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Orr CJ, Gorecki MC, Woo Baidal JA. Applying an Equity Lens to Pediatric Obesity: Clinical, Environmental, and Policy Considerations for Clinicians. Pediatr Clin North Am 2024; 71:805-818. [PMID: 39343494 DOI: 10.1016/j.pcl.2024.07.001] [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] [Indexed: 10/01/2024]
Abstract
The etiology of pediatric obesity is complex and multifactorial. This article encourages pediatric clinicians to consider patient's socioenvironmental context and structural discrimination as drivers of pediatric obesity. Viewing pediatric obesity through an equity lens can inform clinical practice, advocacy, and policy to promote equity.
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Affiliation(s)
- Colin J Orr
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
| | - Michelle C Gorecki
- Department of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Mannion E, Bihrmann K, Plachta-Danielzik S, Müller MJ, Bosy-Westphal A, Ritz C. Exploring the Effect of an Obesity-Prevention Intervention on Various Child Subgroups: A Post Hoc Subgroup Analysis of the Kiel Obesity Prevention Study. Nutrients 2024; 16:3220. [PMID: 39339820 PMCID: PMC11434954 DOI: 10.3390/nu16183220] [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: 08/29/2024] [Revised: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND This study investigated potential subgroups of children within the Kiel Obesity Prevention Study (KOPS) for differing treatment effects for the outcome measures of overweight or obesity at 4 years. The KOPS study delivered a multicomponent school intervention to cohorts of children in Kiel but found no overall effect on the weight status outcome. However, KOPS authors suggested there may be subgroup variations in treatment effect. Data were collected as part of the KOPS for samples of 6-year-olds between 1996 and 2001, with 4-year follow-up measurements between 2000 and 2004. METHODS The present study conducted a post hoc subgroup analysis of the odds of obesity or overweight at 4-year follow-up compared to normal weight (n = 1646). A generalized linear mixed-effects model, including a treatment-subgroup interaction term, was used to estimate subgroups as a moderator of the treatment effects on the outcomes of obesity or overweight at 4-year follow-up. RESULTS The findings indicated several subgroup-treatment interaction effects relating to physical activity indicators. TV or PC not being one of a child's top 3 activities at baseline was associated with a significantly decreased odds ratio of obesity at 4 years in the intervention group (OR, 0.04; 95% CI, 0.004 to 0.45) compared to the non-intervention group (OR, 0.96; 95% CI, 0.29 to 3.14), p = 0.02. Weekly activity in a sports club at baseline was associated with a decreased odds ratio of overweight at 4 years in the intervention group (OR, 0.38; 95% CI, 0.16 to 0.85) compared to the non-intervention group (OR, 0.91; 95% CI, 0.70 to 1.17). This was a significant difference (p = 0.04). CONCLUSIONS These findings suggest that children's baseline physical activity may impact treatment effects on the outcomes of overweight and obesity, creating opportunities to increase the effectiveness of interventions on preventing obesity.
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Affiliation(s)
- Elizabeth Mannion
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (E.M.); (K.B.)
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (E.M.); (K.B.)
| | - Sandra Plachta-Danielzik
- Competence Network for IBD, 24103 Kiel, Germany;
- Institute of Human Nutrition and Food Science, Christian-Albrechts University of Kiel, 24118 Kiel, Germany; (M.J.M.); (A.B.-W.)
| | - Manfred J. Müller
- Institute of Human Nutrition and Food Science, Christian-Albrechts University of Kiel, 24118 Kiel, Germany; (M.J.M.); (A.B.-W.)
| | - Anja Bosy-Westphal
- Institute of Human Nutrition and Food Science, Christian-Albrechts University of Kiel, 24118 Kiel, Germany; (M.J.M.); (A.B.-W.)
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (E.M.); (K.B.)
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Jarvie C, Renaud K. Online Age Verification: Government Legislation, Supplier Responsibilization, and Public Perceptions. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1068. [PMID: 39334601 PMCID: PMC11429505 DOI: 10.3390/children11091068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/23/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024]
Abstract
There are widespread concerns about the online harms to children operating online. As such, governments have enacted laws to require online service providers to deploy age verification to prevent such harms. We investigate the following three research questions regarding this topic: (1) To what extent have different governments legislated age verification controls? (2) Do governments embrace a responsibilization strategy when it comes to online age verification? and (3) How does the UK public feel about online age verification legislation? We find that governments are applying a responsibilization strategy, which has led to widespread deployment of privacy-invasive or ineffective age verification. The former violates the privacy of underage users, with the latter undermining the overarching aims of the legislation. We have also found general disengagement and a lack of trust in the government amongst the public with regards to new online age verification laws within the UK. To conclude, despite governments globally looking to put more robust online age verification mechanisms in place, there remains a general lack of privacy preservation and affordable technological solutions. Moreover, the overarching aims of the online safety and age verification legislative changes may not be satisfied due to the general public stakeholder group's disengagement and lack of trust in their government.
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Affiliation(s)
- Chelsea Jarvie
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Karen Renaud
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
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Angelino D, Nucci D, Rabica F, Rota C, Dinu M, Martini D, Gianfredi V. Nutritional quality and level of processing of food items broadcasted on Italian television in advertisements targeted to children. Int J Food Sci Nutr 2024; 75:475-485. [PMID: 38659128 DOI: 10.1080/09637486.2024.2343924] [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: 03/03/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations.
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Affiliation(s)
- Donato Angelino
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Daniele Nucci
- SSD Igiene Alimenti e Nutrizione, ATS Brescia, Brescia, Italy
| | - Filippo Rabica
- Department of Pharmaceutical Science, University of Perugia, Perugia, Italy
| | - Cristian Rota
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milan, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milan, Italy
| | - Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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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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Neve KL, Coleman P, Hawkes C, Vogel C, Isaacs A. What shapes parental feeding decisions over the first 18 months of parenting: Insights into drivers towards commercial and home-prepared foods among different socioeconomic groups in the UK. Appetite 2024; 196:107260. [PMID: 38403201 DOI: 10.1016/j.appet.2024.107260] [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: 09/18/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
Infants born into families experiencing socioeconomic disadvantage follow a high-risk trajectory for obesity and poor health in later life. Differences in early childhood food experiences may be contributing to these inequalities. This study aimed to explore the factors that influence parental decisions on when, how and what food to introduce over the first 18 months of their child's life and identify differences according to families' social position. Particular attention was given to social and environmental determinants within and outside the home. This research utilised a longitudinal qualitative methodology, with interviews and photo-elicitation exercises completed by participants when their children were 4-6; 10-12 and 16-18 months of age. Participants were parents (61 mothers; 1 father), distributed across low, medium and high socioeconomic position (SEP). During analysis, observable differences in factors directing parents to home-prepared or commercial foods were identified. Factors that undermined the provision of home-prepared meals included lack of time after returning to work, insufficient support from partners, uncertainty around infant and young child feeding (defined as the introduction and provision of solids) and an implicit trust in the messaging on branded products. These factors directed parents towards commercial foods and were most persistent among families experiencing socioeconomic disadvantage due to barriers accessing formal childcare, less flexible working conditions and fathers being less involved in infant feeding. To facilitate an enabling environment for healthy infant and young child feeding practices and address dietary inequalities, immediate steps that policy makers and healthcare providers can take include: i) changing the eligibility criteria for shared parental leave, ii) aligning claims on commercial infant food labels with international best practices, and iii) improving access to formal childcare.
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Affiliation(s)
- Kimberley L Neve
- Centre for Food Policy, City University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Paul Coleman
- Centre for Food Policy, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - Corinna Hawkes
- Centre for Food Policy, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - Christina Vogel
- Centre for Food Policy, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - Anna Isaacs
- Centre for Food Policy, City University of London, Northampton Square, London, EC1V 0HB, UK
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Jindarattanaporn N, Kelly B, Phulkerd S. A comparative analysis of unhealthy food and beverage television advertising to children in Thailand, between 2014 and 2022. Global Health 2024; 20:2. [PMID: 38167506 PMCID: PMC10759748 DOI: 10.1186/s12992-023-01007-7] [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: 05/22/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Food marketing is a key factor that influences children's dietary behaviors. This study assessed the nature and extent of food and beverage advertising on television (TV) in 2014 and 2022 in Thailand. METHODS TV was recorded for one week in March 2014 and in May 2022 from 7-9am and 3-7 pm on weekends, and 3-7 pm on weekdays across two channels (64 h recorded each year). The nutrient profile model from Bureau of Nutrition, Ministry of Public Health Thailand was used to classify food and non-alcoholic beverages as: Group A ('healthy'), Group B ('less unhealthy') or Group C ('unhealthy'). RESULTS In 2014, 475 food advertisements were identified, with on average of 6.3 unhealthy food advertisements per hour. In 2022, 659 food advertisements were identified, with an average of 9.2 unhealthy food advertisement per hour. In both time periods, the most frequently advertised food products were non-alcoholic beverages. The rate of unhealthy food advertising per hour of broadcast was significantly higher than for other moderately unhealthy and healthy foods, and was also significantly higher in 2022 than in 2014. CONCLUSIONS Food and beverage advertising on Thai television is predominantly promotes unhealthy foods and, in particular, sugar-sweetened beverages. Therefore, Thai Government should enact new legislation to protect children from food TV ads in order to control both the frequency and nature of unhealthy TV food marketing to protect the health of Thai children.
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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
| | - Bridget Kelly
- Early Start, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Phutthamonthon, 73170, Nakhon Pathom, Thailand.
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Velasquez A, Parra MF, Mora-Plazas M, Gómez LF, Taillie LS, Dillman Carpentier FR. Food for thought or food for emotions? An analysis of marketing strategies in television food advertising seen by children in Colombia. Public Health Nutr 2023; 26:2243-2255. [PMID: 37559459 PMCID: PMC10641607 DOI: 10.1017/s1368980023001702] [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: 02/07/2023] [Revised: 05/29/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES). DESIGN A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years. SETTING All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017. PARTICIPANTS N/A. RESULTS Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients. CONCLUSION The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.
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Affiliation(s)
- Alcides Velasquez
- Communication Studies Department, University of Kansas, Lawrence, KS, USA
| | | | - Mercedes Mora-Plazas
- Departamento de Nutrición Humana, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Lindsey Smith Taillie
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Gallagher-Squires C, Isaacs A, Reynolds C, Coleman PC. Snacking practices from infancy to adolescence: parental perspectives from longitudinal lived experience research in England. Proc Nutr Soc 2023:1-9. [PMID: 37759428 DOI: 10.1017/s0029665123003592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Consumption of snacks and ultra-processed foods (UPF) high in fat, salt and sugar (HFSS) is associated with rising rates of obesity and growing socioeconomic disparities in nutrition. While infancy, childhood and adolescence are critical periods for development of dietary preferences, there remains a dearth of research exploring factors that underpin snacking behaviour over this time. This review aims to address this gap by drawing from qualitative lived experience research, with 122 families of different socioeconomic position (SEP), to explore how the (i) home food environment, (ii) food environment and (iii) social value and meanings of food shape parental provision of snacks. This review shows that snacking holds important meanings in everyday family life, with infants integrated into existing snacking practices from an early age. Price promotions, low-cost and long shelf-lives all make UPF and HFSS snacks an appealing option for many low-SEP parents; while children's requests and preferences for HFSS snacks present a challenge across SEP. However, higher-SEP parents can ensure fresh fruits are always available as an alternative snack, while fruit is described as a financially risky expenditure for low-SEP families. The present findings also indicate that retailers and producers are increasingly promoting 'healthier' snacks through product packaging and marketing, such as 'meets one of your five a day', despite these products displaying similar nutritional profiles to traditional UPF and HFSS snacks. We outline a series of policy recommendations, including extending Healthy Start Vouchers and the Fruit and Vegetable Scheme in schools and action to address misleading product marketing and packaging.
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Affiliation(s)
- C Gallagher-Squires
- Centre for Food Policy, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - A Isaacs
- Centre for Food Policy, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - C Reynolds
- Centre for Food Policy, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - P C Coleman
- Centre for Food Policy, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
- Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
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Meyerding SGH, Marpert JD. Modern pied pipers: Child social media influencers and junk food on YouTube: A study from Germany. Appetite 2023; 181:106382. [PMID: 36435300 DOI: 10.1016/j.appet.2022.106382] [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: 05/22/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
Kid influencers (under the age of 13) have profiles on social media platforms and create content to generate views and engagements. To reach young consumers, food companies are increasingly using kid influencers, perceived as highly trustworthy among children of the same age, to promote their (high-calorie) food products. Exposure to such content can lead to an increase in calorie intake. Therefore, this study aimed to identify which foods and beverages are featured in the videos of the four kid influencer channels most popular in Germany and, if possible, which Nutri-Score category these products receive. Of each channel, 50 of the most popular and 50 of the newest videos were analyzed regarding the food and beverage products and brands appearing in the video and the thumbnail. To analyze the number of appearances, each product was categorized as to whether it was branded or unbranded. Where possible, the Nutri-Score was then calculated for each product that appeared. Within the total video sample (N = 373), food and/or beverages appeared in almost 70% of the videos, of which 220 were branded and 178 were unbranded products. Due to incomplete nutrition labels of branded products, only 146 branded products could be analyzed, from which 66% received the worst Nutri-Score categories D and E. The unbranded foods were evaluated using products as similar as possible, of which the majority received Nutri-Score A. The most common brands included McDonald's, Kinder, and Coca-Cola, and the most frequent product categories were chocolate, candy, soft drinks, and fruit. The high number of high-calorie products in the videos shows that kid influencers might be regarded as a risk factor when it comes to childhood obesity.
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Affiliation(s)
- Stephan G H Meyerding
- Faculty of Life Sciences, Department of Nutrition and Home Economics, HAW Hamburg, Hamburg, Germany.
| | - Jasmin D Marpert
- Faculty of Life Sciences, Department of Nutrition and Home Economics, HAW Hamburg, Hamburg, Germany.
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Hodges L, Lowery CM, Patel P, McInnis J, Zhang Q. A Systematic Review of Marketing Practices Used in Online Grocery Shopping: Implications for WIC Online Ordering. Nutrients 2023; 15:446. [PMID: 36678317 PMCID: PMC9866762 DOI: 10.3390/nu15020446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plans to allow participants to redeem their food package benefits online, i.e., online ordering. As grocery shopping online has become more common, companies have developed strategies to market food products to customers using online (or mobile) grocery shopping platforms. There is a significant knowledge gap in how these strategies may influence WIC participants who choose to shop for WIC foods online. This review examines the relevant literature to (1) identify food marketing strategies used in online grocery shopping platforms, (2) understand how these strategies influence consumer behavior and consumer diet, and (3) consider the implications for WIC participants. A total of 1862 references were identified from a systematic database search, of which 83 were included for full-text screening and 18 were included for data extraction and evidence synthesis. The included studies provide policymakers and other stakeholders involved in developing WIC online order processes with valuable information about the factors that shape healthy food choices in the online food retail environment. Findings indicate that some marketing interventions, such as nutrition labeling and food swaps, may encourage healthier food choices in the online environment and could potentially be tailored to reinforce WIC messaging about a healthy diet.
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Affiliation(s)
- Leslie Hodges
- Economic Research Service, U.S. Department of Agriculture, Kansas City, MO 64105, USA
| | - Caitlin M. Lowery
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Priyanka Patel
- School of Community & Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
| | - Joleen McInnis
- University Libraries, Old Dominion University, Norfolk, VA 23529, USA
| | - Qi Zhang
- School of Community & Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
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Potvin Kent M, Pauzé E, Remedios L, Wu D, Soares Guimaraes J, Pinto A, Bagnato M, Pritchard M, L’Abbé M, Mulligan C, Vergeer L, Weippert M. Advertising expenditures on child-targeted food and beverage products in two policy environments in Canada in 2016 and 2019. PLoS One 2023; 18:e0279275. [PMID: 36630326 PMCID: PMC9833551 DOI: 10.1371/journal.pone.0279275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The food industry advertises unhealthy foods intended for children which in turn fosters poor diets. This study characterized advertising expenditures on child-targeted products in Canada and compared these expenditures between Quebec, where commercial advertising to children under 13 is restricted, and the rest of Canada, where food advertising to children is self-regulated. METHODS Advertising expenditures data for 2016 and 2019 for 57 select food categories and five media channels were licensed from Numerator. Products and brands targeted to children were identified based on their nature and the advertising techniques used to promote them. Advertising expenditures were classified as healthy/unhealthy using Health Canada's nutrient profile model. Expenditures per child capita aged 2-12 years were calculated and expenditures from 2016 were adjusted for inflation. Advertising expenditures were described by media, food category, year, and geographic region. RESULTS Overall, $57.2 million CAD was spent advertising child-targeted products in Canada in 2019. Television accounted for 77% of expenditures followed by digital media (18%), and the food categories with the highest expenditures were candy/chocolate (30%) and restaurants (16%). The totality of expenditures (99.9%-100%) in both Quebec and the rest of Canada in 2016 and 2019 were considered 'unhealthy'. Across all media channels (excluding digital), advertising expenditures were 9% lower in 2019 versus 2016. Advertising expenditures per capita were 32% lower in Quebec ($9.40/capita) compared to the rest of the country ($13.91/capita). CONCLUSION In Canada, millions are spent promoting child-targeted products considered inappropriate for advertising to children. While per capita advertising expenditures for these products are lower in Quebec compared to the rest of Canada, they remain high, suggesting that Quebec's commercial advertising restrictions directed to children are likely not sufficiently protecting them from unhealthy food advertising.
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Affiliation(s)
- Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- * E-mail:
| | - Elise Pauzé
- School of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Lauren Remedios
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - David Wu
- Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada
| | - Julia Soares Guimaraes
- School of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Adena Pinto
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mariangela Bagnato
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Meghan Pritchard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mary L’Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Laura Vergeer
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Madyson Weippert
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
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Packer J, Croker H, Goddings AL, Boyland EJ, Stansfield C, Russell SJ, Viner RM. Advertising and Young People's Critical Reasoning Abilities: Systematic Review and Meta-analysis. Pediatrics 2022; 150:e2022057780. [PMID: 36377381 PMCID: PMC9724173 DOI: 10.1542/peds.2022-057780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Young people are exposed to an abundance of advertising for unhealthy products (eg, unhealthy foods, tobacco, alcohol). Because of their developing cognition, children may not be able to understand the intent of advertising. However, advertising restrictions often assume that adolescents have critical reasoning capacity and can resist the effects of advertising. This review seeks to assess whether the evidence supports this assumption. METHODS Ten databases were searched in December 2020. Inclusion criteria were participants aged 6 to 17 years, any advertising exposure, objectively measured understanding or attitudinal outcome, a comparison, control, and between-group comparison. This study included all languages and excluded studies published pre-2010. Two reviewers independently extracted data and assessed study quality. RESULTS Thirty-eight articles were included. Meta-analysis of 9 studies with attitudinal outcomes indicated that unhealthy product advertising generated more positive brand or product attitudes compared with neutral or no advertising control in all ages. There were significant effects for digital and nondigital advertising formats. We found greater understanding did not protect against the impact of advertising on brand or product attitudes. Limitations include the inability to meta-analyze the impact of advertising on understanding or the influence of age. CONCLUSIONS Evidence shows that the attitudes of young people were influenced by advertising. Critical reasoning abilities did not appear to be fully developed during adolescence and not found to be protective against the impact of advertising. Policymakers should ensure regulations to restrict marketing of unhealthy commodities protects adolescents as well as younger children.
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Affiliation(s)
- Jessica Packer
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Helen Croker
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Anne-Lise Goddings
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Emma J. Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Claire Stansfield
- EPPI-Centre, UCL Social Research Institute, University College London, United Kingdom
| | - Simon J. Russell
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Russell M. Viner
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Forde H, Boyland EJ, Scarborough P, Smith R, White M, Adams J. Exploring the potential impact of the proposed UK TV and online food advertising regulations: a concept mapping study. BMJ Open 2022; 12:e060302. [PMID: 35715182 PMCID: PMC9207937 DOI: 10.1136/bmjopen-2021-060302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES In July 2020 the UK Government announced an intention to restrict advertisements for products high in fat, salt or sugar on live broadcast, catch-up and on-demand television before 21:00 hours; and paid for online advertising. As no other jurisdiction has implemented similar regulations, there is no empirical evidence about how they might perturb the food system. To guide the regulations' implementation and evaluation, we aimed to develop a concept map to hypothesise their potential consequences for the commercial food system, health and society. METHODS We used adapted group concept mapping in four virtual workshops with food marketing and regulation experts across academia, civil society, government organisations, and industry (n=14), supported by Miro software. We merged concepts derived from the four workshops to develop a master map and then invited feedback from participants via email to generate a final concept map. RESULTS The concept map shows how the reactions of stakeholders to the regulations may reinforce or undermine the impact on the commercial food system, health and society. The map shows adaptations made by stakeholders that could reinforce, or undermine, positive impacts on public health. It also illustrates potential weaknesses in the design and implementation of the regulations that could result in little substantial difference to public health. CONCLUSIONS Prior to the regulations' initial implementation or subsequent iterations, they could be altered to maximise the potential for reinforcing adaptations, minimise the potential for undermining adaptations and ensure they cover a wide range of advertising opportunities and foods. The concept map will also inform the design of an evaluation of the regulations and could be used to inform the design and evaluation of similar regulations elsewhere.
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Affiliation(s)
| | - Emma J Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Richard Smith
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Woelber JP, Al-Ahmad A, Alt KW. On the Pathogenicity of the Oral Biofilm: A Critical Review from a Biological, Evolutionary, and Nutritional Point of View. Nutrients 2022; 14:nu14102174. [PMID: 35631315 PMCID: PMC9144701 DOI: 10.3390/nu14102174] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 12/21/2022] Open
Abstract
Plaque control is one of the most recommended approaches in the prevention and therapy of caries and periodontal diseases. However, although most individuals in industrialized countries already perform daily oral hygiene, caries and periodontal diseases still are the most common diseases of mankind. This raises the question of whether plaque control is really a causative and effective approach to the prevention of these diseases. From an evolutionary, biological, and nutritional perspective, dental biofilms have to be considered a natural phenomenon, whereas several changes in human lifestyle factors during modern evolution are not “natural”. These lifestyle factors include the modern “Western diet” (rich in sugar and saturated fats and low in micronutrients), smoking, sedentary behavior, and continuous stress. This review hypothesizes that not plaque itself but rather these modern, unnatural lifestyle factors are the real causes of the high prevalence of caries and periodontal diseases besides several other non-communicable diseases. Accordingly, applying evolutionary and lifestyle medicine in dentistry would offer a causative approach against oral and common diseases, which would not be possible with oral hygiene approaches used on their own.
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Affiliation(s)
- Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
- Correspondence:
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Kurt Werner Alt
- Center of Natural and Cultural Human History, Danube Private University, Steiner Landstrasse 124, 3500 Krems-Stein, Austria;
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Abstract
Jean Adams discusses the evidence around food marketing restrictions and how they may be an effective way to support public health.
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Affiliation(s)
- Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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