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Lutz MR, Orr CJ, Shonna Yin H, Heerman WJ, Flower KB, Sanders LM, Rothman RL, Schildcrout JS, Bian A, Kay MC, Wood CT, Delamater AM, Perrin EM. Television Time, Especially During Meals, Is Associated With Less Healthy Dietary Practices in Toddlers. Acad Pediatr 2024; 24:741-747. [PMID: 37802249 DOI: 10.1016/j.acap.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/23/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in 2-year-old children. METHODS We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well-child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site. RESULTS Five hundred and thirty-two toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤$20,000 annual household income). Median daily TV watching time was 42 minutes (interquartile range: 25, 60); 25% reported the TV was "usually on" during mealtimes. After adjustment, toddlers who watched more TV daily had higher odds of consuming sugar-sweetened beverages, fast food, and more junk food; those watching less TV had higher odds of consuming more fruits/vegetables. Those with the TV "usually on" during mealtimes were more likely to consume sugar-sweetened beverages (aOR 3.72 [95% confidence interval {CI} 2.16-6.43]), fast food (aOR 2.83 [95%CI 1.54-5.20]), and more junk food (aOR 4.25 [95%CI 2.71-6.65]). CONCLUSIONS Among toddlers from primarily minoritized populations and of lower socioeconomic status, those who watched more TV daily and usually had the TV on during meals had significantly less healthy dietary practices, even after adjusting for known covariates. This study supports the current American Academy of Pediatrics screen time guidelines and underscores the importance of early counseling on general and mealtime TV.
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Affiliation(s)
- Melissa R Lutz
- Department of Pediatrics (MR Lutz and EM Perrin), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Colin J Orr
- Department of Pediatrics (CJ Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Hsiang Shonna Yin
- Departments of Pediatrics and Population Health (HS Yin), New York University Grossman School of Medicine.
| | - William J Heerman
- Department of Pediatrics (WJ Heerman and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Kori B Flower
- Department of Pediatrics (CJ Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Lee M Sanders
- Departments of Pediatrics and Health Policy (LM Sanders), Stanford University, Calif.
| | | | - Jonathan S Schildcrout
- Department of Biostatistics (JS Schildcrout and A Bian), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Aihua Bian
- Department of Biostatistics (JS Schildcrout and A Bian), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Melissa C Kay
- Department of Pediatrics (CT Wood), Duke University School of Medicine, Durham, NC.
| | - Charles T Wood
- Department of Pediatrics (CT Wood), Duke University School of Medicine, Durham, NC.
| | - Alan M Delamater
- Mailman Center for Child Development (AM Delamater), University of Miami Miller School of Medicine, Fla.
| | - Eliana M Perrin
- Department of Pediatrics (MR Lutz and EM Perrin), Johns Hopkins University School of Medicine, Baltimore, Md; Division of General Pediatrics (EM Perrin), Department of Pediatrics, Schools of Medicine and Nursing.
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Albert MA, Churchwell K, Desai N, Johnson JC, Johnson MN, Khera A, Mieres JH, Rodriguez F, Velarde G, Williams DR, Wu JC. Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association. Circulation 2024; 149:e312-e329. [PMID: 38226471 DOI: 10.1161/cir.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.
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Jackson KE, Hamad R, Karasek D, White JS. Sugar-Sweetened Beverage Taxes and Perinatal Health: A Quasi-Experimental Study. Am J Prev Med 2023; 65:366-376. [PMID: 36966893 PMCID: PMC10518370 DOI: 10.1016/j.amepre.2023.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION One in 5 pregnant individuals report consuming sugar-sweetened beverages at least once per day. Excess sugar consumption during pregnancy is associated with several perinatal complications. As sugar-sweetened beverage taxes become increasingly common public health measures to reduce sugar-sweetened beverage consumption, evidence of the downstream effects of sugar-sweetened beverage taxes on perinatal health remains limited. METHODS This longitudinal retrospective study examines whether sugar-sweetened beverage taxes in 5 U.S. cities were associated with decreased risk of perinatal complications, leveraging 2013-2019 U.S. national birth certificate data and a quasi-experimental difference-in-differences approach to estimate changes in perinatal outcomes. Analysis occurred from April 2021 through January 2023. RESULTS The sample included 5,324,548 pregnant individuals and their live singleton births in the U.S. from 2013 through 2019. Sugar-sweetened beverage taxes were associated with a 41.4% decreased risk of gestational diabetes mellitus (-2.2 percentage points; 95% CI= -4.2, -0.2), a -7.9% reduction in weight-gain-for-gestational-age z-score (-0.2 standard deviations; 95% CI= -0.3, -0.01), and decreased risk of infants born small for gestational age (-4.3 percentage points; 95% CI= -6.5, -2.1). There were heterogeneous effects across subgroups, particularly for weight-gain-for-gestational-age z-score. CONCLUSIONS Sugar-sweetened beverage taxes levied in five U.S. cities were associated with improvements in perinatal health. Sugar-sweetened beverage taxes may be an effective policy instrument for improving health during pregnancy, a critical window during which short-term dietary exposures can have lifelong consequences for the birthing person and child.
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Affiliation(s)
- Kaitlyn E Jackson
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Department of Family & Community Medicine, University of California San Francisco, San Francisco, California
| | - Deborah Karasek
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
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4
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Olarte DA, Petimar J, James P, Cooksey-Stowers K, Cash SB, Rimm EB, Economos CD, Rohmann M, Blossom JC, Chen Y, Deo R, Cohen JFW. Trends in Quick-Service Restaurants near Public Schools in the United States: Differences by Community, School, and Student Characteristics. J Acad Nutr Diet 2023; 123:923-932.e1. [PMID: 36740187 PMCID: PMC10200734 DOI: 10.1016/j.jand.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND More than one-third of children and adolescents consume foods from quick-service restaurants (QSRs) daily, which is associated with an increased risk of diet-related adverse health conditions. OBJECTIVE To examine trends in the proximity of top-selling QSR chains to all public schools across the United States between 2006 and 2018 by community-, school-, and student-level characteristics. DESIGN This longitudinal study examined changes in the number QSRs between the 2006-2007 and 2017-2018 school years using data from National Center for Education Statistics, Infogroup US Historical Business Data, and the US Department of Agriculture's Economic Research Service. STATISTICAL ANALYSIS A mixed-model analysis of variance using census tract as a random effect and accounting for repeated measures by school was used to examine the proximity of QSRs near schools. Models adjusted for demographic characteristics and census tract population density. Data were analyzed in 2021. RESULTS During 2006, 9% of schools had QSRs within 400 m, and 25% of schools in the most populated areas had at least one QSR within 400 m. There were more QSRs near schools with a high percentage of poverty (12%), and near schools with high school students with the highest population of Black or African American (16%) and Hispanic or Latino (18%) students. By 2018, the percent of all public schools within 400 m of QSRs increased to 12%. The increase over time was greater near schools with a high percentage of poverty (16%) and near schools with high school students with the highest population of Black or African American students (22%) and Hispanic or Latino (23%) students. CONCLUSIONS This is the first nationwide study to examine trends in QSR proximity to all public schools. QSRs were most likely to be located near schools with high school students, near schools with a high percentage of poverty, and near schools with a higher proportion of racial and ethnic minority students. Over time, there were greater increases in QSRs near these schools which may have important implications for children's health and diet-related disparities.
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Affiliation(s)
- Deborah A Olarte
- Center for Health Inclusion, Research and Practice, Department of Nutrition and Public Health, School of Health Sciences, Merrimack College, North Andover, Massachusetts.
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, East Boston, Massachusetts
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, East Boston, Massachusetts; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kristen Cooksey-Stowers
- Allied Health Sciences, Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Marlaina Rohmann
- Center for Health Inclusion, Research and Practice, Department of Nutrition and Public Health, School of Health Sciences, Merrimack College, North Andover, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeffrey C Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Yuting Chen
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Rinki Deo
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice, Department of Nutrition and Public Health, School of Health Sciences, Merrimack College, North Andover, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Arrona-Cardoza P, Labonté K, Cisneros-Franco JM, Nielsen DE. The Effects of Food Advertisements on Food Intake and Neural Activity: A Systematic Review and Meta-Analysis of Recent Experimental Studies. Adv Nutr 2023; 14:339-351. [PMID: 36914293 DOI: 10.1016/j.advnut.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
Food advertisements are ubiquitous in our daily environment. However, the relationships between exposure to food advertising and outcomes related to ingestive behavior require further investigation. The objective was to conduct a systematic review and meta-analysis of behavioral and neural responses to food advertising in experimental studies. PubMed, Web of Science, and Scopus were searched for articles published from January 2014 to November 2021 using a search strategy following PRISMA guidelines. Experimental studies conducted with human participants were included. A random-effects inverse-variance meta-analysis was performed on standardized mean differences (SMD) of food intake (behavioral outcome) between the food advertisement and nonfood advertisement conditions of each study. Subgroup analyses were performed by age, BMI group, study design, and advertising media type. A seed-based d mapping meta-analysis of neuroimaging studies was performed to evaluate neural activity between experimental conditions. Nineteen articles were eligible for inclusion, 13 for food intake (n = 1303) and 6 for neural activity (n = 303). The pooled analysis of food intake revealed small, but statistically significant, effects of increased intake after viewing food advertising compared with the control condition among adults and children (adult SMD: 0.16; 95% CI: 0.03, 0.28; P = 0.01; I2 = 0; 95% CI: 0, 95.0%; Children SMD: 0.25; 95% CI: 0.14, 0.37; P < 0.0001; I2 = 60.4%; 95% CI: 25.6%, 79.0%). The neuroimaging studies involved children only, and the pooled analysis corrected for multiple comparisons identified one significant cluster, the middle occipital gyrus, with increased activity after food advertising exposure compared with the control condition (peak coordinates: 30, -86, 12; z-value: 6.301, size: 226 voxels; P < 0.001). These findings suggest that acute exposure to food advertising increases food intake among children and adults and that the middle occipital gyrus is an implicated brain region among children. (PROSPERO registration: CRD42022311357).
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Affiliation(s)
| | - Katherine Labonté
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada
| | - José Miguel Cisneros-Franco
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada; Desautels Faculty of Management, McGill University, Montreal, Canada
| | - Daiva E Nielsen
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada.
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The impact of COVID-19 on children's lives in the United States: Amplified inequities and a just path to recovery. Curr Probl Pediatr Adolesc Health Care 2022; 52:101181. [PMID: 35400596 PMCID: PMC8923900 DOI: 10.1016/j.cppeds.2022.101181] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Milan CC, Singh KR, Burac A, Janak AP, Gu Y, Bragg MA. Comparisons of Culturally Targeted Food and Beverage Advertisements in Caribbean-American Neighborhood and Non-Latinx White Neighborhood in New York City. Health Equity 2022; 6:72-80. [PMID: 36186612 PMCID: PMC9518804 DOI: 10.1089/heq.2021.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: This descriptive study aimed to (1) compare the number of food and beverage advertisements (ads) located in a Caribbean-American neighborhood and non-Latinx white neighborhood in New York City (NYC), and (2) qualitatively assess and compare the culturally targeted marketing themes of the food and beverage advertisements in both neighborhoods. Methods: Three research assistants photographed all outdoor food and beverage advertisements (n=361) across a 1.6 kilometer distance on a high-retail street in a Caribbean-American neighborhood and a non-Latinx white neighborhood. We used content analysis to evaluate advertising themes, and sorted food into nutritional categories (e.g., fast food and alcohol). We identified two neighborhoods with similar income levels in Queens, NYC, USA—South Ozone Park residents are predominantly non-white Caribbean Americans based on data from the NYC Department of City Planning, whereas residents of Steinway are predominantly non-Latinx white. Results: We identified a significantly higher proportion of fast-food advertisements in the Caribbean-American neighborhood (19.78%, n=36) compared with the non-Latinx white neighborhood (5.03%, n=9; p<0.001). Among beverage advertisements, 30.77% (n=56) featured alcohol brands in the Caribbean-American neighborhood, whereas 22.91% (n=41) featured alcohol brands in the non-Latinx white neighborhood. In the Caribbean-American neighborhood, 24.18% (n=44) of food and beverage advertisements referenced Caribbean culture. Conclusions: The Caribbean-American neighborhood in this study had more fast-food advertisements relative to non-Latinx white neighborhoods. More research is needed to understand the effects of culturally targeted ads on Caribbean-American communities.
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Affiliation(s)
- Carla C. Milan
- Department of Public Health Nutrition, School of Global Public Health, New York University, New York, New York, USA
| | - Kirti R. Singh
- Department of Public Health Nutrition, School of Global Public Health, New York University, New York, New York, USA
| | - Angelica Burac
- Department of Public Health Nutrition, School of Global Public Health, New York University, New York, New York, USA
| | - Allison P. Janak
- Department of Public Health Nutrition, School of Global Public Health, New York University, New York, New York, USA
| | - Yuanqi Gu
- Department of Public Health Nutrition, School of Global Public Health, New York University, New York, New York, USA
| | - Marie A. Bragg
- Department of Public Health Nutrition, School of Global Public Health, New York University, New York, New York, USA
- Department of Population Health, School of Medicine, New York University, New York, New York, USA
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Rothpletz-Puglia P, Fredericks L, Dreker MR, Patusco R, Ziegler J. Position of the Society for Nutrition Education and Behavior: Healthful Food for Children is the Same as Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:4-11. [PMID: 35000680 DOI: 10.1016/j.jneb.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | | | - Margaret Rush Dreker
- Hackensack Meridian School of Medicine, Interprofessional Health Sciences Library, Nutley, NJ
| | | | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ
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Jensen ML, Choi YY, Fleming-Milici F, Harris JL. Caregivers' Understanding of Ingredients in Drinks Served to Young Children: Opportunities for Nutrition Education and Improved Labeling. Curr Dev Nutr 2022; 6:nzab151. [PMID: 35047722 PMCID: PMC8760421 DOI: 10.1093/cdn/nzab151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Against expert recommendations, sugar-sweetened beverages, especially fruit drinks, are consumed by young children. Misperceptions about drink ingredients and healthfulness can contribute to caregivers' provision. OBJECTIVES To assess caregivers' reasons for serving sweetened fruit-flavored drinks and unsweetened juices to their young children (1-5 y) and perceptions of product healthfulness and drink ingredients. METHODS A cross-sectional online survey assessed participants' (n = 1614) perceptions of sweetened fruit-flavored drinks (fruit drinks and flavored water) and unsweetened juices (100% juice and water/juice blends) provided to their child in the past month, including product healthfulness, reasons for providing, and knowledge of product ingredients [added sugar, nonnutritive sweeteners (NNSs), percentage juice]. One-factor ANOVA compared perceived healthfulness of drink categories and types of sugar and NNSs, and differences between participants who could compared with those who could not accurately identify drink ingredients. RESULTS Participants' top reasons for providing sweetened drinks included child liking it, being inexpensive, child asking for it, and being a special treat. Participants perceived 100% juice as healthiest, followed by juice/water blends, flavored waters, and, lastly, fruit drinks (P < 0.05). Many participants inaccurately believed the fruit drink or flavored water they served their child most often did not contain NNSs (59.0% and 64.9%) and/or added sugars (20.1% and 42.2%), when in fact they did, and 81.3-91.1% overestimated the percentage juice in the drink. Perceived healthfulness of fruit drinks was associated with caregivers' belief that the drink contained added sugar (P < 0.05), but not with their belief that it contained NNS; increased accuracy was associated with decreased perceived healthfulness (P < 0.05). CONCLUSIONS Inaccurate understanding of added sugar, NNSs, and percentage juice in drinks served to young children was common and could contribute to sugary drink provision. Public health efforts should seek to improve labeling practices and revise nutrition education messages.
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Affiliation(s)
- Melissa L Jensen
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
- School of Nutrition, University of Costa Rica, San José, Costa Rica
| | - Yoon Y Choi
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Frances Fleming-Milici
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Jennifer L Harris
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, Sacks FM, Thorndike AN, Van Horn L, Wylie-Rosett J. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e472-e487. [PMID: 34724806 DOI: 10.1161/cir.0000000000001031] [Citation(s) in RCA: 365] [Impact Index Per Article: 121.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.
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Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting Television to Reduce Childhood Obesity: Cost-Effectiveness of Five Population Strategies. Child Obes 2021; 17:442-448. [PMID: 33970695 PMCID: PMC8568801 DOI: 10.1089/chi.2021.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To quantify the potential population-wide costs, number of individuals reached, and impact on obesity of five effective interventions to reduce children's television viewing if implemented nationally. Study Design: Utilizing evidence from systematic reviews, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost, population reach, and impact on childhood obesity from 2020 to 2030 of five hypothetical policy strategies to reduce the negative impact of children's TV exposure: (1) eliminating the tax deductibility of food and beverage advertising; (2) targeting TV reduction during home visiting programs; (3) motivational interviewing to reduce home television time at Women, Infants, and Children (WIC) clinic visits; (4) adoption of a television-reduction curriculum in child care; and (5) limiting noneducational television in licensed child care settings. Results: Eliminating the tax deductibility of food advertising could reach the most children [106 million, 95% uncertainty interval (UI): 105-107 million], prevent the most cases of obesity (78,700, 95% UI: 30,200-130,000), and save more in health care costs than it costs to implement. Strategies targeting young children in child care and WIC also cost little to implement (between $0.19 and $32.73 per child reached), and, although reaching fewer children because of the restricted age range, were estimated to prevent between 25,500 (95% UI: 4600-59,300) and 35,400 (95% UI: 13,200-62,100) cases of obesity. Home visiting to reduce television viewing had high costs and a low reach. Conclusions: Interventions to reduce television exposure across a range of settings, if implemented widely, could help prevent childhood obesity in the population at relatively low cost.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Address correspondence to: Erica L. Kenney, ScD, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | - Rebecca S. Mozaffarian
- Department of Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael W. Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Jessica L. Barrett
- Department of Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Angie L. Cradock
- Department of Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Catherine M. Giles
- Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA
| | - Zachary J. Ward
- Department of Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Steven L. Gortmaker
- Department of Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Eisenberg MD, Avery RJ, Mathios A, Ernst P, Cawley J. Disparities in exposure to television advertising of sugar-sweetened and non-nutritive sweetened beverages among U.S. adults and teens, 2007-2013. Prev Med 2021; 150:106628. [PMID: 34019929 DOI: 10.1016/j.ypmed.2021.106628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to estimate disparities in exposure to television advertising of sugar-sweetened and non-nutritive sweetened beverages among U.S. adults and teens. Data (2007-2013) came from the National Consumer Survey and included 115,510 adult respondents (age 18+) and 8635 teen respondents (age 12-17). The data was originally accessed in 2018 and analyzed in 2019-2020. The main outcomes were individual-level estimated exposure to advertisements for regular soda, diet soda, and energy/sport drinks. The main exposures were by race/ethnicity, household income, and educational attainment. Non-white adults (teens) were exposed to an estimated (per year) 101.5 (190.1) regular soda ads, 49.5 (61.2) diet soda ads, and 157.1 (279.6) energy/sport ads per year while white respondents were exposed to 97.5 (127.7) regular soda ads, 45.8 (44.2) diet soda ads, and 123.9 (192.0) energy/sport ads per year. Adult (teen) respondents who were non-white with low incomes and with low educational attainment were exposed to 4.7% (53.7%) more regular soda ads, 6.6% (43.8%) more diet ads, and 23.2% (56.2%) more energy/sport ads than respondents who were white with high incomes and high educational attainment. Demographic and socio-economic groups with a higher prevalence of obesity were exposed to significantly more advertisements for sugar-sweetened beverages. When evaluating potential policies to regulate marketing of sugar-sweetened and non-nutritive sweetened beverages, policymakers should consider the disparate exposure of at-risk populations to advertising of sugar-sweetened and non-nutritive sweetened beverages.
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Affiliation(s)
- Matthew D Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
| | - Alan Mathios
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
| | - Peter Ernst
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
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13
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Eaton TM, Kumanyika S, DiSantis KI, Yadeta K, Grier S. Black Community Conversations About Opposing Ethnically Targeted Marketing of Unhealthy Foods and Beverages. J Racial Ethn Health Disparities 2021; 9:1946-1956. [PMID: 34417762 PMCID: PMC8378522 DOI: 10.1007/s40615-021-01133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
Efforts to reduce disparities in obesity prevalence affecting Black Americans are having limited success. One reason for this may be the disproportionate, ethnically targeted marketing of foods and beverages high in fat and sugar (FBHFS) to Black consumers. Such marketing promotes high consumption of FBHFS, leading to excess caloric intake and unintentional weight gain. We convened focus groups with Black men and women (total n = 57) in collaboration with community groups in three localities to elicit their views, as consumers and parents/caregivers, about targeted FBHFS marketing and potential ways to combat it. At each location, trained community members facilitated two sets of focus groups: one for adults aged 18 to 25 years and another for adults aged 26 to 55 years who had a 3-to-17-year-old child at home. Each group met twice to discuss food and beverage marketing practices to Black communities and reviewed a booklet about ethnically targeted marketing tactics in between. A directed content analysis of participant comments identified and explored salient themes apparent from initial summarization of results. Results show how parents are concerned with and critical of pervasive FBHFS marketing. In particular, comments emphasize the involvement of Black celebrities in FBHFS marketing—how and why they engage in such marketing and whether this could be shifted towards healthier foods. These findings suggest a potential role for counter marketing efforts focused on Black celebrity endorsements of FBHFS, possibly with a youth focus. They also underscore the need for additional, qualitative exploration of Black consumer views of ethnically targeted FBHFS marketing more generally.
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Affiliation(s)
- Tiffany M Eaton
- Department of Community Health & Prevention, Drexel University Dornsife School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
| | - Shiriki Kumanyika
- Department of Community Health & Prevention, Drexel University Dornsife School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA.
| | | | - Kenna Yadeta
- Intramural Training Program, National Institute of Drug Abuse, Biomedical Research Center, Baltimore, MD, 21224, USA
| | - Sonya Grier
- Department of Marketing, Kogod School of Business, American University, Washington, DC, 20016, USA
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14
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Marketing to Children Inside Quick Service Restaurants: Differences by Community Demographics. Am J Prev Med 2021; 61:96-104. [PMID: 33994053 PMCID: PMC8277431 DOI: 10.1016/j.amepre.2021.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/04/2020] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In the U.S., children regularly consume foods from quick-service restaurants, but little is known about the marketing strategies currently used inside quick-service restaurants. This study aims to validate a child-focused Environmental Assessment Tool for quick-service restaurants, evaluate marketing strategies inside and on the exterior of quick-service restaurants, and examine differences by community race/ethnicity or income. METHODS The inter-rater and test-retest reliability of the Environmental Assessment Tool were assessed across the top 5 national quick-service restaurant chains. Marketing techniques in 165 quick-service restaurants (33 per national chain) in socioeconomically and racially/ethnically diverse communities throughout New England were examined in 2018-2019. Mixed methods ANOVA examined the differences in marketing techniques in 2020. RESULTS The inter-rater and test-retest reliability of the Environmental Assessment Tool were high (Cohen's κ>0.80). Approximately 95% of quick-service restaurants marketed less healthy foods, whereas only 6.5% marketed healthy options. When examining the differences by community demographics, there were significantly more price promotion advertisements inside and on the exterior of quick-service restaurants in lower-income communities. In addition, there was a greater number of child-directed advertisements with cartoon or TV/movie characters as well as fewer healthy entrée options and more sugar-sweetened beverage and dessert options on the children's menu inside quick-service restaurants in communities with higher minority populations. CONCLUSIONS Environmental Assessment Tool is a valid tool to evaluate marketing inside quick-service restaurants. Results suggest that there is a substantial amount of unhealthy food and beverage marketing inside quick-service restaurants, with differences in the number and types of techniques used in lower-income and minority communities. Policies that limit quick-service restaurant marketing to children should be considered.
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15
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Vanderlee L, Czoli CD, Pauzé E, Potvin Kent M, White CM, Hammond D. A comparison of self-reported exposure to fast food and sugary drinks marketing among parents of children across five countries. Prev Med 2021; 147:106521. [PMID: 33744330 DOI: 10.1016/j.ypmed.2021.106521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/28/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
Exposure to unhealthy food and beverage marketing is an important environmental determinant of dietary intake. The current study examined self-reported exposure to marketing of unhealthy foods and beverages across various media channels and settings among parents of children younger than 18 years in five high and upper-middle income countries. Data from 4827 parents living with their children were analyzed from the International Food Policy Study (2017), a web-based survey of adults aged 18-64 years from Canada, the United States (US), the United Kingdom (UK), Australia, and Mexico. Respondents reported their exposure to marketing of fast food and of sugary drinks across media channels/settings overall and how often they see fast food and sugary drink marketing while viewing media with their children. Regression models examined differences across countries and correlates of marketing exposure. Parents in Mexico and the US reported greater exposure to marketing for fast food and sugary drinks compared to parents in Australia, Canada, and the UK. Patterns of exposure among parents were generally consistent across countries, with TV, digital media, and radio being the most commonly reported media channels for both fast food and sugary drinks. Exposure to marketing of fast food and sugary drinks was associated with a variety of sociodemographic factors, most strongly with ethnicity and education, and sociodemographic trends differed somewhat between countries. The findings demonstrate differences in self-reported parental exposure to marketing of fast food and sugary drinks between countries, and may help to evaluate the impact of marketing restrictions implemented over time.
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Affiliation(s)
- Lana Vanderlee
- École de Nutrition, Centre de nutrition, santé et société (NUTRISS), Université Laval, 2425 rue de L'Agriculture, Québec, Québec G1V 0A6, Canada.
| | - Christine D Czoli
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada; Heart and Stroke Foundation of Canada, Ottawa, 110-1525 Carling Avenue, Ottawa, Ontario, K1Z 8R9, Canada
| | - Elise Pauzé
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada.
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada.
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
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16
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The Availability of Culturally Preferred Fruits, Vegetables and Whole Grains in Corner Stores and Non-Traditional Food Stores. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095030. [PMID: 34068641 PMCID: PMC8126097 DOI: 10.3390/ijerph18095030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/03/2022]
Abstract
Chronic health inequities for communities of color is partially attributed to a lack of healthy preferred food access. This manuscript explores whether corner stores and non-traditional food stores stock fruits, vegetables and whole grain foods that the area cultural communities may prefer as part of complying with a local ordinance. This exploratory analysis identified corner and non-traditional food stores located in immigrant populations of color and African American neighborhoods as part of a larger study. Culturally preferred foods were identified from a list of food items in the parent (STORE) study and used to assess changes in availability. Stores did not have a great variety of culturally relevant foods pre- or post-ordinance, and overall findings show no significant changes over time and/or between ordinance and control community. Further interventions are needed to address cultural food availability in stores near communities of color.
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Children's measured exposure to food and beverage advertising on television in a regulated environment, May 2011-2019. Public Health Nutr 2021; 24:5914-5926. [PMID: 33843565 DOI: 10.1017/s1368980021001373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To quantify food/beverage advertising on television in Montreal (Quebec), to estimate and characterise children's exposure and to examine trends over time. DESIGN Television food advertising data were licensed for nineteen food categories and eighteen stations for May 2011, 2016 and 2019. The frequency of advertisements and the average number viewed per child aged 2-11 years overall, by food category and by station type (i.e. youth-appealing (n 3) and generalist (n 15) stations) were determined. The percent change in advertising frequency and exposure between May 2011 and 2019 was calculated. SETTING Montreal, Quebec, Canada. PARTICIPANTS This study used media data and did not directly involve human participants. RESULTS The total number of television advertisements increased by 11 % between May 2011 (n 41 084) and May 2019 (n 45 406); however, exposure to food/beverage advertisements decreased by 53 %, going from 226 ads/child in May 2011 to 107 ads/child in May 2019. Overall, the most advertised food categories in both May 2011 and 2019 were fast food (29·8 % and 39·2 %, respectively) followed by chocolate (14·2 %) in 2011 and savory snacks (9·7 %) in 2019. In May 2019, children were predominantly exposed to unhealthy food categories such as fast food (41·3 % of exposure), savory snacks (7·5 %), chocolate (5·0 %) and regular soft drinks (4·5 %), and most (89·3 %) of their total exposure occurred on generalist television stations. CONCLUSION Despite Quebec's restrictions on commercial advertising directed to children under 13 years, Quebecois children are still frequently exposed to unhealthy food advertising on television. Government should tighten restrictions to protect children from this exposure.
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Maani N, VAN Schalkwyk MC, Petticrew M, Galea S. The Commercial Determinants of Three Contemporary National Crises: How Corporate Practices Intersect With the COVID-19 Pandemic, Economic Downturn, and Racial Inequity. Milbank Q 2021; 99:503-518. [PMID: 33783862 PMCID: PMC8241267 DOI: 10.1111/1468-0009.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Policy Points The United States finds itself in the middle of an unprecedented combination of crises: a global pandemic, economic crisis, and unprecedented civic responses to structural racism. While public sector responses to these crises have faced much justified criticism, the commercial determinants of these crises have not been sufficiently examined. In this commentary we examine the nature of the contributions of such actors to the conditions that underpin these crises in the United States through their market and nonmarket activities. On the basis of this analysis, we make recommendations on the role of governance and civil society in relation to such commercial actors in a post-COVID-19 world.
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Affiliation(s)
- Nason Maani
- Boston University School of Public Health.,London School of Hygiene and Tropical Medicine.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University
| | | | - Mark Petticrew
- London School of Hygiene and Tropical Medicine.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University
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19
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Television advertisements for high-sugar foods and beverages: effect on children's snack food intake. Br J Nutr 2021; 125:591-597. [PMID: 32746948 DOI: 10.1017/s0007114520003116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Energy-dense food advertising affects children's eating behaviour. However, the impact of high-sugar food advertising specifically on the intake of sweet foods is underexplored. This study sought to determine whether children would increase their intake of sugar and total energy following high-sugar food advertising (relative to toy advertising) and whether dental health, weight status and socio-economic status (SES) would moderate any effect. In a crossover, randomised controlled trial, 101 UK children (forty male) aged 8-10 years were exposed to high-sugar food/beverage and toy advertisements embedded within a cartoon. Their subsequent intake of snack foods and beverages varying in sugar content was measured. A dental examination was performed, and height and weight measurements were taken. Home postcode provided by parents was used to assign participants to SES quintiles. Children consumed a significantly greater amount of energy (203·3 (95 % CI 56·5, 350·2) kJ (48·6 (95 % CI 13·5, 83·7) kcal); P = 0·007) and sugar (6·0 (95 % CI 1·3, 10·7) g; P = 0·012) following food advertisements compared with after toy advertisements. This was driven by increased intake of the items with most sugar (chocolate and jelly sweets). Children of healthy weight and with dental caries had the greatest intake response to food advertising exposure, but there were no differences by SES. Acute experimental food advertising exposure increases food intake in children. Specifically, high-sugar food and beverage advertising promotes the consumption of high-sugar food items. The debate around the negative health effects of food advertising on children should be widened to include dental health as well as overall dietary health and obesity.
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20
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Backholer K, Gupta A, Zorbas C, Bennett R, Huse O, Chung A, Isaacs A, Golds G, Kelly B, Peeters A. Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: A systematic review of the evidence. Obes Rev 2021; 22:e13144. [PMID: 33073488 DOI: 10.1111/obr.13144] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Abstract
Children's exposure to advertising of unhealthy food and nonalcoholic beverages that are high in saturated fats, salt and/or sugar is extensive and increases children's preferences for, and intake of, targeted products. This systematic review examines the differential potential exposure and impact of unhealthy food advertising to children according to socio-economic position (SEP) and/or ethnicity. Nine databases (health, business, marketing) and grey literature were searched in November 2019 using terms relating to 'food or drink', 'advertising' and 'socioeconomic position or ethnicity'. Studies published since 2007 were included. Article screening and data extraction were conducted by two independent reviewers. Quality of studies was assessed using the Newcastle-Ottawa quality scale. Of the 25 articles included, 14 focused on exposure to unhealthy food advertising via television, nine via outdoor mediums and two via multiple mediums. Most studies (n = 19) revealed a higher potential exposure or a greater potential impact of unhealthy food advertising among ethnic minority or lower SEP children. Few studies reported no difference (n = 3) or mixed findings (n = 3). Children from minority and socio-economically disadvantaged backgrounds are disproportionately exposed to unhealthy food advertising. Regulations to restrict unhealthy food advertising to children should be implemented to improve children's diets and reduce inequities in dietary intake.
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Affiliation(s)
- Kathryn Backholer
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Adyya Gupta
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Christina Zorbas
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Rebecca Bennett
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Oliver Huse
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Alexandra Chung
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anna Isaacs
- Centre for Food Policy, University of London, London, UK
| | - Gabby Golds
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
| | - Bridget Kelly
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Anna Peeters
- Deakin University, Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development
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21
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Asada Y, Pipito AA, Chriqui JF, Taher S, Powell LM. Oakland's Sugar-Sweetened Beverage Tax: Honoring the "Spirit" of the Ordinance Toward Equitable Implementation. Health Equity 2021; 5:35-41. [PMID: 33681687 PMCID: PMC7929915 DOI: 10.1089/heq.2020.0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose: On November 8, 2016, Oakland, California, voters passed a sugar-sweetened beverage (SSB) tax, which included language to support programs affecting communities and residents most affected by SSB-related health disparities. The purpose of this study was to qualitatively assess the extent to which those communities most affected by SSB-related health disparities were included in implementation decisions and were recipients of funding to support their needs. Methods: A longitudinal case study from 2016 to 2019 in Oakland, CA, explored equity implementation themes through key informant interview transcripts (n=15) triangulated with media (n=90) and archived documents (n=43). Using principals of constant comparative analysis, all documents (n=148) were coded and thematically analyzed in Atlas.ti. Results: SSB taxes-designed to support communities disproportionately impacted by SSB consumption-can be implemented with inclusivity and community representation. The Oakland ordinance established a Community Advisory Board (CAB) that partnered with community organizations throughout implementation to ensure inclusivity and recommend funding for programs to address health inequities, described as the "spirit" of the ordinance. These activities countered the beverage industry's tactics to target lower income communities of color with misinformation campaigns and hinder implementation. Conclusion: A clearly written ordinance provides guidance, which affords an intentional and legal foundation for implementation processes. Establishing a CAB can mitigate inequities as members are invested in the community and initiatives to support residents. Advisory boards are able to liaise between city and local partners, which is a powerful tool for countering opposition campaigns, reaching lower income and communities of color, and ensuring adherence to funding mandates.
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Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A. Pipito
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sabira Taher
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa M. Powell
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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22
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Sutherland ME. Prevalence of Overweight and Obesity Among African American Children and Adolescents: Risk Factors, Health Outcomes, and Prevention/Intervention Strategies. J Racial Ethn Health Disparities 2021; 8:1281-1292. [PMID: 33420607 DOI: 10.1007/s40615-020-00890-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/21/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
This paper examines the biological, psychosocial, cultural, and obesogenic environmental factors that might account for the high prevalence rates of overweight and obesity among African American young children (aged 2-11) and adolescents (aged 12-19). Research findings are discussed on the practices associated with the development of childhood obesity including maternal overweight and obesity, physiological predisposition, infant feeding practices, breastfeeding, rapid infant weight gain, sleep disruption, low nutrition diets, physical inactivity, and sedentary behavior. The psychological correlates of overweight and obesity are discussed. Consistent with the obesogenic arguments, this paper examines the development of childhood obesity as a function of socioeconomic disadvantages, social inequities, urban environmental contingencies, and media food product messages. The potential deleterious health consequences of overweight and obesity are discussed. There is an examination of the structural-level and individual-level prevention/intervention strategies necessary for sustainable declines in childhood overweight and obesity.
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Affiliation(s)
- Marcia E Sutherland
- Departments of Africana Studies & Psychology, University at Albany, State University of New York, Hudson Building, Room l6l, l400 Washington Avenue, Albany, NY, 12222, USA.
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23
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Fischer NM, Duffy EY, Michos ED. Protecting Our Youth: Support Policy to Combat Health Disparities Fueled by Targeted Food Advertising. J Am Heart Assoc 2021; 10:e018900. [PMID: 33375810 PMCID: PMC7955455 DOI: 10.1161/jaha.120.018900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Nicole M. Fischer
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Eamon Y. Duffy
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMD
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24
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Malawa Z, Gaarde J, Spellen S. Racism as a Root Cause Approach: A New Framework. Pediatrics 2021; 147:peds.2020-015602. [PMID: 33386339 DOI: 10.1542/peds.2020-015602] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
The field of public health has identified racial health disparities as a chief concern for decades. Although there has been a myriad of published articles in which researchers describe the severity and complexity of these disparities, they persist into present day relatively unchanged. We believe this lack of progress can be explained, in part, by a failure to acknowledge that racism is at the root of these racial disparities. Many children's health advocates believe more should be done to address our country's systemic racial inequities, but few of us feel able to create meaningful change, and even fewer feel that it is our responsibility. As a result, many opt to pursue programmatic fixes and Band-Aid solutions over addressing the underlying systemic, interpersonal, and historical racism. We hope to empower children's health advocates by introducing a solutions-centered framework for addressing racism as a root cause. This approach can help guide and structure the important work of dismantling racism so Black, Indigenous, and other racially marginalized families can finally have an equal opportunity for good health.
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Affiliation(s)
| | | | - Solaire Spellen
- Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, California; and
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25
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Hooked on Junk: Emerging Evidence on How Food Marketing Affects Adolescents’ Diets and Long-Term Health. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00346-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Factors Influencing the Early Introduction of Sugar Sweetened Beverages among Infants: Findings from the HSHK Birth Cohort Study. Nutrients 2020; 12:nu12113343. [PMID: 33143073 PMCID: PMC7693806 DOI: 10.3390/nu12113343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/27/2022] Open
Abstract
Understanding the determinants of early introduction of sugar sweetened beverages (SSBs) may assist in designing effective public health interventions to prevent childhood weight related conditions (obesity). This study explores the relationship between family/infant characteristics and the early introduction of SSBs among infants in Sydney, Australia. Mothers (n = 934) from an ongoing birth cohort study were interviewed at 8, 17, 34, and 52 weeks postpartum. Multivariable logistic regression analysis was used to identify family/infant factors independently associated with the likelihood of early introduction of SSBs (<52 weeks of age). Of the 934 mothers interviewed, 42.7% (n = 399) of infants were introduced to SSBs before 52 weeks. Mothers who were born in Vietnam (adjusted Odds Ratio (AOR) = 2.14; 95% confidence interval (CI) 1.33, 3.47), other Asian countries (AOR = 1.62; 95% CI 1.02, 2.58) as well as single mothers (AOR = 3.72; 95% CI 2.46, 5.62) had higher odds of introducing SSBs early to their infants. Mothers from highly advantaged socioeconomic background (AOR = 0.43; 95% CI 0.28, 0.68), those who breastfed their baby for 17–25 weeks (AOR = 0.60; 95% CI 0.37, 0.99), 26–51 weeks (AOR = 0.65; 95% CI 0.45, 0.94), and 52 weeks or more (AOR = 0.62; 95% CI 0.43, 0.90); and those who introduced solids between 17–25 weeks (AOR = 0.58; 95% CI 0.36, 0.91) and 26 weeks or more (AOR = 0.55; 95% CI 0.34, 0.91) had reduced odds of introducing SSBs early. Tailoring health promotion programs for these vulnerable groups may delay the introduction of SSBs.
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Te'Eni-Harari T, Eyal K. The Role of Food Advertising in Adolescents' Nutritional Health Socialization. HEALTH COMMUNICATION 2020; 35:882-893. [PMID: 30947557 DOI: 10.1080/10410236.2019.1598737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adolescents are heavily exposed to food advertising in their daily lives. Food ads tend to juxtapose unhealthy food products with overly thin models who promote these foods. This paradoxical presentation of food and body raises important questions about adolescents' perceptions of food ads and the body, as part of the larger realm of nutritional health. The study sheds light on adolescents' nutritional health socialization by exploring the role of food advertising as it intersects with other socialization agents, namely parents and peers. Adolescent's perceptions of and reactions to food ads, and the food products and models in these ads, are examined using the media practice model as the theoretical framework. In-depth interviews were conducted with 82 adolescents in middle- and high-school, taking into consideration their development, heightened vulnerability to messages about the body and appearances, and their lived experiences. The study's findings suggest that adolescents, though skeptical of ads, internalize the mediated thin ideal and expect models in ads to be thin, beautiful, and famous. Parents emerged as positive role models for nutritional health whereas peers are more paradoxical, emphasizing the importance of exercising along with a socially-oriented consumption of junk food. Socialization messages from parents, peers, and the media interact in shaping adolescents' reactions to food ads. Only minimal gender differences were found in adolescents' reactions to food ads and their approach to nutritional health. Mostly, female models are expected to meet more stringent standards of thinness and beauty than male models, especially among female adolescents.
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Affiliation(s)
| | - Keren Eyal
- Sammy Ofer School of Communications, The Interdisciplinary Center (IDC) Herzliya
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Nutritional problems in childhood and adolescence: a narrative review of identified disparities. Nutr Res Rev 2020; 34:17-47. [PMID: 32329426 DOI: 10.1017/s095442242000013x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.
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Gudzune KA, Opara O, Martinez JC, Doshi RS, Levine DM, Latkin CA, Clark JM. Social Network Intervention Reduces Added Sugar Intake Among Baltimore Public Housing Residents: A Feasibility Study. Nutr Metab Insights 2020; 13:1178638820909329. [PMID: 32165849 PMCID: PMC7052458 DOI: 10.1177/1178638820909329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/20/2020] [Indexed: 01/24/2023] Open
Abstract
Public housing residents have high intake of added sugars, which is associated with sugar-sweetened beverage (SSB) consumption in their social networks. In this feasibility study, we designed and tested a network-oriented intervention to decrease added sugar intake by encouraging reduced SSB consumption. We conducted a 6-month single-arm trial testing a small-group curriculum (9 sessions) that combined behavior change strategies to reduce added sugar intake by promoting SSB reduction with a peer outreach approach. We recruited and trained public housing residents to be "Peer Educators," who then communicated information and made changes to reduce SSB with their network members. We calculated the median number of group sessions attended and determined the percentage of individuals satisfied with the program. We estimated added sugar intake using a 5-factor dietary screener and compared baseline and 6-month median values using Wilcoxon signed rank tests. We recruited 17 residents and 17 of their network members (n = 34). Mean age was 45.7 years, 79.4% were women, and 97.1% were African American. Median number of sessions attended was 9 (interquartile range: 4-9), and 88.2% were very satisfied with the program. Overall, baseline median added sugar intake was 38.0 tsp/day, which significantly declined to 17.2 tsp/day at 6 months (P < .001). Residents and network members achieved similar results at 6 months (17.4 vs 16.9 tsp/day, respectively). In conclusion, our results demonstrate that a social network intervention aimed at reducing SSB consumption is feasible and can produce significant decreases in adult added sugar intake, which warrants further investigation in a randomized controlled trial.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Onumara Opara
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan C Martinez
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchi S Doshi
- Division of Internal Medicine-Pediatrics, Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - David M Levine
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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30
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Nguyen KH, Glantz SA, Palmer CN, Schmidt LA. Transferring Racial/Ethnic Marketing Strategies From Tobacco to Food Corporations: Philip Morris and Kraft General Foods. Am J Public Health 2020; 110:329-336. [PMID: 31944842 PMCID: PMC7002936 DOI: 10.2105/ajph.2019.305482] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate the transfer of marketing knowledge and infrastructure for targeting racial/ethnic minorities from the tobacco to the food and beverage industry in the United States.Methods. We analyzed internal industry documents between April 2018 and April 2019 from the University of California San Francisco Truth Tobacco Industry Documents Library, triangulated with other sources.Results. In the 1980s, Philip Morris Companies purchased General Foods and Kraft Foods and created Kraft General Foods. Through centralized marketing initiatives, Philip Morris Companies directly transferred expertise, personnel, and resources from its tobacco to its food subsidiaries, creating a racial/ethnic minority-targeted food and beverage marketing program modeled on its successful cigarette program. When Philip Morris Companies sold Kraft General Foods in 2007, Kraft General Foods had a "fully integrated" minority marketing program that combined target marketing with racial/ethnic events promotion, racial/ethnic media outreach, and corporate donations to racial/ethnic leadership groups, making it a food industry leader.Conclusions. The tobacco industry directly transferred racial/ethnic minority marketing knowledge and infrastructure to food and beverage companies. Given the substantial growth of food and beverage corporations, their targeting of vulnerable populations, and obesity-related disparities, public policy and community action is needed to address corporate target marketing.
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Affiliation(s)
- Kim H Nguyen
- All of the authors are with the Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco (UCSF), San Francisco
| | - Stanton A Glantz
- All of the authors are with the Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco (UCSF), San Francisco
| | - Casey N Palmer
- All of the authors are with the Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco (UCSF), San Francisco
| | - Laura A Schmidt
- All of the authors are with the Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco (UCSF), San Francisco
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Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, Balabanova D, Bhan MK, Bhutta ZA, Borrazzo J, Claeson M, Doherty T, El-Jardali F, George AS, Gichaga A, Gram L, Hipgrave DB, Kwamie A, Meng Q, Mercer R, Narain S, Nsungwa-Sabiiti J, Olumide AO, Osrin D, Powell-Jackson T, Rasanathan K, Rasul I, Reid P, Requejo J, Rohde SS, Rollins N, Romedenne M, Singh Sachdev H, Saleh R, Shawar YR, Shiffman J, Simon J, Sly PD, Stenberg K, Tomlinson M, Ved RR, Costello A. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet 2020; 395:605-658. [PMID: 32085821 DOI: 10.1016/s0140-6736(19)32540-1] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand; Partnership for Maternal Newborn & Child Health, Geneva, Switzerland
| | | | - Anshu Banerjee
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Stefan Peterson
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, OT, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - John Borrazzo
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Fadi El-Jardali
- Department of Health Management and Policy, Beirut, Lebanon; Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Asha S George
- School of Public Health, University of Western Cape, Bellville, South Africa
| | | | - Lu Gram
- Institute for Global Health, London, UK
| | - David B Hipgrave
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Aku Kwamie
- Health Policy and Systems Research Consultant, Accra, Ghana
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Raúl Mercer
- Program of Social Sciences and Health, Latin American School of Social Sciences, Buenos Aires, Argentina
| | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | | | | | | | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Papaarangi Reid
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, Data and Analytics Section, New York, USA
| | - Sarah S Rohde
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Nigel Rollins
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | | | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Rana Saleh
- Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Yusra R Shawar
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy Shiffman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jonathon Simon
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, QLD, Australia
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rajani R Ved
- National Health Systems Resource Centre, New Delhi, India
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Czoli CD, Pauzé E, Potvin Kent M. Exposure to Food and Beverage Advertising on Television among Canadian Adolescents, 2011 to 2016. Nutrients 2020; 12:nu12020428. [PMID: 32046142 PMCID: PMC7071192 DOI: 10.3390/nu12020428] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 11/25/2022] Open
Abstract
Adolescents represent a key audience for food advertisers, however there is little evidence of adolescent exposure to food marketing in Canada. This study examined trends in Canadian adolescents’ exposure to food advertising on television. To do so, data on 19 food categories were licensed from Nielsen Media Research for May 2011, 2013, and 2016 for the broadcasting market of Toronto, Canada. The average number of advertisements viewed by adolescents aged 12–17 years on 31 television stations during the month of May each year was estimated using television ratings data. Findings revealed that between May 2011 and May 2016, the total number of food advertisements aired on all television stations increased by 4%, while adolescents’ average exposure to food advertising decreased by 31%, going from 221 ads in May 2011 to 154 in May 2016. In May 2016, the advertising of fast food and sugary drinks dominated, relative to other categories, accounting for 42% and 11% of all exposures, respectively. The findings demonstrate a declining trend in exposure to television food advertising among Canadian adolescents, which may be due to shifts in media consumption. These data may serve as a benchmark for monitoring and evaluating future food marketing policies in Canada.
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Affiliation(s)
- Christine D Czoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (C.D.C.); (E.P.)
- Heart and Stroke Foundation, Ottawa, ON K1Z 8R9, Canada
| | - Elise Pauzé
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (C.D.C.); (E.P.)
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (C.D.C.); (E.P.)
- Correspondence: ; Tel.: +1-(613)-562-5800 (ext. 7447)
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Emond JA, Longacre MR, Drake KM, Titus LJ, Hendricks K, MacKenzie T, Harris JL, Carroll JE, Cleveland LP, Gaynor K, Dalton MA. Influence of child-targeted fast food TV advertising exposure on fast food intake: A longitudinal study of preschool-age children. Appetite 2019; 140:134-141. [PMID: 31078700 PMCID: PMC6691970 DOI: 10.1016/j.appet.2019.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/27/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Fast food (FF) advertising is a potential risk factor for FF consumption among children, yet the impact of such advertising on children's FF intake has not been assessed in a longitudinal, naturalistic study. Whether parents' FF consumption mitigates advertising effects is also unknown. METHODS One-year, longitudinal study among 624 preschool-age children, 3-5 years old, and one parent each recruited from New Hampshire, 2014-2015. Parents completed six online surveys every eight weeks and, at each, reported the number of times their children consumed FF in the past week. Each child's advertisement exposure was determined by counting the brand-specific FF advertisements aired within the programs they viewed on children's TV networks during the study. At baseline, parents reported the frequency of their own FF consumption. Data were analyzed in 2017-2018. RESULTS Three FF brands targeted TV advertising to children during the study: McDonald's, Wendy's and Subway. Few children were exposed to child-targeted advertising for Wendy's or Subway. Results from adjusted Poisson regression models focused on McDonald's showed a differential effect of advertisement exposure on children's McDonald's intake in the past week (any or mean intake) by parental FF consumption (P < 0.01). Specifically, McDonald's intake was consistently high among children whose parents consumed FF more frequently (≥monthly), regardless of children's advertisement exposure. However, advertisement exposure increased the risk of McDonald's intake among children nearly two-fold when parents consumed FF less frequently ( CONCLUSIONS Results suggest that child-targeted FF advertising may mitigate the protective effect of infrequent parental FF intake on children's FF intake.
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Affiliation(s)
- Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Meghan R Longacre
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Keith M Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Linda J Titus
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Kristy Hendricks
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Todd MacKenzie
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, CT, USA
| | - Jennifer E Carroll
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Lauren P Cleveland
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, MA, USA
| | - Kelly Gaynor
- VA Boston Healthcare System, MAVERIC, Boston, MA, USA
| | - Madeline A Dalton
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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Truman E, Elliott C. Identifying food marketing to teenagers: a scoping review. Int J Behav Nutr Phys Act 2019; 16:67. [PMID: 31426809 PMCID: PMC6700978 DOI: 10.1186/s12966-019-0833-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background Teenagers are aggressively targeted by food marketing messages (primarily for unhealthy foods) and susceptible to this messaging due to developmental vulnerabilities and peer-group influence. Yet limited research exists on the exposure and power of food marketing specifically to teenage populations. Research studies often collapse “teenagers” under the umbrella of children or do not recognize the uniqueness of teen-targeted appeals. Child- and teen-targeted marketing strategies are not the same, and this study aims to advance understanding of teen-targeted food marketing by identifying the teen-specific promotion platforms, techniques and indicators detailed in existing literature. Methods A systematic scoping review collected all available literature on food marketing/advertising with the term “teenager” or “adolescent” from nine databases, as well as Google Scholar for grey literature, and a hand search of relevant institutional websites. Included were all peer-reviewed journal articles, book chapters, and grey literature in which food marketing to youth was the central topic of the article, of any study type (i.e., original research, reviews, commentaries and reports), and including any part of the 12–17 age range. Results The 122 articles reviewed define the scope of existing literature on food marketing to young people age 17 and under, identifying leading trends in countries studied (United States, 52%), populations identified (children and teens studied concurrently, 36%), outcomes measured (advertising exposure, 54%), study type (cross-sectional, 58%) and methods used (content analysis, 46%). The promotion platforms and techniques used by food marketers to appeal to young people (as reported in the literature) are also identified and classified. Few studies (7%) use indicators to identify teen-targeted food marketing. Conclusions Unique treatments of teen populations are limited in food marketing literature, as is the application of clear indicators to identify and differentiate teen-targeted food marketing from child- or adult-targeted content. Given the need to better measure the presence and power of teen food marketing, this is a significant oversight in existing literature. The indicators identified will help researchers to develop more accurate strategies for researching and monitoring teen-targeted food promotion.
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Affiliation(s)
- Emily Truman
- Department of Communication, Media and Film, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Charlene Elliott
- Department of Communication, Media and Film, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Emond JA, Longacre MR, Drake KM, Titus LJ, Hendricks K, MacKenzie T, Harris JL, Carroll JE, Cleveland LP, Langeloh G, Dalton MA. Exposure to Child-Directed TV Advertising and Preschoolers' Intake of Advertised Cereals. Am J Prev Med 2019; 56:e35-e43. [PMID: 30573338 PMCID: PMC6340774 DOI: 10.1016/j.amepre.2018.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Child-directed TV advertising is believed to influence children's diets, yet prospective studies in naturalistic settings are absent. This study examined if child-directed TV advertisement exposure for ten brands of high-sugar breakfast cereals was associated with children's intake of those brands prospectively. METHODS Observational study of 624 preschool-age children and their parents conducted in New Hampshire, 2014-2015. Over 1 year, parents completed a baseline and six online follow-up surveys, one every 8 weeks. Children's exposure to high-sugar breakfast cereal TV advertisements was based on the network-specific TV programs children watched in the 7 days prior to each follow-up assessment, and parents reported children's intake of each advertised high-sugar breakfast cereal brand during that same 7-day period. Data were analyzed in 2017-2018. RESULTS In the fully adjusted Poisson regression model accounting for repeated measures and brand-specific effects, children with high-sugar breakfast cereal advertisement exposure in the past 7 days (i.e., recent exposure; RR=1.34, 95% CI=1.04, 1.72), at any assessment in the past (RR=1.23, 95% CI=1.06, 1.42), or recent and past exposure (RR=1.37, 95% CI=1.15, 1.63) combined had an increased risk of brand-specific high-sugar breakfast cereal intake. Absolute risk difference of children's high-sugar breakfast cereal intake because of high-sugar breakfast cereal TV advertisement exposure varied by brand. CONCLUSIONS This naturalistic study demonstrates that child-directed high-sugar breakfast cereal TV advertising was prospectively associated with brand-specific high-sugar breakfast cereal intake among preschoolers. Findings indicate that child-directed advertising influences begin earlier and last longer than previously demonstrated, highlighting limitations of current industry guidelines regarding the marketing of high-sugar foods to children under age 6 years.
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Affiliation(s)
- Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
| | - Meghan R Longacre
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Keith M Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Greylock McKinnon Associates, Cambridge, Massachusetts
| | - Linda J Titus
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Kristy Hendricks
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Todd MacKenzie
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, Connecticut
| | - Jennifer E Carroll
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lauren P Cleveland
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, Massachusetts
| | - Gail Langeloh
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Madeline A Dalton
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Fleming-Milici F, Harris JL, Liu S. Race, Ethnicity, and Other Factors Predicting U.S. Parents' Support for Policies to Reduce Food and Beverage Marketing to Children and Adolescents. Health Equity 2018; 2:288-295. [PMID: 30345413 PMCID: PMC6195095 DOI: 10.1089/heq.2018.0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Examine parents' support for policies to reduce unhealthy food and beverage marketing to children and adolescents and identify racial, ethnic, and other sociodemographic characteristics that predict support. Methods: Online survey of U.S. parents (N=3356) with children 2-17 years of age conducted annually (2009-2012). Participants provided attitudes about food marketing to their children, including perceived negative impact and support for food marketing-related policies. Sociodemographic characteristics examined were as follows: race, ethnicity, income, gender, political orientation, and child characteristics. Results: Overall, parents agreed that food marketing negatively impacts their children's eating habits (M=6.87±2.08 out of 10) and supported food marketing-related policies (M=6.73±2.37). Perceived negative impact predicted support and was highest among black and Hispanic parents. Controlling for income and age of children in the household, Hispanic and black parents expressed highest support for policies, as did women and parents who identified as liberal or moderate in political orientation. A significant interaction between parents' political orientation and race/ethnicity indicated similarly high support among all parents, except white non-Hispanic conservative parents. Conclusion: These findings are encouraging for efforts to enact policies to address unhealthy food marketing to youth. High levels of support among parents suggest advocates should continue to engage parents in their efforts. Findings also suggest that families of color would welcome policies limiting unhealthy food marketing to youth in their communities. Issues of targeted marketing and disproportionate exposure to unhealthy food marketing by black and Hispanic youth may be incorporated into campaigns to address food justice and health inequities in communities of color.
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Affiliation(s)
- Frances Fleming-Milici
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| | - Jennifer L. Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| | - Sai Liu
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Kumanyika S. The Sociocultural Context for Obesity Prevention and Treatment in Children and Adolescents: Influences of Ethnicity and Gender. CONTEMPORARY ENDOCRINOLOGY 2018. [DOI: 10.1007/978-3-319-68192-4_40] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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