of marketing strategies.

Keystones affecting sub-Saharan Africa's prospects for achieving food security through balanced diets

Socio-economic dynamics determine the transition from diets characterized by the risk of famine, to those characterized by the risk of diet-related non-communicable disease (DR-NCD). This transition is of particular concern in Sub-Saharan Africa (SSA) in which key socio-economic interactions that influence diet include economic growth and rapid urbanization; inequality and a growing middle class; and obesogenic food environments and an increasing prevalence of DR-NCD. In each case, countries in SSA are among those experiencing the most rapid change in the world. These interactions, styled as 'keystones', affect the functioning of other components of the food system and the diets that result. Data from the wealthiest quartile of countries in SSA suggest that these keystones may be increasing the risk of DR-NCD, widening inequalities in health outcomes due to unbalanced diets. To address this, new consumer and government capabilities that address these keystones are required. Food sensitive urban planning, supporting food literacy and fiscal management of consumption are examples.