Caregiver perceptions of the food marketing environment of African-American 3-11-year-olds: a qualitative study

A Black American Nutrition Scholar and Advocate: My Journey

I started my journey as a nutrition scholar in 1974 when I began PhD studies at Cornell University. My journey has been rich with opportunity. I engaged in research on diet-related risks for cardiovascular diseases, diabetes, and cancer, partly motivated by my strong commitment to addressing health disparities affecting Black Americans. Obesity became my major focus and would eventually involve both US and global lenses. This focus was also linked to other dietary intake issues and health disparities and drew on knowledge I had gained in my prior study and practice of social work. I positioned myself as a bridge builder across nutrition, epidemiology, and public health, advocating for certain new ways of thinking and acting in these spheres and in the academy itself. Life skills honed during my formative years living within racially segregated contexts have been critical to any successes I have achieved.

Caregiver Perceptions of Environmental Facilitators and Barriers to Healthy Eating and Active Living during the Summer: Results from the Project SWEAT Sub-Study

Objective: The aim of this study was to examine caregiver perceptions of summertime neighborhood-level environmental barriers and facilitators to healthy eating and active living in their elementary-age racial minority children. Methods: Caregivers with students in the prekindergarten–fifth grade were recruited from two schools located in low-income urban neighborhoods of Columbus, OH, with a predominantly Black population. Participants engaged in the research portion of the Healthy Eating Active Living: Mapping Attribute using Participatory Photographic Surveys (HEALth MAPPS^TM) protocol, which included (1) orientation; (2) photographing and geotagging facilitators and barriers to HEALth on daily routes; (3) in-depth interview (IDI) discussing images and routes taken; (4) focus groups (FG). IDIs and FGs were transcribed verbatim. Analyses were guided by grounded theory and interpretive phenomenology and were coded by researchers (n = 3), who used comparative analysis to develop a codebook and determine major themes. Results: A total of 10 caregivers enrolled and 9 completed the IDIs. Five caregivers participated in focus groups. A majority (77.8%, n = 7) of caregivers identified as Black, female (88.9%, n = 8), and low income (55.6%, n = 5). IDI and FG themes included (1) walkway infrastructure crucial for healthy eating and active living; (2) scarce accessibility to healthy, affordable foods; (3) multiple abandoned properties; (4) unsafe activity near common neighborhood routes. Conclusions: Caregivers perceived multiple neighborhood-level barriers to healthy eating and activity during the summer months when school is closed. Findings from this study provide initial insights into environmental determinants of unhealthy summer weight gain in a sample of predominantly racial minority school-age children from low-income households.

Attitudes of sports organisation members to junk food sponsorship

OBJECTIVES

To explore sports organisation members' attitudes to sponsorship of sport by energy-dense, nutrient-poor food and drink ('junk food') brands.

STUDY DESIGN

The study design is a cross-sectional study.

METHODS

An online survey of adult members of three sports organisations that did not accept junk food sponsorship in Victoria, Australia in 2018: one was responsible for an elite team in a national competition (5000-10,000 members); one managed a team sport competition across Victoria (50,000-100,000 registered junior and adult participants, referees and coaches); and one administered a junior team sport competition for boys and girls in a major city (10,000-15,000 participants).

RESULTS

Most (71%) of the 2224 respondents reported it was important/very important that their organisation did not accept junk food sponsorship. A higher proportion was concerned/very concerned about junk food companies sponsoring children's sport (60%) compared with such companies sponsoring elite (49%, P < 0.001) or community adult (39%, P < 0.001) sport. A higher proportion of respondents were likely/very likely to support a policy that restricted junk food sponsorship of children's sport (84%), compared with a policy restricting sponsorship of elite (76%, P > 0.001) and adult community (74%, P > 0.001) sport. Two-thirds of respondents supported restricting junk food companies from sponsoring sport, even if fees for children's (66%) and community adult (65%) sport increased, or if membership and attendance costs for elite sport supporters increased (63%).

CONCLUSIONS

In the Australian context of this study, junk food sponsorship of sport, particularly children's sport, is a concern to members of sports organisations. Although still high, support for restricting such sponsorship declines if members perceive it will lead to increases in participation costs and decreases in participation opportunities. Initiatives restricting junk food sponsorship of sport are likely to receive strong support from the sports community, particularly when the focus is on children's sport, and participation costs and opportunities are not negatively impacted.

30+ years of media analysis of relevance to chronic disease: a scoping review

BACKGROUND

Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area.

METHODS

We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies.

RESULTS

Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work.

CONCLUSIONS

The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.

Exploring the Role of Grandparents in the Feeding of Grandchildren Aged 1-5 Years

OBJECTIVE

Early childhood is a crucial time for the development of eating behaviors and food preferences. With increased labor force participation by Australian mothers of young children, grandparents are acting as the main informal carers of grandchildren. Therefore, grandparents have the capacity to influence the feeding of young children and thus their eating behaviors.

DESIGN

Eleven semistructured qualitative interviews.

SETTING

Suburban Adelaide, South Australia.

PARTICIPANTS

Grandparents (n = 11; 9 grandmothers and 2 grandfathers).

PHENOMENON OF INTEREST

To gain insight into grandparental perspectives, beliefs, and opinions regarding the feeding of grandchildren aged 1-5 years.

ANALYSIS

Interviews were manually transcribed and coded, and codes were synthesized into common themes.

RESULTS

Four major themes emerged: (1) intergenerational differences (between grandparents and parents); (2) maintaining familial relationships; (3) treating grandchildren with food, and (4) nutritional efficacy. Grandparents thoughtfully managed familial relations, including intergenerational differences, in relation to feeding grandchildren. They showed some cognitive dissonance with regard to provision of treat foods (defined as discretionary foods) in which grandparents simultaneously prioritized healthy foods and treats.

CONCLUSIONS AND IMPLICATIONS

Grandparents' social role in the complex psychosocial space of child feeding warrants serious recognition and deeper understanding to engage them fully as stakeholders in children's nutritional health.

Children's and parents' opinions on the sport-related food environment: a systematic review

Sport is a key setting for interventions to address child obesity given its obesogenic nature. Understanding children's and parents' opinions on the sport-related food environment is critical in developing effective programmes and policies to improve children's health. This systematic review synthesizes quantitative and qualitative research examining children's and parents' opinions on the sport-related food environment. During July 2016, a range of electronic databases of academic and grey literature were searched. Thirty-two publications (11 including children, 17 parents and 4 both) were included for review. The publications were assessed using the Analysis Grid for Environments Linked to Obesity framework to categorize the sport-related food environment into the physical, sociocultural, economic and political environments. The literature available investigating children's and parents' opinions of the sport-related food environment suggests that many children and parents consider the environment neither conducive to nor supportive of children's healthy food behaviours or wider health and well-being. Both groups would likely support actions to change and improve it. This systematic review found that original research specifically investigating children's and parents' perspectives on almost all aspects of the sport-related food environment is limited. Thus, there is scope for further investigation into this important part of children's food environments.

Sugar consumption, metabolic disease and obesity: The state of the controversy

The impact of sugar consumption on health continues to be a controversial topic. The objective of this review is to discuss the evidence and lack of evidence that allows the controversy to continue, and why resolution of the controversy is important. There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly. The direct pathway involves the unregulated hepatic uptake and metabolism of fructose, leading to liver lipid accumulation, dyslipidemia, decreased insulin sensitivity and increased uric acid levels. The epidemiological data suggest that these direct effects of fructose are pertinent to the consumption of the fructose-containing sugars, sucrose and high fructose corn syrup (HFCS), which are the predominant added sugars. Consumption of added sugar is associated with development and/or prevalence of fatty liver, dyslipidemia, insulin resistance, hyperuricemia, CVD and T2DM, often independent of body weight gain or total energy intake. There are diet intervention studies in which human subjects exhibited increased circulating lipids and decreased insulin sensitivity when consuming high sugar compared with control diets. Most recently, our group has reported that supplementing the ad libitum diets of young adults with beverages containing 0%, 10%, 17.5% or 25% of daily energy requirement (Ereq) as HFCS increased lipid/lipoprotein risk factors for CVD and uric acid in a dose-response manner. However, un-confounded studies conducted in healthy humans under a controlled, energy-balanced diet protocol that enables determination of the effects of sugar with diets that do not allow for body weight gain are lacking. Furthermore, recent reports conclude that there are no adverse effects of consuming beverages containing up to 30% Ereq sucrose or HFCS, and the conclusions from several meta-analyses suggest that fructose has no specific adverse effects relative to any other carbohydrate. Consumption of excess sugar may also promote the development of CVD and T2DM indirectly by causing increased body weight and fat gain, but this is also a topic of controversy. Mechanistically, it is plausible that fructose consumption causes increased energy intake and reduced energy expenditure due to its failure to stimulate leptin production. Functional magnetic resonance imaging (fMRI) of the brain demonstrates that the brain responds differently to fructose or fructose-containing sugars compared with glucose or aspartame. Some epidemiological studies show that sugar consumption is associated with body weight gain, and there are intervention studies in which consumption of ad libitum high-sugar diets promoted increased body weight gain compared with consumption of ad libitum low- sugar diets. However, there are no studies in which energy intake and weight gain were compared in subjects consuming high or low sugar, blinded, ad libitum diets formulated to ensure both groups consumed a comparable macronutrient distribution and the same amounts of fiber. There is also little data to determine whether the form in which added sugar is consumed, as beverage or as solid food, affects its potential to promote weight gain. It will be very challenging to obtain the funding to conduct the clinical diet studies needed to address these evidence gaps, especially at the levels of added sugar that are commonly consumed. Yet, filling these evidence gaps may be necessary for supporting the policy changes that will help to turn the food environment into one that does not promote the development of obesity and metabolic disease.

Food and Beverage Marketing to Youth

After nearly a decade of concern over the role of food and beverage marketing to youth in the childhood obesity epidemic, American children and adolescents - especially those from communities of color - are still immersed in advertising and marketing environments that primarily promote unhealthy foods and beverages. Despite some positive steps, the evidence shows that the food and beverage industry self-regulation alone is not likely to significantly reduce marketing of unhealthy foods and beverages to youth. A variety of research is needed to monitor industry marketing of unhealthy products to young people, and identify the most promising approaches to improve children's food marketing environments. The continued presence of unhealthy marketing toward children despite years of industry self-regulation suggests it is time for stronger action by policymakers to protect young people from harmful marketing practices.

Report of an EU-US symposium on understanding nutrition-related consumer behavior: strategies to promote a lifetime of healthy food choices

This report summarizes an EU-US Task Force on Biotechnology Research symposium on healthy food choices and nutrition-related purchasing behaviors. This meeting was unique in its transdisciplinary approach to obesity and in bringing together scientists from academia, government, and industry. Discussion relevant to funders and researchers centered on (1) increased use of public-private partnerships, (2) the complexity of food behaviors and obesity risk and multilevel aspects that must be considered, and (3) the importance of transatlantic cooperation and collaboration that could accelerate advances in this field. A call to action stressed these points along with a commitment to enhanced communication strategies.