1
|
Ruggles PR, Pasch KE, Poulos NS, Thomas JE. Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage. PLoS One 2024; 19:e0302048. [PMID: 38781217 PMCID: PMC11115223 DOI: 10.1371/journal.pone.0302048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 03/24/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES. METHODS Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower). RESULTS Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17-69), vs Medianhigh = 10.5 (IQR 4-17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16-99) vs Medianhigh = 13.5 (IQR 6-25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8-19) vs Medianhigh = 6 (IQR 2-8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13-65) vs Medianhigh = 14 (IQR 4-29), p = 0.045).There were no significant differences by school type. CONCLUSION This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.
Collapse
Affiliation(s)
- Phoebe R. Ruggles
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, United States of America
| | - Keryn E. Pasch
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, United States of America
| | - Natalie S. Poulos
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jacob E. Thomas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, United States of America
| |
Collapse
|
2
|
Akl C, El-Helou N, Safadi G, Semaan A, El Sammak A, Trabelsi T, Sassi S, Akik C, El Ati J, Traissac P, Ghattas H. Urban school neighbourhoods dominated by unhealthy food retailers and advertisements in Greater Tunis: a geospatial study in the midst of the nutrition transition. Public Health Nutr 2024; 27:e44. [PMID: 38169454 PMCID: PMC10882541 DOI: 10.1017/s1368980023002860] [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: 01/05/2024]
Abstract
OBJECTIVE Food environments are a major determinant of children's nutritional status. Scarce evidence on food environments exists in low- and middle-income countries (LMIC). This study aims to fill this gap by documenting the obesogenicity of food environments around schools in Greater Tunis, Tunisia - an LMIC of the Middle East and North Africa region with an ongoing nutrition transition and increasing rates of childhood obesity. DESIGN In this cross-sectional study, we assessed built food environments around fifty primary schools. Ground-truthing was performed to collect geographic coordinates and pictures of food retailers and food advertisement sets within an 800-m road network buffer of each school. Retailers and advertisement sets were categorised as healthy or unhealthy according to a NOVA-based classification. Associations between school characteristics and retailers or advertisement sets were explored using multinomial regression models. SETTING Greater Tunis, Tunisia. PARTICIPANTS Random sample of fifty (thirty-five public and fifteen private) primary schools. RESULTS Overall, 3621 food retailers and 2098 advertisement sets were mapped. About two-thirds of retailers and advertisement sets were labelled as unhealthy. Most retailers were traditional corner stores (22 %) and only 6 % were fruit and vegetable markets. The prevailing food group promoted was carbonated and sugar-sweetened beverages (22 %). The proportion of unhealthy retailers was significantly higher in the richest v. poorest areas. CONCLUSIONS School neighbourhood food environments included predominantly unhealthy retailers and advertisements. Mapping of LMIC food environments is crucial to document the impact of the nutrition transition on children's nutritional status. This will inform policies and interventions to curb the emergent childhood obesity epidemic.
Collapse
Affiliation(s)
- Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Aline Semaan
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aya El Sammak
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tarek Trabelsi
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis1007, Tunisia
| | - Sonia Sassi
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis1007, Tunisia
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis1007, Tunisia
| | - Pierre Traissac
- MoISA - University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC29208, USA
| |
Collapse
|
3
|
Ruggles PR, Thomas JE, Poulos NS, Pasch KE. School-Level Socioeconomic Status and Nutrient Content of Outdoor Food/Beverage Advertisements. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6730. [PMID: 37754591 PMCID: PMC10530988 DOI: 10.3390/ijerph20186730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/28/2023]
Abstract
We examined if areas around schools with more students of lower socioeconomic status (SES) have more total food/beverage advertisements and/or more advertisements with poorer nutritional content as compared to areas around schools with fewer students with lower SES. All outdoor food/beverage advertisements within a half-mile radius of 47 middle and high schools in the United States were objectively documented in 2012 and coded for nutritional content. The total number of advertisements and the macronutrient and micronutrient contents (total calories, fat (g), protein (g), carbohydrate (g), sugar (g), and sodium (mg)) of food and beverage items depicted in the advertisements were calculated. In total, 9132 unique advertisements were recorded, with 3153 ads displaying food and beverages that could be coded for nutrient content. Schools located in areas of lower SES (≥60% students receiving free/reduced-price lunch) had significantly more advertisements displaying food and beverages that could be coded for nutrient content (z = 2.01, p = 0.04), as well as advertisements that contained more sodium (z = 2.20, p = 0.03), as compared to schools located in areas of higher SES. There were no differences in calorie, fat, protein, carbohydrate, or sugar content. Policies to reduce the prevalence of outdoor food and beverage advertising are warranted.
Collapse
Affiliation(s)
- Phoebe R. Ruggles
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Jacob E. Thomas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Natalie S. Poulos
- School of Community and Rural Health, Heath Science Center, The University of Texas at Tyler, Tyler, TX 78708, USA
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Keryn E. Pasch
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| |
Collapse
|
4
|
Amevinya GS, Vandevijvere S, Kelly B, Afagbedzi SK, Aryeetey R, Adjei AP, Quarpong W, Tandoh A, Nanema S, Agyemang C, Zotor F, Laar ME, Mensah K, Laryea D, Asiki G, Holdsworth M, Laar A. Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana's most urbanized and populous region. Front Public Health 2022; 10:917456. [PMID: 36211683 PMCID: PMC9539976 DOI: 10.3389/fpubh.2022.917456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana's most populous and urbanized region, Greater Accra. Materials and methods Outdoor advertisements for foods and beverages within a 250 m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems. Results A total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most-69% were cartoons or manufacturer's characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables). Conclusions There is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children's settings are needed to protect pupils from such advertising practices.
Collapse
Affiliation(s)
- Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Seth Kwaku Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Akosua Pokua Adjei
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Wilhemina Quarpong
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Silver Nanema
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda E. Laar
- Department Family and Consumer Sciences, School of Agriculture, University of Ghana, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Accra, Ghana
| | - Dennis Laryea
- Non-communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| |
Collapse
|
5
|
Finlay A, Robinson E, Jones A, Maden M, Cerny C, Muc M, Evans R, Makin H, Boyland E. A scoping review of outdoor food marketing: exposure, power and impacts on eating behaviour and health. BMC Public Health 2022; 22:1431. [PMID: 35896996 PMCID: PMC9330687 DOI: 10.1186/s12889-022-13784-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is convincing evidence that unhealthy food marketing is extensive on television and in digital media, uses powerful persuasive techniques, and impacts dietary choices and consumption, particularly in children. It is less clear whether this is also the case for outdoor food marketing. This review (i) identifies common criteria used to define outdoor food marketing, (ii) summarises research methodologies used, (iii) identifies available evidence on the exposure, power (i.e. persuasive creative strategies within marketing) and impact of outdoor food marketing on behaviour and health and (iv) identifies knowledge gaps and directions for future research. METHODS A systematic search was conducted of Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL, PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and a number of grey literature sources. Titles and abstracts were screened by one researcher. Relevant full texts were independently checked by two researchers against eligibility criteria. RESULTS Fifty-three studies were conducted across twenty-one countries. The majority of studies (n = 39) were conducted in high-income countries. All measured the extent of exposure to outdoor food marketing, twelve also assessed power and three measured impact on behavioural or health outcomes. Criteria used to define outdoor food marketing and methodologies adopted were highly variable across studies. Almost a quarter of advertisements across all studies were for food (mean of 22.1%) and the majority of advertised foods were unhealthy (mean of 63%). The evidence on differences in exposure by SES is heterogenous, which makes it difficult to draw conclusions, however the research suggests that ethnic minority groups have a higher likelihood of exposure to food marketing outdoors. The most frequent persuasive creative strategies were premium offers and use of characters. There was limited evidence on the relationship between exposure to outdoor food marketing and eating behaviour or health outcomes. CONCLUSIONS This review highlights the extent of unhealthy outdoor food marketing globally and the powerful methods used within this marketing. There is a need for consistency in defining and measuring outdoor food marketing to enable comparison across time and place. Future research should attempt to measure direct impacts on behaviour and health.
Collapse
Affiliation(s)
- Amy Finlay
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, L69 3GB, UK
| | - Caroline Cerny
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
- Obesity Health Alliance, Liverpool, UK
| | - Magdalena Muc
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Rebecca Evans
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Harriet Makin
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| |
Collapse
|
6
|
Chung A, Zorbas C, Riesenberg D, Sartori A, Kennington K, Ananthapavan J, Backholer K. Policies to restrict unhealthy food and beverage advertising in outdoor spaces and on publicly owned assets: A scoping review of the literature. Obes Rev 2022; 23:e13386. [PMID: 34783421 DOI: 10.1111/obr.13386] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/25/2023]
Abstract
Unhealthy food marketing influences attitudes, preferences, and consumption of unhealthy foods, leading to excess weight gain. Outdoor advertising is highly visible (often displayed on publicly owned assets), but the evidence supporting regulation is unclear. This systematic scoping review of academic and grey literature aimed to (1) describe potential health and economic impacts of implementing government-led policies that restrict unhealthy food advertising in outdoor spaces or on public assets (including studies examining prevalence of advertising, associations with health outcomes and interventional studies); (2) identify and describe existing policies; and (3) identify factors perceived to have influenced policy implementation. Thirty-six academic studies were eligible for inclusion. Most reported on prevalence of unhealthy food advertising, demonstrating high prevalence around schools and in areas of lower socioeconomic position. None examined health and economic impacts of implemented policies. Four jurisdictions were identified with existing regulations; five had broader marketing or consumer protection policies that captured outdoor food marketing. Facilitators of policy implementation included collaboration, effective partnerships, and strong political leadership. Barriers included lobbying by food, media, and advertising industries. Implementation of food marketing policies in outdoor spaces and on public assets is feasible and warranted. Strong coalitions and leadership will be important to drive the policy agenda forward.
Collapse
Affiliation(s)
- Alexandra Chung
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina Zorbas
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Devorah Riesenberg
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | | | | | - Jaithri Ananthapavan
- Global Obesity Centre, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| |
Collapse
|
7
|
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.
Collapse
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)
| |
Collapse
|
8
|
Finlay AH, Lloyd S, Lake A, Armstrong T, Fishpool M, Green M, Moore HJ, O’Malley C, Boyland EJ. An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England. Public Health Nutr 2022; 25:1-12. [PMID: 34974851 PMCID: PMC9991712 DOI: 10.1017/s1368980021005048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people. DESIGN Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation. SETTING Middlesbrough and Redcar and Cleveland in South Teesside. PARTICIPANTS N/A. RESULTS Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation. CONCLUSIONS Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.
Collapse
Affiliation(s)
| | - Scott Lloyd
- Public Health South Tees, Middlesbrough, UK
- School of Health & Life Sciences, Teesside University and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Amelia Lake
- SHLS Allied Health Professions Centre for Public Health, Teesside University, and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Thomas Armstrong
- SHLS Allied Health Professions Centre for Public Health, Teesside University, Middlesbrough, UK
| | | | - Mark Green
- Department of Geography and Planning, University of Liverpool, Liverpool, UK
| | - Helen J Moore
- SHLS Allied Health Professions Centre for Public Health, Teesside University, and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Claire O’Malley
- SHLS Allied Health Professions Centre for Public Health, Teesside University, and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Emma J Boyland
- Department of Psychology, University of Liverpool, LiverpoolL69 7ZA, UK
| |
Collapse
|
9
|
Robertson T, Jepson R, Lambe K, Olsen JR, Thornton LE. Socio-economic patterning of food and drink advertising at public transport stops in Edinburgh, UK. Public Health Nutr 2021; 25:1-9. [PMID: 34886922 PMCID: PMC7612707 DOI: 10.1017/s1368980021004766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Outdoor advertisements for food and drink products form a large part of the food environment and they disproportionately promote unhealthy products. However, less is known about the social patterning of such advertisements. The main aim of this study was to explore the socio-economic patterning of food and drink advertising at bus stops in Scotland's capital city, Edinburgh. DESIGN Bus stop advertisements were audited to identify food/drink adverts and classify them by food/drink category (i.e. 'advert category'). This data were then linked to area-based deprivation and proximity measures. Neighbourhood deprivation was measured using the bus stop x/y co-ordinates, which were converted to postcodes to identify the matching 2012 deprivation level via the Scottish Index of Multiple Deprivation. Distance to schools and leisure centres were also collected using location data. Generalised estimating equations and linear regression analyses were used to assess associations between the promotion of advert categories and deprivation and proximity to schools/leisure centres, respectively. SETTING Edinburgh city, United Kingdom. RESULTS 561 food/drink advertisements were identified across 349 bus stops, with 8 advertisement categories noted and included in the final analysis, including alcohol, fast food outlets and confectionary. The majority of adverts were for 'unhealthy' food and drink categories, however there was no evidence for any socio-economic patterning of these advertisements. There was no evidence of a relationship between advertisements and proximity to schools and leisure centres. CONCLUSIONS While there is no evidence for food and drink advertising being patterned by neighbourhood deprivation, the scale of unhealthy advertising is an area for policy evaluations and interventions on the control of such outdoor advertising.
Collapse
Affiliation(s)
- Tony Robertson
- Biological and Environmental Sciences, Cottrell Building, University of Stirling, StirlingFK9 4LA, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Kyle Lambe
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan R Olsen
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lukar E Thornton
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Marketing, Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Bridger Staatz C, Kelly Y, Lacey RE, Blodgett JM, George A, Arnot M, Walker E, Hardy R. Socioeconomic position and body composition in childhood in high- and middle-income countries: a systematic review and narrative synthesis. Int J Obes (Lond) 2021; 45:2316-2334. [PMID: 34315999 PMCID: PMC8528703 DOI: 10.1038/s41366-021-00899-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI), a measure of weight for height, has been extensively reviewed in children, showing consistent associations between disadvantaged SEP and higher BMI in high-income countries (HICs) and lower BMI in middle-income countries (MICs). Fat mass (FM), a more accurate measure of adiposity, and fat-free mass (FFM) are not captured by BMI, but have been shown to track from childhood to adulthood, and be important for cardiovascular health and functional outcomes in later life. It is not clear whether body composition is associated with SEP. We systematically reviewed the association between SEP and body composition in childhood. METHODS A systematic review was carried out following PRISMA guidelines. The protocol was pre-registered with PROSPERO (CRD42019119937). Original studies in the English language, which examined the association between SEP and body composition in childhood, were included. An electronic search of three databases was conducted. Two independent reviewers carried out screening, data extraction and quality assessment. Due to heterogeneity in results, a narrative synthesis was conducted. Heterogeneity in findings according to SEP, sex, body composition measure and country income level was investigated. RESULTS 50 papers were included, the majority from HICs. No papers were from low-income countries. Disadvantage in childhood was associated with greater FM and lower FFM in HICs, but with lower FM and lower FFM in MICs. When measures of FFM indexed to height were used there was no evidence of associations with SEP. In HICs, more studies reported associations between disadvantaged SEP and higher FM among girls comparative to boys. CONCLUSIONS Inequalities in FM are evident in HICs and, in the opposite direction, in MICs and follow similar trends to inequalities for BMI. Inequalities in height are likely important in understanding inequalities in FFM.
Collapse
Affiliation(s)
- Charis Bridger Staatz
- Social Research Institute, Institute of Education, University College London, London, UK.
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca E Lacey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Joanna M Blodgett
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Anitha George
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Megan Arnot
- Department of Anthropology, University College London, London, UK
| | - Emma Walker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, Institute of Education, University College London, London, UK
| |
Collapse
|
11
|
Thompson C, Clary C, Er V, Adams J, Boyland E, Burgoine T, Cornelsen L, de Vocht F, Egan M, Lake AA, Lock K, Mytton O, Petticrew M, White M, Yau A, Cummins S. Media representations of opposition to the 'junk food advertising ban' on the Transport for London (TfL) network: A thematic content analysis of UK news and trade press. SSM Popul Health 2021; 15:100828. [PMID: 34141852 PMCID: PMC8184652 DOI: 10.1016/j.ssmph.2021.100828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/28/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Advertising of less healthy foods and drinks is hypothesised to be associated with obesity in adults and children. In February 2019, Transport for London implemented restrictions on advertisements for foods and beverages high in fat, salt or sugar across its network as part of a city-wide strategy to tackle childhood obesity. The policy was extensively debated in the press. This paper identifies arguments for and against the restrictions. Focusing on arguments against the restrictions, it then goes on to deconstruct the discursive strategies underpinning them. METHODS A qualitative thematic content analysis of media coverage of the restrictions (the 'ban') in UK newspapers and trade press was followed by a document analysis of arguments against the ban. A search period of March 1, 2018 to May 31, 2019 covered: (i) the launch of the public consultation on the ban in May 2018; (ii) the announcement of the ban in November 2018; and (iii) its implementation in February 2019. A systematic search of printed and online publications in English distributed in the UK or published on UK-specific websites identified 152 articles. RESULTS Arguments in favour of the ban focused on inequalities and childhood obesity. Arguments against the ban centred on two claims: that childhood obesity was not the 'right' priority; and that an advertising ban was not an effective way to address childhood obesity. These claims were justified via three discursive approaches: (i) claiming more 'important' priorities for action; (ii) disputing the science behind the ban; (iii) emphasising potential financial costs of the ban. CONCLUSION The discursive tactics used in media sources to argue against the ban draw on frames widely used by unhealthy commodities industries in response to structural public health interventions. Our analyses highlight the need for interventions to be framed in ways that can pre-emptively counter common criticisms.
Collapse
Affiliation(s)
- Claire Thompson
- Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Christelle Clary
- Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vanessa Er
- Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean Adams
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Burgoine
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amelia A. Lake
- Centre for Public Health Research, 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 & Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oliver Mytton
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Martin White
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Amy Yau
- Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
12
|
Lauber K, Hunt D, Gilmore AB, Rutter H. Corporate political activity in the context of unhealthy food advertising restrictions across Transport for London: A qualitative case study. PLoS Med 2021; 18:e1003695. [PMID: 34473694 PMCID: PMC8412307 DOI: 10.1371/journal.pmed.1003695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diets with high proportions of foods high in fat, sugar, and/or salt (HFSS) contribute to malnutrition and rising rates of childhood obesity, with effects throughout the life course. Given compelling evidence on the detrimental impact HFSS advertising has on children's diets, the World Health Organization unequivocally supports the adoption of restrictions on HFSS marketing and advertising. In February 2019, the Greater London Authority introduced novel restrictions on HFSS advertising across Transport for London (TfL), one of the most valuable out-of-home advertising estates. In this study, we examined whether and how commercial actors attempted to influence the development of these advertising restrictions. METHODS AND FINDINGS Using requests under the Freedom of Information Act, we obtained industry responses to the London Food Strategy consultation, correspondence between officials and key industry actors, and information on meetings. We used an existing model of corporate political activity, the Policy Dystopia Model, to systematically analyse arguments and activities used to counter the policy. The majority of food and advertising industry consultation respondents opposed the proposed advertising restrictions, many promoting voluntary approaches instead. Industry actors who supported the policy were predominantly smaller businesses. To oppose the policy, industry respondents deployed a range of strategies. They exaggerated potential costs and underplayed potential benefits of the policy, for instance, warning of negative economic consequences and questioning the evidence underlying the proposal. Despite challenging the evidence for the policy, they offered little evidence in support of their own claims. Commercial actors had significant access to the policy process and officials through the consultation and numerous meetings, yet attempted to increase access, for example, in applying to join the London Child Obesity Taskforce and inviting its members to events. They also employed coalition management, engaging directly and through business associations to amplify their arguments. Some advertising industry actors also raised the potential of legal challenges. The key limitation of this study is that our data focused on industry-policymaker interactions; thus, our findings are unable to present a comprehensive picture of political activity. CONCLUSIONS In this study, we identified substantial opposition from food and advertising industry actors to the TfL advertising restrictions. We mapped arguments and activities used to oppose the policy, which might help other public authorities anticipate industry efforts to prevent similar restrictions in HFSS advertising. Given the potential consequences of commercial influence in these kinds of policy spaces, public bodies should consider how they engage with industry actors.
Collapse
Affiliation(s)
- Kathrin Lauber
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, United Kingdom
- * E-mail:
| | - Daniel Hunt
- Independent Researcher and Freelance Health Policy Consultant, Bath, United Kingdom
| | - Anna B. Gilmore
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, United Kingdom
| | - Harry Rutter
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, United Kingdom
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| |
Collapse
|
13
|
Dia OEW, Løvhaug AL, Rukundo PM, Torheim LE. Mapping of outdoor food and beverage advertising around primary and secondary schools in Kampala city, Uganda. BMC Public Health 2021; 21:707. [PMID: 33845809 PMCID: PMC8042698 DOI: 10.1186/s12889-021-10661-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Marketing of unhealthy foods and beverages is recognized as a contributing factor to the global increase in overweight and obesity, particularly among children. Such marketing negatively affects children's dietary preferences, food choices, purchasing requests, and consumption patterns. Given that little is known about food marketing in Africa, including in Uganda, monitoring children's exposure to food marketing is essential to generate evidence on the problem and develop meaningful policy responses. The aim of this study was to describe the food and beverage marketing environment surrounding schools in urban and peri-urban areas of Kampala city. METHODS Outdoor advertising around 25 randomly sampled primary and secondary schools within a radius of 250 m of each school was mapped. Information on size, setting, type, and position of the advertisements and the healthiness of the foods and beverages promoted was collected using the INFORMAS Outdoor Advertising Protocol. The occurrence of advertising was described using frequencies, median, and density per 100m2. RESULTS A total of 1034 branded advertisements were identified around the schools. Of these, 86% featured unhealthy products, 7% healthy products, and 7% miscellaneous products. The most advertised products were sugar-sweetened beverages and alcoholic beverages (51 and 23%, respectively). Schools in the urban area were surrounded by more unhealthy ads than those in the peri-urban areas (median of 45 vs 24 advertisements). CONCLUSION The widespread extent of unhealthy food and beverage advertisements around primary and secondary schools highlights the need for food marketing regulation in Uganda, in line with the World Health Organization's recommendations, to ensure that young people are protected from unhealthy food marketing.
Collapse
Affiliation(s)
- Oumy Erica Wie Dia
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Peter Milton Rukundo
- Department of Human Nutrition and Home Economics, Kyambogo University, P.O. Box 1, Kyambogo, Uganda
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway.
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
A deep learning approach to identify unhealthy advertisements in street view images. Sci Rep 2021; 11:4884. [PMID: 33649490 PMCID: PMC7921635 DOI: 10.1038/s41598-021-84572-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/05/2021] [Indexed: 12/21/2022] Open
Abstract
While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements, which may encourage their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool [Formula: see text] Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 25,349, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th-18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas and those frequented by students. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities.
Collapse
|
16
|
Backholer K, Gupta A, Zorbas C, Bennett R, Huse O, Chung A, Isaacs A, Golds G, Kelly B, Peeters A. Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: A systematic review of the evidence. Obes Rev 2021; 22:e13144. [PMID: 33073488 DOI: 10.1111/obr.13144] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Abstract
Children's exposure to advertising of unhealthy food and nonalcoholic beverages that are high in saturated fats, salt and/or sugar is extensive and increases children's preferences for, and intake of, targeted products. This systematic review examines the differential potential exposure and impact of unhealthy food advertising to children according to socio-economic position (SEP) and/or ethnicity. Nine databases (health, business, marketing) and grey literature were searched in November 2019 using terms relating to 'food or drink', 'advertising' and 'socioeconomic position or ethnicity'. Studies published since 2007 were included. Article screening and data extraction were conducted by two independent reviewers. Quality of studies was assessed using the Newcastle-Ottawa quality scale. Of the 25 articles included, 14 focused on exposure to unhealthy food advertising via television, nine via outdoor mediums and two via multiple mediums. Most studies (n = 19) revealed a higher potential exposure or a greater potential impact of unhealthy food advertising among ethnic minority or lower SEP children. Few studies reported no difference (n = 3) or mixed findings (n = 3). Children from minority and socio-economically disadvantaged backgrounds are disproportionately exposed to unhealthy food advertising. Regulations to restrict unhealthy food advertising to children should be implemented to improve children's diets and reduce inequities in dietary intake.
Collapse
Affiliation(s)
- Kathryn Backholer
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Adyya Gupta
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Christina Zorbas
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Rebecca Bennett
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Oliver Huse
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Alexandra Chung
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anna Isaacs
- Centre for Food Policy, University of London, London, UK
| | - Gabby Golds
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Bridget Kelly
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Anna Peeters
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| |
Collapse
|
17
|
Density of outdoor food and beverage advertising around gathering place for children and adolescent in East Java, Indonesia. Public Health Nutr 2020; 24:1066-1078. [PMID: 33261696 DOI: 10.1017/s1368980020004917] [Citation(s) in RCA: 5] [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 survey outdoor food and beverage advertisements ('F&B adverts') for products that may be a risk factor for obesity, diabetes and CVD located in the vicinity of gathering places for children and adolescents. DESIGN We recorded the GPS coordinates of all F&B adverts visible from the streets at distances of 0-100, 100-300 and 300-500 m from facilities often used by children and adolescents. Those for unhealthy foods and beverages were identified. The density (number per square kilometre) of such advertisements was calculated and evaluated using hotspot analysis. SETTING The sub-districts Mulyorejo and Sukolilo in Surabaya city and the sub-districts Banyuwangi and Giri in Banyuwangi District, Indonesia. PARTICIPANTS None. RESULTS The proportion of all outdoor advertisements that were F&B adverts was slightly higher in Banyuwangi than in Surabaya. Of the 570 F&B adverts recorded in Banyuwangi, 227 (39·8 %) and 273 (47·9 %) were for unhealthy foods and beverages, respectively. Of 960 F&B adverts in Surabaya, 271 (28·2 %) and 445 (46·3 %) were for unhealthy foods and beverages. In both regions, F&B advert density increased near gathering places for children and adolescents; all recreational areas had at least one set of advertisements for unhealthy beverages and food at 100-300 and 300-500 m. Both regions had one hotspot with significantly high numbers of unhealthy advertisements; Banyuwangi had one cold spot with a significantly low number of healthy advertisements. CONCLUSION Regulations to control advertisements for unhealthy foods and beverages in areas frequented by children and adolescents are urgently needed.
Collapse
|
18
|
Liu W, Barr M, Pearson AL, Chambers T, Pfeiffer KA, Smith M, Signal L. Space-time analysis of unhealthy food advertising: New Zealand children's exposure and health policy options. Health Promot Int 2020; 35:812-820. [PMID: 31407790 DOI: 10.1093/heapro/daz083] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reducing children's exposure to unhealthy food advertising is an accepted strategy to end childhood obesity. This study aimed to (i) measure children's space-time exposures to unhealthy food advertising in public outdoor spaces, using GPS and wearable cameras; and (ii) test effectiveness of banning options. We compiled data (collected July 2014-June 2015) on 138 12-year-old children in Wellington, New Zealand, using wearable cameras and GPS devices worn over 4 days. In 2017-18, we linked 59 150 images taken in public outdoor spaces to GPS data. Of these, 1631 contained unhealthy food advertising exposures, defined as ≥50% of an advertisement observed in each image. We examined spatial patterns using kernel density mapping and graphed space-time trends. We interpolated a kriged exposure rate across Wellington to estimate exposure reductions for potential bans. Children were exposed to 7.4 (95% CI 7.0-7.8) unhealthy food advertisements/hour spent in outdoor public spaces. Exposures occurred in shopping centres, residential areas and sports facilities, commonly involving fast food, sugary drinks and ice cream. Peak exposure times were weekend afternoons/evenings and weekdays before/after school. In Wellington, we estimated that banning such advertising within 400 m of playgrounds would yield a 33% reduction in exposure, followed by in residential areas (27%), within 400 m of schools (25%), and 50% for a ban combining all above. This work documents the extent of children's exposure to unhealthy food advertising and the potential impact of bans. Given the ubiquity of advertising in public spaces, this New Zealand research offers innovative methods and findings likely relevant in other jurisdictions.
Collapse
Affiliation(s)
- Wei Liu
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, MI 48824, USA
| | - Michelle Barr
- Department of Public Health, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Amber L Pearson
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, MI 48824, USA.,Department of Public Health, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Tim Chambers
- Department of Public Health, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Karin A Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Louise Signal
- Department of Public Health, University of Otago, Wellington, Wellington 6242, New Zealand
| |
Collapse
|
19
|
Abstract
AbstractObjectives:To examine the extent and characteristics of food and beverage (F&B) promotion in Hong Kong mass transit railway (MTR) stations in districts with different socioeconomic statuses (SES) and school density.Design:All advertisements located in the eight selected MTR stations were recorded by photographs or videos, and classified into F&B and non-F&B. The percentage of F&B advertisements and unhealthy F&B being promoted, and common persuasive marketing strategies used in F&B advertisements were compared between low v. high SES districts and school zones v. non-school zones.Setting:MTR stations in Hong Kong.Participants:Not applicable.Results:Of the 8064 advertisements documented, 861 (10·7 %) were F&B advertisements, promoting 1860 F&B items. More than half of the these were unhealthy foods. Stations in high SES districts or school zones tend to advertise more unhealthy items (high v. low SES: 55·8 v. 50·8 %, P = 0·049; school v. non-school: 60·8 v. 49·3 %, P < 0·001). More than one-third of the F&B advertisements recorded did not utilise any of those persuasive marketing techniques that were examined, and using models (13·9 %) or providing discounts (8·8 %) were the two most frequently used non-festival-related persuasive marketing strategies.Conclusions:Unhealthy F&B advertising in MTR stations is prevalent regardless of SES and school density, and persuasive marketing strategies were infrequently used. These suggest that a ban on unhealthy F&B advertising around schools or the use of persuasive marketing strategies alone would be ineffective in Hong Kong. To align with the recommendation from WHO, a universal ban of junk food advertising should be enacted.
Collapse
|
20
|
Fagerberg P, Langlet B, Oravsky A, Sandborg J, Löf M, Ioakimidis I. Ultra-processed food advertisements dominate the food advertising landscape in two Stockholm areas with low vs high socioeconomic status. Is it time for regulatory action? BMC Public Health 2019; 19:1717. [PMID: 31864323 PMCID: PMC6925898 DOI: 10.1186/s12889-019-8090-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/15/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ultra-processed food consumption is a risk factor for obesity and has a negative environmental impact. Food companies spend billions of dollars on advertisements each year to increase the consumption of ultra-processed food. In Australia, USA, and New Zealand, most food advertisements around schools and in train stations promote ultra-processed food, but no similar studies have been conducted in Sweden. The aim of this study was to explore the proportion of ultra-processed food advertisements in two districts of Stockholm, Sweden with low vs. high socioeconomic status (SES). METHODS Two independent researchers (per area) mapped all advertisements, including storefronts, in two Stockholm districts. During consecutive days, all advertisements were photographed in Skärholmen (low SES district), and Östermalmstorg (high SES district), on the streets inside and outside the subway stations, as well as inside and outside of local shopping malls. Advertisements promoting food products were identified and a trained dietician categorized whether they promoted ultra-processed foods. Chi-Square test was conducted to test for differences in the proportion of ultra-processed food advertisements between the two study areas. RESULTS In total, 4092 advertisements were photographed in Skärholmen (n = 1935) and Östermalm (n = 2157). 32.8% of all advertisements promoted food, while 65.4% of food advertisements promoted ultra-processed foods. A significantly higher proportion of ultra-processed food advertisements out of total food advertisements was identified in the low SES area, irrespective of the researcher taking the pictures (74.6% vs. 61.8%, p < 0.001 and 70.4% vs. 54.8%, p = 0.001). There was no significant difference in the proportion of food advertisements out of total advertisements between the two areas. CONCLUSIONS This study provides initial evidence about the scale and the differences in exposure to food advertisements across areas in Stockholm. The observed high proportion of ultra-processed food advertisements is concerning and is in sharp contrast to the Swedish dietary guidelines that recommend reduced consumption of such foods. Based on our results, residents in low SES areas might be more exposed to ultra-processed food advertisements than those in high SES areas in Stockholm. If such findings are confirmed in additional areas, they should be considered during the deployment of food advertisement regulatory actions.
Collapse
Affiliation(s)
- Petter Fagerberg
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152, Stockholm, Sweden.
| | - Billy Langlet
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152, Stockholm, Sweden
| | - Aleksandra Oravsky
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152, Stockholm, Sweden
| | - Johanna Sandborg
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152, Stockholm, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Löf
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152, Stockholm, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ioannis Ioakimidis
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152, Stockholm, Sweden
| |
Collapse
|
21
|
Velazquez CE, Daepp MI, Black JL. Assessing exposure to food and beverage advertisements surrounding schools in Vancouver, BC. Health Place 2019; 58:102066. [DOI: 10.1016/j.healthplace.2018.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/17/2018] [Accepted: 12/12/2018] [Indexed: 11/15/2022]
|
22
|
Vandevijvere S, Molloy J, Hassen de Medeiros N, Swinburn B. Unhealthy food marketing around New Zealand schools: a national study. Int J Public Health 2018; 63:1099-1107. [DOI: 10.1007/s00038-018-1158-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/29/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022] Open
|
23
|
Herrera A, Pasch K. Targeting Hispanic adolescents with outdoor food & beverage advertising around schools. ETHNICITY & HEALTH 2018; 23:691-702. [PMID: 28277028 PMCID: PMC6091513 DOI: 10.1080/13557858.2017.1290217] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Although some research has focused on the food environment and food marketing, little has examined outdoor food and beverage (FB) advertising, particularly its relationship to the Hispanic composition in schools. Therefore, the purpose of this study was to determine if the prevalence of outdoor FB advertising was greater around middle and high schools with a majority Hispanic population as compared to schools with a lower Hispanic population. DESIGN All FB advertisements located within a half-mile of 47 schools in Central Texas were documented. Advertisements were coded as free standing or on establishments. Advertisements were coded for theme including price (emphasizing price) and deals/value meals (promoting discounted price/meal deals). These two themes were combined to create an overall price promotion variable. In order to determine if the prevalence of FB advertising varied by the Hispanic composition of the students in the school, data from the Texas Education Agency was used to create a variable which dichotomized the schools into two groups: schools that reported ≥60% Hispanic students or 'Hispanic schools' (n = 21) and schools that reported <60% Hispanic students or 'non-Hispanic schools' (n = 26). Linear regression analyses were conducted to determine if the prevalence of outdoor FB advertising was greater around Hispanic schools as compared to non-Hispanic schools. RESULTS Hispanic schools had more overall outdoor FB advertisements as compared to non-Hispanic schools (p = 0.02). Similarly, we found significantly more outdoor FB establishment (p = 0.02) and price promotion (p = 0.05) around Hispanic schools as compared to non-Hispanic schools. Differences in freestanding advertisements by school type approached significance (p = 0.07) with Hispanic schools having more freestanding FB advertisements on average. CONCLUSION Further research is needed that documents the content of these advertisements and determines the extent to which these advertisements affect Hispanic and other racial/ethnic minority youth's attitudes and behaviors toward the consumption of these products.
Collapse
Affiliation(s)
- A.L. Herrera
- Department of Kinesiology and Health Education, The University of Texas, Austin, TX 78712
| | - K.E. Pasch
- Department of Kinesiology and Health Education, The University of Texas, Austin, TX 78712
| |
Collapse
|
24
|
Signal LN, Stanley J, Smith M, Barr MB, Chambers TJ, Zhou J, Duane A, Gurrin C, Smeaton AF, McKerchar C, Pearson AL, Hoek J, Jenkin GLS, Ni Mhurchu C. Children's everyday exposure to food marketing: an objective analysis using wearable cameras. Int J Behav Nutr Phys Act 2017; 14:137. [PMID: 28988542 PMCID: PMC5632829 DOI: 10.1186/s12966-017-0570-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background Over the past three decades the global prevalence of childhood overweight and obesity has increased by 47%. Marketing of energy-dense nutrient-poor foods and beverages contributes to this worldwide increase. Previous research on food marketing to children largely uses self-report, reporting by parents, or third-party observation of children’s environments, with the focus mostly on single settings and/or media. This paper reports on innovative research, Kids’Cam, in which children wore cameras to examine the frequency and nature of everyday exposure to food marketing across multiple media and settings. Methods Kids’Cam was a cross-sectional study of 168 children (mean age 12.6 years, SD = 0.5) in Wellington, New Zealand. Each child wore a wearable camera on four consecutive days, capturing images automatically every seven seconds. Images were manually coded as either recommended (core) or not recommended (non-core) to be marketed to children by setting, marketing medium, and product category. Images in convenience stores and supermarkets were excluded as marketing examples were considered too numerous to count. Results On average, children were exposed to non-core food marketing 27.3 times a day (95% CI 24.8, 30.1) across all settings. This was more than twice their average exposure to core food marketing (12.3 per day, 95% CI 8.7, 17.4). Most non-core exposures occurred at home (33%), in public spaces (30%) and at school (19%). Food packaging was the predominant marketing medium (74% and 64% for core and non-core foods) followed by signs (21% and 28% for core and non-core). Sugary drinks, fast food, confectionary and snack foods were the most commonly encountered non-core foods marketed. Rates were calculated using Poisson regression. Conclusions Children in this study were frequently exposed, across multiple settings, to marketing of non-core foods not recommended to be marketed to children. The study provides further evidence of the need for urgent action to reduce children’s exposure to marketing of unhealthy foods, and suggests the settings and media in which to act. Such action is necessary if the Commission on Ending Childhood Obesity’s vision is to be achieved. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0570-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- L N Signal
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand.
| | - J Stanley
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand
| | - M Smith
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand
| | - M B Barr
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand
| | - T J Chambers
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand
| | - J Zhou
- Insight Centre for Data Analytics, Dublin City University, Belfield, Dublin, Ireland
| | - A Duane
- Insight Centre for Data Analytics, Dublin City University, Belfield, Dublin, Ireland
| | - C Gurrin
- Insight Centre for Data Analytics, Dublin City University, Belfield, Dublin, Ireland
| | - A F Smeaton
- Insight Centre for Data Analytics, Dublin City University, Belfield, Dublin, Ireland
| | - C McKerchar
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand
| | - A L Pearson
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Rd, East Lansing, MI, 48825, USA
| | - J Hoek
- Department of Marketing, University of Otago, Level 4, Business School, Clyde St, North Dunedin, Dunedin, 9016, New Zealand
| | - G L S Jenkin
- Department of Public Health, Health Promotion & Policy Research Unit, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand
| | - C Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand
| |
Collapse
|
25
|
Abstract
OBJECTIVES This was a two-part descriptive study designed to (1) assess the marketing themes and sugar content of beverages promoted in outdoor advertisements (ads) within a portion of Accra, Ghana and (2) quantify the types of ads that appeared along the Accra-Cape Coast Highway. SETTING A 4.7 km2 area of Accra, Ghana and a 151 km region along the highway represented the target areas for collecting photos of outdoor beverage ads. PRIMARY AND SECONDARY OUTCOME MEASURES Number and types of beverage ads, sugar content of beverage products featured in ads and marketing themes used in ads. DESIGN Two researchers photographed outdoor beverage ads in a 4.7 km2 area of Accra and used content analysis to assess marketing themes of ads, including the portrayal of children, local culture, music, sports and health. Researchers also recorded the number and type of ads along a 151 km stretch of the Accra-Cape Coast Highway. Researchers assessed the added sugar content to determine which beverages were sugar-sweetened beverages (SSBs). RESULTS Seventy-seven photographed ads were analysed. Seventy-three per cent (72.7%) of ads featured SSBs, and Coca-Cola accounted for 59.7% of ads. Sixty-five per cent (64.9%) of all ads featured sodas, while 35.1% advertised energy drinks, bottled or canned juice drinks and coffee-based, milk-based and water-based beverages. Thirteen per cent (13%) of ads featured children and 5.2% were located near schools or playgrounds. Nine per cent (9.1%) of ads contained a reference to health and 7.8% contained a reference to fitness/strength/sport. Along the Accra-Cape Coast Highway, Coca-Cola accounted for 60% of branded ads. CONCLUSION This study demonstrates the frequency of outdoor SSB ads within a 4.7 km2 area of Accra, Ghana. Coca-Cola was featured in the majority of ads, and the child-targeted nature of some ads indicates a need to expand the Children's Food and Beverage Advertising Initiative pledge to reduce child-targeted marketing on a global scale.
Collapse
Affiliation(s)
- Marie A Bragg
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
- Department of Public Health Nutrition, New York University College of Global Public Health, New York City, New York, USA
| | - Tamara Hardoby
- New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Natasha G Pandit
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Yemi R Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
- Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, New York City, New York, USA
| |
Collapse
|
26
|
Sainsbury E, Colagiuri S, Magnusson R. An audit of food and beverage advertising on the Sydney metropolitan train network: regulation and policy implications. BMC Public Health 2017; 17:490. [PMID: 28532472 PMCID: PMC5440940 DOI: 10.1186/s12889-017-4433-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/15/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Increased marketing of energy-dense, nutrient-poor foods has been identified as a driver of the global obesity epidemic and a priority area for preventative efforts. Local and international research has focused on the unhealthiness of television advertising, with limited research into the growing outdoor advertising industry. This study aimed to examine the extent of food and beverage advertising on the Sydney metropolitan train network, and to assess the nutritional quality of advertised products against the Australian Guide to Healthy Eating. METHODS All 178 train stations on the Sydney metropolitan train network were surveyed in summer and winter. A survey tool was developed to collect information for all advertisements on and immediately surrounding the train station. Information included product, brand, location and advertisement format. Advertisements were coded by nutrition category, product subcategory and size. Chi-square, ANOVA and ANCOVA tests were conducted to test for differences in the amount of food and beverage advertising by season and area socioeconomic status (SES). RESULTS Of 6931 advertisements identified, 1915 (27.6%) were promoting a food or beverage. The majority of food and beverage advertisements were for unhealthy products; 84.3% were classified as discretionary, 8.0% core and 7.6% miscellaneous. Snack foods and sugar-sweetened beverages were the most frequently advertised products, regardless of season. Coca-Cola and PepsiCo were the largest advertisers on the network, contributing 10.9% and 6.5% of total advertisements respectively. There was no difference in the mean number of food and beverage advertisements by area SES, but the proportion of advertising that was for discretionary foods was highest in low SES areas (41.9%, p < 0.001). CONCLUSIONS The results indicate that, irrespective of season, food and beverage advertisements across the Sydney metropolitan train network are overwhelmingly for unhealthy (discretionary) products. The results of this study highlight the inadequacy of Australia's voluntary self-regulatory system in protecting members of the public from exposure to unhealthy food advertising. Regulatory action by government, such as placing a cap on the amount of unhealthy food advertisements, or requiring a proportion of all advertising to be for the promotion of healthy foods, is required to address this issue.
Collapse
Affiliation(s)
- Emma Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006 Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006 Australia
| | - Roger Magnusson
- Sydney Law School, The University of Sydney, Sydney, NSW 2006 Australia
| |
Collapse
|
27
|
Soler LG. [Nutrition policies: What possible impacts on health inequalities?]. Rev Epidemiol Sante Publique 2016; 64 Suppl 2:S55-60. [PMID: 27038908 DOI: 10.1016/j.respe.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- L-G Soler
- Unité alimentation et sciences sociales (Aliss), UR1303 Inra, 65, boulevard de Brandebourg, 94205 Ivry-sur-Seine, France.
| |
Collapse
|
28
|
Isgor Z, Powell L, Rimkus L, Chaloupka F. Associations between retail food store exterior advertisements and community demographic and socioeconomic composition. Health Place 2016; 39:43-50. [PMID: 26945871 DOI: 10.1016/j.healthplace.2016.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/01/2015] [Accepted: 02/19/2016] [Indexed: 11/28/2022]
Abstract
This paper examines the association between the prevalence of various types of outdoor food and beverage advertising found on the building exteriors and properties of retail food outlets and community racial/ethnic and socioeconomic composition in a nationwide sample of food outlets in the U.S. Our major finding from multivariable analysis is that food stores in low-income communities have higher prevalence of all food and beverage ads, including those for unhealthy products such as regular soda, controlling for community racial/ethnic composition and other covariates. This adds to growing research pointing to socioeconomic disparities in food and beverage marketing exposure.
Collapse
Affiliation(s)
- Zeynep Isgor
- Institute for Health Research and Policy, University of Illinois at Chicago, USA.
| | - Lisa Powell
- Health Policy and Administration, School of Public Health and Institute for Health Research and Policy, University of Illinois at Chicago, USA.
| | - Leah Rimkus
- Institute for Health Research and Policy, University of Illinois at Chicago, USA.
| | - Frank Chaloupka
- Department of Economics and Institute for Health Research and Policy, University of Illinois at Chicago, USA.
| |
Collapse
|
29
|
Fekete C, Weyers S. Soziale Ungleichheit im Ernährungsverhalten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:197-205. [DOI: 10.1007/s00103-015-2279-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Settle PJ, Cameron AJ, Thornton LE. Socioeconomic differences in outdoor food advertising at public transit stops across Melbourne suburbs. Aust N Z J Public Health 2015; 38:414-8. [PMID: 25269979 DOI: 10.1111/1753-6405.12257] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/01/2014] [Accepted: 04/01/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess and compare the number and type of outdoor food advertisements at public transit stops within suburbs of varying levels of socioeconomic disadvantage. METHOD An observational audit tool was developed and implemented to assess the number and type of food advertisements at public transit stops within Melbourne, Victoria. A total of 20 Melbourne neighbourhoods (suburbs) from across the least and the most socioeconomically disadvantaged areas were selected. All public transit stops, including train stations and bus and tram stops with a shelter were audited. RESULTS A similar proportion of transit stops in the least and most-disadvantaged suburbs displayed food advertisements (total n=203). However, some differences in the type of advertisements across suburbs were noted with advertisements for fast food restaurants, flavoured milk and fruit juice more common in the most-disadvantaged neighbourhoods (all p<0.05) and advertisements for diet soft drink, tea, coffee and convenience stores more common in the least-disadvantaged neighbourhoods (all p<0.05). CONCLUSION This exploration of outdoor food advertising at Melbourne transit stops found 30% displayed food advertisements, with those in more disadvantaged suburbs more frequently promoting chain-brand fast food and less frequently promoting diet varieties of soft drinks. These findings may help raise awareness of unhealthy environmental exposures.
Collapse
Affiliation(s)
- Philippa J Settle
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Victoria
| | | | | |
Collapse
|
31
|
Poulos NS, Pasch KE. The Outdoor MEDIA DOT: The development and inter-rater reliability of a tool designed to measure food and beverage outlets and outdoor advertising. Health Place 2015; 34:135-42. [PMID: 26022774 PMCID: PMC4497920 DOI: 10.1016/j.healthplace.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 11/20/2022]
Abstract
Few studies of the food environment have collected primary data, and even fewer have reported reliability of the tool used. This study focused on the development of an innovative electronic data collection tool used to document outdoor food and beverage (FB) advertising and establishments near 43 middle and high schools in the Outdoor MEDIA Study. Tool development used GIS based mapping, an electronic data collection form on handheld devices, and an easily adaptable interface to efficiently collect primary data within the food environment. For the reliability study, two teams of data collectors documented all FB advertising and establishments within one half-mile of six middle schools. Inter-rater reliability was calculated overall and by advertisement or establishment category using percent agreement. A total of 824 advertisements (n=233), establishment advertisements (n=499), and establishments (n=92) were documented (range=8-229 per school). Overall inter-rater reliability of the developed tool ranged from 69-89% for advertisements and establishments. Results suggest that the developed tool is highly reliable and effective for documenting the outdoor FB environment.
Collapse
Affiliation(s)
- Natalie S Poulos
- Department of Kinesiology and Health Education, University of Texas at Austin, 1 University Station, D3700 Austin, TX, USA.
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, University of Texas at Austin, 1 University Station, D3700 Austin, TX, USA.
| |
Collapse
|
32
|
Kelly B, King L, Jamiyan B, Chimedtseren N, Bold B, Medina VM, De los Reyes SJ, Marquez NV, Rome ACP, Cabanes AMO, Go JJ, Bayandorj T, Carlos MCB, Varghese C. Density of outdoor food and beverage advertising around schools in Ulaanbaatar (Mongolia) and Manila (The Philippines) and implications for policy. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.940850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
33
|
Kelly B, King L, Baur L, Rayner M, Lobstein T, Monteiro C, Macmullan J, Mohan S, Barquera S, Friel S, Hawkes C, Kumanyika S, L'Abbé M, Lee A, Ma J, Neal B, Sacks G, Sanders D, Snowdon W, Swinburn B, Vandevijvere S, Walker C. Monitoring food and non-alcoholic beverage promotions to children. Obes Rev 2013; 14 Suppl 1:59-69. [PMID: 24074211 DOI: 10.1111/obr.12076] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising 'minimal', 'expanded' and 'optimal' monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.
Collapse
Affiliation(s)
- B Kelly
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Pitts A, Burke W, Adams J. Marketing messages in food and alcohol magazine advertisements, variations across type and nutritional content of promoted products: a content analysis. J Public Health (Oxf) 2013; 36:417-25. [DOI: 10.1093/pubmed/fdt072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
35
|
The local touch. Public Health Nutr 2011; 14:943-4. [DOI: 10.1017/s1368980011000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
36
|
Adams J, Simpson E, White M. Variations in food and drink advertising in UK monthly women's magazines according to season, magazine type and socio-economic profile of readers: a descriptive study of publications over 12 months. BMC Public Health 2011; 11:368. [PMID: 21605388 PMCID: PMC3121635 DOI: 10.1186/1471-2458-11-368] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity are recognised nationally and internationally as key public health challenges. Food and drink advertising is one of the array of factors that influence both diet and physical activity choices and, hence, body weight and obesity. Little previous work has focused on food and drink advertising in magazines. We studied food and drink advertising in a wide range of popular UK monthly women's magazines published over a full year. We explored differences in the prevalence of food and drink advertising and the type of food and drinks advertised according to season, magazine type and socio-economic profile of readers. METHODS All advertisements in all issues of 18 popular UK monthly women's magazines published over 12 months were identified. For each food or drink advertisement, branded food and drinks were noted and categorised into one of seven food groups. All analyses were at the level of the individual advertisement. RESULTS A total of 35 053 advertisements were identified; 1380 (3.9%) of these were for food or drink. The most common food group represented was 'food and drinks high in fat and/or sugar' (28.0% of food advertisements), the least common group was 'fruits & vegetables' (2.0% of food advertisements). Advertisements for alcohol accounted for 10.1% of all food advertisements. Food and drink advertisements were most common in summer, general interest magazines, and those with the most affluent readerships. There were some differences in the type of food and drink advertised across season, magazine type and socio-economic profile of readers. CONCLUSIONS Food and drink advertisements represented only a small proportion of advertisements in UK women's monthly magazines. Food and drink advertisements in these magazines feature a high proportion of 'less healthy' foods. There were a number of differences across season, magazine type and according to the socio-economic profile of readers in the prevalence of food and drink advertisements. Fewer differences were seen in the type of food and drinks advertised.
Collapse
Affiliation(s)
- Jean Adams
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | | | | |
Collapse
|