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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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Courbet D, Jacquemier L, Hercberg S, Touvier M, Sarda B, Kesse-Guyot E, Galan P, Buttafoghi N, Julia C. 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. Int J Behav Nutr Phys Act 2024; 21:38. [PMID: 38622707 PMCID: PMC11017538 DOI: 10.1186/s12966-024-01588-5] [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: 07/13/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
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.
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Affiliation(s)
- Didier Courbet
- Aix-Marseille Univ, Université de Toulon, IMSIC, InCIAM, Marseille, France.
- Département Techniques de Commercialisation, Aix-Marseille University, IUT d'Aix-en-Provence, 413 Avenue Gaston Berger, Aix-en-Provence, 13100, France.
| | - Laure Jacquemier
- Aix-Marseille Univ, CRETLOG, Aix-en-Provence, France
- Département Techniques de Commercialisation, Aix-Marseille University, IUT d'Aix-en-Provence, 413 Avenue Gaston Berger, Aix-en-Provence, 13100, France
| | - Serge Hercberg
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Mathilde Touvier
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Barthélémy Sarda
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Emmanuelle Kesse-Guyot
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Pilar Galan
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | | | - Chantal Julia
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France
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Boyland E. Is it ethical to advertise unhealthy foods to children? Proc Nutr Soc 2023; 82:234-240. [PMID: 36606537 DOI: 10.1017/s0029665123000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The marketing of foods and non-alcoholic beverages (hereafter: food) high in fats, salt and/or sugar (HFSS) has been strongly implicated in the rising levels of childhood obesity worldwide. Multiple ethical concerns arise from the practice of exposing children to such marketing and efforts to monitor and restrict it through regulatory policies. There is considerable evidence that exposure to powerful food marketing messages affects children's food behaviours in ways that are detrimental to good dietary health. Children are particularly vulnerable to being exploited and deceived by food marketing messages based on their cognitive and developmental immaturity. HFSS food marketing also affects numerous child rights enshrined within the UN Convention on the Rights of the Child (of which the UK is a signatory) including the right to the enjoyment of the highest attainable standard of health. The debate has become somewhat polarised between the public health community's evidence-based assertion that all marketing is inherently exploitative and the rebuttal from food and marketing industry stakeholders that provided the marketing is 'accurate and truthful' and there is no ethical need to regulate. This polarisation is reflected in the complexity of policymaking decisions regarding the rationale for mandatory government-led policies or industry self-regulation. There are also ethical considerations inherent in the monitoring of children's food marketing exposure, particularly in the digital sphere, by researchers for the purposes of informing policy design, scope and implementation. This review paper will explore the latest evidence on these issues and consider the implications for public health research, policy, and practice.
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Affiliation(s)
- E Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Unhealthy food and beverage marketing to children on digital platforms in Aotearoa, New Zealand. BMC Public Health 2022; 22:2407. [PMID: 36550491 PMCID: PMC9773428 DOI: 10.1186/s12889-022-14790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Children's exposure to unhealthy food and beverage marketing has a direct impact on their dietary preference for, and consumption of, unhealthy food and drinks. Most children spend time online, yet marketing restrictions for this medium have had slow uptake globally. A voluntary Children's and Young People's Advertising (CYPA) Code was implemented in Aotearoa, New Zealand (NZ) in 2017. This study explores the Code's limitations in protecting children from harmful food and beverage marketing practices on digital platforms accessible to children. METHODS A cross-sectional content analysis of company websites (n = 64), Facebook pages (n = 32), and YouTube channels (n = 15) of the most popular food and beverage brands was conducted between 2019 and 2021 in NZ. Brands were selected based on market share, web traffic analysis and consumer engagement (Facebook page 'Likes' and YouTube page views). Analysis focused on volume and type of food posts/videos, level of consumer interaction, nutritional quality of foods pictured (based on two different nutrient profile models), and use of specific persuasive marketing techniques. RESULTS Eighty-one percent of websites (n = 52) featured marketing of unhealthy food and beverages. Thirty-five percent of websites featuring unhealthy food and beverages used promotional strategies positioning their products as 'for kids'; a further 13% used 'family-oriented' messaging. Several websites featuring unhealthy products also had designated sections for children, 'advergaming,' or direct messaging to children. Eighty-five percent of all food and drink company Facebook posts and YouTube videos were classified as unhealthy. Twenty-eight percent of Facebook posts for unhealthy products featured persuasive promotional strategies, and 39% premium offers. Nearly 30% of YouTube videos for unhealthy food and beverages featured promotional strategies, and 13% premium offers. Ten percent of Facebook posts and 13% of YouTube videos of unhealthy food and beverages used marketing techniques specifically targeting children and young people. CONCLUSIONS The voluntary CYPA Code has been in effect since 2017, but the inherent limitations and loopholes in the Code mean companies continue to market unhealthy food and beverages in ways that appeal to children even if they have committed to the Code. Comprehensive and mandatory regulation would help protect children from exposure to harmful marketing.
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Sing F, Reeve B, Backholer K, Mackay S, Swinburn B. Designing legislative responses to restrict children’s exposure to unhealthy food and non-alcoholic beverage marketing: a case study analysis of Chile, Canada and the United Kingdom. Global Health 2022; 18:72. [PMID: 35870937 PMCID: PMC9308290 DOI: 10.1186/s12992-022-00865-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Introducing legislation that restricts companies from exposing children to marketing of unhealthy food and beverage products is both politically and technically difficult. To advance the literature on the technical design of food marketing legislation, and to support governments around the world with legislative development, we aimed to describe the legislative approach from three governments.
Methods
A multiple case study methodology was adopted to describe how three governments approached designing comprehensive food marketing legislation (Chile, Canada and the United Kingdom). A conceptual framework outlining best practice design principles guided our methodological approach to examine how each country designed the technical aspects of their regulatory response, including the regulatory form adopted, the substantive content of the laws, and the implementation and governance mechanisms used. Data from documentary evidence and 15 semi-structured key informant interviews were collected and synthesised using a directed content analysis.
Results
All three countries varied in their legislative design and were therefore considered of variable strength regarding the legislative elements used to protect children from unhealthy food marketing. When compared against the conceptual framework, some elements of best practice design were present, particularly relating to the governance of legislative design and implementation, but the scope of each law (or proposed laws) had limitations. These included: the exclusion of brand marketing; not protecting children up to age 18; focusing solely on child-directed marketing instead of all marketing that children are likely to be exposed to; and not allocating sufficient resources to effectively monitor and enforce the laws. The United Kingdom’s approach to legislation is the most comprehensive and more likely to meet its regulatory objectives.
Conclusions
Our synthesis and analysis of the technical elements of food marketing laws can support governments around the world as they develop their own food marketing restrictions. An analysis of the three approaches illustrates an evolution in the design of food marketing laws over time, as well as the design strengths offered by a legislative approach. Opportunities remain for strengthening legislative responses to protect children from unhealthy food marketing practices.
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Cazzaniga E, Orlando A, Terenzio A, Suardi C, Mognetti C, Gennaro F, Antolini L, Palestini P. Health Status and Nutritional Habits in Maldives Pediatric Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15728. [PMID: 36497802 PMCID: PMC9740220 DOI: 10.3390/ijerph192315728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Chronic noncommunicable diseases (NCDs) have become the major cause of morbidity and mortality in the Maldives, triggered by the nutrition transition to a "Western diet" that dramatically increases the prevalence of excess weight and hypertension. Our study aimed to evaluate dietary habits, blood pressure (BP) and body mass index in Maghoodoo Public School's students. A sample of 145 students (72 males and 73 females, age 9.37 ± 2.97 years) was enrolled. Factors causing excess weight were investigated through descriptive statistics. The relationship between blood pressure percentiles and possible influencing factors was investigated by a linear regression model.. Excess weight was present in 15.07% and 12.5% females and males, respectively. 15.18% of the subjects had elevated BP, with a significant difference according to gender detected only in the PAS z-score. Eating habits were investigated through a parent-filled questionnaire; 70.15% of the students consumed less than two portions of fruit per day, with a significant difference between gender (84.06% and 55.38% for boys and girls, respectively, p < 0.0001) and 71.64% ate less than two servings of vegetables per day. An alarming finding emerged for sweet snacks (30.6% of the students consumed 2-3 servings per day) and sugary drinks (2-3 servings per day for 32.84% of students) consumption. Our findings suggest that excess weight and hypertension in this population could be due to energy-rich, packaged-foods consumption. A nutrition education approach might thus help to reduce cardiovascular risk.
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Affiliation(s)
- Emanuela Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
- Bicocca Center of Science and Technology for Food, University of Milano-Bicocca, Piazza della Scienza, 2, 20126 Milano, Italy
| | - Antonina Orlando
- Cardiologic Unit, Istituto Auxologico Italiano, IRCCS, 20100 Milan, Italy
| | - Annalisa Terenzio
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
| | - Carlotta Suardi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
| | - Chiara Mognetti
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
| | - Francesca Gennaro
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20133 Milano, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
| | - Paola Palestini
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
- Bicocca Center of Science and Technology for Food, University of Milano-Bicocca, Piazza della Scienza, 2, 20126 Milano, Italy
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Boyland E, McGale L, Maden M, Hounsome J, Boland A, Jones A. Systematic review of the effect of policies to restrict the marketing of foods and non-alcoholic beverages to which children are exposed. Obes Rev 2022; 23:e13447. [PMID: 35384238 PMCID: PMC9541016 DOI: 10.1111/obr.13447] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/28/2022]
Abstract
This systematic review examined the effectiveness of policies restricting the marketing of foods and/or non-alcoholic beverages to children to inform updated World Health Organization (WHO) guidelines. Databases were searched to March 2020. Inclusion criteria were primary studies of any design assessing implemented policies to restrict food marketing to children (0-19 years). Critical outcomes were exposure to and power of marketing, dietary intake, choice, preference, and purchasing. Important outcomes were purchase requests, dental caries, body weight, diet-related noncommunicable diseases, product change, and unintended consequences. Forty-four observational studies met inclusion criteria; most were moderate quality. Pooling was conducted using vote counting by direction of effect, and GRADE was used to judge evidence certainty. Evidence suggests food marketing policies may result in reduced purchases of unhealthy foods and in unintended consequences favorable for public health. Desirable or potentially desirable (for public health) effects of policies on food marketing exposure and power were also found. Evidence on diet and product change was very limited. The certainty of evidence was very low for four outcomes (exposure, power, dietary intake, and product change) and low for two (purchasing and unintended consequences). Policies can effectively limit food marketing to children; policymakers should prioritize mandatory approaches aligned with WHO recommendations.
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Affiliation(s)
- Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Lauren McGale
- Department of Psychology, University of Liverpool, Liverpool, UK.,Department of Psychology, Edge Hill University, Ormskirk, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Juliet Hounsome
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, UK
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Vaivada T, Sharma N, Das JK, Salam RA, Lassi ZS, Bhutta ZA. Interventions for Health and Well-Being in School-Aged Children and Adolescents: A Way Forward. Pediatrics 2022; 149:186939. [PMID: 35503328 DOI: 10.1542/peds.2021-053852m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
The health and well-being of school-aged children has received little attention compared with younger children aged < 5 years and adolescents. In this final article in a supplement of reviews that have assessed the effectiveness of interventions for school-aged children across a variety of health-related domains (including infectious diseases, noncommunicable diseases, healthy lifestyle, mental health, unintentional injuries, and sexual and reproductive health), we summarize the main findings and offer a way forward for future research, policy, and implementation. We complement this evidence base on interventions with a summary of the literature related to enabling policies and intersectoral actions supporting school-aged child health. The school represents an important platform for both the delivery of preventive interventions and the collection of data related to child health and academic achievement, and several frameworks exist that help to facilitate the creation of a health-promoting environment at school.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Naeha Sharma
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute and.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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Nanchahal K, Vasiljevic M, Petticrew M. A content analysis of the aims, strategies, and effects of food and nonalcoholic drink advertising based on advertising industry case studies. Obes Sci Pract 2022; 8:208-218. [PMID: 35388346 PMCID: PMC8976544 DOI: 10.1002/osp4.561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- Kiran Nanchahal
- Department of Public Health, Environments and Society London School of Hygiene & Tropical Medicine London UK
| | | | - Mark Petticrew
- Department of Public Health, Environments and Society London School of Hygiene & Tropical Medicine London UK
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Coleman PC, Hanson P, van Rens T, Oyebode O. A rapid review of the evidence for children’s TV and online advertisement restrictions to fight obesity. Prev Med Rep 2022; 26:101717. [PMID: 35141122 PMCID: PMC8814640 DOI: 10.1016/j.pmedr.2022.101717] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 12/31/2022] Open
Abstract
The relationship between obesity and exposure to food advertising meets all criteria commonly used to demonstrate the presence of a causal relationship in epidemiology. Younger children (≤8 years of age) are more susceptible to the impacts of food marketing, in terms of quantity and quality of calories consumed, than older children and adults, although emerging evidence suggests that adolescents (10–19 years) may be most susceptible to the impacts of online advertisements. Children from socio-economically disadvantaged and ethnic minority backgrounds are disproportionately exposed to unhealthy food advertisements. Statutory regulation is a potentially cost-effective policy option, in terms of healthcare savings outweighing the costs of implementing the policy. However, advertising restrictions must be accompanied by community-based interventions that address other causes of poor diet and sedentary behaviour; this is because online and TV advertisements represent one small dimension in the wider obesogenic environment. Voluntary bans are ineffective. Exposure to unhealthy food advertising is similar before and after the introduction of voluntary food advertisements.
The World Health Organisation has urged all governments to address rising rates of obesity by implementing population-based interventions, such as restrictions on the marketing to children of unhealthy food and beverage items. However, the relationship between unhealthy food advertisements and childhood obesity is disputed by industry-sponsored reports, which recommend promoting physical activity and weight loss campaigns rather than policies to limit exposure to advertisements. We aimed to elucidate this debate by providing a narrative review of the evidence on the relationship between unhealthy TV and online food advertisements, short-term food consumption and childhood obesity. We also examined the impact of unhealthy food advertisements on vulnerable groups and identified which policy interventions are supported by current evidence. We conducted a rapid overview of reviews published since 2006. From a synthesis of 18 reviews meeting the inclusion criteria, we conclude that exposure to unhealthy TV and online food advertising is a contributing factor to childhood obesity. Evidence of a relationship between exposure to unhealthy food advertisements and childhood obesity was evident at all stages of the causal pathway, including a clear dose-response relationship. The evidence base was particularly strong for children aged 3–12 years of age and for children from socio-economically disadvantaged and minority ethnic backgrounds. The introduction of statutory regulation is a potentially cost-effective policy option, in terms of healthcare savings outweighing the costs of implementing the policy, although voluntary codes were shown to be ineffective, with exposure to unhealthy food advertisements similar in countries before and after their introduction. Food advertising, however, is just one factor in the wider obesogenic environment and further advertising restrictions must be implemented alongside population-based interventions that aim to address systemic causes of poor diet.
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Yau A, Berger N, Law C, Cornelsen L, Greener R, Adams J, Boyland EJ, Burgoine T, de Vocht F, Egan M, Er V, Lake AA, Lock K, Mytton O, Petticrew M, Thompson C, White M, Cummins S. Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis. PLoS Med 2022; 19:e1003915. [PMID: 35176022 PMCID: PMC8853584 DOI: 10.1371/journal.pmed.1003915] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. METHODS AND FINDINGS Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. CONCLUSIONS This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.
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Affiliation(s)
- Amy Yau
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (AY); (SC)
| | - Nicolas Berger
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Epidemiology and Public Health, Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Cherry Law
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Greener
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emma J. Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Applied Research Collaboration West, Bristol, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vanessa Er
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amelia A. Lake
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Fuse–The Centre for Translational Research in Public Health, Newcastle upon Tyne, United Kingdom
| | - Karen Lock
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oliver Mytton
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Claire Thompson
- Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (AY); (SC)
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12
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Abstract
Context Policy-specific actions to improve food environments will support healthy population diets. Objective To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. Data sources A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. Data extraction Data on government-led FEPs, barriers, and facilitators from key informants were collected. Data synthesis The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. Results A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. Conclusions The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. Systematic Review Registration PROSPERO registration no. CRD42018115034.
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Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- T. Karupaiah, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia. E-mail:
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13
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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14
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Shen S, Mackay S, Lee A, Ni Mhurchu C, Sherif A, Eyles H. Impact of a voluntary industry code for advertising food to children and young people: an analysis of New Zealand television data. Public Health Nutr 2021; 25:1-11. [PMID: 34865662 PMCID: PMC9991689 DOI: 10.1017/s1368980021004705] [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: 11/06/2022]
Abstract
OBJECTIVE To evaluate the impact of the 2017 update to the voluntary Advertising Standards Authority (ASA) code for advertising food on children and young people's exposure to unhealthy food advertisements on New Zealand television. DESIGN Audience ratings data were analysed for New Zealand children and young people's television viewing for eight random days prior to (June to August 2015) and following (October to December 2018) the code update, from 06.00 to midnight (864 h). Food advertisements were coded using three nutrient profiling models. The number of children and young people watching television each year was compared. SETTING Three free-to-air New Zealand television channels. PARTICIPANTS New Zealand children aged 5-18 years. RESULTS Television viewer numbers decreased over the 3 years (P < 0·0001). The mean rate of unhealthy food advertising on weekdays was 10·4 advertisements/h (2015) and 9·5 advertisements/h (2018). Corresponding rates for weekend days were 8·1 and 7·3 advertisements/h, respectively. The percentage of food advertisements which were for unhealthy foods remained high (63·7 % on weekdays and 65·9 % on weekends) in 2018. The ASA definition of children's 'peak viewing time' (when 25 % of the audience are children) did not correspond to any broadcast times across weekdays and weekend days. CONCLUSIONS Between 2015 and 2018, children and young people's television exposure to unhealthy food advertising decreased. However, almost two-thirds of all food advertisements were still unhealthy, and the updated ASA code excluded the times when the greatest number of children was watching television. Consequently, government regulation and regular monitoring should reflect the evolving food marketing environment.
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Affiliation(s)
- Stephanie Shen
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Arier Lee
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- Department of Pacific Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ahmed Sherif
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Helen Eyles
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
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15
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Abstract
AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.
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16
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Carters-White L, Chambers S, Skivington K, Hilton S. Whose rights deserve protection? Framing analysis of responses to the 2016 Committee of Advertising Practice consultation on the non-broadcast advertising of foods and soft drinks to children. FOOD POLICY 2021; 104:102139. [PMID: 34720343 PMCID: PMC8547229 DOI: 10.1016/j.foodpol.2021.102139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
Exposure to advertising of food and beverages high in fat sugar and salt (HFSS) is considered a factor in the development of childhood obesity. This paper uses framing analysis to examine the strategic discursive practices employed by non-industry and industry responders to the Committee of Advertising Practice's consultation responses (n = 86) on UK regulation of non-broadcast advertising of foods and soft drinks to children. Our analysis demonstrates non-industry and industry responders engaged in a moral framing battle centred on whose rights were deemed as being of greatest importance to protect: children or industry. Both industry and non-industry responders acknowledged that childhood obesity and non-broadcast advertising were complex issues but diverged on how they morally framed their arguments. Non-industry responders employed a moral framework that aligned with the values represented in social justice approaches to public health policy, where children were identified as vulnerable, in need of protection from harmful HFSS product advertising and childhood obesity was a societal problem to solve. In contrast, industry responders emphasised industry rights, portraying themselves as a responsible industry that is victim to perceived disproportionate policymaking, and values more closely aligned with a market justice approach to public health policy. Our analysis provides detailed insights into the framing strategies used in the policy debate surrounding the non-broadcast advertising of HFSS foods to children. This has relevance as to how advocacy organisations can develop counter-framing to industry frames which seek to limit effective regulation.
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Affiliation(s)
- Lauren Carters-White
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom
- SPECTRUM Consortium, Usher Institute of Population Health Sciences and Informatics, Doorway 1, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh EH8 9AG, United Kingdom
| | - Stephanie Chambers
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom
- School of Social and Political Sciences, University of Glasgow, United Kingdom
| | - Kathryn Skivington
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom
| | - Shona Hilton
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom
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17
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Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Implications of international trade and investment agreements on policy space for restricting marketing of unhealthy food and beverages to children: lessons from inter-disciplinary expert interviews. Public Health Nutr 2021; 24:4750-4764. [PMID: 33972007 DOI: 10.1017/s1368980021001993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the implications of international trade and investment agreements (TIA) for national governments' policy space to restrict the marketing of unhealthy food and beverages to children. DESIGN In-depth interviews based on a series of policy scenario 'vignettes,' guided by an adapted scenario analysis methodology. SETTING Global. PARTICIPANTS Nine key informants from relevant sectors, with expertise regarding the intersection of public health nutrition policy, international trade law and international investment law. RESULTS Participants consistently identified the relevance of several principles, common to many TIA: non-discrimination, necessity and justification, market access requirements and quantitative restrictions, intellectual property rights and trademark protections and fair and equitable treatment of investors. Two main policy design factors that interact heavily with TIA-related policy space were the framing of objectives and regulatory distinctions drawn. Contextual factors may shape the analysis of TIA-related policy space on a case-by-case basis, while the relative power of the actors and institutions involved in both domestic and international policy spheres may influence whether and how such legal constraints to policy space are activated. CONCLUSIONS Regulatory marketing restrictions run the risk of incurring challenges under World Trade Organization agreements and other free TIA. However, concerned policymakers should be aware of the difference between theoretical risk, threat of a challenge and realistic initiation and/or loss of a formal dispute. Our findings indicate that there is policy space to adopt significant marketing restrictions, though an understanding of these legal risks and strategic policy design are important.
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19
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Yau A, Adams J, Boyland EJ, Burgoine T, Cornelsen L, de Vocht F, Egan M, Er V, Lake AA, Lock K, Mytton O, Petticrew M, Thompson C, White M, Cummins S. Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data. BMJ Open 2021; 11:e048139. [PMID: 33827849 PMCID: PMC8031692 DOI: 10.1136/bmjopen-2020-048139] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI). DESIGN Cross-sectional survey. SETTING UK. PARTICIPANTS 1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England. OUTCOME MEASURES Self-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics. RESULTS Overall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18-34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity. CONCLUSIONS Exposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.
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Affiliation(s)
- Amy Yau
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jean Adams
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Emma J Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Thomas Burgoine
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Frank de Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West, Bristol, UK
| | - Matt Egan
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Vanessa Er
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Amelia A Lake
- Centre for Public Health Research, Teesside University, Middlesbrough, UK
- Centre for Translational Research in Public Health (Fuse), Newcastle upon Tyne, UK
| | - Karen Lock
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Mytton
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Mark Petticrew
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Claire Thompson
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Martin White
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
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20
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Taillie LS, Busey E, Stoltze FM, Dillman Carpentier FR. Governmental policies to reduce unhealthy food marketing to children. Nutr Rev 2021; 77:787-816. [PMID: 31329232 DOI: 10.1093/nutrit/nuz021] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Reducing children's exposure to food marketing is an important obesity prevention strategy. This narrative review describes current statutory regulations that restrict food marketing; reviews available evidence on the effects of these regulations; and compares policy design elements in Chile and the United Kingdom. Currently, 16 countries have statutory regulations on unhealthy food marketing to children. Restrictions on television advertising, primarily during children's programming, are most common. Schools are also a common setting for restrictions. Regulations on media such as cinema, mobile phone applications, print, packaging, and the internet are uncommon. Eleven evaluations of policies in 4 jurisdictions found small or no policy-related reductions in unhealthy food advertising, in part because marketing shifted to other programs or venues; however, not all policies have been evaluated. Compared with the United Kingdom, Chile restricts marketing on more products, across a wider range of media, using more marketing techniques. Future research should examine which elements of food marketing policy design are most effective at reducing children's exposure to unhealthy food marketing.
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Affiliation(s)
- Lindsey Smith Taillie
- UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Busey
- UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fernanda Mediano Stoltze
- UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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21
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Critchlow N, Bauld L, Thomas C, Hooper L, Vohra J. Awareness of marketing for high fat, salt or sugar foods, and the association with higher weekly consumption among adolescents: a rejoinder to the UK government's consultations on marketing regulation. Public Health Nutr 2020; 23:2637-2646. [PMID: 32434618 PMCID: PMC7116036 DOI: 10.1017/s1368980020000075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Exposure to marketing for foods high in fat, salt or sugar (HFSS) reportedly influences consumption, nutritional knowledge and diet-related health among adolescents. In 2018/2019, the UK government held two consultations about introducing new restrictions on marketing for HFSS foods. To reinforce why these restrictions are needed, we examined adolescents' awareness of marketing for HFSS foods, and the association between past month awareness and weekly HFSS food consumption. DESIGN Cross-sectional survey that measured past month awareness of ten marketing activities for HFSS foods (1 = everyday; 6 = not in last month). Frequencies were converted into aggregate past month awareness across marketing activities and grouped into three categories (low/medium/high). Consumption was self-reported for fifteen foods (twelve HFSS) (1 = few times/d; 9 = never). For each food, frequency was divided into higher/lower weekly consumption. SETTING United Kingdom. PARTICIPANTS 11-19-year-olds (n 3348). RESULTS Most adolescents (90·8 %) reported awareness of a least one marketing activity for HFSS foods, and at least half reported seeing ≥70 instances in the past month. Television, social media and price offers were the marketing activities most frequently reported. Awareness was associated with higher weekly consumption for ten of the twelve HFSS foods. For example, those reporting medium marketing awareness were 1·5 times more likely to report higher weekly consumption of cakes/biscuits compared with those reporting low awareness (AOR = 1·51, P = 0·012). The likelihood of higher weekly HFSS food consumption increased relative to the level of marketing awareness. CONCLUSIONS Assuming there is a causal relationship between marketing awareness and consumption, the restrictions proposed by the UK government are likely to help reduce HFSS consumption.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, StirlingFK9 4LA, UK
- Cancer Policy Research Centre, Cancer Research UK, London, UK
| | - Linda Bauld
- Cancer Policy Research Centre, Cancer Research UK, London, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Lucie Hooper
- Cancer Policy Research Centre, Cancer Research UK, London, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, London, UK
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Sacks G, Robinson E, Cameron AJ, Vanderlee L, Vandevijvere S, Swinburn B. Benchmarking the Nutrition-Related Policies and Commitments of Major Food Companies in Australia, 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176118. [PMID: 32842662 PMCID: PMC7504100 DOI: 10.3390/ijerph17176118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 02/05/2023]
Abstract
The food industry has an important role to play in efforts to improve population diets. This study aimed to benchmark the comprehensiveness, specificity and transparency of nutrition-related policies and commitments of major food companies in Australia. In 2018, we applied the Business Impact Assessment on Obesity and Population Level Nutrition (BIA-Obesity) tool and process to quantitatively assess company policies across six domains. Thirty-four companies operating in Australia were assessed, including the largest packaged food and non-alcoholic beverage manufacturers (n = 19), supermarkets (n = 4) and quick-service restaurants (n = 11). Publicly available company information was collected, supplemented by information gathered through engagement with company representatives. Sixteen out of 34 companies (47%) engaged with data collection processes. Company scores ranged from 3/100 to 71/100 (median: 40.5/100), with substantial variation by sector, company and domain. This study demonstrated that, while some food companies had made commitments to address population nutrition and obesity-related issues, the overall response from the food industry fell short of global benchmarks of good practice. Future studies should assess both company policies and practices. In the absence of stronger industry action, government regulations, such as mandatory front-of-pack nutrition labelling and restrictions on unhealthy food marketing, are urgently needed.
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Affiliation(s)
- Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (E.R.); (A.J.C.)
- Correspondence: ; Tel.: +61-0-39-251-7105
| | - Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (E.R.); (A.J.C.)
| | - Adrian J. Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (E.R.); (A.J.C.)
| | - Lana Vanderlee
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada;
| | | | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland 1142, New Zealand;
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Ide N, Ajenikoko A, Steele L, Cohn J, J. Curtis C, Frieden TR, Cobb LK. Priority Actions to Advance Population Sodium Reduction. Nutrients 2020; 12:nu12092543. [PMID: 32842580 PMCID: PMC7551205 DOI: 10.3390/nu12092543] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022] Open
Abstract
High sodium intake is estimated to cause approximately 3 million deaths per year worldwide. The estimated average sodium intake of 3.95 g/day far exceeds the recommended intake. Population sodium reduction should be a global priority, while simultaneously ensuring universal salt iodization. This article identifies high priority strategies that address major sources of sodium: added to packaged food, added to food consumed outside the home, and added in the home. To be included, strategies needed to be scalable and sustainable, have large benefit, and applicable to one of four measures of effectiveness: (1) Rigorously evaluated with demonstrated success in reducing sodium; (2) suggestive evidence from lower quality evaluations or modeling; (3) rigorous evaluations of similar interventions not specifically for sodium reduction; or (4) an innovative approach for sources of sodium that are not sufficiently addressed by an existing strategy. We identified seven priority interventions. Four target packaged food: front-of-pack labeling, packaged food reformulation targets, regulating food marketing to children, and taxes on high sodium foods. One targets food consumed outside the home: food procurement policies for public institutions. Two target sodium added at home: mass media campaigns and population uptake of low-sodium salt. In conclusion, governments have many tools to save lives by reducing population sodium intake.
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Consumer-based actions to reduce plastic pollution in rivers: A multi-criteria decision analysis approach. PLoS One 2020; 15:e0236410. [PMID: 32797095 PMCID: PMC7428181 DOI: 10.1371/journal.pone.0236410] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/13/2020] [Indexed: 01/09/2023] Open
Abstract
The use and management of single use plastics is a major area of concern for the public, regulatory and business worlds. Focusing on the most commonly occurring consumer plastic items present in European freshwater environments, we identified and evaluated consumer-based actions with respect to their direct or indirect potential to reduce macroplastic pollution in freshwater environments. As the main end users of these items, concerned consumers are faced with a bewildering array of choices to reduce their plastics footprint, notably through recycling or using reusable items. Using a Multi-Criteria Decision Analysis approach, we explored the effectiveness of 27 plastic reduction actions with respect to their feasibility, economic impacts, environmental impacts, unintended social/environmental impacts, potential scale of change and evidence of impact. The top ranked consumer-based actions were identified as: using wooden or reusable cutlery; switching to reusable water bottles; using wooden or reusable stirrers; using plastic free cotton-buds; and using refill detergent/ shampoo bottles. We examined the feasibility of top-ranked actions using a SWOT analysis (Strengths, Weaknesses, Opportunities and Threats) to explore the complexities inherent in their implementation for consumers, businesses, and government to reduce the presence of plastic in the environment.
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25
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Lobstein T, Neveux M, Landon J. Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development. Obes Sci Pract 2020; 6:562-583. [PMID: 33082998 PMCID: PMC7556431 DOI: 10.1002/osp4.423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost‐effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front‐of‐pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost‐effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front‐of‐pack nutritional labelling is likely to be highly cost‐effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child‐directed advertising are likely to be highly cost‐effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.
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Affiliation(s)
- Tim Lobstein
- Policy Department World Obesity Federation London UK.,The Boden Institute, Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
| | - Margot Neveux
- Policy Department World Obesity Federation London UK
| | - Jane Landon
- Policy Department UKPH Consultancy London UK
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Sing F, Mackay S, Culpin A, Hughes S, Swinburn B. Food Advertising to Children in New Zealand: A Critical Review of the Performance of a Self-Regulatory Complaints System Using a Public Health Law Framework. Nutrients 2020; 12:nu12051278. [PMID: 32365952 PMCID: PMC7281994 DOI: 10.3390/nu12051278] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022] Open
Abstract
New Zealand has the second highest overweight and obese child population in the Organisation for Economic Co-operation and Development (OECD). This paper evaluates whether New Zealand’s self-regulatory controls on the advertising of unhealthy food and beverages to children and young people adequately protects children from the exposure to, and power of, such marketing in order to limit its impact on children’s food and beverage preferences. First, an analysis of the relevant New Zealand Advertising Standards Authority (ASA) Codes was conducted, including the ASA Complaints Board and Appeals Board decisions from 2017–2019 to determine the application of the Codes in practice. Second, a public health law framework was applied to the self-regulatory system. Of the 16 complaints assessed, 12 were not upheld, and only one was upheld under the Children and Young People’s Advertising Code (CYPA Code). Three complaints were upheld under the Advertising Standards Code (ASC) but not the CYPA Code. An analysis of the Codes and their interpretation by the Complaints Board found that many facets of the public health law framework were not met. The self-regulatory system does not adequately protect children from the exposure to, and power of, unhealthy food and beverage marketing, and government-led, comprehensive, and enforceable marketing restrictions are required.
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Affiliation(s)
- Fiona Sing
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (S.M.); (B.S.)
- Correspondence:
| | - Sally Mackay
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (S.M.); (B.S.)
| | - Angela Culpin
- Auckland Regional Public Health Service, Auckland 1051, New Zealand; (A.C.); (S.H.)
| | - Sally Hughes
- Auckland Regional Public Health Service, Auckland 1051, New Zealand; (A.C.); (S.H.)
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (S.M.); (B.S.)
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Austin EW, Austin BW, Kaiser CK. Effects of Family-Centered Media Literacy Training on Family Nutrition Outcomes. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:308-318. [PMID: 32060881 DOI: 10.1007/s11121-020-01101-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parents frustrated about food marketing influences need media management skills to challenge marketing messages and interpret factual content. We tested a media literacy-based, family-centered intervention to reduce effects of appealing, but unrealistic, food marketing. We hypothesized that participation would facilitate family discussion that improves the home dietary environment and increases youth consumption of fruits and vegetables. Parent-child (age 9-14) dyads (N = 189) participated in a matched-group, pretest/posttest field experiment testing a 6-week media literacy-based curriculum. Hypothesis testing employed multiple analysis of covariance and Bayesian multigroup structural equation modeling (MGSEM). Improved nutrition outcomes for parents included talk with youth about food nutrition labels (d = 0.343) and ratio of healthy to unhealthy food in home (d = 0.232); youth improved talk with parent about food nutrition labels (d = 0.211), vegetables eaten yesterday (d = 0.264), and fruit eaten yesterday (d = 1.386). Bayesian MGSEM revealed that in the intervention group, 12 of 17 tested paths were significant (p < .05), compared with only 4 in the control group, with average effect size magnitudes of 0.236 and 0.113, respectively. Media literacy education can empower parents and improve youths' critical thinking to reduce negative effects of food marketing on families and improve use of media to obtain nutrition information that aids dietary choices. This approach reduces the risk for reactance from youth who like media and resist limiting media use, while helping families use media together to make better nutrition decisions.
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Affiliation(s)
- Erica Weintraub Austin
- Edward R. Murrow Center for Media & Health Promotion Research, Edward R. Murrow College of Communication, Goertzen Communication Addition 101, Washington State University, Mail Code 2520, Pullman, WA, 99164-2520, USA.
| | - Bruce W Austin
- Department of Kinesiology and Educational Psychology, Washington State University, Mail Code 2136, Pullman, WA, 99164-2136, USA
| | - C Kit Kaiser
- Edward R. Murrow Center for Media & Health Promotion Research, Edward R. Murrow College of Communication, Goertzen Communication Addition 101, Washington State University, Mail Code 2520, Pullman, WA, 99164-2520, USA
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28
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Green M, Hadihardjono DN, Pries AM, Izwardy D, Zehner E, Huffman SL. High proportions of children under 3 years of age consume commercially produced snack foods and sugar-sweetened beverages in Bandung City, Indonesia. MATERNAL AND CHILD NUTRITION 2020; 15 Suppl 4:e12764. [PMID: 31225706 PMCID: PMC6619027 DOI: 10.1111/mcn.12764] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 01/06/2023]
Abstract
Child undernutrition continues to be a national concern in Indonesia, whereas childhood overweight/obesity rises. Economic development has led to wide availability of highly processed foods and beverages, with growing evidence that children are consuming commercial snack products during the critical complementary feeding period. This study assessed the prevalence and patterns of consumption of commercially produced snack foods and sugar‐sweetened beverages among Indonesian children. A cross‐sectional survey was conducted with 495 mothers of children aged 6–35 months living in Bandung City, Indonesia. Among all children, 81.6% consumed a commercial snack food and 40.0% consumed a sugar‐sweetened beverage in the day preceding the interview. At 6–11 months, 46.5% of children consumed a snack food and 2.0% consumed a sugar‐sweetened beverage. Snack foods were consumed 3 or more times a day by 60.0% of children 24–35 months of age. Sweet biscuits and savory snacks were the most commonly consumed snack foods; sweetened milks and sweetened teas were the most common beverages. Maternal education, child age, and consumption of a commercially produced complementary food were associated with snack food consumption. Factors associated with sugar‐sweetened beverage consumption were child age and consumption of a commercially produced complementary food or breastmilk substitute. These findings reflect a high presence of processed, high‐sugar/salt commercial snack products in the diets of children 6–35 months. National attention should focus on interventions to reduce reliance on processed snack products and increase consumption of nutrient‐rich, locally available foods during the complementary feeding period.
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Affiliation(s)
| | | | | | - Doddy Izwardy
- Direktorat Gizi Masyarakat-Kementerian Kesehatan RI, Jakarta, Indonesia
| | | | - Sandra L Huffman
- Consultant to Helen Keller International, New York, New York, USA
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29
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Dunford EK, Ng SW, Taillie LS. How Does the Healthfulness of the US Food Supply Compare to International Guidelines for Marketing to Children and Adolescents? Matern Child Health J 2018; 23:768-776. [PMID: 30569302 DOI: 10.1007/s10995-018-02693-1] [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] [Indexed: 11/26/2022]
Abstract
Objectives Food marketing to children is pervasive and linked to increased preference and intake of unhealthy foods. The World Health Organization (WHO) developed the only multi-country nutrient criteria, and Chile recently released the world's most comprehensive regulation to identify foods that should not be marketed to children. Our objective was to examine the proportion of US packaged food and beverage products eligible for marketing to children under the WHO Europe Nutrient Profile Model (NPM) and the 2019 Chilean regulation. Methods Data for this study are from Label Insight's 2017 Open Access branded food database. Each product was assigned to one of 13 food categories, and nutritional content compared to both the NPM and Chilean criteria. The proportion of US products meeting criteria for marketing to children using both schemes was examined overall and by category. Agreement between the two criteria was examined using Cohen's Kappa. Results Of 17,740 US products, 21% were eligible to be marketed to children using the WHO criteria and 26% using the Chilean criteria. 'Egg and egg products' and 'Seafood' had the highest proportion of products eligible for marketing to children under both schemes. 'Confectionery' and 'Snack foods' had the lowest proportion eligible. Conclusions for practice The WHO NPM and Chilean criteria both restrict less healthy items from being marketed to children. Regulatory agencies in the US developing policies should consider the implementation of nutrient criteria to restrict the marketing of less healthy foods and beverages to children and adolescents.
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Affiliation(s)
- Elizabeth K Dunford
- Food Policy Division, The George Institute for Global Health, Sydney, Australia.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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30
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Tselengidis A, Östergren PO. Lobbying against sugar taxation in the European Union: Analysing the lobbying arguments and tactics of stakeholders in the food and drink industries. Scand J Public Health 2018; 47:565-575. [PMID: 29974816 DOI: 10.1177/1403494818787102] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: This study investigates the lobbying actors of the food and drink industry (FDI), their web lobbying arguments used in the sugar taxation debate and the tactics deployed when facing legislative restrictions on their products to curb the burden of non-communicable diseases in Europe. Methods: A stakeholder analysis was performed to identify the FDI's actors lobbying against sugar taxation within the EU Platform for Action on Diet, Physical Activity and Health during December 2015. Qualitative content analysis was applied to assess the FDI's web lobbying claims related to three main concepts (sugar as a product, sugar's association with non-communicable diseases and sugar taxation), guided by a framework for corporate political activity. Results: The web site content of a front organization and six FDI lobbyists was analysed. Some new strategies emerged alongside known corporate strategies ('questioning the effectiveness of regulation and promoting benefits of a withdrawal', 'promoting sugar's good traits and shift the blame away from it' and 'establishing relationships with trade unions'). The lobby tactics were similar to those previously applied by the tobacco industry in Europe, although the argument that sugar is a natural ingredient in many foods was unique to the FDI. Conclusions: The observed tactics and arguments presented by the FDI in opposition to sugar taxation have striking similarities with those previously used by the tobacco industry. An improved understanding of the stakeholders' mandate and resources and their most important tactics will strengthen the position of public health experts when debating sugar taxation with the FDI, which may contribute to improving population health.
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Affiliation(s)
- Arsenios Tselengidis
- Department of Clinical Sciences in Malmö, Division of Social Medicine and Global Health, Lund University, Sweden
| | - Per-Olof Östergren
- Department of Clinical Sciences in Malmö, Division of Social Medicine and Global Health, Lund University, Sweden
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Tong T, Rangan A, Gemming L. Evaluating the Nutritional Content of Children's Breakfast Cereals in Australia. CHILDREN-BASEL 2018; 5:children5070084. [PMID: 29933610 PMCID: PMC6068905 DOI: 10.3390/children5070084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Abstract
Breakfast is an important contributor to the daily dietary intake of children. This study investigated the nutritional composition of ready to eat (RTE) children’s breakfast cereals, which display fictional cartoon characters and themes, compared to other cereals available in Australia. Nutrient content claims on packaging were also examined. Data were collected from RTE breakfast cereal packages (N = 347) from four major supermarkets in Sydney. Cereals were classified based on product type and promotional information displayed. Overall, 46% of children’s cereals were classified as “less healthy” as per nutrient profiling score criteria. Children’s cereals had a similar energy and sodium content per 100 g compared to other cereals but contained significantly higher levels of total sugar and lower levels of protein and dietary fibre compared to other varieties. Children’s cereals with nutrient content claims had improved (lower) nutrient profiling scores than those that did not (2 vs. 13, p = 0.021), but total sugar per 100 g was similar: 25 g (interquartile range (IQR) 14 g) vs. 32 g (IQR 19 g). In conclusion, RTE children’s breakfast cereals were found to be less healthy compared to other cereals on the market and the use of nutrient content claims on children’s cereals may mislead consumers regarding their overall nutrient profile.
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Affiliation(s)
- Terence Tong
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney NSW 2006, Australia.
| | - Anna Rangan
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney NSW 2006, Australia.
| | - Luke Gemming
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney NSW 2006, Australia.
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The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children. Nutrients 2018; 10:nu10050622. [PMID: 29762517 PMCID: PMC5986502 DOI: 10.3390/nu10050622] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Abstract
Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M⁻AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m²). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372⁻25,155); total cost-savings AUD126.3M (95% UI AUD58.7M⁻196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812⁻15,679); total cost-savings AUD90.9M (95% UI AUD44.3M⁻136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP.
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Austin EW, Austin BW, French BF, Cohen MA. The Effects of a Nutrition Media Literacy Intervention on Parents' and Youths' Communication about Food. JOURNAL OF HEALTH COMMUNICATION 2018; 23:190-199. [PMID: 29338585 DOI: 10.1080/10810730.2018.1423649] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Interventions addressing links between media exposure and obesity risk for school-age youth have not explicitly addressed the role of family communication about media. Youths' influence attempts on parents to purchase advertised foods can create conflict and negatively affect parental food choices. This study tested whether a family-based media literacy curriculum improves parents' media management skills and decreases youths' susceptibility to appealing but unrealistic food marketing. A matched-group pretest/posttest field experiment of parent-youth dyads with control group (N = 100 dyads, youth M = 11 years of age) tested the six-session curriculum. Hypotheses were analyzed using a Bayesian structural equation model. The curriculum increased parents' active negative mediation to foster youths' critical thinking about food marketing, b* = 0.35, 95% CCI [0.17, 0.50], increased parent Efficacy for making healthy dietary changes for their families, b* = 0.59, 95% CCI [0.41, 0.75], and fostered family discussion about nutrition labels (total effect = 0.22). Additionally, cumulative influences of Perceived Desirability and Wishful Identification on youths' requests for marketed foods were reduced (total effect = 0.04). Media literacy education can empower parents and improve youths' critical thinking to reduce effects of food marketing on families and improve use of media to obtain nutrition information.
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Affiliation(s)
- Erica Weintraub Austin
- a Murrow Center for Media & Health Promotion Research, Edward R. Murrow College of Communication, Washington State University, Pullman, WA, USA
- b Office of the Provost and Executive Vice President, Washington State University, Pullman, WA, USA
| | - Bruce W Austin
- c Department of Educational Leadership, Sport Studies, and Educational/Counseling Psychology, Washington State University, Pullman , WA, USA
| | - Brian F French
- c Department of Educational Leadership, Sport Studies, and Educational/Counseling Psychology, Washington State University, Pullman , WA, USA
| | - Marilyn A Cohen
- d Northwest Center for Excellence in Media Literacy , College of Education, University of Washington, Seattle, WA, USA
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Boyland EJ, Burgon RH, Hardman CA. Reactivity to television food commercials in overweight and lean adults: Physiological, cognitive and behavioural responses. Physiol Behav 2017; 177:182-188. [DOI: 10.1016/j.physbeh.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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Théodore FL, Tolentino-Mayo L, Hernández-Zenil E, Bahena L, Velasco A, Popkin B, Rivera JA, Barquera S. Pitfalls of the self-regulation of advertisements directed at children on Mexican television. Pediatr Obes 2017; 12:312-319. [PMID: 27135300 DOI: 10.1111/ijpo.12144] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/21/2016] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are no academic studies that characterize advertisements directed at children from the companies that signed the self-regulation. OBJECTIVE The aim of this paper was to assess the extent and nature of food advertisements and the persuasive techniques used to market unhealthy food and beverages (UFB) to children, by signatory companies of self-regulation. METHODS From December 2012 to April 2013, 600 h of programming were recorded on the four broadcast public television channels in Mexico with the highest rating nationwide. Marketing aimed at children directly (broadcast on children's programmes or advertisements with a specific appeal to children) or indirectly (aimed at other target audiences with messages or scenes that link children to the product) were considered. RESULTS About 74.9% (2148) of the total food and beverage advertisements tried to influence children directly and indirectly. Companies, which had signed the self-regulation, focused 92.7% of their advertisements on UFB. Of the total number, 23.9% were aimed at children, 7.1% at adolescents, 12.5% at parents and 56.2% at the general public. Most of these advertisements were broadcast on movies (29.8%), cartoons (18%), soap operas (17.6%), entertainment shows (17.2%) and sports programs (6.4%). CONCLUSION Despite the self-regulation of television marketing, children were surrounded by UFB advertisements. Signatory companies influence children indirectly by targeting other audiences and by marketing during family television programs, which are also watched by children.
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Affiliation(s)
- F L Théodore
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Tolentino-Mayo
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - E Hernández-Zenil
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Bahena
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Velasco
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - B Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J A Rivera
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - S Barquera
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
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Regulation of food marketing to children: are statutory or industry self-governed systems effective? Public Health Nutr 2017; 20:761-764. [DOI: 10.1017/s1368980017000465] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Liao LL, Lai IJ, Chang LC, Lee CK. Effects of a food advertising literacy intervention on Taiwanese children's food purchasing behaviors. HEALTH EDUCATION RESEARCH 2016; 31:509-520. [PMID: 27177778 DOI: 10.1093/her/cyw025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 04/19/2016] [Indexed: 06/05/2023]
Abstract
Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising.
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Affiliation(s)
| | - I-Ju Lai
- Department of Nutrition, I-Shou University, Kaohsiung City 82445, Taiwan, R.O.C
| | - Li-Chun Chang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan 33303, Taiwan, R.O.C
| | - Chia-Kuei Lee
- School of Nursing, University of Rochester, Rochester, New York 14642, USA
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Cairns G, Macdonald L. Stakeholder insights on the planning and development of an independent benchmark standard for responsible food marketing. EVALUATION AND PROGRAM PLANNING 2016; 56:109-120. [PMID: 27085486 DOI: 10.1016/j.evalprogplan.2016.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 06/05/2023]
Abstract
A mixed methods qualitative survey investigated stakeholder responses to the proposal to develop an independently defined, audited and certifiable set of benchmark standards for responsible food marketing. Its purpose was to inform the policy planning and development process. A majority of respondents were supportive of the proposal. A majority also viewed the engagement and collaboration of a broad base of stakeholders in its planning and development as potentially beneficial. Positive responses were associated with views that policy controls can and should be extended to include all form of marketing, that obesity and non-communicable diseases prevention and control was a shared responsibility and an urgent policy priority and prior experience of independent standardisation as a policy lever for good practice. Strong policy leadership, demonstrable utilisation of the evidence base in its development and deployment and a conceptually clear communications plan were identified as priority targets for future policy planning. Future research priorities include generating more evidence on the feasibility of developing an effective community of practice and theory of change, the strengths and limitations of these and developing an evidence-based step-wise communications strategy.
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Affiliation(s)
- Georgina Cairns
- Institute for Social Marketing, University of Stirling, Stirling, UK.
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