Monitoring food and non-alcoholic beverage promotions to children

Food for thought or food for emotions? An analysis of marketing strategies in television food advertising seen by children in Colombia

OBJECTIVE

To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES).

DESIGN

A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years.

SETTING

All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017.

PARTICIPANTS

N/A.

RESULTS

Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients.

CONCLUSION

The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

The impact of fast food marketing on brand preferences and fast food intake of youth aged 10-17 across six countries

BACKGROUND

Consumption of fast food, which is associated with poor diet, weight gain and the development of noncommunicable diseases, is high amongst youth. Fast food marketing, a modifiable determinant of excess weight and obesity, affects youth's food-related behaviours. This study aimed to examine the relationship between exposure to fast food marketing and the fast food brand preferences and intake amongst youth aged 10-17 across six countries.

METHODS

Data from 9,695 youth respondents living in Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States (US) were analyzed from the 2019 International Food Policy Study (IFPS) Youth Survey. Survey measures assessed exposure to fast food marketing and brand-specific marketing, and preference for these brands and fast food intake. Regression models adjusted for age, sex, income adequacy and ethnicity were used to examine the associations.

RESULTS

Exposure to fast food marketing was positively associated with brand preferences and intake consistently across most countries. Overall, preference for McDonald's (OR:1.97; 95% CI:1.52, 2.56), KFC (OR:1.61; 95% CI:1.24, 2.09) and Subway (OR:1.73; 95% CI:1.34, 2.24) were highest when exposed to general fast food marketing ≥ 2x/week compared to never. Preference for McDonald's (OR:2.32; 95% CI:1.92, 2.79), KFC (OR:2.28; 95% CI:1.95, 2.68) and Subway (OR:2.75; 95% CI:2.32, 3.27) were also higher when exposed to marketing for each brand compared to not. Fast food intake was highest in Chile (IRR:1.90; 95% CI:1.45, 2.48), the UK (IRR:1.40; 95% CI:1.20, 1.63), Canada (IRR:1.32; 95% CI:1.19, 1.48), Mexico (IRR:1.26; 95% CI:1.05, 1.53) and the US (IRR:1.21; 95% CI:1.05, 1.41) when exposed to general fast food marketing ≥ 2x/week compared to never and was higher across most countries when exposed to brand-specific marketing compared to not. Respondents classified as ethnic minorities were more likely to report consuming fast food than ethnic majorities, and females were less likely to report consuming fast food than males.

CONCLUSIONS

Exposure to fast food marketing is consistently and positively associated with brand preferences and fast food intake in all six countries. Our results highlight the need for strict government regulation to reduce exposure of unhealthy food marketing to youth in all six countries.

Unhealthy food advertising on Costa Rican and Guatemalan television: a comparative study

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.

[From production to impacts on health and the environment: an analysis of food systems in Brazil, Colombia and Panama]

The scope of this article is to describe the main components of the food systems of Brazil, Colombia and Panama. It involved a narrative review of the literature from 2000 to 2022, based on the concept of food systems proposed by the Committee on World Food Security. A system of agro-industrial production, monoculture, use of pesticides and exploitation of natural resources predominates in all three countries, and the area occupied by family farmers is reduced. Multinational supermarket chains dominate food distribution, essentially in large urban centers, despite the increasing search for alternative models. Advances have been made in food labeling regulation (Colombia and Brazil) and in the taxation of sugar-sweetened beverages (Panama). The predominant food systems in these countries generate a significant and negative environmental impact, favor the consumption of ultra-processed foods, high prevalence of obesity and chronic non-transmissible diseases and increase in hunger, violating the human right to adequate food.

Contemporary Approaches for Monitoring Food Marketing to Children to Progress Policy Actions

PURPOSE OF REVIEW

Protecting children from unhealthful food marketing is a global priority policy for improving population diets. Monitoring the nature and extent of children's exposure to this marketing is critical in policy development and implementation. This review summarises contemporary approaches to monitor the nature and extent of food marketing to support policy reform.

RECENT FINDINGS

Monitoring approaches vary depending on the stage of progress of related policy implementation, with resource implications and opportunity costs. Considerations include priority media/settings. marketing techniques assessed, approach to classifying foods, study design and if exposure assessments are based on media content analyses or are estimated or observed based on children's media use. Current evidence is largely limited to high-income countries and focuses on content analyses of TV advertising. Ongoing efforts are needed to support monitoring in low-resource settings and to progress monitoring to better capture children's actual exposures across media and settings.

A Scoping Review of Observational Studies on Food and Beverage Advertising on Social Media: A Public Health Perspective

Popular social media platforms have been actively used by ultra-processed food companies to promote their products. Being exposed to this type of advertising increases the consumption of unhealthy foods and the risk of developing obesity and other non-communicable diseases (NCDs). Thus, monitoring commercial content on social media is a core public health practice. We aimed to characterize the methods used for monitoring food advertising on social media and summarize the investigated advertising strategies via a scoping review of observational studies. This study is reported according to the MOOSE Statement, and its protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration nº. CRD42020187740). Out of the 6093 citations retrieved, 26 met our eligibility criteria. The studies were published from 2014 to 2021, mostly after 2018. They focused on Australia, Facebook, strategies aimed at children and adolescents, and advertising practices of ultra-processed food companies. We grouped strategies in eight classes: post features (n = 18); connectivity and engagement (n = 18); economic advantages, gifts, or competitions (n = 14); claims (n = 14); promotional characters (n = 12); brand in evidence (n = 8); corporate social responsibility or philanthropy (n = 7); and COVID-19 (n = 3). We found similarities in the investigation of strategies regardless of the type of social media. Our findings can contribute to the designing of tools for monitoring studies and regulatory mechanisms to restrict the exposure of food advertising.

Systematic review of the effect of policies to restrict the marketing of foods and non-alcoholic beverages to which children are exposed

This systematic review examined the effectiveness of policies restricting the marketing of foods and/or non-alcoholic beverages to children to inform updated World Health Organization (WHO) guidelines. Databases were searched to March 2020. Inclusion criteria were primary studies of any design assessing implemented policies to restrict food marketing to children (0-19 years). Critical outcomes were exposure to and power of marketing, dietary intake, choice, preference, and purchasing. Important outcomes were purchase requests, dental caries, body weight, diet-related noncommunicable diseases, product change, and unintended consequences. Forty-four observational studies met inclusion criteria; most were moderate quality. Pooling was conducted using vote counting by direction of effect, and GRADE was used to judge evidence certainty. Evidence suggests food marketing policies may result in reduced purchases of unhealthy foods and in unintended consequences favorable for public health. Desirable or potentially desirable (for public health) effects of policies on food marketing exposure and power were also found. Evidence on diet and product change was very limited. The certainty of evidence was very low for four outcomes (exposure, power, dietary intake, and product change) and low for two (purchasing and unintended consequences). Policies can effectively limit food marketing to children; policymakers should prioritize mandatory approaches aligned with WHO recommendations.

The extent and nature of television food and non-alcoholic beverage advertising to children during chinese New Year in Beijing, China

Background

Exposure to food and non-alcoholic beverage advertisements (F&B ads) on television, which can affect children’s nutrition knowledge, food consumption, diet quality, and purchasing preferences, is one aspect of the obesogenic environment. This aspect has been well-studied and assessed in many countries. In China, however, only few studies have been done in earlier years and all of them were focus on regular days. This study aimed to assess the extent and nature of F&B ads on television (TV) during the public holiday directed towards children aged 4–14 years in Beijing.

Method

Top 3 channels viewed by children aged 4–14 years in Beijing were selected by TV viewership data, survey, and expert consultation. Each channel was recorded for 7 days (24 h) during the public holiday of the Chinese New Year in 2019. F&B ads were coded and analyzed following the adapted food promotion module of INFORMAS protocol. Three nutrient profile models were used to classify F&B ads as healthy or unhealthy F&B ads.

Results

Of the 10,082 ads in 504-hour recorded programs, 42.9% were F&B ads. The hourly average ads and F&B ads per channel were 19.8 (SD 15.32) and 8.6 (SD 9.84), while that was higher on the national children’s channel (17.15, SD 12.25) than other channels (p < 0.05). Of F&B ads classified with the three nutrient profile models, more than 55% were unhealthy for children. The categories most frequently advertised were savory snacks, milk drinks, nonpermitted milk drinks, cakes/sweet biscuits, and beverages. Unhealthy F&B ads were more likely to use promotional characters, brand benefit claims, and health claims than permitted F&B ads (p < 0.05).

Conclusions

Children in Beijing were exposed to a high proportion of unhealthy F&B ads during the Chinese New Year holiday. Our findings support the need to assess and regulate TV F&B ads marketing for children.

Methodologies for Monitoring the Digital Marketing of Foods and Beverages Aimed at Infants, Children, and Adolescents (ICA): A Scoping Review

While television has been the most widely used medium for food and beverage marketing, companies are shifting in favor of digital media. The ubiquitous digital marketing of breast-milk substitutes (BMS) and foods and beverages high in saturated fat, salt, and/or free sugars (FBHFSS) has been considered a powerful environmental determinant of inadequate dietary practices during infancy, childhood, and adolescence. The scoping review’s aim was to systematically identify and map the types of methodologies available to monitor the digital marketing of foods and beverages targeting infants, children, and adolescents (ICA) worldwide. Research evidence published from 2011 to October 2021 was examined using search strategies including multiple databases and citation tracking. A total of 420 sources were evaluated, and 28 studies from 81 countries meeting the inclusion criteria were retained. Most of the studies (n = 24) documenting methodologies to monitor inappropriate digital marketing were published since 2015 and were primarily aimed at identifying the promotional techniques and nutritional content of FBHFSS targeting adolescents (n = 13). It is paramount to develop a feasible and scalable monitoring system to develop effective policies to protect parents and ICA from BMS and FBHSFF digital marketing.

Impact of Obesogenic Environments on Sugar-Sweetened Beverage Consumption among Preschoolers: Findings from a Cross-Sectional Survey in Beijing

The excessive consumption of sugar-sweetened beverages (SSBs) has been proven to be critical for obesity among preschoolers. This study aimed to describe the SSB consumption rates among preschoolers in the Dongcheng District of Beijing, China, and to explore the association between obesogenic environmental determinants and consumption. We applied a stratified cluster sampling method and recruited 3057 primary caregivers of preschoolers in June 2019 to participate in the survey. The caregivers reported their children’s consumption rates of six categories of SSBs and their exposure rates to SSB-related obesogenic environments. The associations between them were tested using multivariate logistic regression models. The mean (SD) age of the children was 5.6 (0.6) years and nearly half (48.3%) were girls. About 84.5% of the children had consumed SSBs over the past three months, and sugar-sweetened milk beverages had the highest consumption rate. Higher exposure to advertisements for the corresponding SSB categories in children, higher frequency rates of consuming SSBs and of taking children to fast-food restaurants in caregivers, and lower frequency rates of reading the Nutrition Facts Panels by caregivers were associated with higher SSB consumption rates among children (p < 0.05 in all of the SSB categories investigated, except for the Nutrition Facts Panel reading behaviors for the sports and energy beverages). SSB consumption among preschoolers is of concern, and comprehensive policy actions and education are urgently needed.

Factors Influencing Adolescents' Dietary Behaviors in the School and Home Environment in Addis Ababa, Ethiopia

Background

Malnutrition affects many adolescents in Ethiopia. Over one-third of adolescent girls and two-thirds of boys are thin. Overweight and obesity in Ethiopia is mostly a concern in urban populations of higher wealth quintiles. Urbanization and globalization of diets is shifting food environments. The objective of this study was to assess whether food environments in and around schools in urban Ethiopia influence dietary diversity, quality, BMI status or perceptions of adolescents.

Methods

Twelve high schools were selected in Addis Ababa (private/government). From each school, 20 pupils aged 15–19 years were randomly selected (n = 217) and interviewed about assets in their households, their diets (categorized into 10 food groups of the Minimum Dietary Diversity, the Global Dietary Recommendations scores and four categories of the NOVA classification based on level of processing) and their use of pocket money. In addition, food environment audits were conducted within the school compound and a 0.5 km radius around each school and types of food outlets.

Results

On average there were 436 food outlets and 246 food or drink advertisements around each school. The majority of the advertisements (89.9%) were of ultra-processed foods, mostly sugar-sweetened beverages (SSBs). Most were positioned on food outlets (89.1%). SSBs or sweets were visibly on display in 26.3% of the outlets and fresh fruits and vegetables in 17.9% of outlets. Dietary diversity of adolescents was poor with an average of 3.6 food groups out of 10 consumed in the last 24 h. Ultra-processed foods and beverages were consumed by 23.5% of adolescents. The majority of adolescents spent their pocket money on SSBs, sweets or fried foods. Our analysis found that higher assets in adolescents' households were associated with higher dietary diversity and consumption of healthy food groups. We found no association between the food environment and dietary indicators or the BMI-z-score.

Conclusion

While the school food environments investigated were not conducive with promoting healthy dietary behaviors, we cannot conclude that these environmental factors directly influence adolescents' diets. The pervasive advertising and availability of unhealthy foods and beverages requires policy action for healthy school food environments.

Food promoted on an online food delivery platform in a Brazilian metropolis during the COVID-19 pandemic: a longitudinal analysis

OBJECTIVE

To analyse food advertised on an online food delivery (OFD) platform during 16 weeks of the COVID-19 pandemic in Brazil.

DESIGN

Longitudinal study. We randomly selected foods advertised on the OFD app's home page, classifying the food items into water; natural juices and smoothies; vegetables; fruits; traditional meals and pasta; ultra-processed beverages; ice cream and candies, and salty packaged snacks; sandwiches; savoury snacks; and pizza. We also registered the marketing strategies used to promote the food items, such as photos, discounts, 'combo deals', and messages on healthiness, value for the money, tastiness, and pleasure.

SETTING

Belo Horizonte, Minas Gerais, Brazil.

PARTICIPANTS

1,593 food items.

RESULTS

In general, the OFD platform most commonly promoted traditional meals and pasta, ultra-processed beverages, and sandwiches-these food groups were offered 20-25% of the time during the 16 weeks. There were no promotions for water during the whole period, and the least common promotions were those for natural juices and smoothies, vegetables, and fruits (<5%). The most common food promotion strategies were photos (>80%) and discounts (>95%), while approximately 30% of the offers featured combo deals. Messages on tastiness, pleasure, and value for the money varied from 15% to 40%.

CONCLUSION

Although the OFD platform offered traditional meals and pasta, most of the foods and beverages advertised were unhealthy and promoted with persuasive strategies. This finding highlights a growing public health concern: an increase in unhealthy eating patterns during the pandemic.

Evidence Gaps in Assessments of the Healthiness of Online Supermarkets Highlight the Need for New Monitoring Tools: a Systematic Review

PURPOSE OF REVIEW

Online grocery shopping is increasingly popular, but the extent to which these food environments encourage healthy or unhealthy purchases is unclear. This review identifies studies assessing the healthiness of real-world online supermarkets and frameworks to support future efforts.

RECENT FINDINGS

A total of 18 studies were included and 17 assessed aspects of online supermarkets. Pricing and promotional strategies were commonly applied to unhealthy products, while nutrition labelling may not meet regulated requirements or support consumer decision-making. Few studies investigated the different and specific ways online supermarkets can influence consumers. One framework for comprehensively capturing the healthiness of online supermarkets was identified, particularly highlighting the various ways retailers can tailor the environment to target individuals. Comprehensive assessments of online supermarkets can identify the potential to support or undermine healthy choices and dietary patterns. Common, validated instruments to facilitate consistent analysis and comparison are needed, particularly to investigate the new opportunities the online setting offers to influence consumers.

Advertising patterns of a fast-food chain on social media in Brazil

OBJECTIVE

To investigate the advertising patterns on the posts of a fast-food chain in Brazil on three social media platforms in 2019.

DESIGN

An exploratory cross-sectional study.

SETTING

Advertising strategies on the posts of a major fast-food chain on their official Facebook, Instagram and YouTube accounts. The strategies were investigated according to the INFORMAS protocol for food promotion monitoring. Principal component analysis (PCA) was employed to identify advertising patterns in each platform.

PARTICIPANTS

305 advertisements.

RESULTS

Four advertising patterns were identified in the PCA of Facebook and Instagram. In both platforms, the components for kids and product exaltation were similar. On Facebook, a pattern corresponding to economic appeal was identified as price and discount, while on Instagram, this pattern also included a practical approach. On Facebook, the fourth component was named celebrity, while on Instagram it was celebrity/innovation since on this second social media the component also included the 'new brand development' variable. On YouTube, three advertising patterns were identified in PCA. Similar to the other platforms, the first and the second patterns were called for kids and price and discount, and the third component referred to both celebrity and commemorative dates.

CONCLUSIONS

The advertising patterns of the fast-food chain on three social media platforms were commonly directed to children and addressed price, discounts and the celebrities' universe. The findings of this study corroborate other data in the literature regarding unhealthy food advertising on social media. This study discusses the urgency of regulating food advertising content on this medium.

Use of persuasive strategies in food advertising on television and on social media in Brazil

We analyzed the use of persuasive advertising strategies by 18 food brands on TV and Facebook, Instagram, and YouTube in Brazil in April 2018. Advertising strategies were investigated from three groups: power of advertising strategies (n = 10) (e.g., use of licensed character, celebrities, awards, etc), use of the prize offering (n = 9) (e.g., pay 2 take 3 or more, gifts or collectable, limited edition, etc), and use of brand benefit claims (n = 8) (e.g., messages that exalt sensory-based characteristics such as flavor, taste, aroma and recommend how to use/consume the product, etc). Almost 90% of the brands were ultra-processed foods producers and they carried 52 ads on TV and 194 posts on social media platforms. A higher frequency of the strategy ‘cartoon/company owned character’ was found on TV ads (19.2%; p < 0.0001) in comparison to social media platforms (0% on the three platforms) while the presence of ‘famous sportsperson/team’ prevailed on YouTube (41.4%) in comparison to TV (19.2%), Facebook (10.9%) and Instagram (9.1%), p < 0.0001. On YouTube ads, the claims ‘sensory-based characteristics’ (86.2%), ‘suggested use’ (51.7%), and ‘emotive claims’ (31.0%) were more commonly seen in comparison to the other media, while the claims about ‘new brand developments’ (23.1%), ‘price’ (9.6%) and ‘suggesting to children and the whole family to use the advertised product’ (21.1%) prevailed on TV. Ultra-processed food brands are the main food companies that advertise on Brazilian TV and social media and the message transmitted by these brands varies in each media according to the advertising strategies that are used.

TV exposure, attitudes about targeted food ads and brands, and unhealthy consumption by adolescents: Modeling a hierarchical relationship

Public health experts raise concerns that extensive exposure to advertising for calorie-dense nutrient-poor food negatively influences adolescents' diets, but few studies have explored how food advertising affects children over age 12. This study examines adolescents' attitudes about highly targeted unhealthy food brands and assesses the hierarchical relationship between TV exposure, intermediary measures of advertising effects, and healthy and unhealthy food consumption. A cross-sectional online survey of 1566 adolescents (13-17 years) measured TV exposure, attitudes about eight highly advertised teen-targeted food brands and their advertising, and unhealthy and healthy food consumption. A theory-based structural equation model (SEM) tested hypothesized paths from TV exposure to unhealthy food consumption, with attitudes about teen-targeted TV ads and brands as intermediary variables, controlling for healthy food consumption and demographic characteristics. Participants reported high liking of targeted-brand advertising (M = 4.05/5.0, SD = 0.65), strong perceptions that the ads were targeted to someone like them (M = 4.07/5.0, SD = 0.66), positive brand attitudes (M = 4.07/5.0, SD = 0.56), brand popularity (M = 4.01/5.0, SD = 0.63), and consuming the brands a few times in the past month on average. As hypothesized, the SEM supported significant positive paths from TV exposure to ad attitudes (β = 0.50, 95% CI = 0.40-0.60) to brand attitudes (β = 0.90, 95% CI = 0.87-0.92) to unhealthy food consumption (β = 0.41, 95% CI = 0.32-0.50). Contrary to expectations, healthy consumption was positively associated with both brand attitudes (β = 0.11, 95% CI = 0.04-0.18) and unhealthy consumption (β = 0.42, 95% CI = 0.33-0.51). These results further public health concerns about the potential impact of adolescents' exposure to unhealthy food advertising on brand consumption and unhealthy food consumption more broadly. They also support marketing theories that ad liking and perceived targeting may increase the influence of ad exposure on brand attitudes and unhealthy consumption.

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

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

Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol

Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS).

Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools.

Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting.

Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children.

Abusive advertising of food and drink products on Brazilian television

In Brazil, any advertising strategies that take advantage of the child's judgment or induce consumers to make harmful health choices are considered abusive. However, the efficacy of restrictions on their use on television (TV) food advertising remains poorly understood. This study analysed the extent and nature of abusive techniques according to national regulations and patterns in their use in food-related ads. Cross-sectional studyrecorded the programming of the three most popular TV channels (6 am-12 am), during eight non-consecutive days, in April 2018. Data collection was based on the INFORMAS protocol and two national regulations. Descriptive analyses were used to describe the types of food ads and abusive techniques used in ultra-processed products (UPP) ads. Principal component analysis was applied to identify patterns of abusive marketing techniques and to relate them to specific food groups. More than 90% of food ads included at least one UPP. Overall, 10.1% of UPP ads targeted children and 57.7% used some kind of abusive technique directed to children and adolescents. Most ads contained messages inducing harmful health choices did not present adequate and clear information about the product and contained more than one type of abusive technique. Four out of five patterns in the use of abusive techniques in UPP ads were specifically directed to children, and fast-food meals were associated with three out of five patterns. The high abusiveness of food advertising in UPP ads should be considered a public health concern given their impact on children's food choices and health.

Intersectoral policy on industries that produce unhealthy commodities: governing in a new era of the global economy?

Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.

Gaps and priorities in assessment of food environments for children and adolescents in low- and middle-income countries

School-aged children and adolescents have complex interactions with their food environments-the point of engagement of individuals with the food system-and are influenced by a diversity of individual, household and organizational factors. Although a wide range of methods have been proposed to define, monitor and evaluate food environments, few are tailored to school-aged children and adolescents. Here, we interrogate published literature on food metrics and methodologies for the characterization of food environments for school-aged children and adolescents living in low- and middle-income counties. We identify key priority actions and potential indicators for better monitoring and evaluation to galvanize policymaking to improve the healthiness of these interactions, which are so crucial to future adult well-being.

Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.

A comparison of self-reported exposure to fast food and sugary drinks marketing among parents of children across five countries

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.

Mapping of outdoor food and beverage advertising around primary and secondary schools in Kampala city, Uganda

BACKGROUND

Marketing of unhealthy foods and beverages is recognized as a contributing factor to the global increase in overweight and obesity, particularly among children. Such marketing negatively affects children's dietary preferences, food choices, purchasing requests, and consumption patterns. Given that little is known about food marketing in Africa, including in Uganda, monitoring children's exposure to food marketing is essential to generate evidence on the problem and develop meaningful policy responses. The aim of this study was to describe the food and beverage marketing environment surrounding schools in urban and peri-urban areas of Kampala city.

METHODS

Outdoor advertising around 25 randomly sampled primary and secondary schools within a radius of 250 m of each school was mapped. Information on size, setting, type, and position of the advertisements and the healthiness of the foods and beverages promoted was collected using the INFORMAS Outdoor Advertising Protocol. The occurrence of advertising was described using frequencies, median, and density per 100m2.

RESULTS

A total of 1034 branded advertisements were identified around the schools. Of these, 86% featured unhealthy products, 7% healthy products, and 7% miscellaneous products. The most advertised products were sugar-sweetened beverages and alcoholic beverages (51 and 23%, respectively). Schools in the urban area were surrounded by more unhealthy ads than those in the peri-urban areas (median of 45 vs 24 advertisements).

CONCLUSION

The widespread extent of unhealthy food and beverage advertisements around primary and secondary schools highlights the need for food marketing regulation in Uganda, in line with the World Health Organization's recommendations, to ensure that young people are protected from unhealthy food marketing.

Exposure of Children to Unhealthy Food and Beverage Advertisements in South Africa

Television (TV) is a powerful medium for marketing food and beverages. Food and beverage marketers tend to use this medium to target children with the hope that children will in turn influence their families' food choices. No study has assessed the compliance of TV marketers with the South African Marketing to Children pledge since the enactment of the 2014 food advertising recommendations by the South African Department of Health and the Advertising Standards Authority. This study investigated the extent and nature of advertising of unhealthy versus healthy food and beverages to children in South African TV broadcasting channels. The date, time, type, frequency and target audience of food advertisements (ads) on four free-to-air South African TV channels were recorded and captured using a structured assessment guide. The presence of persuasive marketing techniques was also assessed. Unhealthy food and beverage advertising was recorded at a significantly higher rate compared with healthy food and beverages during the time frame when children were likely to be watching TV. Brand benefit claims, health claims and power strategies (e.g., advertising using cartoon characters and celebrated individuals) were used as persuasive strategies. These persuasive strategies were used more in unhealthy versus healthy food ads. The findings are in breach of the South African Marketing to Children pledge and suggest a failure of the industry self-regulation system. We recommend the introduction of monitored and enforced statutory regulations to ensure healthy TV food advertising space.

Governmental policies to reduce unhealthy food marketing to children

Reducing children's exposure to food marketing is an important obesity prevention strategy. This narrative review describes current statutory regulations that restrict food marketing; reviews available evidence on the effects of these regulations; and compares policy design elements in Chile and the United Kingdom. Currently, 16 countries have statutory regulations on unhealthy food marketing to children. Restrictions on television advertising, primarily during children's programming, are most common. Schools are also a common setting for restrictions. Regulations on media such as cinema, mobile phone applications, print, packaging, and the internet are uncommon. Eleven evaluations of policies in 4 jurisdictions found small or no policy-related reductions in unhealthy food advertising, in part because marketing shifted to other programs or venues; however, not all policies have been evaluated. Compared with the United Kingdom, Chile restricts marketing on more products, across a wider range of media, using more marketing techniques. Future research should examine which elements of food marketing policy design are most effective at reducing children's exposure to unhealthy food marketing.

Monitoring the Power of Child-Targeted Food Packaging: a Review of the Literature

PURPOSE OF REVIEW

Given the need to limit unhealthy food marketing to children, more information is required around strategies for its monitoring. Child-directed food packaging, in particular, requires special consideration: packaging drives decision-making at the point-of-sale and is a powerful means of capturing children's attention. This review examines and summarizes literature that monitors the "power" (persuasive techniques) of packaging, in order to assess what these broader strategies contribute to monitoring child-targeted packaged foods.

RECENT FINDINGS

Eleven relevant studies on monitoring (spanning food, tobacco, and cannabis packaging) were examined. Strategies regarding the precise measurement indicators, accurate data collection and management, and time trends analysis were identified; from this, a set of criteria for monitoring the power of packaging in retail settings was proposed. Examining literature on the monitoring of the "power" of packaging reveals the paucity of research in this area. This review details how packaging features can be effectively tracked in different contexts and over time.

Overabundance of unhealthy food advertising targeted to children on Guatemalan television

To assess, for the first time, the extent (by hour channel) and nature (e.g. persuasive marketing techniques (PMT) and health-related claims) of unhealthy food advertisements (ads) targeted at children (3–11 years) on the six most-watched television (TV) channels in Guatemala. We recorded 864 h of video on the six most popular channels featuring children’s programmes. We classified food and beverage ads as permitted or non-permitted for marketing to children, according to the 2015 World Health Organisation (WHO) nutrient profile. Furthermore, we also analysed PMT (i.e. premium offers, promotional characters, brand benefit claims) and health-related claims. Most food ads (85%) were non-permitted to be marketed to children. Non-permitted food ads were six times more likely, either on weekdays or weekends, for all programme and channel categories compared with permitted food ads. There was no difference in the frequency of non-permitted food ads between peak and non-peak hours, weekend and weekdays or children and non-children programmes. PMT and health-related claims were present in all food ads (5.3 ± 1.9 techniques/claims per ad). There is a need to regulate food ads on TV channels featuring children’s programmes in Guatemala as a result of a high frequency of non-permitted food ads and extensive use of PMT together with health-related claims.

Non-core food product advertising on free-to-air television in Hong Kong

Objective:

To study the extent and nature of free-to-air television advertisements for non-core products (e.g., fast food or soda) directed at children in Hong Kong.

Design:

Television programs from two major Hong Kong free-to-air television channels airing between 06.00 and 24.00 hours from October 2018 to January 2019 were recorded. Eight nonconsecutive days (four weekdays and four weekend days) were selected for analysis. Pearson’s χ2 tests were conducted to compare the pattern of food advertisements by program categories, days of the week, television viewing periods and persuasive marketing techniques.

Setting:

Free-to-air television programs.

Participants:

Not applicable.

Results:

Of the 10 348 commercials identified, 18·4 % were for foods, and 35·2 % of these were for non-core items. Baby and toddler milk formula (19·5 %) were the most advertised food products, while the most frequently advertised non-core food was fast foods (12·3 %). There was a higher non-core to core product ratio during prime time than the children’s time slot (7 v. 1·7). Non-sports celebrity endorsement (27·1 %) was the most frequently used persuasive marketing technique overall, while that for non-core products was sensory characteristics (38·2 %). Most food product placements recorded were non-core products, mentions of local and fast food restaurants and recipe additions.

Conclusions:

Non-core products were highly advertised in Hong Kong, while core product advertising was infrequent. Regulations on junk food advertising in Hong Kong should focus on prime time, as well as on food product placement, to reduce children’s exposure to persuasive junk food marketing.

AdHealth: a feasibility study to measure digital food marketing to adolescents through Facebook

OBJECTIVE

To test the feasibility of a browser extension to estimate the exposure of adolescents to (un)healthy food and beverage advertisements on Facebook and the persuasive techniques used to market these foods and beverages.

DESIGN

A Chrome browser extension (AdHealth) was developed to automatically collect advertisements seen by participants on their personal Facebook accounts. Information was extracted and sent to a web server by parsing the Document Object Model tree representation of Facebook web pages. Key information retrieved included the advertisement type seen and duration of each ad sighting. The WHO-Europe Nutrient Profile Model was used to classify the healthiness of products advertised as permitted (healthy) or not permitted (unhealthy) to be advertised to children.

SETTING

Auckland, New Zealand.

PARTICIPANTS

Thirty-four Facebook users aged 16-18 years.

RESULTS

The browser extension retrieved 4973 advertisements from thirty-four participants, of which 204 (4 %) were food-related, accounting for 1·1 % of the exposure duration. Of those food advertisements, 98 % were classified as not permitted, and 33·7 and 31·9 %, respectively, of those featured promotional characters or premium offers. The mean rate of exposure to not permitted food was 4·8 (sd = 2·5) advertisements per hour spent on Facebook.

CONCLUSIONS

Using a Chrome extension to monitor exposure to unhealthy food and beverage advertisements showed that the vast majority of advertisements were for unhealthy products, despite numerous challenges to implementation. Further efforts are needed to develop tools for use across other social media platforms and mobile devices, and policies to protect young people from digital food advertising.

Ultra-processed food and beverage advertising on Brazilian television by International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support benchmark

OBJECTIVE

To analyse the extent and nature of food and beverage advertising on the three major Brazilian free-to-air television (TV) channels.

DESIGN

Cross-sectional study. A protocol developed for the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support was applied for data collection. A total of 432 h of TV programming was recorded from 06.00 to 24.00 hours, for eight non-consecutive and randomly selected days, in April 2018. All TV advertisements (ads) were analysed, and food-related ads were classified according to the NOVA classification system. Descriptive analyses were used to describe the number and type of ads, food categories and the distribution of ads throughout the day and time of the day.

SETTING

The three most popular free-to-air channels on Brazilian TV.

PARTICIPANTS

The study did not involve human subjects.

RESULTS

In total, 14·2 % (n 1156 out of 7991) of ads were food related (858 were specific food items). Approximately 91 % of food items ads included ultra-processed food (UPF) products. The top three most promoted products were soft drinks, alcoholic beverages and fast-food meals. Alcoholic beverage ads were more frequently broadcast in the evening.

CONCLUSION

The high risk of exposure of the Brazilian population to UPF ads should be considered a public health concern given the impact of unhealthy food advertising on people's food choices and health.

Fiction Is Sweet. The Impact of Media Consumption on the Development of Children's Nutritional Knowledge and the Moderating Role of Parental Food-Related Mediation. A Longitudinal Study

Nutritional knowledge is an important cognitive facilitator that potentially helps children to follow a healthy diet. Two main information agents influence children’s development of nutritional knowledge: the media and their parents. While a high amount of media consumption potentially decreases children’s nutritional knowledge, parents may shape the amount of information children can gather about nutrition through their food-related mediation styles. In addition, children’s individual preconditions predict how children can process the provided nutritional information. This two-wave panel study with children (N = 719; 5–11 years) and their parents (N = 719) investigated the main effects and interplay of children’s amount of media consumption and their parents’ food-related mediation styles by performing linear regression analysis. Children’s individual preconditions were also considered. We measured children’s self-reported amount of media consumption, children’s age, sex, weight, and height (BMI). Additionally, in a parent survey we asked parents about how they communicate their rules about eating while especially focusing on active and restrictive food rule communication styles. As a dependent measure, we examined children’s nutritional knowledge at Time 1 and 2. The results show that the amount of media consumption has a negative effect on children’s nutritional knowledge over time. Parents’ restrictive or active food-related mediation asserted no main effects and could not lever out the negative effect of the amount of media consumption. Therefore, we argue that parents should limit children’s amount of media consumption to avoid the manifestation of misperceptions about nutrition.

Food Environment Typology: Advancing an Expanded Definition, Framework, and Methodological Approach for Improved Characterization of Wild, Cultivated, and Built Food Environments toward Sustainable Diets

The food environment is a critical place in the food system to implement interventions to support sustainable diets and address the global syndemic of obesity, undernutrition, and climate change, because it contains the total scope of options within which consumers make decisions about which foods to acquire and consume. In this paper, we build on existing definitions of the food environment, and provide an expanded definition that includes the parameter of sustainability properties of foods and beverages, in order to integrate linkages between food environments and sustainable diets. We further provide a graphical representation of the food environment using a socio-ecological framework. Next, we provide a typology with descriptions of the different types of food environments that consumers have access to in low-, middle-, and high-income countries including wild, cultivated, and built food environments. We characterize the availability, affordability, convenience, promotion and quality (previously termed desirability), and sustainability properties of food and beverages for each food environment type. Lastly, we identify a methodological approach with potential objective and subjective tools and metrics for measuring the different properties of various types of food environments. The definition, framework, typology, and methodological toolbox presented here are intended to facilitate scholars and practitioners to identify entry points in the food environment for implementing and evaluating interventions that support sustainable diets for enhancing human and planetary health.

Nutritional quality of foods and non-alcoholic beverages advertised on Brazilian free-to-air television: a cross-sectional study

BACKGROUND

Evidence shows that foods marketed on television are often low-nutrient-dense foods associated with poor nutritional diet quality, obesity and non-communicable diseases. However, little research has been undertaken in Brazil around this issue. This study assessed the nutritional profile of foods and non-alcoholic beverages advertised on Brazilian television by applying the Pan American Health Organization (PAHO) and the World Health Organization (WHO/Europe) nutrient profiling models.

METHODS

Cross-sectional study based on the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) protocol. A total of 432 h on the three major Brazilian free-to-air TV channels was recorded from April 1st to 30th 2018. Recordings were done for eight non-consecutive and randomly selected days from 6 am to 12 am (midnight). All food-related ads were coded using a systematic approach and classified according to the PAHO and the WHO/Europe nutrient profile models as "eligible"/"not eligible" for marketing restrictions. Absolute and relative frequencies were used to describe absolute numbers and proportions of food and beverage advertisements. The nutritional profile of foods was compared by day, time of the day and types of TV program. For each advertisement, the parent company of promoted food products, supermarkets and restaurants was identified.

RESULTS

A total of 1610 food and beverage ads were broadcast, representing 18.1% of the total ads shown on selected channels. Over 80.0% of all foods and beverages advertised on Brazilian TV channels did not meet the PAHO and the WHO/Europe nutritional quality standards and were considered eligible for marketing restrictions. The proportion of unhealthy food ads was significantly higher on weekends, in the afternoon, and during soap operas programming. Altogether, 10 transnational and local food and beverage companies, two large international fast food chains and two of Brazil's largest supermarket retailers accounted for almost 90% of all unhealthy food ads shown.

CONCLUSIONS

The findings of the present study indicate a high exposure of the Brazilian population to unhealthy food marketing and an inefficient enforcement of existing regulations. Further research to monitor population exposure to unhealthy food marketing and understand the policy inertia that is preventing policy progress, is highly recommended.

The first INFORMAS national food environments and policies survey in New Zealand: A blueprint country profile for measuring progress on creating healthy food environments

The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support aims to benchmark national food environments. This study proposes a blueprint country profile to measure progress on creating healthy food environments, based on the results of the first, comprehensive survey in New Zealand (NZ). We assessed the implementation of national food environment policies and food industry commitments to improve population nutrition and the strength and comprehensiveness of public sector settings' nutrition policies. The healthiness of the packaged food supply, including health-related labelling, was evaluated. Food environments were measured in 833 schools, 204 supermarkets, 1500 takeaway outlets, 28 hospitals, 70 sport centres, and around all NZ schools. Food swamps, defined as areas with high relative density of unhealthy food outlets, were identified, and food marketing to children on television, websites, social media and packages, in magazines, and in and around schools was measured. The cost differential between healthy and current household diets was calculated for different population groups. NZ's food environment profile is largely unhealthy, and there are inequalities in access to healthy food environments. It is anticipated that the proposed country profile can help other countries tackle unhealthy food environments through increasing accountability of governments and the industry.

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.

The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases

OBJECTIVE

Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition.

DESIGN

Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings.

SETTING

Studies conducted in LA countries.

PARTICIPANTS

The search yielded 2695 articles of which eighty-four met inclusion criteria.

RESULTS

Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision (n 27), marketing (n 16) and labelling (n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods.

CONCLUSIONS

Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.

Children's exposure to food advertising: the impact of statutory restrictions

Evidence demonstrating links between exposure to unhealthy food marketing, poor eating behaviours and paediatric obesity has led to calls for regulatory change in many countries, including the UK. However no official monitoring system exists to inform international debate on food advertising policy. This study systematically explores food advertising on UK television in 2010 (post-regulation) and compare this to 2008 (mid-regulation) to assess if food adverts improved in nutritional quality after implementation of regulations. Television was recorded between 6 a.m. and 10 p.m. for one weekday and one weekend day during 6 months of 2010 across 13 commercial television channels popular with children. These data were directly compared with previously published data for 2008. Food and beverages were the third most frequently advertised product type (11.9% of all ads), a decrease of 0.9% from 2008 (12.8%). Non-core food commercials decreased (down 2.2-53.8%) and core food advertising increased (up 0.5-18.6%). Fast food items were the third most frequently advertised food product (15.4%, up 3.5% from 2008). During peak children's viewing times, 17.0% of all commercials were for food, an increase of 4.7% from non-peak children's viewing times and fewer core (-0.9%) and more non-core (+0.5%) foods were advertised at these times. Despite statutory regulation, frequency and balance of food commercials (core, non-core and miscellaneous) remained relatively static over the 2 years. Children are still exposed to high amounts of unhealthy food advertising on television. Continued monitoring of television food advertising remains crucial and policymakers should examine the comparative efficacy of other restrictions.

Trends in marketing foods to children in Slovenian magazines: a content analysis

OBJECTIVE

Food marketing is an important factor influencing children's food preferences. In Slovenia the use of magazines is widespread among children. We investigated food advertising in children's and teens' magazines (CTM) in 2013 and 2017. The penetration of food advertising was compared with magazines targeting the adult population.

DESIGN

A repeated cross-sectional study. Magazines were searched for branded food references (BFR). All BFR were categorised and evaluated using the WHO Europe nutrient profile model.

SETTING

Slovenia.

SUBJECTS

All issues of CTM and a selected sample of issues of adult-targeting magazines and newspapers published in Slovenia in 2013 and 2017.

RESULTS

One hundred and seventy-five issues of CTM (ninety-two in 2013, eighty-three in 2017) and 675 issues of adult-targeted magazines and newspapers were analysed (345 in 2013, 330 in 2017). In 2017, food advertising in CTM dropped notably but the opposite was found for adult-targeted magazines. Regular advertisements dominated in 2017 in CTM, while in 2013, 83 % of BFR types were games/puzzles, competitions and product placements. Chocolate and confectionery were the most advertised in CTM and food supplements in adults' magazines. Most foods in CTM were classed as 'not permitted' in both years (98 % in 2013 and 100 % in 2017).

CONCLUSIONS

The advertisements in CTM still mostly refer to unhealthy foods. The extent of food advertising has dropped considerably since 2013. On the contrary, food advertising in printed media targeting adults has increased, chiefly referring to food supplements and foods that do not pass the WHO Europe nutrient profile model criteria.

Unhealthy food and non-alcoholic beverage advertising on children's, youth and family free-to-air and digital television programmes in Thailand

Background

Food advertising is a key factor which influences children’s food preferences. This study assessed the rates, nutritional quality and contents of food and beverage advertising in children’s, youth and family television programmes in Thailand.

Methods

Free TV was recorded for two weeks in March 2014 from six to ten am and three to eight pm on weekends and three to eight pm on weekdays across all four channels; a total of 344 h recorded. Digital TV was recorded across three channels for one week for 24 h per day in October 2014; a total 504 h recorded.

Results

For Free TV, 1359 food advertisements were identified, with on average 2.9 non-core food advertisements per hour per channel. The most frequently advertised food products on free TV were sugar-sweetened drinks. The rates of advertisements containing promotional characters and premium offers were significantly higher for non-core than core foods, 1.2 versus 0.03 and 0.6 versus 0.0 per hour respectively. For Digital TV, 693 food advertisements were identified, with an average of one non-core food advertisement per hour per channel. The most frequently advertised food products on digital TV were baby and toddler milk formulae.

Conclusions

Food and beverage advertising on Thai television is predominantly unhealthy. Therefore, the Government and related agencies should introduce and enforce policies to address this issue. Current regulations should be adapted to control both the frequency and nature of unhealthy on-air food marketing to protect the health of Thai children.

Reliability and validity of a novel tool to comprehensively assess food and beverage marketing in recreational sport settings

Background

Current methods for evaluating food marketing to children often study a single marketing channel or approach. As the World Health Organization urges the removal of unhealthy food marketing in children’s settings, methods that comprehensively explore the exposure and power of food marketing within a setting from multiple marketing channels and approaches are needed. The purpose of this study was to test the inter-rater reliability and the validity of a novel settings-based food marketing audit tool.

Methods

The Food and beverage Marketing Assessment Tool for Settings (FoodMATS) was developed and its psychometric properties evaluated in five public recreation and sport facilities (sites) and subsequently used in 51 sites across Canada for a cross-sectional analysis of food marketing. Raters recorded the count of food marketing occasions, presence of child-targeted and sports-related marketing techniques, and the physical size of marketing occasions. Marketing occasions were classified by healthfulness. Inter-rater reliability was tested using Cohen’s kappa (κ) and intra-class correlations (ICC). FoodMATS scores for each site were calculated using an algorithm that represented the theoretical impact of the marketing environment on food preferences, purchases, and consumption. Higher FoodMATS scores represented sites with higher exposure to, and more powerful (unhealthy, child-targeted, sports-related, large) food marketing. Validity of the scoring algorithm was tested through (1) Pearson’s correlations between FoodMATS scores and facility sponsorship dollars, and (2) sequential multiple regression for predicting “Least Healthy” food sales from FoodMATS scores.

Results

Inter-rater reliability was very good to excellent (κ = 0.88–1.00, p < 0.001; ICC = 0.97, p < 0.001). There was a strong positive correlation between FoodMATS scores and food sponsorship dollars, after controlling for facility size (r = 0.86, p < 0.001). The FoodMATS score explained 14% of the variability in “Least Healthy” concession sales (p = 0.012) and 24% of the variability total concession and vending “Least Healthy” food sales (p = 0.003).

Conclusions

FoodMATS has high inter-rater reliability and good validity. As the first validated tool to evaluate the exposure and power of food marketing in recreation facilities, the FoodMATS provides a novel means to comprehensively track changes in food marketing environments that can assist in developing and monitoring the impact of policies and interventions.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0667-3) contains supplementary material, which is available to authorized users.

The obesogenic environment around elementary schools: food and beverage marketing to children in two Mexican cities

Background

Unhealthy environments and food advertisements are major determinants of childhood obesity. Recent regulation has banned unhealthy foods from schools in Mexico. However, currently there is no regulation limiting exposure to food marketing around schools. Thus, our objective was to analyze the characteristics of food advertising practices around 60 elementary schools in two cities and to evaluate compliance with the Pan American Health Organization (PAHO) recommendations and the local food industry self-regulatory marketing code.

Methods

Data were collected during the period of October 2012 to March 2013. A random sample of elementary schools was selected from two Mexican cities. Using geographic information systems, we drew a 100-m-diameter buffer around each school. Trained personnel obtained photographs to assess the locations and types of food advertisements. Our results were stratified by school type and by indicators of compliance with the PAHO and industry recommendations. We developed a multivariate negative binomial regression model to determine factors predicting the number of advertisements around schools.

Results

The number of advertisements was significantly higher around public schools than around private schools (6.5 ± 5.6 vs. 2.4 ± 3.5, p < 0.05). Printed posters were the most common type of marketing medium (97%), showing mostly sugar-sweetened beverages, sweet breads, candies, and bottled water. Promotions, such as special prices or gifts, were included on 30% of printed posters. Food advertising practices were often in compliance with industry recommendations (83%) but not with those from the PAHO (32%) (p < 0.001).

Conclusion

Our results support the importance of monitoring the obesogenic environment and identifying policy tools to protect children from food marketing not only inside schools but also around them, particularly in lower income communities.

Unhealthy food advertising directed to children on New Zealand television: extent, nature, impact and policy implications

Objective

To comprehensively assess the extent, nature and impact of unhealthy food advertising targeted to children on New Zealand television.

Design

Four weekdays and four weekend days were randomly selected over the period June–August 2015. Programming was recorded from 06.00 to 00.00 hours (midnight), for a total of 432 h. Audience ratings were used to identify children’s peak viewing times.

Setting

New Zealand.

Subjects

The three major free-to-air channels.

Results

The majority of foods advertised (n 1807) were unhealthy; 68·5 % of food advertisements included at least one food not permitted to be marketed to children according to the WHO nutrient profiling model. The mean hourly rate of unhealthy food advertising was 9·1 (sd 5·2). One-third of unhealthy food advertisements included a promotional character and one-third a premium offer. About 88 % of unhealthy food advertisements were shown during children’s peak viewing times. If unhealthy food advertisements were to be restricted during times when at least 25 % of children are watching television, this would reduce the average unhealthy food advertising impact by 24 % during weekdays and 50 % during weekend days, and if the WHO instead of the current nutrient profiling model were used to restrict unhealthy food advertising to children, the average impact would be reduced by 24 % during weekdays and 29 % during weekend days.

Conclusions

Current self-regulation is ineffective in protecting children from exposure to unhealthy food advertising on television. The WHO nutrient profiling model needs to be used to restrict unhealthy food advertising, especially during children’s peak viewing times.

An audit of food and beverage advertising on the Sydney metropolitan train network: regulation and policy implications

BACKGROUND

Increased marketing of energy-dense, nutrient-poor foods has been identified as a driver of the global obesity epidemic and a priority area for preventative efforts. Local and international research has focused on the unhealthiness of television advertising, with limited research into the growing outdoor advertising industry. This study aimed to examine the extent of food and beverage advertising on the Sydney metropolitan train network, and to assess the nutritional quality of advertised products against the Australian Guide to Healthy Eating.

METHODS

All 178 train stations on the Sydney metropolitan train network were surveyed in summer and winter. A survey tool was developed to collect information for all advertisements on and immediately surrounding the train station. Information included product, brand, location and advertisement format. Advertisements were coded by nutrition category, product subcategory and size. Chi-square, ANOVA and ANCOVA tests were conducted to test for differences in the amount of food and beverage advertising by season and area socioeconomic status (SES).

RESULTS

Of 6931 advertisements identified, 1915 (27.6%) were promoting a food or beverage. The majority of food and beverage advertisements were for unhealthy products; 84.3% were classified as discretionary, 8.0% core and 7.6% miscellaneous. Snack foods and sugar-sweetened beverages were the most frequently advertised products, regardless of season. Coca-Cola and PepsiCo were the largest advertisers on the network, contributing 10.9% and 6.5% of total advertisements respectively. There was no difference in the mean number of food and beverage advertisements by area SES, but the proportion of advertising that was for discretionary foods was highest in low SES areas (41.9%, p < 0.001).

CONCLUSIONS

The results indicate that, irrespective of season, food and beverage advertisements across the Sydney metropolitan train network are overwhelmingly for unhealthy (discretionary) products. The results of this study highlight the inadequacy of Australia's voluntary self-regulatory system in protecting members of the public from exposure to unhealthy food advertising. Regulatory action by government, such as placing a cap on the amount of unhealthy food advertisements, or requiring a proportion of all advertising to be for the promotion of healthy foods, is required to address this issue.

Restricting the marketing of foods and non-alcoholic beverages to children in South Africa: are all nutrient profiling models the same?

The WHO has called for governments to improve children’s food environment by implementing restrictions on the marketing of ‘unhealthy’ foods to children. Nutrient profiling (NP) models are used to define ‘unhealthy’ foods and support child-directed food marketing regulations. The aim of the present study was to assess the suitability of the South African NP model (SANPM), developed and validated for health claim regulations, for child-directed food marketing regulations. The SANPM was compared with four NP models specifically developed for such regulations. A representative list of 197 foods was compiled by including all foods advertised on South African free-to-air television channels in 2014 and foods commonly consumed by South African children. The nutritional information of the foods was sourced from food packaging, company websites and a food composition table. Each individual food was classified by each of the five NP models. The percentage of foods that would be allowed according to the different NP models ranged from 6 to 45 %; the models also varied considerably with regard to the type of foods allowed for marketing to children. The majority of the pairwise comparisons between the NP models yieldedκstatistics >0·4, indicating a moderate agreement between the models. An almost perfect pairwise agreement (κ=0·948) existed between the SANPM and the UK Food Standards Agency model (United Kingdom Office of Communication nutrient profiling model), a model extensively tested and validated for such regulations. The SANPM is considered appropriate for child-directed food marketing regulations in South Africa.

Análise da publicidade televisiva de alimentos no contexto das recomendações do Guia Alimentar para a População Brasileira

O objetivo do estudo é analisar a publicidade televisiva de alimentos no Brasil com base nas recomendações do Guia Alimentar para a População Brasileira de 2014. A programação dos quatro canais mais populares de televisão foi gravada em janeiro de 2014, por dois dias não consecutivos. Os comerciais foram categorizados em (i) alimentos e bebidas, (ii) restaurantes e (iii) serviços, bens e produtos não alimentícios, sendo aqueles referentes à alimentação subdivididos conforme recomendações do guia. As categorias de comerciais foram descritas por meio de sua frequência (e intervalo de 95% de confiança), para o conjunto total dos registros e segundo o dia da semana. Dos 2.732 comerciais que foram identificados, a publicidade de alimentos e bebidas representou a terceira maior categoria anunciada, com 10,2%. Nessa categoria, os alimentos ultraprocessados corresponderam a 60,7% dos anúncios, e os alimentos in natura ou minimamente processados a cerca de 7%. A realidade evidenciada se opõe às recomendações do guia, reforçando a importância de ações para a regulamentação da publicidade de alimentos no Brasil.