Like and share: associations between social media engagement and dietary choices in children

Nigerian adolescents' exposure to fast food marketing via Instagram

OBJECTIVES

To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement.

DESIGN

A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received.

RESULTS

The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, 'teen language' and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content.

CONCLUSION

Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents' exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements.

From Pixels to Palate: Communication around #vegan on Instagram and its relation with eating intentions

Social media is an increasingly important yet understudied context for eating behaviors in general and veganism in particular. In four studies, we first explored and described the information environment the platform Instagram presents related to veganism. Second, we examined how engaging with this environment is associated with offline eating intentions via psychological mechanisms. We scraped datasets of Instagram posts tagged with #vegan (44,316 posts in total) and employed network analysis with their hashtags (Study 1), as well as clustering with images and sentiment analysis with texts (Study 2). Studies 3 (N = 117) and 4 (N = 251) used online surveys to investigate associations between different forms of engaging with social media content, psychological constructs, and offline eating intentions. Posts about veganism were frequently related to food, health and fitness, cosmetics, and photography. Images most often depicted food (34.7%), non-food products (30.4%), people (7.9%), and animals (2.0%). The sentiment of most posts was positive. Being exposed to Instagram content about veganism was more strongly and consistently associated with eating intentions than active forms of engagement. Attitude and self-identity emerged as the most relevant mechanisms for these effects. Food is the most prominent yet not sole topic among posts about veganism on Instagram, and hashtags used in this context partially relate to motives for following a vegan diet. Exposure to this information environment might influence offline eating decisions via psychological mechanisms. With growing usage and its potential influence, social media should receive increasing attention in (health) psychological research and practice.

Unhealthy Food and Beverage Marketing to Children in the Digital Age: Global Research and Policy Challenges and Priorities

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Associations of Contemporary Screen Time Modalities With Early Adolescent Nutrition

OBJECTIVE

To determine the associations between screen time across several contemporary screen modalities (eg, television, video games, text, video chat, social media) and adherence to the Mediterranean-DASH (dietary approaches to stop hypertension) intervention for neurodegenerative delay (MIND) diet in early adolescents.

METHODS

We analyzed data from the Adolescent Brain Cognitive Development study of 9 to 12-year-old adolescents in the United States. Multiple linear regression analyses examined the relationship between self-reported screen time measures at baseline (year 0) and the 1-year follow-up (year 1) and caregiver-reported nutrition assessments at year 1, providing a prospective and cross-sectional analysis. Cross-sectional marginal predicted probabilities were calculated.

RESULTS

In a sample of 8267 adolescents (49.0% female, 56.9% white), mean age 10 years, total screen time increased from 3.80 h/d at year 0 to 4.61 h/d at year 1. Change in total screen time from year 0 and year 1 was associated with lower nutrition scores at year 1.

PROSPECTIVE

Screen time spent on television, video games, and videos at year 0 was associated with lower nutrition scores at year 1. Cross-sectional: Screen time spent on television, video games, videos, texting, and social media at year 1 was associated with lower MIND diet scores at year 1.

CONCLUSIONS

Both traditional (television) and several contemporary modalities of screen time are associated, prospectively and cross-sectionally, with lower overall diet quality, measured by the MIND diet nutrition score, in early adolescents. Future studies should further explore the effect of rising digital platforms and media on overall adolescent nutrition.

Development of a questionnaire for assessing the impact of children's food marketing exposure on diet-related outcomes

Introduction

The Government of Thailand has drafted legislation to protect children from the harmful impact of unhealthy food (including beverages) marketing. Local evidence on Thai children's exposure to, and the impact of, this marketing is necessary to, first, support the adoption of this Law and, second, to contribute to assessing policy implementation and effectiveness. This study aimed to develop and validate a questionnaire for examining Thai children's exposure to unhealthy food marketing and its impact on diet-related outcomes.

Materials and methods

To design the questionnaire, we first conceptualised the range of impacts of unhealthy food marketing on children's diet-related outcomes based on published frameworks. These outcomes related to food brand loyalty, preference, purchase and consumption. We conducted a literature review to gather related questions used in earlier surveys to assess these outcomes. Using these questions, we assessed content validity with five experts. Face validity and reliability were assessed for 32 children. Validity was assessed using Content Validity Index (CVI) and Kappa statistics. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC).

Results

We identified 15 survey questions that had been used to assess the outcomes of interest. The CVI of all questions was 1.0, indicating perfect agreement with each question's relevance by the experts. Most questions were perceived to be easy to read and comprehend, suggesting face validity. Cronbach's alpha and ICC of all questions were both 0.75, demonstrating internal consistency across responses to questions about, separately, brand loyalty, preferences, purchase and consumption.

Conclusion

The final 15-item questionnaire provides a valid and reliable survey instrument for measuring the impact of unhealthy food marketing on children's diet-related outcomes. This instrument will be useful for gathering local evidence on the need for policy reform to protect children from unhealthy food marketing in Thailand. The instrument also provides a cost-effective approach for generating evidence in other jurisdictions to propel policy actions. This is a pilot study and the validity and reliability needs further testing after a larger-scale roll-out.

Caring for screenagers (Part 1): a pediatrician's primer on popular social media platforms

PURPOSE OF REVIEW

Since the inception of social media, children have used platforms in manners unbeknownst to their parents. Just when parents feel they may finally understand what platform is relevant or trend is "in," the landscape evolves, and children shift to something new. It is therefore critical that pediatricians stay informed about what is popular in youth populations. This enables the recognition of the potential dangers of contemporary social media engagement.

RECENT FINDINGS

Short-form content and livestreaming continue to rise in popularity while certain older forms of social media have retained relevancy in youth circles. YouTube is the dominant social media force, with both livestreaming and short-form offerings. Twitch and TikTok provide alternatives to YouTube for livestreaming and short-form content, respectively. Instagram and Snapchat - two social media apps that have existed for over 10 years - remain as the most popular mechanisms for children to interact with their friends online.

SUMMARY

Issues related to body image, attention deficits, cyberbullying, and other potential harms have many parents wary of their child's presence on social media. Social media sites have in-place mechanisms to prevent the likelihood of harm, but pediatricians and parents should still counsel children on best social media practices.

Associations between everyday exposure to food marketing and hunger and food craving in adults: An ecological momentary assessment study

Food marketing in television and digital media negatively affects appetitive sensations and eating behaviour in children, but effects are less well understood for outdoor food advertising and adults. This research used Ecological Momentary Assessment (EMA) to explore associations between exposures to food advertising in various contexts (television, digital, outdoors) and adults' hunger and craving for highly advertised food categories. Over one week, participants provided ratings of cravings for types of food (fast food, soft drinks, snacks/confectionery, other) and hunger on a smartphone app up to six times per day when they saw a food advertisement (reactive assessment) and at random intervals (random assessment). Fifty-four participants (70.4 % female; 21.24 ± 3.84 years) provided 1223 assessments (24.7 % reactive, 75.3 % random). Data were analysed in R using multilevel multivariable linear regression models. Participants reported feeling hungrier (X2(1) = 5.85, p = .016, ΔAIC = 3.9) and having stronger cravings (X2(1) = 20.64, p < .001, ΔAIC = 318.6) after seeing food advertisements vs. random assessments. This was driven by greater hunger following television advertising exposure vs. random assessments (β = 1.58, SE = 0.61, p = .010, 95 %CIs 0.38 to 2.78), food advertising via digital devices or outdoors was not associated with hunger. Participants experienced stronger craving after seeing a food advertisement on television (β = 0.52, SE = 0.19, p = .006, 95 %CIs 0.15 to 0.89), outdoors (β = 0.39, SE = 0.12, p < .001, 95 % CIs 0.16 to 0.62) and in digital media (β = 0.36, SE = 0.14, p = .012, 95 % CIs 0.08 to 0.64), vs. random assessments. Cravings were (largely) specific to the advertised food category. EMA can be effective for assessing food marketing associations in adults. The current study provides evidence that food marketing is associated with hunger and craving in adults, which may, with replication, have implications for public health policy.

Food and non-alcoholic beverage marketing via Fortnite streamers on Twitch: A content analysis

Food and non-alcoholic beverage (hereafter: food) marketing is prevalent in digital media and predominantly for foods high in fats, salt and/or sugar (HFSS). However, little is known about food marketing in videogame livestreaming platforms - a hybridisation of social and gaming media where individuals can watch influencers (i.e., streamers) play videogames. No studies have explored food cues within the streamed content or content likely to be viewed by adolescents. The current study analysed the food cues in Twitch (the leading videogame livestreaming platform) videos (n = 52, 52h) uploaded to the platform during October 2020-September 2021 by influencers likely to be popular with adolescents. Food cues (n = 133, 2.56 per hour) were coded for exposure (e.g., display type, healthfulness) and power (e.g., presentation) using a World Health Organization (WHO) protocol and the UK Nutrient Profile Model. The majority (70.7%) of cues were HFSS, with energy drinks being the most featured food category (62.4%). Most cues were branded (80.5%) and featured as either product placement (44.4%) or a looping image (40.6%). Influencers were more likely to consume healthy (88.5%) than HFSS items (33.4%). The mean duration of each food cue was 20 min and 25 s per hour. Only 2.3% of cues had an advertising disclosure. This study provides the first empirical assessment of food cues on Twitch in livestreamed content likely to be popular with adolescents and has implications for digital food marketing policy development.

The food and beverage cues in digital marketing model: special considerations of social media, gaming, and livestreaming environments for food marketing and eating behavior research

Digital marketing to children, teens, and adults contributes to substantial exposure to cues and persuasive messages that drive the overconsumption of energy dense foods and sugary beverages. Previous food marketing research has focused on traditional media, but less is known about how marketing techniques translate within digital platforms, such as social media, livestreaming, and gaming. Building upon previous theories and models, we propose a new model entitled food and beverage cues in digital marketing (FBCDM). The FBCDM model specifies key marking elements and marketing integration strategies that are common on digital platforms and are hypothesized to enhance the effects of advertising and incentive sensitization process. FBCDM also categorizes measurable outcomes into three domains that include brand, food, and social outcomes. Additionally, repeated marketing exposure and the resulting outcomes are hypothesized to have long term consequences related to consumer markets, consumption behavior, culture, and health. We include a discussion of what is currently known about digital marketing exposure within the outcome domains, and we highlight gaps in research including the long-term consequences of digital marketing exposure. The FBCDM model provides a conceptual framework to guide future research to examine the digital marketing of food and beverages to children and adolescents in order to inform government and industry policies that restrict the aggressive marketing of products associated with obesity and adverse diet related outcomes.

Food marketing on digital platforms: what do teens see?

OBJECTIVE

Given the aggressive marketing of foods and beverages to teenagers on digital platforms, and the paucity of research documenting teen engagement with food marketing and its persuasive content, the objective of this study is to examine what teenagers see as teen-targeted food marketing on four popular digital platforms and to provide insight into the persuasive power of that marketing.

DESIGN

This is an exploratory, participatory research study, in which teenagers used a special mobile app to capture all teen-targeted food and beverage marketing they saw on digital media for 7 d. For each ad, participants identified the brand, product and specific appeals that made it teen-targeted, as well as the platform on which it was found.

SETTING

Online (digital media) with teenagers in Canada.

PARTICIPANTS

Two hundred and seventy-eight teenagers, aged 13-17 years, were participated. Most participants were girls (63 %) and older teenagers (58 % aged 16-17 years).

RESULTS

Participants captured 1392 teen-targeted food advertisements from Instagram, Snapchat, TikTok and YouTube. The greatest number of food marketing examples came from Instagram (46 %) (with no difference across genders or age), while beverages (28·7 %), fast food (25·1 %) and candy/chocolate were the top categories advertised. When it comes to persuasive power, visual style was the top choice across all platforms and participants, with other top techniques (special offer, theme and humour), ranking differently, depending on age, gender and platform.

CONCLUSIONS

This study provides insight into the nature of digital food marketing and its persuasive power for teenagers, highlighting considerations of selection and salience when it comes to examining food marketing and monitoring.

Eating behaviours, social media usage, and its association: A cross-sectional study in Indian medical undergraduates

Background

Despite increasing incidence, there is little data on abnormal eating behaviours or disorders in Indian youth, especially medical students. Additionally, little literature exists measuring the association of social media use with abnormal eating behaviours.

Aim

To assess the prevalence of abnormal eating behaviours amongst medical students, social media usage, and any association of social media usage with eating behaviours.

Materials and Methods

An online cross-sectional questionnaire-based study was conducted with 272 participants at a medical college, and two scales: the Three-Factor Eating Questionnaire-Revised 21items (TFEQ-R21) and the Scale of Effects of social media on Eating Behaviour (SESMEB) were used.

Results

22% of the participants reported abnormal eating behaviours. A significant difference in the effect of social media on eating behaviour according to the year of study [f = 3.08, P = 0.02] was seen with the final years having the lowest and the first years having the highest SESMEB scores. Students using more than 4 social media platforms had a higher SESMEB score [t = -2.02, P < 0.04]. A positive correlation was seen between TFEQ domains such as uncontrolled eating [r = 0.38, P = 0.01], emotional eating [r = 0.30, P = 0.01], and TFEQ total score [r = 0.40, P = 0.01] with SESMEB scores.

Conclusion

This study finds a significant correlation between increased social media usage and developing abnormal eating behaviours in medical students. It highlights the need for the creation of policies regulating social media use with eating behaviours in mind.

Gluten-free diet on video platforms: Retrospective infodemiology study

Background

Video platform is an important approach for individuals to access and adopt health information. Online information on gluten-free diet (GFD) videos remains underinvestigated.

Methods

GFD videos were identified by hashtag-based searching strategy. Videos' basic information, engagement metrics, and content were recorded. Mann-Kendall test was performed to examine time trends of submitting videos and engagement metrics. Video quality was evaluated by the DISCERN instrument and the HONcode.

Results

A total of 822 videos were included in the analysis, with the majority focusing on gluten-free food recipes. The number of videos related to GFD was showing an upward trend. Engagement metrics varied between platforms and video types, with non-recipe videos receiving higher user engagement. The average DISCERN score was 50.20 out of 80 and the average HONcode score was 1.93 out of 8. Videos submitted by health professionals demonstrated better quality compared to those submitted by patients or general users.

Conclusion

There was a rise in the number of videos related to GFD on Chinese video platforms. The overall quality of these videos was poor, most of them were not rigorous enough. Highlighting using social media as a health information source has the potential risk of disseminating one-sided messages and misleading. Efforts should be made to enhance the transparency of advertisements and establish clear guidelines for information sharing on social media platforms.

Testing a conceptual Hierarchy of Effects model of food marketing exposure and associations with children and adolescents' diet-related outcomes

OBJECTIVE

Children's exposure to unhealthy food marketing contributes to poor diets by influencing the foods that children like, request, buy and consume. This study aimed to use confirmatory mediational analyses to test a hypothetical model of marketing effects, to better understand the mechanisms behind food marketing's impacts on children.

DESIGN

Children responded to a cross-sectional online survey about their attitudes towards, and purchase and consumption behaviours of, ten frequently promoted food/beverage brands and their media use. Structural equation modelling tested a priori potential pathways for the effects of food marketing exposure on children's diets.

PARTICIPANTS

10-16-year-old children (n 400).

SETTING

Australia.

RESULTS

There was a significant positive correlation between children's commercial screen media use and their attitudes towards brands (related to perceived social norms) and their brand purchasing behaviours, including their own purchases and requests to parents. The use of strategies to avoid advertising in commercial screen media reduced but did not remove the association between media use and brand purchases. Other brand exposures (on clothing, outdoor advertising, sponsorships) had a positive association with children's perceived social norms about brands and their brand purchases and requests. Non-commercial screen media use was not associated with any brand-related outcomes.

CONCLUSIONS

Commercial screen media use and other brand exposures were strongly positively associated with children's perceptions and purchasing behaviours of frequently marketed food/beverages. Regulations to restrict children's exposures to food marketing on-screen and through other media are required to reduce the effect of marketing exposure on children's food purchasing behaviours.

A systematic review and meta-analysis of the effect of digital game-based or influencer food and non-alcoholic beverage marketing on children and adolescents: Exploring hierarchy of effects outcomes

Videogame livestreaming platforms are an emerging form of digital media, popular with young people, where users watch gaming influencers play videogames. Food and non-alcoholic beverage (hereafter: food) brands have a substantial presence on these platforms, yet no studies have examined the impact of this food marketing on young people. This systematic review and meta-analysis examined the evidence (quantitative or mixed-method) for a relationship between exposure to digital game-based or influencer food marketing, and food-related (brand awareness, attitudes, preferences, purchase, and consumption), and post-consumption (weight, body mass index [BMI], and dental caries) outcomes in young people (≤18 years). Twenty-three databases were searched in March 2021. Twenty-two studies met the inclusion criteria, of which 20 were included in the quantitative synthesis. Meta-analyses indicated food marketing was associated with more positive attitudes and greater preferences (OR = 1.74, p < 0.001 [95%CI: 1.355, 2.232]), and increased consumption (SMD = 0.37, p < 0.001 [95%CI: 0.219, 0.529]). Narrative synthesis indicated that food marketing may increase brand awareness but not pester intent, although data were limited. Evidence suggests that there is a relationship between exposure to food marketing via influencers and digital gaming media, and several food-related outcomes. This is the first quantitative synthesis to demonstrate these relationships; this work has implications for food marketing policy.

A systematic review of the adolescent-directed marketing strategies of transnational fast food companies in low- and middle-income countries

INTRODUCTION

Fast food consumption is associated with excessive intake of energy-dense foods; a major determinant of childhood obesity. The lack of data on the marketing strategies used to promote fast food to adolescents in low and middle-income countries (LMICs) acts as a barrier to global efforts to reduce the marketing of unhealthy foods to young people around the world.

OBJECTIVES

This systematic review aimed to identify the adolescent-directed marketing strategies of transnational fast food corporations in LMICs.

METHODS

A systematic search of eight scientific databases (PubMed, CINAHL, Medline, Embase, ProQuest, PsycInfo, Scopus and Google Scholar) was conducted. Following PRISMA guidelines, primary research articles written in English were included if they were published between 1 January 2010 and 30 December 2022, and reported any adolescent-directed marketing activity undertaken by a transnational fast food company operating in a LMIC. Articles were excluded if they were not peer reviewed. The quality of the included articles was assessed using a condensed version of the Consolidated Criteria for Reporting Qualitative Research tool.

RESULTS

Twelve articles met the eligibility criteria and were included in this review. A narrative synthesis of these articles revealed that the most documented strategies used to promote fast food to adolescents in LMICs were the use of incentives or premium offers, product appeals, promotional characters and brand familiarity. These strategies were mostly observed on social media, suggesting that there are serious concerns about adolescent exposure to fast food via social media in developing settings, especially as contextual differences in the nature of such marketing were identified.

DISCUSSION

The promotion of fast food to adolescents in LMICs is contextual in nature, with the nature of marketing strategies employed by transnational fast food corporations varying greatly across cultural and socio-economic contexts. These findings are crucial for the development of guidelines and regulations restricting the marketing of fast food to adolescents in lower income settings, contributing to global efforts to reduce adolescent exposure to unhealthy food promotion.

Revisiting 42 Years of literature on food marketing to children: A morphological analysis

Despite the preventive measures taken by the WHO, childhood obesity is still on the rise and is expected to increase by 100% between 2020 and 2035. Food marketing continues to permeate children's environments in numerous ways and influence the food behaviour of children, thus significantly contributing to the rise of obesity. Studies suggest that the literature on the effects of food marketing on children is complex and multidimensional. To fully understand these effects, a comprehensive and systematic approach is required. Nonetheless, existing reviews have focused only on specific aspects and have not comprehensively covered the literature on food marketing to children. Therefore, this review aims to navigate potential research gaps in the existing literature through a comprehensive examination of the literature by using morphological analysis (MA) methodology, the first time in this domain. Using PRISMA, 202 papers were considered eligible for inclusion and further analysed using MA. The articles were categorised into three dimensions to develop the MA framework: Stimuli (Food well-being), Organism, and Response, and 34 variants. The review has presented future research prospects by identifying at least 218 research gaps. With these findings, researchers can further explore the gaps and develop new research questions that could foster an understanding of the multifarious literature. Moreover, these findings can also provide marketers and practitioners with a better comprehension of the current state of the literature and develop more effective strategies for responsible marketing practices and policies.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Identifying factors that shape whether digital food marketing appeals to children

OBJECTIVE

Children are frequently exposed to unhealthy food marketing on digital media. This marketing contains features that often appeal to children, such as cartoons or bold colours. Additional factors can also shape whether marketing appeals to children. In this study, in order to assess the most important predictors of child appeal in digital food marketing, we used machine learning to examine how marketing techniques and children's socio-demographic characteristics, weight, height, BMI, frequency of screen use and dietary intake influence whether marketing instances appeal to children.

DESIGN

We conducted a pilot study with thirty-nine children. Children were divided into thirteen groups, in which they evaluated whether food marketing instances appealed to them. Children's agreement was measured using Fleiss' kappa and the S score. Text, labels, objects and logos extracted from the ads were combined with children's variables to build four machine-learning models to identify the most important predictors of child appeal.

SETTING

Households in Calgary, Alberta, Canada.

PARTICIPANTS

39 children aged 6-12 years.

RESULTS

Agreement between children was low. The models indicated that the most important predictors of child appeal were the text and logos embedded in the food marketing instances. Other important predictors included children's consumption of vegetables and soda, sex and weekly hours of television.

CONCLUSIONS

Text and logos embedded in the food marketing instances were the most important predictors of child appeal. The low agreement among children shows that the extent to which different marketing strategies appeal to children varies.

Characterizing the Discourse of Popular Diets to Describe Information Dispersal and Identify Leading Voices, Interaction, and Themes of Mental Health: Social Network Analysis

BACKGROUND

Social media has transformed the way health messages are communicated. This has created new challenges and ethical considerations while providing a platform to share nutrition information for communities to connect and for information to spread. However, research exploring the web-based diet communities of popular diets is limited.

OBJECTIVE

This study aims to characterize the web-based discourse of popular diets, describe information dissemination, identify influential voices, and explore interactions between community networks and themes of mental health.

METHODS

This exploratory study used Twitter social media posts for an online social network analysis. Popular diet keywords were systematically developed, and data were collected and analyzed using the NodeXL metrics tool (Social Media Research Foundation) to determine the key network metrics (vertices, edges, cluster algorithms, graph visualization, centrality measures, text analysis, and time-series analytics).

RESULTS

The vegan and ketogenic diets had the largest networks, whereas the zone diet had the smallest network. In total, 31.2% (54/173) of the top users endorsed the corresponding diet, and 11% (19/173) claimed a health or science education, which included 1.2% (2/173) of dietitians. Complete fragmentation and hub and spoke messaging were the dominant network structures. In total, 69% (11/16) of the networks interacted, where the ketogenic diet was mentioned most, with depression and anxiety and eating disorder words most prominent in the "zone diet" network and the least prominent in the "soy-free," "vegan," "dairy-free," and "gluten-free" diet networks.

CONCLUSIONS

Social media activity reflects diet trends and provides a platform for nutrition information to spread through resharing. A longitudinal exploration of popular diet networks is needed to further understand the impact social media can have on dietary choices. Social media training is vital, and nutrition professionals must work together as a community to actively reshare evidence-based posts on the web.

The Association of Influencer Marketing and Consumption of Non-Alcoholic Beer with the Purchase and Consumption of Alcohol by Adolescents

In this study, we examined influencer marketing and consumption of non-alcoholic beer by adolescents to determine how these factors could affect the intentions of adolescents to purchase and drink alcohol. A total of 3121 high-school students recruited from 36 schools in Taiwan completed a self-administered questionnaire during the COVID-19 pandemic in 2022. The results indicate that 19% of these adolescents consumed non-alcoholic beer and 28% consumed alcohol in the past year. Multivariate analysis positively associated adolescents' exposure to influencer marketing with their purchase and consumption of non-alcoholic beer. Adolescents' exposure to influencer marketing of non-alcoholic beer combined with lower levels of parental restrictive mediation was associated with increased odds of the purchase and consumption of alcohol. For individuals who did not purchase alcohol in the past year, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to purchase alcohol in the future. Similarly, individuals who previously abstained from the consumption of alcohol, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to consume alcohol. In conclusion, when adolescents were exposed to influencer marketing of non-alcoholic beer they were more likely to consume it, which resulted in an increased likelihood that they would then purchase and consume alcohol.

Recall of food marketing on videogame livestreaming platforms: Associations with adolescent diet-related behaviours and health

Digital media has become an integral part of adolescents' lives. Mirroring this trend, food and non-alcoholic beverage (hereafter: food) brands increasingly promote products in digital media to maximise reach with young consumers. Videogame livestreaming platforms, where individuals can broadcast or watch streamed videogame footage, are a growing form of digital media. The top three platforms (market share by hours watched) are Twitch (72%), YouTube Gaming (13%), and Facebook Gaming Live (9%), with a combined 34.6 billion hours watched in 2021. These platforms represent a hybridisation of two popular digital trends amongst teenagers: viewing online video content and playing videogames. On these platforms, gaming influencers promote food brands and products, with energy drinks and fast-food restaurants representing the most frequently promoted categories. Evidence suggests that food marketing via Twitch is associated with food craving, purchasing and consumption in adults. Yet, despite the evident teenage appeal and prevalence of food marketing on these platforms, research is yet to explore its associations with adolescent eating behaviour. Adolescents (n = 490, M_age = 16.81, 30.2% female) completed an online cross-sectional questionnaire exploring their recall of food marketing on the top three videogame livestreaming platforms, and relevant behavioural (purchase, consumption) and health (Body Mass Index) outcomes. Structural equation modelling was used to explore hierarchical relationships between the key variables. Results showed that recall of unhealthy food marketing on these platforms was significantly associated with purchase and consumption of marketed food categories. Attitudes towards unhealthy foods mediated this relationship. Findings are the first to demonstrate the relationships between unhealthy food marketing via videogame livestreaming platforms and adolescent eating behaviours, which has implications for the design of policies to restrict digital food marketing to young people.

The extent of energy drink marketing on Canadian social media

BACKGROUND

Caffeinated energy drink (CED) consumption among children and adolescents is a growing global public health concern due to its potential to produce adverse effects. CED marketing viewed by children and adolescents contributes to this problem as it increases consumption and favourable attitudes towards these high-caffeine and high-sugar products. This study aimed to describe the social media marketing of CEDs by estimating the frequency of user-generated and company-generated CED marketing and analyzing the marketing techniques used by Canadian CED brands on social media.

METHODS

CED products and brands were identified using the list of CEDs that received a Temporary Marketing Authorization from Health Canada in June 2021. The data on the frequency, reach and engagement of CED-related posts created by users and Canadian CED brands on Facebook, Instagram, Twitter, Reddit, Tumblr, and YouTube were licensed from Brandwatch for 2020-2021. A content analysis was conducted to assess the marketing techniques used in Canadian CED company-generated posts using a coding manual.

RESULTS

A total of 72 Canadian CED products were identified. Overall, there were 222,119 user-level mentions of CED products in total and the mentions reached an estimated total of 351,707,901 users across platforms. The most popular product accounted for 64.8% of the total user-level mentions. Canadian social media company-owned accounts were found for 27 CED brands. Two CED brands posted the most frequently on Twitter and accounted for the greatest reach, together making up 73.9% of the total company-level posts and reaching 62.5% of the total users in 2020. On Instagram/Facebook, the most popular brand accounted for 23.5% of the company-level posts and 81.3% of the reach between July and September 2021. The most popular marketing techniques used by Canadian CED brands were the use of viral marketing strategies (82.3% of Twitter posts and 92.5% of Instagram/Facebook posts) and the presence of teen themes (73.2% of Twitter posts and 39.4% of Instagram/Facebook posts).

CONCLUSION

CED companies are extensively promoting their products across social media platforms using viral marketing strategies and themes that may appeal to adolescents. These findings may inform CED regulatory decision-making. Continued monitoring is warranted.

Tracking teen food marketing: Participatory research to examine persuasive power and platforms of exposure

Food marketing has long been recognized to influence children's food preferences and consumption patterns, yet only in recent years have teenagers been recognized as a uniquely vulnerable audience for food marketing appeals. Marketing pressures on teenagers around food promotion continue to intensify, yet little is known about the marketing channels and specific persuasive appeals targeting this audience. Given this research gap, this participatory research study engages teenagers to capture the food marketing targeting them and to identify its persuasive "power" and platforms of exposure. Using a specially designed mobile app called GrabFM! (Grab Food Marketing!) teenagers (ages 13-17, n = 309) identified and tagged examples of teen-targeted food marketing in their physical and digital environments over a 7-day period. Results reveal that: 1) digital platforms dominate teen-targeted food marketing, with over three quarters of the ads found on Instagram, Snapchat, TikTok, ad YouTube; 2) branded beverages, fast food, and candy/chocolate comprise the majority (72%) of ads; and 3) the most powerful techniques for attracting teens attention are visual style, special offer and theme. In 40% of advertisements submitted, teenagers used only one indicator to identify "teen-targeted", although older teenagers (ages 15-17) were more likely to report multiple indicators per ad. This study provides important insights into the platforms targeting teenagers (and their relative importance), the food products endorsed, and the specific appeals that teenagers find persuasive. For the purposes of monitoring, it is helpful to know that digital platforms comprise the majority of teen-directed food promotions, and that the Big Food brands have been joined by countless smaller players to sell food to teens.

Food Advertisement and Dietary Choices in Adolescents: An Overview of Recent Studies

Adolescents are exposed to food marketing through many routes, including television, movies, videos, print media, online games, and social media. The interplay between exposure to unhealthy food advertisements and food choices by adolescents is a field of special interest given the ongoing evolution of social media trends and marketing strategies. The purpose of this review was to synthesize the scientific findings in the last five years (2017–2022) regarding the possible influence of nutrition-related advertisements through television, social media, or video games on the choice and consumption of unhealthy foods and drinks in adolescents. Nineteen studies were included in this review. Adolescents exposed to unhealthy food and beverage advertising showed high desire and intention to consume the advertised foods, as evidenced by the majority of included studies. The effects of advertisements are reinforced by peer pressure and influencers and interact with socioeconomic, biological, and environmental factors. Food marketing represents part of the obesogenic environment of the present time.

User engagement with a popular food brand before, during and after a multi-day interactive marketing campaign on a popular live streaming platform

OBJECTIVE

To assess viewer engagement of a food advertising campaign on the live streaming platform Twitch.tv, a social media platform that allows creators to live stream content and communicate with their audience in real time.

DESIGN

Observational analysis of chat comments across the Twitch platform containing the word 'Wendy's' or 'Wendys' during a 5-day ad campaign compared with two 5-day non-campaign time periods. Comments were categorised as positive, negative or neutral in how their sentiment pertained to the brand Wendy's.

SETTING

Twitch chatrooms.

PARTICIPANTS

None.

RESULTS

There were significantly more chatroom messages related to the Wendy's brand during the campaign period. When considering all messages, the proportion of messages was statistically different (x2 = 1417·41, P < 0·001) across time periods, with a higher proportion of neutral and positive messages and a lower proportion of negative messages during the campaign compared with the comparison periods. Additionally, the proportion of negative messages following the campaign was lower than before the campaign. When considering only positive and negative messages, the proportion of messages was statistically different (x2 = 366·38, P < 0·001) across each time period with a higher proportion of positive messages and a lower proportion of negative messages during the campaign when compared with the other time periods. Additionally, there was a higher proportion of positive messages and a lower portion of negative messages following the campaign when compared with before the campaign.

CONCLUSIONS

This study demonstrates the impact and sustained impact of a fast-food brand ad campaign on brand engagement on the live streaming platform Twitch.

Front-of-package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives

This work aims to provide a comprehensive overview of the use of front-of-package nutritional labeling (FOPL), identify and characterize the major existing FOPL systems, examine the impact of FOPL systems on consumer behavior, and discuss future perspectives. The searched databases were PubMed, Scopus, and Web of Science, and papers in English, Portuguese, Spanish, and French were considered. The integrative review method was used, comprising 68 papers. The FOPL system from more than 47 countries from North America, South America, Africa, Europe, Australia, and Asia was included in this study. The two main ways to characterize FOPL are the level of interpretation and the type of information provided. Interpretive schemes (such as warning labels, multiple traffic lights, and Nutri-Score) appear to lead to better consumer understanding and support healthier food purchases. However, due to the differences among the results and the specificity of the contexts in which they are used, it is impossible to define one FOPL interpretation scheme superior to the others. Some potential factors that influence the effectiveness of FOPL on consumer attitudes have been identified, such as food taste, as a major intrinsic factor. Extrinsic factors, such as price, food category, cultural diversity, politics, and economics, were also relevant. The lack of availability of similar alternatives, lack of understanding of the importance of FOPL, and lower levels of income and education were also some cognitive and social aspects impairing FOPL effectiveness. Prospects for the United States, Europe, Brazil, Colombia, and Argentina were discussed.

Advertising of foods and beverages in social media aimed at children: high exposure and low control

Background

This work is aimed to describe the recent scientific literature developed in the food/beverage sector and social networks aimed at children and adolescents, as well as current regulations.

Methods

A rapid review of the studies on advertising and social media aimed at children, published from 2010 tp 2020 is carried out, following the established inclusion criteria. In addition, the regulations in the countries in which the studies were carried out were also reviewed.

Results

Of the 573 articles, 7 met these criteria. The great attraction of unhealthy foods for children is observed, who remembered and recognized a greater number of unhealthy food brands and, by extension, the ability to influence of communication in social networks. Each country has its own self-regulation, two (Ireland and USA) have legislation on children’s food advertising, and Australia has legislation that applies only to open television. However, none of the analyzed countries have specific regulations on food, children and media advertising.

Conclusions

Given the fact that there is evidence about the great attraction that social networks suppose for the child, that they are a stimulus for the consumption of food and that many of these foods are harmful to their health; we should work in two directions: 1) Promote public policies based on promoting healthy habits among minors; and 2) Monitor and implement regulations in commercial communication social media.

'Even if you don't pay attention to it, you know it's there': A qualitative exploration of adolescents' experiences with digital food marketing

Adolescents are particularly vulnerable to digital food marketing. However, research on adolescents' recall, awareness, and opinions of this type of marketing is still scarce. Accordingly, the present study aimed to conduct an in-depth examination of adolescents' experiences with digital food marketing. A convenience sample of 209 adolescents was recruited at two private educational institutions and a public health facility in Montevideo, the capital city of Uruguay. Semi-structured group interviews were conducted, recorded in audio and transcribed. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Results showed that participants were highly exposed to digital food marketing, as they all remembered having seen advertisements, with those of fast-food restaurants and food-ordering apps being the most frequently mentioned. According to the adolescents' accounts, images, colors, music, oversized portions, product novelty, price promotions and celebrities were the most memorable aspects of food advertisements. Participants recognized the effect of advertisements on product awareness and wanting, and, to a lesser extent, on actual purchase and consumption behavior. Factors that were thought to mediate the impact of digital marketing on food choice were also identified. In the final part of the interviews, participants proposed strategies to reduce the effect of digital marketing on their food choices, which included both regulatory approaches to reduce exposure to digital marketing of unhealthy foods and behavior change communication. Together, the current findings provide insights for the development of multifaceted strategies to reduce the effects of digital food marketing on the eating habits of adolescents.

The influence of unhealthy food and beverage marketing through social media and advergaming on diet-related outcomes in children-A systematic review

Children are increasingly exposed to food and beverage marketing, but little is known about the specific effects of marketing through media most used by children. This study aims to systematically review the influence of unhealthy food and beverage marketing through social media and advergaming on diet-related outcomes in children. Seven databases were systematically searched for English peer-reviewed quantitative and qualitative scientific studies on the effects of marketing of unhealthy products through social media or advergaming on a range of diet-related outcomes in children. Risk of bias was assessed with tools specific for the different study designs. Twenty-six studies were included, of which 20 examined the effect of food and beverage marketing through advergaming and six through social media. Most studies had a high risk of bias. The results suggested that unhealthy food and beverage marketing through social media and advergaming has a significant effect on pester behaviors, food choice, and food intake of children. The studies demonstrate that unhealthy food and beverage marketing through media popular with children significantly impacts different diet-related outcomes. Combined with existing evidence on this effect in other settings, this review provides clear evidence of the need for policies targeting screen-based marketing.

Exposure to Food Marketing via Social Media and Obesity among University Students in Saudi Arabia

This study investigated the associations between obesity and unhealthy food/drink intake with both the frequency of social media platform usage and food/drink marketing exposure on social media. Data were obtained from 316 university students aged 18−29 years at two universities in Jeddah, Saudi Arabia. These participants completed online questionnaires with sections on demographics, anthropometric measurements, social media platform usage, food marketing exposure via social media, and unhealthy food consumption. All of the participants, 20.3% and 13.6% were overweight and obese, respectively. Snapchat was the most popular application (85.8%), followed by Instagram (75%), YouTube (61%), Twitter (51%), and TikTok (50%). The obese participants were more likely to purchase foods/drinks after watching relevant social media advertisements than their non-obese counterparts (p < 0.04). Moreover, those who purchased foods/drinks more frequently after watching such advertisements consumed higher amounts of potato chips (p < 0.01) and fast foods (p < 0.03). Finally, those who used Snapchat, TikTok, and Instagram tended to have higher consumption rates for potato chips (p < 0.02), fast foods (p < 0.01), sweets (p < 0.02), and sugary drinks (p < 0.04). Public health policymakers in Saudi Arabia should consider regulating unhealthy food and drink advertisements on social media platforms, especially those targeted at younger generations.

Social Media and Children's and Adolescents' Diets: A Systematic Review of the Underlying Social and Physiological Mechanisms

The association between social media (SM) and children's and adolescents' diet is poorly understood. This systematic literature review aims to explore the role of SM in children's and adolescents' diets and related behaviors, considering also the underlying mechanisms. We searched Medline, Scopus, and CINAHL (2008-December 2021) for studies assessing the relation of SM exposure with food intake, food preference, dietary behaviors, and the underlying mechanisms (e.g., brain activation to digital food images-as proxy for SM food images) among healthy children and adolescents aged 2-18 y. A total of 35 articles were included. Of 4 studies, 1 found that exposure to peers' videos on healthy eating, but not SM influencers', increased vegetable intake. Most studies reported that SM was associated with skipping breakfast, increased intake of unhealthy snacks and sugar-sweetened beverages, and lower fruit and vegetable intake, independent of age. Children and adolescents exposed to unhealthy compared with healthy digital food images showed increased brain response in reward- and attention-related regions. The mechanisms underpinning the abovementioned associations were 1) physiological (appetitive state, increased neural response to portion size and energy density of food depicted) and 2) social (food advertising via SM influencers and peers). SM exposure leads to unfavorable eating patterns both in children and adolescents. The identified mechanisms may help tailor future health interventions. Downregulating SM advertising and limiting SM exposure to children and adolescents may improve food intake and subsequent health outcomes. The protocol of this review was registered in PROSPERO as CRD42020213977 (https://www.crd.york.ac.uk/prospero/).

[Measuring adolescents' use of social media: A systematic review]

OBJECTIVE

The purpose of this review was to provide an overview of the methods used to measure social network site use among adolescents. Such a review is important given the number and diversity of sites and the prevalence of their use among adolescents.

METHODS

A systematic review of the literature was conducted in line with PRISMA guidelines to arrive at an analysis of 58 peer-reviewed studies indexed in PubMed, PsychInfo, or Scopus. To be included in the review, articles had to be peer-reviewed, available in full text, and published in French or English. For inclusion, studies were required to pertain to adolescents aged between 11 and 18 years; to focus on social network site use and indicate how their use was estimated. Studies that simultaneously examined social network sites and general internet use or video games and only provided a combined analysis were excluded. The keywords for the search were: social media use, social media usage, social media misuse, measure, teen, and adolescents.

RESULTS

In the literature, different methods were used to operationalize the use of social network sites: quantitative methods with the measurement of frequency and duration of use of social network sites, and qualitative methods to measure the different activities adolescents engage in on such sites. In this review, 28 articles investigated the use of social media through a measurement of frequency and 22 articles through a measurement of the duration of use. Most of the studies focused on social network sites in general, without specifying which sites in particular were considered by the respondents when answering the question. However, some articles provided cross measures of quantitative and qualitative measurements resulting in the examination of both the frequency of use and the time spent on specific activities on social network sites.

CONCLUSIONS

The present review highlights the great diversity in the methods used to measure the use of social network sites among adolescents. The reliance on frequency-based measurements without taking into account the specificities of the activities or sites involved limits the investigation of their impact on adolescent functioning and behaviors. Given the observed discrepancies in the literature concerning the measurement of social network site use among adolescents and their associated biases, the development of specific instruments is needed to advance in this important field of research.

Rising to the challenge: Introducing protocols to monitor food marketing to children from the World Health Organization Regional Office for Europe

Unhealthy marketing has been unequivocally linked to children's food preferences, requests, purchases and eating behaviors and hence to childhood obesity. Regulating children's exposure to such marketing has been identified as a key challenge to which States must rise. Regulation mandates the need for monitoring and hence for credible data that are comparable between countries, regions and across time. However, there are major challenges presented by the complexity of the digital marketing ecosystem including the personalized targeting with persuasive, exploitative advertising to which children are subject. This narrative review identifies challenges faced by researchers in the digital ecosystem; reviews recent papers attempting to address these and specifies benefits and limitations; and introduces a set of WHO protocols with templates and guidance for studies of food marketing to children.

Social media's influence on adolescents' food choices: A mixed studies systematic literature review

Over 90% of adolescents have at least one social media account, and their presence on social media continues to grow. Food and beverage brands capitalize on this trend by marketing their products on social media to adolescents. Depending on the nutrition value of the products being marketed, social media advertisements' influence may contribute to the risk of developing unfavorable health outcomes such as obesity, hypertension, and type 2 diabetes. This review aimed to investigate social media's food and beverage advertisements' role in influencing adolescents' food choices by appraising published literature. A systematic literature review was conducted reporting on social media's role in adolescents' food choices. Articles were searched through CINAHL and PubMed from scholarly journals between 2015 and 2020, using the search terms: social media use, food advertisements, adolescents, and food choices. Eligible articles were selected based on inclusion criteria. PRISMA guidelines were followed, and study quality was assessed using the Mixed Methods Appraisal Tool. The analysis was conducted using narrative analysis to identify key findings. Of the 234 records, six articles met inclusion criteria. The studies revealed two major findings: adolescents were more likely to recall unhealthy food and celebrity influence was a common component of the advertisements. This review suggests that food and beverage companies use social media for marketing their products by targeting the adolescent population. The use of celebrities and influencers and the promotion of "unhealthy" products appear to be commonly used tactics. With these findings, healthcare professionals should consider screening adolescents routinely for social media use and current eating habits and educating the adolescents, parents, and families about health risk. Additionally, implementing legislation and policies may be beneficial in preventing this exposure.

Life-long prevention of cardiovascular disease. Part II: childhood and adolescence

In recent years, researchers have increasingly noted that the development and health of cardiovascular system is influenced by both traditional risk factors (RF) and other determinants of human exposome — a combination of factors of the external and internal environment that affect genetics and epigenetics, as a result of which, one or another (more or less healthy) phenotype is formed. Exposome components have a continuous effect throughout all periods of life. Many RFs have a cumulative effect, and therefore it is important to start prevention of cardiovascular diseases (CVDs) as early as possible. The aim of this review was to consider various aspects of CVD prevention in childhood and adolescence. These periods are critical for the development of most behavioral habits, which maintain throughout life. Leading by personal example by parents and the immediate environment plays a paramount role in healthy lifestyle inclusion of children and adolescents. Targeted programs in kindergartens and schools aim at improving health literacy, early detection and timely changing traditional and non-traditional CVD RFs, diagnosis of genetic diseases involving the heart and blood vessels, prevention of sudden cardiac death are also important methods of CVD prevention in childhood and adolescence. Measures of population-based prevention are of great importance, including monitoring of advertising and media content, statutory ban of alcohol and tobacco sale, and the formation of healthy lifestyle.

"Everywhere You Look, You'll Find Food": Emerging Adult Perspectives Toward the Food Media Landscape

This study explores what emerging adults value in food media, i.e. food-focused content and personae in media. Emerging adults (18-25) are an important target group for food media as they transition toward nutritional independence and consume media substantially. Seven semi-structured focus groups were conducted with thirty-seven Belgian participants. Thematic analysis revealed three themes (hedonism, ability, information) grouping nine subthemes (entertainment, sensory appeal, convenience, familiarity, cost, autonomy, education, health and fitness, and innovation) characterizing emerging adults' food media experiences. Incidental exposure and interpersonal influences also mark their food media consumption. This demonstrates food media's interwovenness in emerging adults' media habits. Further research should consider these themes and complexities, including their potential impact toward food-related habits and media use.

Whose rights deserve protection? Framing analysis of responses to the 2016 Committee of Advertising Practice consultation on the non-broadcast advertising of foods and soft drinks to children

Exposure to advertising of food and beverages high in fat sugar and salt (HFSS) is considered a factor in the development of childhood obesity. This paper uses framing analysis to examine the strategic discursive practices employed by non-industry and industry responders to the Committee of Advertising Practice's consultation responses (n = 86) on UK regulation of non-broadcast advertising of foods and soft drinks to children. Our analysis demonstrates non-industry and industry responders engaged in a moral framing battle centred on whose rights were deemed as being of greatest importance to protect: children or industry. Both industry and non-industry responders acknowledged that childhood obesity and non-broadcast advertising were complex issues but diverged on how they morally framed their arguments. Non-industry responders employed a moral framework that aligned with the values represented in social justice approaches to public health policy, where children were identified as vulnerable, in need of protection from harmful HFSS product advertising and childhood obesity was a societal problem to solve. In contrast, industry responders emphasised industry rights, portraying themselves as a responsible industry that is victim to perceived disproportionate policymaking, and values more closely aligned with a market justice approach to public health policy. Our analysis provides detailed insights into the framing strategies used in the policy debate surrounding the non-broadcast advertising of HFSS foods to children. This has relevance as to how advocacy organisations can develop counter-framing to industry frames which seek to limit effective regulation.

Policy Inertia on Regulating Food Marketing to Children: A Case Study of Malaysia

Unhealthy food marketing shapes children’s preference towards obesogenic foods. In Malaysia, policies regulating this food marketing were rated as poor compared to global standards, justifying the need to explore barriers and facilitators during policy development and implementation processes. The case study incorporated qualitative methods, including historical mapping, semi-structured interviews with key informants and a search of cited documents. Nine participants were interviewed, representing the Federal government (n = 5), food industry (n = 2) and civil society (n = 2). Even though the mandatory approach to government-led regulation of food marketing to children was the benchmark, more barriers than facilitators in the policy process led to industry self-regulations in Malaysia. Cited barriers were the lack of political will, industry resistance, complexity of legislation, technical challenges, and lack of resources, particularly professional skills. The adoption of industry self-regulation created further barriers to subsequent policy advancement. These included implementer indifference (industry), lack of monitoring, poor stakeholder relations, and policy characteristics linked to weak criteria and voluntary uptake. These underlying barriers, together with a lack of sustained public health advocacy, exacerbated policy inertia. Key recommendations include strengthening pro-public health stakeholder partnerships, applying sustained efforts in policy advocacy to overcome policy inertia, and conducting monitoring for policy compliance and accountability. These form the key lessons for advocating policy reforms.

Australian Children's Exposure to, and Engagement With, Web-Based Marketing of Food and Drink Brands: Cross-sectional Observational Study

BACKGROUND

Food is one of the most frequently promoted commodities, and promoted foods are overwhelmingly unhealthy. Marketing normalizes unhealthy foods, creates a positive brand image, and encourages overconsumption. Limited research is available to describe the extent of food marketing to children on web-based media, and measuring actual exposure is challenging.

OBJECTIVE

This study aims to monitor the extent of children's exposure to web-based media food marketing as an essential step in increasing the accountability of industry and governments to protect children.

METHODS

Children aged 13-17 years were recruited from October 2018 to March 2019. Children recorded their mobile device screen for 2 weekdays and 1 weekend day any time they visited relevant web-based platforms. After each day, the participants uploaded the video files to a secure server. Promoted products were defined using the World Health Organization European Region nutrient profile model.

RESULTS

The sample of 95 children uploaded 267.8 hours of video data. Children saw a median of 17.4 food promotions each hour on the internet. Considering the usual time spent on the internet on mobile devices, children would be exposed to a median of 168.4 food promotions on the web on mobile devices per week, 99.5 of which would not be permitted to be marketed based on nutrient profiling criteria. Most promotions (2613/4446, 58.77%) were peer endorsed and derived from third-party sources.

CONCLUSIONS

Exposure to brand content that is seemingly endorsed by peers or web-based communities likely heightens the effects of marketing on children. Regulations to protect children from this marketing must extend beyond paid advertising to paid content in posts generated through web-based communities and influencers.

How food companies use social media to influence policy debates: a framework of Australian ultra-processed food industry Twitter data

OBJECTIVE

To understand if, and how, Australian ultra-processed food industry actors use Twitter to influence food and health policy debates and produce a conceptual framework to describe such influence.

DESIGN

Twitter data of prominent industry actors were defined through purposive sampling and inductively coded to investigate possible influence on food and health policy debates. These are described using descriptive statistics and coded extracts.

SETTING

Australia.

PARTICIPANTS

Twitter accounts of nine prominent ultra-processed food industry actors, including major trade associations.

RESULTS

Ultra-processed food industry actors actively used Twitter to influence food and health policy debates. Seven overarching strategies were identified: co-opting public health narratives; opposing regulation; supporting voluntary, co- or self-regulation; engaging policy processes and decision-makers; linking regulatory environments to the need for ongoing profitability; affecting public perceptions and value judgements; and using ignorance claims to distort policy narratives. Each lobbying strategy is underpinned with tactics described throughout and captured in a framework.

CONCLUSIONS

The current study creates a framework to monitor how food industry actors can use social media to influence food and health policy debates. As such, social media appears to be not only an important commercial determinant of health for brand marketing, but also an extension of lobbying practices to reshape public perceptions of corporate conduct and policy-making.

#SupportLocal: how online food delivery services leveraged the COVID-19 pandemic to promote food and beverages on Instagram

Objective:

To explore the promotion of discretionary foods/beverages and marketing strategies employed by the top three online food delivery services’ (OFDS) Instagram accounts in three countries before and during the coronavirus disease 2019 (COVID-19) pandemic.

Design:

Publicly available data were extracted for the top three OFDS Instagram accounts for Australia, United Kingdom (UK) and the United States of America (USA) from March to May 2019 and 2020. Food/beverage items from posts were classified as ‘discretionary’ or from the five food groups (FFG) according to the Australian Dietary Guidelines. Marketing strategies were coded using an existing framework. Posts referring to COVID-19 were coded under four marketing strategies: (i) appropriating frontline workers; (ii) combatting the pandemic; (iii) selling social distancing; and (iv) accelerating digitalisation.

Results:

From 581 posts, 618 food/beverage items were shown, of which 69 % (427/618) were classified as discretionary. In 2019, the most used marketing strategies were product imagery (unbranded) (137/195, 70 %), links (111/195, 57 %) and sponsorships/partnerships (58/195, 30 %). In 2020, the most used were links (252/386, 68 %), product imagery (unbranded) (179/386, 49 %) and branding elements (175/386, 45 %). The most common COVID-19 marketing strategy was combatting the pandemic (76/123, 62 %) followed by selling social distancing (53/123, 43 %), appropriating frontline workers (34/123, 28 %) and accelerating digitalisation (32/123, 26 %).

Conclusions:

Following the COVID-19 pandemic, OFDS adapted their marketing, creating content with the theme of ‘combatting the pandemic’. Due to the growing number of discretionary foods/beverages promoted on Instagram, this highlights the need for policy action to counter the potential influence social media platforms have on dietary behaviours.

Food marketing and gender among children and adolescents: a scoping review

BACKGROUND

Pervasive marketing of unhealthy foods is a contributing factor to the growth of the global epidemic of childhood and adolescent overweight and obesity. Sex and gender differences come into play in the design of and responses to these marketing strategies, contributing to the perpetuation of stereotyped behavior and generating disparities in food choices and health. The purpose of this paper is to review the current literature regarding gender differences in food marketing design and perception among children and adolescents to facilitate evidence-based policy dialogues to address gender-based health disparities in NCD prevention.

METHODS

Scoping review of articles published in scientific journals in English and Spanish, from 2003 to 2018, that addressed the influence of food marketing among children and adolescents including a gender perspective. The methodological quality of each article was assessed following criteria specific to each study design.

RESULTS

From a total of 37 articles (39 studies) included in the review, 17 were experimental and 22 had descriptive, cross-sectional designs. Twenty-one studies were found to have low methodological quality, while 10 and 8 were of medium and high quality, respectively. A total of 23 studies among children and adolescents found gender-based differences. Differences were found in the following dimensions: food marketing on intake; responses to specific marketing; perceptions and attitudes towards food marketing and marketing regulation initiatives; exposure to food advertising and gendered marketing content. The evidence was not conclusive in any of the dimensions.

CONCLUSIONS

The evidence suggests that food marketing has a similar impact on the consumption of unhealthy foods on boys and girls, but boys were found to be exposed to food advertising more intensively and their preferences to be more affected by this exposure, coinciding with a male-dominant advertising content. Limitations of these studies include taking gender as an unproblematic construct equivalent to biological sex and the lack of studies focused on developing countries. As gender is a cross-sectional dimension that interacts with other factors driving health disparities, an integrated gender perspective is needed to develop effective, evidence-based policies to control food marketing and tackle the childhood overweight and obesity pandemic.

Food and drink marketing on social media and dietary intake in Australian adolescents: Findings from a cross-sectional survey

Unhealthy food and drink marketing is prominent on social media and use of such platforms is widespread among adolescents. This study aims to examine the association between exposure to and engagement with food or drink advertisements on social media and unhealthy food and drink intake in Australian adolescents. In 2018, a representative sample of secondary school students aged 12-17 years (N = 8708) self-reported how frequently they saw food or drink advertisements on social media (exposure), 'liked' or 'shared' food or drink posts (engagement), and consumption of various unhealthy food and drinks. Multilevel logistic regression assessed the association between exposure to and engagement with food marketing on social media and high intake of unhealthy food and drinks. Fifty-five percent of students reported seeing a food or drink advertisement on social media at least weekly, while engagement was less frequent. Exposure to a food or drink advertisement on social media at least once in the last week was associated with a high intake of unhealthy drinks, while liking or sharing a food or drink post at least once in the last month was associated with a high intake of unhealthy food and drinks (all p < 0.01). As frequency of engagement with this type of marketing increased, so too did the likelihood of a high intake of unhealthy food and drinks. The association between exposure to and engagement with food or drink marketing and high unhealthy drink intake was driven by males, while all associations persisted irrespective of age. Holding manufacturers to higher standards in their digital marketing of unhealthy food and drink products through improved policy design and enforcement capability may be crucial in enabling young individuals to maintain a healthy diet.

Promoting healthy eating habits among youth according to their preferences: Indications from a discrete choice experiment in Tuscany

INTRODUCTION

The incidence of overweight among youth in Western Countries requires the implementation of initiatives to promote healthy lifestyles. Although under particular conditions obesity is not preventable, drawing attention on factors affecting teenagers' preferences can ameliorate the efficacy of public interventions designed for health promotion.

METHODS

This study aims at eliciting teenagers' food preferences through a discrete choice experiment, conducted in Tuscany using a webAPP survey, with the participation of more than 4,700 teenagers. Respondents expressed their preferences for breakfast food based on three attributes: food quality, packaging and claim. The survey also collected information on respondents' socio-demographic characteristics, social influence and media use for food information.

RESULTS

Teenagers' preferences for healthy foods seem positively related with their own level of food literacy. The tendency of respondents to read labels and nutritional facts is positively associated with preferences for healthier foods. Peers' influence is not significant, while family influence has a positive impact on teenagers' healthy choices. Internet usage is associated with unhealthy choices with a healthy aspect.

CONCLUSION

The results can be useful in defining effective actions for the promotion of healthy behaviors among teenagers, either in communication and awareness campaigns or in education and activation initiatives, with respect to the reading and interpretation of nutritional facts and labels, the role of family and friends, and the use of media.

The Timing, Nature and Extent of Social Media Marketing by Unhealthy Food and Drinks Brands During the COVID-19 Pandemic in New Zealand

Background: Concerns have been raised that health and societal causes surrounding the COVID-19 pandemic were misappropriated by companies to promote their unhealthy products to vulnerable populations during a time of increased stress and hardship (i.e., COVID-washing). Social media is a common medium for unhealthy foods and beverage marketing due to lack of regulation and low levels of monitoring. Purpose: This study aimed to investigate the timing, nature and extent of COVID-washing on public social media accounts by New Zealand's major food and drink brands in the initial stage of the pandemic after the first case was detected in New Zealand and when stay-at-home lockdown restrictions (Level 4 and 3 Alert levels) were in place. Methods: A content analysis of social media posts from February to May 2020 by the twenty largest confectionery, snacks, non-alcoholic beverages, and quick-service restaurant (fast-food) brands was undertaken. COVID-19 related posts were identified and classified to investigate the timing, themes and engagement with social media marketing campaigns, flagging those that may breach New Zealand's Advertising Standards. Results: 14 of 20 unhealthy food and drink brands referenced COVID-19 in posts during the 4-month period, peaking during nationwide lockdown restrictions. Over a quarter of all posts by the 14 brands (n = 372, 27.2%) were COVID-19 themed. Fast-food brands were most likely to use COVID-19 themed posts (n = 251/550 posts, 46%). Fast-food brands also had the highest number of posts overall during the pandemic and the highest engagement. The most commonly-used theme, present in 36% of all social media posts referring to COVID-19, was to draw on feelings of community support during this challenging time. Suggesting brand-related isolation activities was also common (23%), and the message that "consumption helps with coping" (22%). Six posts were found to potentially breach one of New Zealand's advertising standards codes by promoting excessive consumption or targeting children. Conclusion: COVID-washing was used by unhealthy food and drinks brands to increase brand loyalty and encourage consumption. The current Advertising Standards system is ineffective and must be replaced with a government-led approach to effectively regulate social media advertising to protect all New Zealanders, particularly in times of crisis.

Food Marketing as a Special Ingredient in Consumer Choices: The Main Insights from Existing Literature

The choices and preferences of food consumers are influenced by several factors, from those related to the socioeconomic, cultural, and health dimensions to marketing strategies. In fact, marketing is a determinant ingredient in the choices related to food consumption. Nonetheless, for an effective implementation of any marketing approach, the brands play a crucial role. Creating new brands in the food sector is not always easy, considering the relevant amount of these goods produced within the agricultural sector and in small food industries. The small dimension of the production units in these sectors hinders both brand creation and respective branding. In this context, it would seem important to analyse the relationships between food marketing and consumer choice, highlighting the role of brands in these frameworks. For this purpose, a literature review was carried out considering 147 documents from Scopus database for the topics of search “food marketing” and “choices” (search performed on 16 October 2020). As main insights, it is worth highlighting that the main issues addressed by the literature, concerning food marketing and consumer choices, are the following: economic theory; label and packaging; marketing strategies; agriculture and food industry; market segments; social dimensions; brand and branding. In turn, food marketing heavily conditions consumer choices; however, these related instruments are better manipulated by larger companies. In addition, this review highlights that bigger companies have dominant positions in these markets which are not always beneficial to the consumers’ objectives.