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Driessen C, Bennett R, Cameron AJ, Kelly B, Bhatti A, Backholer K. Understanding parents' perceptions of children's exposure to unhealthy food marketing in digital and retail environments. Appetite 2024; 200:107553. [PMID: 38906180 DOI: 10.1016/j.appet.2024.107553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/08/2024] [Accepted: 06/09/2024] [Indexed: 06/23/2024]
Abstract
Unhealthy food and non-alcoholic beverage marketing (UFM) adversely impacts children's selection and intake of foods and beverages, undermining parents' efforts to promote healthy eating. Parents' support for restrictions on children's exposure to food marketing can catalyse government action, yet research describing parent concerns is limited for media other than television. We examined parents' perceptions of UFM and their views on potential policies to address UFM in supermarkets and on digital devices - two settings where children are highly exposed to UFM and where little recent research exists. We conducted in-depth interviews with sixteen parents of children aged 7-12 from Victoria, Australia, analysing the data thematically. Parents perceived UFM as ubiquitous and viewed exposure as having an immediate but temporary impact on children's food desires and pestering behaviours. Parents were concerned about UFM in supermarkets as they viewed it as leading their children to pester them to buy marketed products, undermining their efforts to instil healthy eating behaviours. Parents generally accepted UFM as an aspect of contemporary parenting. Concern for digital UFM was lower compared to supermarkets as it was not directly linked to pestering and parents had limited awareness of what their children saw online. Nevertheless, parents felt strongly that companies should not be allowed to target their children with UFM online and supported government intervention to protect their children. While parents supported government policy actions for healthier supermarket environments, their views towards restricting UFM in supermarkets varied as some parents felt it was their responsibility to mitigate supermarket marketing. These findings could be used to advocate for policy action in this area.
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Affiliation(s)
- Christine Driessen
- Deakin University, Geelong, Institute for Health Transformation, Faculty of Health, Global Centre for Preventive Health and Nutrition (GLOBE), Victoria, Australia.
| | - Rebecca Bennett
- Deakin University, Geelong, Institute for Health Transformation, Faculty of Health, Global Centre for Preventive Health and Nutrition (GLOBE), Victoria, Australia
| | - Adrian J Cameron
- Deakin University, Geelong, Institute for Health Transformation, Faculty of Health, Global Centre for Preventive Health and Nutrition (GLOBE), Victoria, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Asim Bhatti
- Deakin University, Geelong, Institute for Intelligent Systems Research and Innovation (IISRI), Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Geelong, Institute for Health Transformation, Faculty of Health, Global Centre for Preventive Health and Nutrition (GLOBE), Victoria, Australia
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Zelber-Sagi S, Carrieri P, Pericàs JM, Ivancovsky-Wajcman D, Younossi ZM, Lazarus JV. Food inequity and insecurity and MASLD: burden, challenges, and interventions. Nat Rev Gastroenterol Hepatol 2024:10.1038/s41575-024-00959-4. [PMID: 39075288 DOI: 10.1038/s41575-024-00959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/31/2024]
Abstract
Liver disease prevalence, severity, outcomes and hepatic risk factors (for example, unhealthy diet) are heavily affected by socioeconomic status and food insecurity. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally and is likely to co-occur with other liver diseases associated with food insecurity. Though weight reduction and adopting a healthy diet can reverse the course of MASLD, gaps between recommendations and practice transcend individual responsibility and preference. Broader sociocultural determinants of food choices (social nutrition) include food insecurity, community and social norms and the local environment, including commercial pressures that target people experiencing poverty, ethnic minorities and children. Food insecurity is a barrier to a healthy diet, as a low-quality diet is often less expensive than a healthy one. Consequently, food insecurity is an 'upstream' risk factor for MASLD, advanced fibrosis and greater all-cause mortality among patients with liver disease. Intervening on food insecurity at four major levels (environment, policy, community and health care) can reduce the burden of liver disease, thereby reducing social and health inequities. In this Review, we report on the current research in the field, the need for implementing proven interventions, and the role liver specialists can have.
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Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
- The Global NASH Council, Washington, DC, USA.
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Dana Ivancovsky-Wajcman
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Zobair M Younossi
- The Global NASH Council, Washington, DC, USA
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA
| | - Jeffrey V Lazarus
- The Global NASH Council, Washington, DC, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
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Backholer K, Huse O, Brooks R, Martino F, Chung A, Zorbas C, Driessen C, Sartori A, Browne J. The rise and fall of the Queensland Government policy to restrict unhealthy food and alcohol advertising on publicly owned assets. Aust N Z J Public Health 2024; 48:100148. [PMID: 38839474 DOI: 10.1016/j.anzjph.2024.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE To examine the strategies employed by opponents of the Queensland Government's policy to restrict unhealthy food and alcohol advertising on publicly owned assets and identify which of the opposing arguments appeared to influence the policy outcomes. METHODS Retrospective qualitative policy analysis case study informed by the Policy Dystopia Model of corporate political activity. We used qualitative content analysis to examine data from stakeholder submissions to the 'Advertising content on Queensland Government advertising spaces' policies (v1 and 2), and Minister for Health's diaries. RESULTS Stakeholders from the food, beverage, alcohol and advertising industries and several not-for-profit health organisations opposed the policy. Industry actors used discursive strategies, coalition management (including co-option of not-for-profit health organisations), information management and direct involvement with policy makers to communicate their arguments against the policy. The second version of the policy was weaker regarding scope and key policy provisions, reflecting the arguments of industry actors. CONCLUSIONS Influence from industries with a clear conflict of interest should be minimised throughout policy development to ensure public health is prioritised over corporate gain. IMPLICATIONS FOR PUBLIC HEALTH Our findings can support other jurisdictions to prepare for industry opposition when designing policies to restrict unhealthy food and alcohol marketing.
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Affiliation(s)
- Kathryn Backholer
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia.
| | - Oliver Huse
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Ruby Brooks
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Florentine Martino
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina Zorbas
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | - Christine Driessen
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
| | | | - Jennifer Browne
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Geelong, Australia
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Ruggles PR, Pasch KE, Poulos NS, Thomas JE. Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage. PLoS One 2024; 19:e0302048. [PMID: 38781217 PMCID: PMC11115223 DOI: 10.1371/journal.pone.0302048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 03/24/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES. METHODS Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower). RESULTS Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17-69), vs Medianhigh = 10.5 (IQR 4-17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16-99) vs Medianhigh = 13.5 (IQR 6-25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8-19) vs Medianhigh = 6 (IQR 2-8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13-65) vs Medianhigh = 14 (IQR 4-29), p = 0.045).There were no significant differences by school type. CONCLUSION This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.
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Affiliation(s)
- Phoebe R. Ruggles
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, United States of America
| | - Keryn E. Pasch
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, United States of America
| | - Natalie S. Poulos
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jacob E. Thomas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, United States of America
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Harris JL, Taillie LS. More than a Nuisance: Implications of Food Marketing for Public Health Efforts to Curb Childhood Obesity. Annu Rev Public Health 2024; 45:213-233. [PMID: 38109516 DOI: 10.1146/annurev-publhealth-090419-102616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Fifteen years ago, public health experts urged industry, governments, and advocates to take action to dramatically improve the unhealthy food-marketing environment surrounding children in order to address the global childhood obesity crisis. Since then, research has confirmed that food marketing to children has far-reaching negative effects on their diets and health, takes advantage of adolescent vulnerabilities, and contributes to health disparities. In addition, digital marketing has profoundly changed young people's engagement with brands. Moreover, reliance on industry self-regulation as a solution has proven ineffective. Government-led policies have been more successful, but they remain limited in scope and challenging to adopt and implement. New approaches are necessary to increase public and policy maker awareness that food marketing is more than a nuisance, that it threatens the long-term health of children and adolescents worldwide, and that meaningful governmental action is urgently required to curtail industry's negative impact on young people's well-being.
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Affiliation(s)
- Jennifer L Harris
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut, USA;
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Boyland E, Spanakis P, O'Reilly C, Christiansen P. Associations between everyday exposure to food marketing and hunger and food craving in adults: An ecological momentary assessment study. Appetite 2024; 196:107241. [PMID: 38307297 DOI: 10.1016/j.appet.2024.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
Food marketing in television and digital media negatively affects appetitive sensations and eating behaviour in children, but effects are less well understood for outdoor food advertising and adults. This research used Ecological Momentary Assessment (EMA) to explore associations between exposures to food advertising in various contexts (television, digital, outdoors) and adults' hunger and craving for highly advertised food categories. Over one week, participants provided ratings of cravings for types of food (fast food, soft drinks, snacks/confectionery, other) and hunger on a smartphone app up to six times per day when they saw a food advertisement (reactive assessment) and at random intervals (random assessment). Fifty-four participants (70.4 % female; 21.24 ± 3.84 years) provided 1223 assessments (24.7 % reactive, 75.3 % random). Data were analysed in R using multilevel multivariable linear regression models. Participants reported feeling hungrier (X2(1) = 5.85, p = .016, ΔAIC = 3.9) and having stronger cravings (X2(1) = 20.64, p < .001, ΔAIC = 318.6) after seeing food advertisements vs. random assessments. This was driven by greater hunger following television advertising exposure vs. random assessments (β = 1.58, SE = 0.61, p = .010, 95 %CIs 0.38 to 2.78), food advertising via digital devices or outdoors was not associated with hunger. Participants experienced stronger craving after seeing a food advertisement on television (β = 0.52, SE = 0.19, p = .006, 95 %CIs 0.15 to 0.89), outdoors (β = 0.39, SE = 0.12, p < .001, 95 % CIs 0.16 to 0.62) and in digital media (β = 0.36, SE = 0.14, p = .012, 95 % CIs 0.08 to 0.64), vs. random assessments. Cravings were (largely) specific to the advertised food category. EMA can be effective for assessing food marketing associations in adults. The current study provides evidence that food marketing is associated with hunger and craving in adults, which may, with replication, have implications for public health policy.
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Affiliation(s)
- Emma Boyland
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Panagiotis Spanakis
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Connor O'Reilly
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Paul Christiansen
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
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Gage R, Liu W, Pearson AL, Smith M, Barr M, Shortridge A, Signal L. Comparison of ten policy options to equitably reduce children's exposure to unhealthy food marketing. Public Health Nutr 2024; 27:e130. [PMID: 38680070 PMCID: PMC11112427 DOI: 10.1017/s1368980024000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 02/24/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Reducing children's exposure to unhealthy food marketing is crucial to combat childhood obesity. We aimed to estimate the reduction of children's exposure to food marketing under different policy scenarios and assess exposure differences by socio-economic status. DESIGN Data on children's exposure to unhealthy food marketing were compiled from a previous cross-sectional study in which children (n 168) wore wearable cameras and Global Positioning System (GPS) units for 4 consecutive days. For each exposure, we identified the setting, the marketing medium and food/beverage product category. We analysed the percentage reduction in food marketing exposure for ten policy scenarios and by socio-economic deprivation: (1) no product packaging, (2) no merchandise marketing, (3) no sugary drink marketing, (4) no confectionary marketing in schools, (5) no sugary drink marketing in schools, (6) no marketing in public spaces, (7) no marketing within 400 m of schools, (8) no marketing within 400 m of recreation venues, (9) no marketing within 400 m of bus stops and (10) no marketing within 400 m of major roads. SETTING Wellington region of New Zealand. PARTICIPANTS 168 children aged 11-14 years. RESULTS Exposure to food marketing varied by setting, marketing medium and product category. Among the ten policy scenarios, the largest reductions were for plain packaging (60·3 %), no sugary drink marketing (28·8 %) and no marketing in public spaces (22·2 %). There were no differences by socio-economic deprivation. CONCLUSIONS The results suggest that plain packaging would result in the greatest decrease in children's exposure to food marketing. However, given that children are regularly exposed to unhealthy food marketing in multiple settings through a range of marketing mediums, comprehensive bans are needed to protect children's health.
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Affiliation(s)
- Ryan Gage
- Department of Public Health, University of Otago, Wellington, 6242, New Zealand
| | - Wei Liu
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI48824, USA
- Department of Water Ecology and Environment, China Institute of Water Resources and Hydropower Research, Beijing100038, China
| | - Amber L Pearson
- Department of Public Health, University of Otago, Wellington, 6242, New Zealand
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, MI48502, USA
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, 6242, New Zealand
| | - Michelle Barr
- Department of Public Health, University of Otago, Wellington, 6242, New Zealand
| | - Ashton Shortridge
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI48824, USA
| | - Louise Signal
- Department of Public Health, University of Otago, Wellington, 6242, New Zealand
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Agurs-Collins T, Alvidrez J, ElShourbagy Ferreira S, Evans M, Gibbs K, Kowtha B, Pratt C, Reedy J, Shams-White M, Brown AG. Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity. Adv Nutr 2024; 15:100194. [PMID: 38616067 PMCID: PMC11031378 DOI: 10.1016/j.advnut.2024.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.
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Affiliation(s)
- Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States.
| | | | - Sanae ElShourbagy Ferreira
- National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States
| | | | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Marissa Shams-White
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Alison Gm Brown
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
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Henney AE, Gillespie CS, Alam U, Hydes TJ, Boyland E, Cuthbertson DJ. Ultra-processed food and non-communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature. Obes Rev 2024; 25:e13682. [PMID: 38204299 DOI: 10.1111/obr.13682] [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: 07/27/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
The social and economic constructs of the United Kingdom (UK) provide a fertile food environment for the dramatic expansion in the ultra-processed food (UPF) market, driving increased UPF consumption. This has coincided with the significant increase in the incidence and prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and cancer, with an inherent impact on morbidity and mortality. Our review aims to assess the current epidemiological and public health trends in the United Kingdom, specifically examining consumption of UPFs and subsequent development of NCDs, summarizing existing meta-analytical and experimental approaches. First, we address important socioeconomic and psychosocial domains that may contribute to increased availability and consumption of UPF. Additionally, we explore the putative mechanistic basis for the association between UPFs and NCDs: partly attributable to their energy density, the macro- and micronutrient composition (including high refined carbohydrate, saturated, and trans fats composition, in addition to low fiber and protein content), and artificially engineered additives and other compounds that adversely affect health in inadequately researched pathophysiological pathways. This review highlights the importance of promoting minimally processed diets to both clinical and political decision makers.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Theresa J Hydes
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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Royo-Bordonada MÁ, Cavero-Esponera C, Romero-Fernández MM, González-Díaz C, Ordaz Castillo E. Differences in children's exposure to television advertising of unhealthy foods and beverages in Spain by socio-economic level. BMC Public Health 2024; 24:739. [PMID: 38454414 PMCID: PMC10921598 DOI: 10.1186/s12889-023-17410-z] [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: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. METHODS Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. RESULTS The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). CONCLUSION Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television.
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Affiliation(s)
- Miguel Ángel Royo-Bordonada
- National School of Public Health, Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, 28029, Spain
| | - Cristina Cavero-Esponera
- Department of Preventive Medicine and Public Health, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, 28003, Spain.
- Doctoral Program in Biomedical Sciences and Public Health, International Doctorate Program, National University of Distance Education (UNED), Madrid, 28015, Spain.
| | - María Mar Romero-Fernández
- Puertollano Integrated Care Management. Health Service of Castilla-La Mancha, Unit of Teaching and Research, Santa Bárbara Hospital, Castilla-La Mancha, Spain
| | | | - Elena Ordaz Castillo
- National School of Public Health, Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, 28029, Spain
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Maksi SJ, Keller KL, Dardis F, Vecchi M, Freeman J, Evans RK, Boyland E, Masterson TD. The food and beverage cues in digital marketing model: special considerations of social media, gaming, and livestreaming environments for food marketing and eating behavior research. Front Nutr 2024; 10:1325265. [PMID: 38384857 PMCID: PMC10880034 DOI: 10.3389/fnut.2023.1325265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 02/23/2024] Open
Abstract
Digital marketing to children, teens, and adults contributes to substantial exposure to cues and persuasive messages that drive the overconsumption of energy dense foods and sugary beverages. Previous food marketing research has focused on traditional media, but less is known about how marketing techniques translate within digital platforms, such as social media, livestreaming, and gaming. Building upon previous theories and models, we propose a new model entitled food and beverage cues in digital marketing (FBCDM). The FBCDM model specifies key marking elements and marketing integration strategies that are common on digital platforms and are hypothesized to enhance the effects of advertising and incentive sensitization process. FBCDM also categorizes measurable outcomes into three domains that include brand, food, and social outcomes. Additionally, repeated marketing exposure and the resulting outcomes are hypothesized to have long term consequences related to consumer markets, consumption behavior, culture, and health. We include a discussion of what is currently known about digital marketing exposure within the outcome domains, and we highlight gaps in research including the long-term consequences of digital marketing exposure. The FBCDM model provides a conceptual framework to guide future research to examine the digital marketing of food and beverages to children and adolescents in order to inform government and industry policies that restrict the aggressive marketing of products associated with obesity and adverse diet related outcomes.
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Affiliation(s)
- Sara J. Maksi
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Kathleen L. Keller
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Frank Dardis
- Department of Advertising and Public Relations, The Pennsylvania State University, University Park, PA, United States
| | - Martina Vecchi
- Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, University Park, PA, United States
| | - Jason Freeman
- Department of Advertising, School of Communications, Brigham Young University, Provo, UT, United States
| | - Rebecca K. Evans
- Department of Psychology, The University of Liverpool, Liverpool, United Kingdom
| | - Emma Boyland
- Department of Psychology, The University of Liverpool, Liverpool, United Kingdom
| | - Travis D. Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
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12
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Prescott SL, Logan AC, D’Adamo CR, Holton KF, Lowry CA, Marks J, Moodie R, Poland B. Nutritional Criminology: Why the Emerging Research on Ultra-Processed Food Matters to Health and Justice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:120. [PMID: 38397611 PMCID: PMC10888116 DOI: 10.3390/ijerph21020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
There is mounting concern over the potential harms associated with ultra-processed foods, including poor mental health and antisocial behavior. Cutting-edge research provides an enhanced understanding of biophysiological mechanisms, including microbiome pathways, and invites a historical reexamination of earlier work that investigated the relationship between nutrition and criminal behavior. Here, in this perspective article, we explore how this emergent research casts new light and greater significance on previous key observations. Despite expanding interest in the field dubbed 'nutritional psychiatry', there has been relatively little attention paid to its relevancy within criminology and the criminal justice system. Since public health practitioners, allied mental health professionals, and policymakers play key roles throughout criminal justice systems, a holistic perspective on both historical and emergent research is critical. While there are many questions to be resolved, the available evidence suggests that nutrition might be an underappreciated factor in prevention and treatment along the criminal justice spectrum. The intersection of nutrition and biopsychosocial health requires transdisciplinary discussions of power structures, industry influence, and marketing issues associated with widespread food and social inequalities. Some of these discussions are already occurring under the banner of 'food crime'. Given the vast societal implications, it is our contention that the subject of nutrition in the multidisciplinary field of criminology-referred to here as nutritional criminology-deserves increased scrutiny. Through combining historical findings and cutting-edge research, we aim to increase awareness of this topic among the broad readership of the journal, with the hopes of generating new hypotheses and collaborations.
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Affiliation(s)
- Susan L. Prescott
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia;
- Nova Institute for Health, Baltimore, MD 21231, USA;
- Department of Family and Community Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
- The ORIGINS Project, Telethon Kids Institute, Perth, WA 6009, Australia
| | - Alan C. Logan
- Nova Institute for Health, Baltimore, MD 21231, USA;
| | - Christopher R. D’Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA;
- Department of Family and Community Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Kathleen F. Holton
- Departments of Health Studies and Neuroscience, Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA;
| | - Christopher A. Lowry
- Department of Psychology and Neuroscience, Center for Neuroscience and Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA;
| | - John Marks
- Department of Criminal Justice, Louisiana State University of Alexandria, Alexandria, LA 71302, USA;
| | - Rob Moodie
- School of Population and Global Health (MSPGH), University of Melbourne, Melbourne, VIC 3052, Australia;
| | - Blake Poland
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5R 0A3, Canada;
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13
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Boyland E, Maden M, Coates AE, Masterson TD, Alblas MC, Bruce AS, Roberts CA. Food and non-alcoholic beverage marketing in children and adults: A systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Obes Rev 2024; 25:e13643. [PMID: 37766661 DOI: 10.1111/obr.13643] [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: 09/23/2022] [Revised: 07/12/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
Food marketing impacts the food behaviors of children and adults, but the underpinning neural mechanisms are poorly understood. This systematic review and meta-analysis pooled evidence from neuroimaging studies of exposure to food marketing stimuli (vs. control) on brain activations in children and adults to clarify regions associated with responding. Databases were searched for articles published to March 2022. Inclusion criteria included human functional magnetic resonance imaging (fMRI) studies employing a contrast between a food marketing stimulus and a non-food/non-exposure control, published in English in a peer-reviewed journal, reporting whole brain (not Region of Interest [ROI] only) co-ordinates. Eleven studies met inclusion criteria, of which eight were included in the quantitative synthesis (Activation Likelihood Estimation [ALE] meta-analysis). Food marketing exposures (vs. controls) produced greater activation in two clusters lying across the middle occipital gyrus, lingual gyrus, and cuneus (cluster 1), and the postcentral gyrus, precentral gyrus, and the inferior parietal lobule/supramarginal gyrus (cluster 2). Brain responses to food marketing are most consistently observed in areas relating to visual processing, attention, sensorimotor activity, and emotional processing. Subgroup analyses (e.g., adults vs. children) were not possible because of the paucity of data, and sensitivity analyses highlighted some instability in the clusters; therefore, conclusions remain tentative pending further research.
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Affiliation(s)
- Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Anna E Coates
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Travis D Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, Pennsylvania, USA
| | - Monique C Alblas
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda S Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas, USA
| | - Carl A Roberts
- Department of Psychology, University of Liverpool, Liverpool, UK
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14
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Johnson O, Delk DW. #Wematter: Creating culturally tailored health promotion content for Black and Latina college women on Instagram. Digit Health 2024; 10:20552076241241919. [PMID: 38596403 PMCID: PMC11003336 DOI: 10.1177/20552076241241919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Although students at Minority-Serving Institutions (HBCUs, HSIs, TCUs, AAPISIs) have been found to make sound health choices as compared to their counterparts at Predominately White Institutions and have positive expectancy outcomes of physical activity engagement, it is consistently suggested that MSIs examine and bolster health enhancing avenues. Black and Latina women frequently use social media platforms to connect to content that can initiate and support lifestyle changes or improvements. Thus, establishing culturally relevant health related social media content geared toward Black and Latina College Women (BLCW) may be successful in achieving health-related goals. Therefore, the purpose of this study using social identity theory as a theoretical lens, was to identify the fundamental characteristics of culturally tailored health-related content for BLCW. Method This study employed a qualitative approach to ascertain the characteristics of culturally tailored health-related content for BLCW. Black and Latina college women were asked to provide feedback on mock culturally tailored health-related content in semi-structured focus groups. Participants discussed the authenticity and cultural relevancy of images designed to promote physical activity engagement and other healthy behaviors. Results Results indicated that at a minimum, culturally tailored health-related content should include an array of body shapes, authentic language and messaging, in relevant settings. Moreover, BLCW prefer content that is realistic, reflects their experiences, and embodies their relevant identities. Conclusion Social media content designed to attract and promote healthy lifestyles of BLCW must be comprised of imagery and language that represent the diversity of the priority group. The findings from this study can help to establish best practices when designing content intended to strengthen wellness among college students and young adults.
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15
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Evans RK, Christiansen P, Finlay A, Jones A, Maden M, Boyland E. A systematic review and meta-analysis of the effect of digital game-based or influencer food and non-alcoholic beverage marketing on children and adolescents: Exploring hierarchy of effects outcomes. Obes Rev 2023; 24:e13630. [PMID: 37608618 DOI: 10.1111/obr.13630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
Videogame livestreaming platforms are an emerging form of digital media, popular with young people, where users watch gaming influencers play videogames. Food and non-alcoholic beverage (hereafter: food) brands have a substantial presence on these platforms, yet no studies have examined the impact of this food marketing on young people. This systematic review and meta-analysis examined the evidence (quantitative or mixed-method) for a relationship between exposure to digital game-based or influencer food marketing, and food-related (brand awareness, attitudes, preferences, purchase, and consumption), and post-consumption (weight, body mass index [BMI], and dental caries) outcomes in young people (≤18 years). Twenty-three databases were searched in March 2021. Twenty-two studies met the inclusion criteria, of which 20 were included in the quantitative synthesis. Meta-analyses indicated food marketing was associated with more positive attitudes and greater preferences (OR = 1.74, p < 0.001 [95%CI: 1.355, 2.232]), and increased consumption (SMD = 0.37, p < 0.001 [95%CI: 0.219, 0.529]). Narrative synthesis indicated that food marketing may increase brand awareness but not pester intent, although data were limited. Evidence suggests that there is a relationship between exposure to food marketing via influencers and digital gaming media, and several food-related outcomes. This is the first quantitative synthesis to demonstrate these relationships; this work has implications for food marketing policy.
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Affiliation(s)
- Rebecca K Evans
- Department of Psychology, The University of Liverpool, Liverpool, UK
| | - Paul Christiansen
- Department of Psychology, The University of Liverpool, Liverpool, UK
| | - Amy Finlay
- Department of Psychology, The University of Liverpool, Liverpool, UK
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, Institute of Population Health, The University of Liverpool, Liverpool, UK
| | - Emma Boyland
- Department of Psychology, The University of Liverpool, Liverpool, UK
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16
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Vandevijvere S, De Pauw R, Djojosoeparto S, Gorasso V, Guariguata L, Løvhaug AL, Mialon M, Van Dam I, von Philipsborn P. Upstream Determinants of Overweight and Obesity in Europe. Curr Obes Rep 2023; 12:417-428. [PMID: 37594616 DOI: 10.1007/s13679-023-00524-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants. RECENT FINDINGS Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.
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Affiliation(s)
- Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sanne Djojosoeparto
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Leonor Guariguata
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | | | - Iris Van Dam
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Peter von Philipsborn
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Munich, Germany
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17
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McKevitt S, White M, Petticrew M, Summerbell C, Vasiljevic M, Boyland E, Cummins S, Laverty AA, Millett C, de Vocht F, Junghans C, Vamos EP. Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England. J Public Health (Oxf) 2023; 45:878-887. [PMID: 37608490 PMCID: PMC10687598 DOI: 10.1093/pubmed/fdad155] [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: 04/03/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs. METHODS We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation). RESULTS Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods. CONCLUSIONS English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.
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Affiliation(s)
- Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Martin White
- MRC Epidemiology Unit, School of Clinical Sciences, University of Cambridge, Cambridge, UK
| | - Mark Petticrew
- Department of Public Health, Environments & Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carolyn Summerbell
- Centre for Translational Research in Public Health, Fuse, Newcastle, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Milica Vasiljevic
- Centre for Translational Research in Public Health, Fuse, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration Northwest London (NIHR ARC), London, UK
| | - Cornelia Junghans
- NIHR Applied Research Collaboration Northwest London (NIHR ARC), London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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18
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Hilton S, Vaczy C, Buckton C, Patterson C, Smith MJ. Expert views on high fat, salt and sugar food marketing policies to tackle obesity and improve dietary behaviours in the UK: a qualitative study. BMC Public Health 2023; 23:1951. [PMID: 37814236 PMCID: PMC10561510 DOI: 10.1186/s12889-023-16821-2] [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: 11/08/2022] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND There has been a lack of progress in reducing obesity in the United Kingdom (UK) despite Government strategies released over the last 30 years. These strategies, including the most recent publication from July 2020, have focused on childhood obesity and high fat, sugar and/or salt (HFSS) marketing restrictions, particularly broadcast advertising. In this study, we aimed to examine a range of expert views on the potential impact and the relative importance of such policies. METHODS Semi-structured interviews were conducted with 42 experts in policy (n = 19), industry (n = 10), and advocacy (n = 13) with an interest in obesity. The UK Government's 2020 obesity strategy was used as a prompt to guide discussion on policy options. Qualitative thematic analysis was employed to answer the three research questions and themes were inductively coded within each research question. Data were also cross compared using matrix coding and a form of framework analysis to examine the views expressed by the different types of stakeholders. RESULTS Reactions to the July 2020 proposal were mixed among policy and advocacy stakeholders, while commercial stakeholders expressed disappointment. A main theme emerging in all groups was frustration with the policy process and wishing to see more clarity regarding restrictions and their implementation. There was an overall lack of trust that the government would carry out their proposed plan and agreement that a more comprehensive, multi-sector approach aimed at the underlying drivers of obesity would be most effective, with some stakeholders indicating that some of the proposed policies could make a difference if implemented robustly. On the theme of promoting healthier options, some stakeholders suggested lowering the prices of 'healthy' products and making them more accessible to combat regressivity. There was a potentially surprising level of agreement between policy/advocacy stakeholders and commercial stakeholders, although commercial stakeholders were more likely to advocate for collaboration between government and industry as well as voluntary industry measures. CONCLUSION While HFSS marketing restrictions have a role to play and send a strong signal - provided they are implemented comprehensively - investment in these policies needs to be part of wider efforts to tackle the underlying drivers of obesity.
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Affiliation(s)
- Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
| | - Caroline Vaczy
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK.
| | - Christina Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
| | - Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
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19
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Sykes S, Watkins M, Bond M, Jenkins C, Wills J. What works in advocating for food advertising policy change across an english region - a realist evaluation. BMC Public Health 2023; 23:1896. [PMID: 37784142 PMCID: PMC10544363 DOI: 10.1186/s12889-023-16829-8] [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: 01/11/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND With increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change. METHODS Guided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes. RESULTS Outcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors. CONCLUSION Effecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.
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Affiliation(s)
- Susie Sykes
- London South Bank University, 101 Borough Road, SE1 0AA, London, England.
| | - Megan Watkins
- London South Bank University, 101 Borough Road, SE1 0AA, London, England
| | - Matthew Bond
- London South Bank University, 101 Borough Road, SE1 0AA, London, England
| | - Catherine Jenkins
- London South Bank University, 101 Borough Road, SE1 0AA, London, England
| | - Jane Wills
- London South Bank University, 101 Borough Road, SE1 0AA, London, England
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20
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Ruggles PR, Thomas JE, Poulos NS, Pasch KE. School-Level Socioeconomic Status and Nutrient Content of Outdoor Food/Beverage Advertisements. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6730. [PMID: 37754591 PMCID: PMC10530988 DOI: 10.3390/ijerph20186730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/28/2023]
Abstract
We examined if areas around schools with more students of lower socioeconomic status (SES) have more total food/beverage advertisements and/or more advertisements with poorer nutritional content as compared to areas around schools with fewer students with lower SES. All outdoor food/beverage advertisements within a half-mile radius of 47 middle and high schools in the United States were objectively documented in 2012 and coded for nutritional content. The total number of advertisements and the macronutrient and micronutrient contents (total calories, fat (g), protein (g), carbohydrate (g), sugar (g), and sodium (mg)) of food and beverage items depicted in the advertisements were calculated. In total, 9132 unique advertisements were recorded, with 3153 ads displaying food and beverages that could be coded for nutrient content. Schools located in areas of lower SES (≥60% students receiving free/reduced-price lunch) had significantly more advertisements displaying food and beverages that could be coded for nutrient content (z = 2.01, p = 0.04), as well as advertisements that contained more sodium (z = 2.20, p = 0.03), as compared to schools located in areas of higher SES. There were no differences in calorie, fat, protein, carbohydrate, or sugar content. Policies to reduce the prevalence of outdoor food and beverage advertising are warranted.
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Affiliation(s)
- Phoebe R. Ruggles
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Jacob E. Thomas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Natalie S. Poulos
- School of Community and Rural Health, Heath Science Center, The University of Texas at Tyler, Tyler, TX 78708, USA
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Keryn E. Pasch
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
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21
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Dillman Carpentier FR, Stoltze FM, Popkin BM. Comprehensive mandatory policies are needed to fully protect all children from unhealthy food marketing. PLoS Med 2023; 20:e1004291. [PMID: 37747882 PMCID: PMC10575484 DOI: 10.1371/journal.pmed.1004291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/13/2023] [Indexed: 09/27/2023] Open
Abstract
The World Health Organization (WHO) have released a new guideline, "Policies to protect children from the harmful impact of food marketing" [1] which recommends the development of comprehensive laws to reduce children's exposure to unhealthy food marketing. This new guideline extends previous recommendations [2] to limit the adverse effects of unhealthy food marketing on the health of the world's children. We consider here whether these new recommendations go far enough.
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Affiliation(s)
| | | | - Barry M. Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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22
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Boyland E. Is it ethical to advertise unhealthy foods to children? Proc Nutr Soc 2023; 82:234-240. [PMID: 36606537 DOI: 10.1017/s0029665123000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The marketing of foods and non-alcoholic beverages (hereafter: food) high in fats, salt and/or sugar (HFSS) has been strongly implicated in the rising levels of childhood obesity worldwide. Multiple ethical concerns arise from the practice of exposing children to such marketing and efforts to monitor and restrict it through regulatory policies. There is considerable evidence that exposure to powerful food marketing messages affects children's food behaviours in ways that are detrimental to good dietary health. Children are particularly vulnerable to being exploited and deceived by food marketing messages based on their cognitive and developmental immaturity. HFSS food marketing also affects numerous child rights enshrined within the UN Convention on the Rights of the Child (of which the UK is a signatory) including the right to the enjoyment of the highest attainable standard of health. The debate has become somewhat polarised between the public health community's evidence-based assertion that all marketing is inherently exploitative and the rebuttal from food and marketing industry stakeholders that provided the marketing is 'accurate and truthful' and there is no ethical need to regulate. This polarisation is reflected in the complexity of policymaking decisions regarding the rationale for mandatory government-led policies or industry self-regulation. There are also ethical considerations inherent in the monitoring of children's food marketing exposure, particularly in the digital sphere, by researchers for the purposes of informing policy design, scope and implementation. This review paper will explore the latest evidence on these issues and consider the implications for public health research, policy, and practice.
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Affiliation(s)
- E Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Bagnato M, Roy-Gagnon MH, Vanderlee L, White C, Hammond D, Potvin Kent M. The impact of fast food marketing on brand preferences and fast food intake of youth aged 10-17 across six countries. BMC Public Health 2023; 23:1436. [PMID: 37501119 PMCID: PMC10373354 DOI: 10.1186/s12889-023-16158-w] [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: 02/07/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
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.
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Affiliation(s)
- Mariangela Bagnato
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, Santé Et Société (Centre NUTRISS), and Institut Sur La Nutrition Et Les Aliments Fonctionnels (INAF), Université Laval, Quebec City, Canada
| | - Christine White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
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Prescott SL, D’Adamo CR, Holton KF, Ortiz S, Overby N, Logan AC. Beyond Plants: The Ultra-Processing of Global Diets Is Harming the Health of People, Places, and Planet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6461. [PMID: 37569002 PMCID: PMC10419141 DOI: 10.3390/ijerph20156461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Global food systems are a central issue for personal and planetary health in the Anthropocene. One aspect of major concern is the dramatic global spread of ultra-processed convenience foods in the last 75 years, which is linked with the rising human burden of disease and growing sustainability and environmental health challenges. However, there are also calls to radically transform global food systems, from animal to plant-derived protein sources, which may have unintended consequences. Commercial entities have moved toward this "great plant transition" with vigor. Whether motivated by profit or genuine environmental concern, this effort has facilitated the emergence of novel ultra-processed "plant-based" commercial products devoid of nutrients and fiber, and sometimes inclusive of high sugar, industrial fats, and synthetic additives. These and other ingredients combined into "plant-based" foods are often assumed to be healthy and lower in calorie content. However, the available evidence indicates that many of these products can potentially compromise health at all scales-of people, places, and planet. In this viewpoint, we summarize and reflect on the evidence and discussions presented at the Nova Network planetary health meeting on the "Future of Food", which had a particular focus on the encroachment of ultra-processed foods into the global food supply, including the plant-sourced animal protein alternatives (and the collective of ingredients therein) that are finding their way into global fast-food chains. We contend that while there has been much uncritical media attention given to the environmental impact of protein and macronutrient sources-meat vs. novel soy/pea protein burgers, etc.-the impact of the heavy industrial processing on both human and environmental health is significant but often overlooked, including effects on cognition and mental health. This calls for a more nuanced discourse that considers these complexities and refocuses priorities and value systems towards mutualistic solutions, with co-benefits for individuals, local communities, and global ecology.
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Affiliation(s)
- Susan L. Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Christopher R. D’Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kathleen F. Holton
- Departments of Health Studies and Neuroscience, Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA;
| | - Selena Ortiz
- Department of Health Policy and Administration, The Pennsylvania State University, State College, PA 16802, USA;
| | - Nina Overby
- Department of Nutrition and Public Health, Centre for Lifecourse Nutrition, University of Agder, 4630 Kristiansand, Norway;
| | - Alan C. Logan
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
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25
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Scott LJ, Nobles J, Sillero-Rejon C, Brockman R, Toumpakari Z, Jago R, Cummins S, Blake S, Horwood J, de Vocht F. Advertisement of unhealthy commodities in Bristol and South Gloucestershire and rationale for a new advertisement policy. BMC Public Health 2023; 23:1078. [PMID: 37277744 DOI: 10.1186/s12889-023-15995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Bristol City Council introduced a new advertisement policy in 2021/2022 which included prohibiting the advertising of unhealthy food and drink (HFSS), alcohol, gambling and payday loans across council-owned advertising spaces. This mixed methods study is part of the BEAR study, and aimed to explore the rationale and the barriers and facilitators to implementing the policy, and describe the perceived advertising environment prior to implementation. METHODS Semi-structured interviews were carried out with seven stakeholders involved in the design and implementation of the advertising policy. A stakeholder topic guide was developed before interviews took place to help standardise the lines of inquiry between interviewees. A resident survey was developed to collect socio-demographic data and, for the purpose of this study, information regarding observations of advertising for HFSS products, alcohol and gambling. RESULTS Fifty-eight percent of respondents residing in Bristol and South Gloucestershire reported seeing advertisements for unhealthy commodities in the week prior to completing the survey. This was highest for HFSS products (40%). 16% of residents reported seeing HFSS product advertisements specifically appealing to children. For HFSS products in particular, younger people were more likely to report seeing adverts than older people, as were those who were from more deprived areas. An advertisement policy that restricts the advertisement of such unhealthy commodities, and in particular for HFSS products, has the potential to reduce health inequalities. This rationale directly influenced the development of the advertisement policy in Bristol. Implementation of the policy benefitted from an existing supportive environment following the 'health in all policies' initiative and a focus on reducing health inequalities across the city. CONCLUSIONS Unhealthy product advertisements, particularly for unhealthy food and drinks, were observed more by younger people and those living in more deprived areas. Policies that specifically restrict such advertisements, therefore, have the potential to reduce health inequalities, as was the hope when this policy was developed. Future evaluation of the policy will provide evidence of any public health impact.
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Affiliation(s)
- Lauren J Scott
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - James Nobles
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Carlos Sillero-Rejon
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rowan Brockman
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russell Jago
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Steven Cummins
- Department of Public Health, Environments & Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Blake
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
| | - Jeremy Horwood
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Frank de Vocht
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
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26
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Logan AC, D'Adamo CR, Prescott SL. The Founder: Dispositional Greed, Showbiz, and the Commercial Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095616. [PMID: 37174136 PMCID: PMC10178243 DOI: 10.3390/ijerph20095616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Marketing unhealthy products by multinational corporations has caused considerable harm to individual health, collective wellbeing, and environmental sustainability. This is a growing threat to all societies and a significant contributor to the rising global burden of non-communicable diseases and early mortality. While there is growing consideration of the commercial determinants of health, this is largely focused on the methods by which unhealthy products are marketed and disseminated, including efforts to manipulate policy. Little attention has been paid to the underlying psychological traits and worldviews that are driving corporate greed. Here, we consider the role of "dispositional greed" in the commercial determinants of health with a focus on the historical attitudes and culture in the ultra-processed food industry-exemplified by "The Founder" of the McDonald's franchise. We argue that greed and associated psychological constructs, such as social dominance orientation and collective narcissism, permeate the commercial determinants of health at a collective level. This includes how a culture of greed within organizations, and individual dispositional greed, can magnify and cluster at scale, perpetuated by social dominance orientation. We also consider the ways in which "showbiz" marketing specifically targets marginalized populations and vulnerable groups, including children-in ways that are justified, or even celebrated despite clear links to non-communicable diseases and increased mortality. Finally, we consider how greed and exploitative mindsets mirror cultural values and priorities, with trends for increasing collective narcissism at scale, recognizing that many of these attitudes are cultivated in early life. A healthier future will depend on navigating a path that balances material prosperity with physical and spiritual wellbeing. This will require cultural change that places higher value on kindness, reciprocity, and mutualistic values especially in early life, for more equitable flourishing.
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Affiliation(s)
- Alan C Logan
- Nova Institute for Health, Baltimore, MD 21231, USA
| | - Christopher R D'Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Susan L Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
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27
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Homs C, Berruezo P, Arcarons A, Wärnberg J, Osés M, González-Gross M, Gusi N, Aznar S, Marín-Cascales E, González-Valeiro MÁ, Serra-Majem L, Terrados N, Tur JA, Segú M, Fitó M, Benavente-Marín JC, Labayen I, Zapico AG, Sánchez-Gómez J, Jiménez-Zazo F, Alcaraz PE, Sevilla-Sanchez M, Herrera-Ramos E, Pulgar-Muñoz S, Bouzas C, Milà R, Schröder H, Gómez SF. Independent and Joined Association between Socioeconomic Indicators and Pediatric Obesity in Spain: The PASOS Study. Nutrients 2023; 15:nu15081987. [PMID: 37111206 PMCID: PMC10143028 DOI: 10.3390/nu15081987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Childhood obesity is a public health problem worldwide. An important determinant of child and adolescent obesity is socioeconomic status (SES). However, the magnitude of the impact of different SES indicators on pediatric obesity on the Spanish population scale is unclear. The aim of this study was to assess the association between three SES indicators and obesity in a nationwide, representative sample of Spanish children and adolescents. A total of 2791 boys and girls aged 8 to 16 years old were included. Their weight, height, and waist circumference were measured. SES was assessed using two parent/legal guardian self-reported indicators (educational level -University/non-University- and labor market status -Employed/Unemployed-). As a third SES indicator, the annual mean income per person was obtained from the census section where the participating schools were located (≥12.731€/<12.731€). The prevalence of obesity, severe obesity, and abdominal obesity was 11.5%, 1.4%, and 22.3%, respectively. Logistic regression models showed an inverse association of both education and labor market status with obesity, severe obesity, and abdominal obesity (all p < 0.001). Income was also inversely associated with obesity (p < 0.01) and abdominal obesity (p < 0.001). Finally, the highest composite SES category (University/Employed/≥12.731€ n = 517) showed a robust and inverse association with obesity (OR = 0.28; 95% CI: 0.16-0.48), severe obesity (OR = 0.20; 95% CI: 0.05-0.81), and abdominal obesity (OR = 0.36; 95% CI: 0.23-0.54) in comparison with the lowest composite SES category (Less than University/Unemployed/<12.731€; n = 164). No significant interaction between composite SES categories and age and gender was found. SES is strongly associated with pediatric obesity in Spain.
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Affiliation(s)
- Clara Homs
- Gasol Foundation Europe, 08830 Sant Boi de Llobregat, Spain
- Global Research on Wellbeing (GroW), Faculty of Health Sciences, Blanquerna Ramon Llull University, 08025 Barcelona, Spain
| | - Paula Berruezo
- Gasol Foundation Europe, 08830 Sant Boi de Llobregat, Spain
| | - Albert Arcarons
- Office of the High Commissioner against Child Poverty, 28079 Madrid, Spain
- Department of Sociology, National Distance Education University (UNED), 28012 Madrid, Spain
| | - Julia Wärnberg
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, 29590 Málaga, Spain
| | - Maddi Osés
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Marcela González-Gross
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, 28003 Madrid, Spain
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Susana Aznar
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha-Toledo Campus, 45071 Toledo, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Elena Marín-Cascales
- UCAM Research Center for High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Strength & Conditioning Society, 30008 Murcia, Spain
| | | | - Lluis Serra-Majem
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Preventive Medicine Service, Canarian Health Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), 35016 Las Palmas de Gran Canaria, Spain
| | - Nicolás Terrados
- Regional Unit of Sports Medicine-Municipal Sports Foundation of Avilés, 33402 Avilés, Spain
| | - Josep A Tur
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), 07122 Palma de Mallorca, Spain
| | - Marta Segú
- Barça Foundation, 08028 Barcelona, Spain
| | - Montserrat Fitó
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Juan Carlos Benavente-Marín
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, 29590 Málaga, Spain
| | - Idoia Labayen
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Augusto G Zapico
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, 28003 Madrid, Spain
- Department of Language, Arts and Physical Education, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jesús Sánchez-Gómez
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Fabio Jiménez-Zazo
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha-Toledo Campus, 45071 Toledo, Spain
| | - Pedro E Alcaraz
- UCAM Research Center for High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Strength & Conditioning Society, 30008 Murcia, Spain
| | - Marta Sevilla-Sanchez
- Faculty of Sports Sciences and Physical Education, Universida de da Coruña, 15001 A Coruña, Spain
| | - Estefanía Herrera-Ramos
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Susana Pulgar-Muñoz
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Cristina Bouzas
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), 07122 Palma de Mallorca, Spain
| | - Raimon Milà
- Global Research on Wellbeing (GroW), Faculty of Health Sciences, Blanquerna Ramon Llull University, 08025 Barcelona, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
| | - Santiago F Gómez
- Gasol Foundation Europe, 08830 Sant Boi de Llobregat, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
- Nursing and Physiotherapy Department, University of Lleida, 25198 Lleida, Spain
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28
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Acton RB, Bagnato M, Remedios L, Potvin Kent M, Vanderlee L, White CM, Hammond D. Examining differences in children and adolescents' exposure to food and beverage marketing in Canada by sociodemographic characteristics: Findings from the International Food Policy Study Youth Survey, 2020. Pediatr Obes 2023; 18:e13028. [PMID: 36958860 DOI: 10.1111/ijpo.13028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Many countries, including Canada, are considering regulations to restrict food and beverage marketing to children. However, little evidence is available outside of the US on how marketing exposure differs across sociodemographic subgroups. OBJECTIVE To investigate potential associations between child and adolescent sociodemographic characteristics and exposure to food and beverage marketing in Canada. METHODS Participants (n = 3780) aged 10-17 self-reported exposure to food and beverage marketing across food categories, locations and marketing techniques. Logistic regression models tested relationships between sociodemographics (age, sex, ethnicity and income adequacy) and marketing exposure. RESULTS Among other differences identified, 13-17 years old were more likely than 10-12 years old to report seeing unhealthy food marketing online. Girls were more likely than boys to see such marketing online and in retail settings, while boys were more likely to see it in video games. Minority ethnicities (including Indigenous youth) and respondents with lower income adequacy generally reported more exposure than White and higher income respondents, respectively. CONCLUSIONS This study highlights important differences in marketing exposure among youth of different sociodemographic groups in Canada, including greater exposure to marketing among those most disadvantaged and emphasizes the essential need to consider food marketing across equity groups when developing restrictions on marketing to kids.
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Affiliation(s)
- Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mariangela Bagnato
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren Remedios
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, Québec, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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29
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Kelly B, Backholer K, Boyland E, Kent MP, Bragg MA, Karupaiah T, Ng S. Contemporary Approaches for Monitoring Food Marketing to Children to Progress Policy Actions. Curr Nutr Rep 2023; 12:14-25. [PMID: 36746878 PMCID: PMC9974707 DOI: 10.1007/s13668-023-00450-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Bridget Kelly
- Early Start, School of Health & Society, University of Wollongong, Wollongong, NSW, Australia.
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Emma Boyland
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marie A Bragg
- Department of Population Health, NYU School of Medicine, New York, NY, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, 47500, Selangor, Malaysia
| | - SeeHoe Ng
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, 47500, Selangor, Malaysia
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Sneed NM, Ukwuani S, Sommer EC, Samuels LR, Truesdale KP, Matheson D, Noerper TE, Barkin SL, Heerman WJ. Reliability and validity of assigning ultraprocessed food categories to 24-h dietary recall data. Am J Clin Nutr 2023; 117:182-190. [PMID: 36789937 PMCID: PMC10196599 DOI: 10.1016/j.ajcnut.2022.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Nova classification system categorizes foods into 4 processing levels, including ultraprocessed foods (UPFs). Consumption of UPFs is extensive in the United States, and high UPF consumption is associated with chronic disease risk. A reliable and valid method to Nova-categorize foods would advance understanding of UPF consumption and its relationship to health outcomes. OBJECTIVES Test the reliability and validity of training coders and assigning Nova categories to individual foods collected via 24-h dietary recalls. DESIGN A secondary analysis of 24-h dietary recalls from 610 children who participated in a randomized controlled trial and were 3-5 y old at baseline was conducted. The Nutrition Data System for Research (NDSR) software was used to collect 2-3 dietary recalls at baseline and yearly for 3 y. Trained and certified coder pairs independently categorized foods into one of 4 Nova categories (minimally processed, processed culinary ingredients, processed, and ultraprocessed). Interrater reliability was assessed by percent concordance between coder pairs and by Cohen's κ coefficient. Construct validity was evaluated by comparing the average daily macronutrient content of foods between Nova categories. RESULTS In 5546 valid recall days, 3099 unique foods were categorized: minimally processed (18%), processed culinary ingredients (0.4%), processed (15%), and ultraprocessed (67%). Coder concordance = 88.3%, and κ coefficient = 0.75. Descriptive comparisons of macronutrient content across 66,531 diet recall food entries were consistent with expectations. On average, UPFs were 62% (SD 19) of daily calories, and a disproportionally high percentage of daily added sugar (94%; SD 16) and low percentage of daily protein (47%; SD 24). Minimally processed foods were 30% (SD 17) of daily calories, and a disproportionally low percentage of daily added sugar (1%; SD 8) and high percentage of daily protein (43%; SD 24). CONCLUSIONS This method of Nova classifying NDSR-based 24-h dietary recalls was reliable and valid for identifying individual intake of processed foods, including UPFs.
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Affiliation(s)
- Nadia M Sneed
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, TN, USA.
| | - Somto Ukwuani
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Evan C Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donna Matheson
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Shari L Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Haynes A, Bayly M, Dixon H, McAleese A, Martin J, Chen YJM, Wakefield M. Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia. Health Promot Int 2022; 37:6827736. [DOI: 10.1093/heapro/daac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Summary
Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016–18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
- Melbourne School of Psychological Sciences, The University of Melbourne , Parkville, VIC , Australia
| | - Megan Bayly
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
- Melbourne School of Psychological Sciences, The University of Melbourne , Parkville, VIC , Australia
| | - Alison McAleese
- Prevention Division, Cancer Council Victoria , Melbourne, VIC , Australia
| | - Jane Martin
- Obesity Policy Coalition, Cancer Council Victoria , Melbourne, VIC , Australia
| | - Yan Jun Michelle Chen
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
- Melbourne School of Psychological Sciences, The University of Melbourne , Parkville, VIC , Australia
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Djojosoeparto SK, Kamphuis CBM, Harrington JM, Løvhaug AL, Roos G, Sawyer ADM, Stronks K, Terragni L, Torheim LE, Vandevijvere S, Poelman MP, van Lenthe FJ. How theory can help to understand the potential impact of food environment policies on socioeconomic inequalities in diet: an application of Bourdieu's capital theory and the scarcity theory. Eur J Public Health 2022; 32:iv66-iv70. [PMID: 36444101 PMCID: PMC9706114 DOI: 10.1093/eurpub/ckac052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Government policies that promote healthy food environments are considered promising to reduce socioeconomic inequalities in diet. Empirical evidence of effects on these inequalities, however, is relatively scarce and, with a few exceptions, tends to be inconclusive. We use two contemporary theories that help to understand socioeconomic inequalities in health and health-related behaviours (Bourdieu's capital theory and Mullainathan and Shafir's scarcity theory) to reason how policies influencing food environments may differentially impact lower and higher socioeconomic groups. In essence, these theories enable us to understand how specific elements of broader daily living conditions (e.g. social practices that lead to habitus formation, material conditions that shape experiences of scarcity) may lead to a greater benefit of certain food environment policies for the healthfulness of diets of lower or higher socioeconomic groups. We conclude that the application of theories on the mechanisms underlying socioeconomic inequalities in health can help to guide future empirical studies in testing theory-based hypotheses on differential effects of policies, and thereby enhance the development of effective policies tackling socioeconomic inequalities in dietary intakes.
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Affiliation(s)
- Sanne K Djojosoeparto
- Correspondence: Sanne K. Djojosoeparto, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Vening Meinesz Building A, Princetonlaan 8a, Utrecht 3584 CB, The Netherlands, e-mail:
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Gun Roos
- Consumption Research Norway (SIFO), OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Alexia D M Sawyer
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Terragni
- Department of Nursing and Health Promotion, OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet—Oslo Metropolitan University, Oslo, Norway,Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Miguel-Berges ML, Jimeno-Martínez A, Larruy-García A, Moreno LA, Rodríguez G, Iguacel I. The Effect of Food Vouchers and an Educational Intervention on Promoting Healthy Eating in Vulnerable Families: A Pilot Study. Nutrients 2022; 14:nu14234980. [PMID: 36501009 PMCID: PMC9739317 DOI: 10.3390/nu14234980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Cost has been reported as the main barrier to healthy eating in vulnerable groups. We aimed to evaluate the effect of a nutrition education intervention on adherence to Mediterranean Diet and health when providing food vouchers. This pilot study has a randomized control trial design. We included 66 vulnerable users from the Red Cross of Zaragoza (Spain). Intervention and control group individuals received 120 euros/month of food vouchers over 3 months to be spent in supermarkets (60 euros/month if under 12 y) plus a 10-week nutrition education program for the intervention group. Family food purchases were assessed using electronically recorded supermarket-obtained transactions. During and at the end of the intervention the percentage of healthy food was higher in the intervention than in the control group. Once the nutrition education was over, differences between groups dissipated. In the intervention group, health parameters improved, particularly weight-status, lipids, and liver enzymes. Control participants gained weight, although lipid and liver enzymes improved. Blood pressure and HbA1c did not improve in either the intervention or the control group. In conclusion, providing unrestricted food vouchers to vulnerable groups to increase healthy food consumption appears to be insufficient and should be accompanied by medium-long term nutrition education.
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Affiliation(s)
- María L. Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 50009 Zaragoza, Spain
| | - Andrea Jimeno-Martínez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón, 50013 Zaragoza, Spain
| | - Alicia Larruy-García
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón, 50013 Zaragoza, Spain
| | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 50009 Zaragoza, Spain
| | - Gerardo Rodríguez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Isabel Iguacel
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 50009 Zaragoza, Spain
- Correspondence: ; Tel.:+34-(97)-6761749
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Jani A, Exner A, Braun R, Braun B, Torri L, Verhoeven S, Murante AM, Van Devijvere S, Harrington J, Ochoa A, Marchiori GDL, Defranceschi P, Bunker A, Bärnighausen T, Sanz Sanz E, Napoléone C, Verger EO, Schader C, Röklov J, Stegeman I, Tonello S, Pederson R, Kristensen NH, Smits T, Wascher D, Voshol P, Kaptejins A, Nesrallah S, Kjørven O, DeClerck F, Biella C, Gjorgjioska MA, Tomicic A, Ferreira Oliveira AT, Bracco S, Estevens S, Rossi L, Laister G, Różalska A, Jankuloski B, Hurbin C, Jannic M, Steel F, Manbaliu E, De Jager K, Sfetsos A, Konstantopoulou M, Kapetanakis PA, Hickersberger M, Chiffard E, Woolhead C. Transitions to food democracy through multilevel governance. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.1039127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Food systems in Europe are largely unjust and not sustainable. Despite substantial negative consequences for individual health, the environment and public sector health and care services, large multi-national corporations continue to benefit from the way food systems are designed—perpetuating “Lose–Lose–Lose–Win” food systems that see these large corporations benefit at the expense of health, the environment and public sector finances. Transitioning to “Win–Win–Win–Win” food systems is challenging because of the heterogeneity, complexity and unpredictable nature of food systems—one-size fits-all solutions to correct imbalances and injustices cannot exist. To address these challenges, we propose the use of heuristics—solutions that can flexibly account for different contexts, preferences and needs. Within food systems, food democracy could be a heuristic solution that provides the processes and can form the basis for driving just transitions. However, ensuring that these transition processes are fair, equitable, sustainable and constructive, requires an approach that can be used across vertical and horizontal governance spheres to ensure the voices of key stakeholders across space, time and spheres of power are accounted for. In this manuscript we outline a new Horizon project, FEAST, that aims to use multilevel governance approaches across vertical and horizontal spheres of governance to realize constructive food democracy. We envisage this as a means to inform just processes that can be used to design and implement policies, in line with food democracy, to facilitate transitions to “Win–Win–Win–Win” food systems across Europe that makes it easy for every European to eat a healthy and sustainable diet.
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Rodríguez Delgado J, Campoy C, Galera Martínez R, Gallego Mayo E, Gil-Campos M, González Jiménez D, Redecillas Ferreiro S, Sáenz de Pipaón M, Leis R. Publicidad de alimentos no saludables. Posicionamiento del Comité de Nutrición y Lactancia Materna de la Asociación Española de Pediatría. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
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Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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37
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Murrell AJ, Jones R, Rose S, Firestine A, Bute J. Food Security as Ethics and Social Responsibility: An Application of the Food Abundance Index in an Urban Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10042. [PMID: 36011677 PMCID: PMC9408679 DOI: 10.3390/ijerph191610042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
High levels of food insecurity signal the presence of disparities and inequities in local food access that have been shown to negatively impact the health and well-being of individuals and communities. Some argue that the lack of healthy, affordable and culturally relevant food within a community represents a troubling social and ethical concern for any society. The current research conducts an assessment of a specific community utilizing the framework outlined by the Food Abundance Index (FAI) scorecard. Combined with contemporary regional data on the demographics of the area, data revealed extremely low scores for both access and density dimensions. Our findings can help business, community and policymakers better understand and target evidence-based solutions to address the issue of food insecurity within this region.
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Affiliation(s)
- Audrey J. Murrell
- David Berg Center for Ethics and Leadership, School of Business, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Ray Jones
- David Berg Center for Ethics and Leadership, School of Business, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Sam Rose
- Food21 of Pennsylvania, Pittsburgh, PA 15139, USA
| | - Alex Firestine
- College of Business Administration, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Joe Bute
- Food21 of Pennsylvania, Pittsburgh, PA 15139, USA
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Unhealthy food advertising. A position paper by the AEP Committee on Nutrition and Breastfeeding. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:206.e1-206.e9. [PMID: 35953384 DOI: 10.1016/j.anpede.2022.07.003] [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: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Some important factors influencing and maintaining unhealthy habits are food advertising and products accessibility. In order to develop and support recommendations, an analysis of the available evidence on the impact of food advertising on the health of children and adolescents has been carried out. METHODS Literature review of systematic reviews and meta-analyses published up to January 2022 for the term "food advertising" that analyzed the impact of food advertising on weight, body mass index (BMI), adiposity, dietary intake, behavior toward the advertised product, its purchase or consumption in children and adolescents. RESULTS Twenty-one systematic reviews fulfilled the inclusion criteria, including a total of 490 primary studies, 5 of which also contained a meta-analysis. The vast majority of the primary studies evaluate intermediate effects, related to the behavior of children and adolescents in relation to advertised products and their consumption. There is great variety in terms of the type of advertising and effects studied. Most of the studies agree that there is an association between food advertising and effect analyzed, being more evident in children under 12 years of age and in obese children. Most recent systematic reviews are focused on online advertising, noticing the negative effects especially in adolescents. CONCLUSIONS Children and adolescents are a particularly vulnerable population to food advertising strategies. Despite the difficulty to demonstrate an independent effect, there is evidence of an association between food advertising and childhood and adolescents' behavior respect to the announced products, and the increase of consumption at short-term. In Spain unhealthy product advertising are still very common in the media and in the children and adolescent's online environment. The Nutrition and Breastfeeding Committee of the Spanish Association of Pediatrics supports the need for regulation and limitation of unhealthy food advertising, covering all media and marketing strategies.
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Finlay A, Robinson E, Jones A, Maden M, Cerny C, Muc M, Evans R, Makin H, Boyland E. A scoping review of outdoor food marketing: exposure, power and impacts on eating behaviour and health. BMC Public Health 2022; 22:1431. [PMID: 35896996 PMCID: PMC9330687 DOI: 10.1186/s12889-022-13784-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is convincing evidence that unhealthy food marketing is extensive on television and in digital media, uses powerful persuasive techniques, and impacts dietary choices and consumption, particularly in children. It is less clear whether this is also the case for outdoor food marketing. This review (i) identifies common criteria used to define outdoor food marketing, (ii) summarises research methodologies used, (iii) identifies available evidence on the exposure, power (i.e. persuasive creative strategies within marketing) and impact of outdoor food marketing on behaviour and health and (iv) identifies knowledge gaps and directions for future research. METHODS A systematic search was conducted of Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL, PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and a number of grey literature sources. Titles and abstracts were screened by one researcher. Relevant full texts were independently checked by two researchers against eligibility criteria. RESULTS Fifty-three studies were conducted across twenty-one countries. The majority of studies (n = 39) were conducted in high-income countries. All measured the extent of exposure to outdoor food marketing, twelve also assessed power and three measured impact on behavioural or health outcomes. Criteria used to define outdoor food marketing and methodologies adopted were highly variable across studies. Almost a quarter of advertisements across all studies were for food (mean of 22.1%) and the majority of advertised foods were unhealthy (mean of 63%). The evidence on differences in exposure by SES is heterogenous, which makes it difficult to draw conclusions, however the research suggests that ethnic minority groups have a higher likelihood of exposure to food marketing outdoors. The most frequent persuasive creative strategies were premium offers and use of characters. There was limited evidence on the relationship between exposure to outdoor food marketing and eating behaviour or health outcomes. CONCLUSIONS This review highlights the extent of unhealthy outdoor food marketing globally and the powerful methods used within this marketing. There is a need for consistency in defining and measuring outdoor food marketing to enable comparison across time and place. Future research should attempt to measure direct impacts on behaviour and health.
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Affiliation(s)
- Amy Finlay
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, L69 3GB, UK
| | - Caroline Cerny
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
- Obesity Health Alliance, Liverpool, UK
| | - Magdalena Muc
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Rebecca Evans
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Harriet Makin
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
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Impact of Obesogenic Environments on Sugar-Sweetened Beverage Consumption among Preschoolers: Findings from a Cross-Sectional Survey in Beijing. Nutrients 2022; 14:nu14142860. [PMID: 35889817 PMCID: PMC9321344 DOI: 10.3390/nu14142860] [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: 06/07/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
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.
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Packer J, Russell SJ, McLaren K, Siovolgyi G, Stansfield C, Viner RM, Croker H. The impact on dietary outcomes of licensed and brand equity characters in marketing unhealthy foods to children: A systematic review and meta-analysis. Obes Rev 2022; 23:e13443. [PMID: 35261144 PMCID: PMC9285539 DOI: 10.1111/obr.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 01/02/2023]
Abstract
Licensed and brand equity characters are used to target children in the marketing of products high in fat, salt, and sugar (HFSS), but the impact of characters on dietary outcomes is unclear. The primary aim of this review was to quantify the impact of both licensed and brand equity characters on children's dietary outcomes given that existing regulations often differentiates between these character types. We systematically searched eight interdisciplinary databases and included studies from 2009 onwards until August 2021, including all countries and languages. Participants were children under 16 years, exposure was marketing for HFSS product with a character, and the outcomes were dietary consumption, preference, or purchasing behaviors of HFSS products. Data allowed for meta-analysis of taste preferences. A total of 16 articles (including 20 studies) met the inclusion criteria, of which five were included in the meta-analysis. Under experimental conditions, the use of characters on HFSS packaging compared with HFSS packaging with no character was found to result in significantly higher taste preference for HFSS products (standardized mean difference on a 5-point scale 0.273; p < 0.001). Narrative findings supported this, with studies reporting impact of both character types on product preferences including food liking and snack choice. There was limited evidence on the impact on purchase behaviors and consumption. These findings are supportive of policies that limit the exposure of HFSS food marketing using characters to children.
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Affiliation(s)
- Jessica Packer
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Simon J Russell
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie McLaren
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Gabriela Siovolgyi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire Stansfield
- EPPI-Centre, UCL Social Research institute, University College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Ingersoll RN, Bailey CP, Mavredes MN, Wang Y, Napolitano MA. Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity. EMERGING ADULTHOOD (PRINT) 2022; 10:679-688. [PMID: 35957940 PMCID: PMC9364838 DOI: 10.1177/21676968211064777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m2. For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.
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Affiliation(s)
- Rachel N Ingersoll
- Department of Prevention and Community Health Milken Institute School of Public Health The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC 20052, USA
| | - Caitlin P Bailey
- Department of Prevention and Community Health Milken Institute School of Public Health The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC 20052, USA
| | - Meghan N Mavredes
- Department of Prevention and Community Health Milken Institute School of Public Health The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC 20052, USA
| | - Yan Wang
- Department of Prevention and Community Health Milken Institute School of Public Health The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC 20052, USA
| | - Melissa A Napolitano
- Department of Prevention and Community Health Milken Institute School of Public Health The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC 20052, USA
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Chiong R, Figueroa R. Food Insecurity and the Association between Perceptions and Trust of Food Advertisements and Consumption of Ultra-Processed Foods among U.S. Parents and Adolescents. Nutrients 2022; 14:1964. [PMID: 35565932 PMCID: PMC9099781 DOI: 10.3390/nu14091964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/25/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Adolescents exposed to food and beverage advertisements (FBAs) typically low in nutrient density can be influenced in their food choices, eating behaviors, and health. This study examines the association between perceptions and trust of FBAs (key predictor) and the outcome of daily consumption of ultra-processed foods (UPFs) in parent-adolescent dyads, with risk of food insecurity as a potential moderator. Cross-sectional data from the Family, Life, Activity, Sun, Health and Eating (FLASHE) study was used to test actor and partner effects using structural equation modeling. The final model was adjusted for parent sex and education level, and effects were compared between dyads at risk of food insecurity (n = 605) and dyads not at risk (n = 1008). In the unadjusted model, actor effects (parent: b = 0.23, p = 0.001; adolescent b = 0.12, p = 0.001) and parent-partner effects were found (b = 0.08, p = 0.004). The final comparative model produced similar results for dyads not at risk of food insecurity (parent actor: b = 0.27, p = 0.001; parent partner: b = 0.10, p = 0.01; adolescent actor: b = 0.11, p = 0.003). For dyads at risk of food insecurity, only actor effects were significant (parent: b = 0.22, p = 0.001; adolescent: b = 0.11, p = 0.013). These findings suggest that parents' favorability towards FBAs influence parent-adolescent unhealthy food consumption, and that this association is different when accounting for risk of food insecurity.
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Affiliation(s)
- Reah Chiong
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA;
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Zhou M, Ramírez AS, Chittamuru D. Toward a Recipe for Deep versus Surface Level Tailoring: Mixed-Methods Validation of Message Features to Reduce Sugary Beverage Consumption. JOURNAL OF HEALTH COMMUNICATION 2022; 27:211-221. [PMID: 35730401 PMCID: PMC9391283 DOI: 10.1080/10810730.2022.2089301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Targeted marketing contributes to the overconsumption of sugary beverages, which contributes to obesity and diabetes disparities among African American and Latino populations in the U.S. Health communicators can similarly use culturally tailored messages to decrease sugary beverage consumption among these groups, yet the specific strategies to operationalize cultural tailoring-the message components essential for such tailoring-are ill-described. We sought to identify and validate authentically created, culturally tailored messages using a multiple step mixed-methods approach. First, we used a snowball approach to identify nutrition education messages targeting ethnic minorities about reducing sugary beverage consumption (N = 85). Via content analysis, we assessed message features (character gender and race/ethnicity), level of change of the appeal (individual or social), and level of cultural tailoring (surface level tailoring in the form of matching character gender and race/ethnicity with target audience versus deep structural tailoring in the form of appealing to values is an effective message strategy). The highest-rated videos were then validated by a sample of the target audience using a quantitative survey and qualitative comments (N = 76). The results inform theorizing on message tailoring and provide a validated pool of culturally relevant messages intended both to reduce intentions to consume sugary beverages and to engage in social change actions.
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Affiliation(s)
- Mi Zhou
- Department of Public Health, University of California
Merced, Merced, USA
| | - A. Susana Ramírez
- Department of Public Health, University of California
Merced, Merced, USA
| | - Deepti Chittamuru
- Department of Public Health, University of California
Merced, Merced, USA
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Socioeconomic Disparities in Outdoor Branded Advertising in San Francisco and Oakland, California. Prev Med Rep 2022; 27:101796. [PMID: 35656224 PMCID: PMC9152783 DOI: 10.1016/j.pmedr.2022.101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 12/01/2022] Open
Abstract
Advertising exerts a powerful influence over consumer decision-making, and disproportionate marketing for unhealthy products may contribute to health inequities. The objective of this study was to examine socioeconomic and racial and ethnic disparities in outdoor branded advertising for products harmful to health in San Francisco and Oakland, CA. We collected cross-sectional data on outdoor advertising from 372 blocks with ≥ 1 residential or mixed-residential parcel in SF and Oakland in 2018–2019. Blocks were randomly sampled by city, land use, majority vs. non-majority Black and/or Hispanic composition, and upper and lower tertiles of household income. Advertisements were coded by product, healthfulness, and branding. Exposure variables were neighborhood household median income and percent of residents who were Hispanic of any race, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White. The primary outcome variable was block-level dichotomous presence of any unhealthy branded advertisement for food, beverage, alcohol, or tobacco. Analyses were unadjusted and adjusted for land use and number of total advertisements on each block. Each additional $10,000 in neighborhood household median income was associated with an 11% lower adjusted odds of having any unhealthy branded advertisements on the block (95%CI: 0.80–0.99; P = 0.03). There were no significant associations between neighborhood racial and ethnic composition and presence of unhealthy branded advertisements, but with each 10% higher neighborhood composition of Hispanic residents, there was a borderline significant higher presence of unhealthy branded advertisements (OR = 1.23; 95%CI: 1.00–1.51; P = 0.05). Results indicate that low-income neighborhoods were disproportionately exposed to outdoor branded advertisements for unhealthy products.
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Zhou M, Chittamuru D, Ha S, Schillinger D, Ramírez AS. Protocol: Effectiveness of message content and format on individual and collective efficacy in reducing the intention to consume sugar-sweetened beverages. Contemp Clin Trials 2022; 115:106711. [PMID: 35189374 PMCID: PMC9018616 DOI: 10.1016/j.cct.2022.106711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
The strategic use of media is a common approach to promote health. A large body of evidence identifies specific features that increase message efficacy, including tailoring messages to the target audience and using a storytelling format. Yet most message testing research has focused on individual-level outcomes, ignoring the social and environmental determinants of health behaviors, which require collective action and political will to change. Grounded in an ecological approach to communication, we will carry out two double-blinded randomized experiments to test the relative effectiveness of message tailoring (culturally-tailored vs. standard) and format (narrative vs. didactic) to increase the intention to reduce individual sugar-sweetened beverage consumption, the understanding of social and commercial determinants of health, and the sense of empowerment among young adult Latinas. Based on power analyses (80% power at alpha = 0.05), we will randomize 438 participants to two groups (traditional standard infographic and culturally-tailored infographic) in the first study, and 662 participants to two groups (culturally-tailored infographic and culturally-tailored comic book) in the second study. All participants will be measured by a pre-treatment test and an immediate post-treatment test. We hypothesize that culturally-tailored comic book will be most effective, and traditional standard infographic will be least effective, on all levels of outcomes. This study will provide empirical evidence in communication strategies to help young Latinos or other racial/ethnic minority young people to pursue positive dietary behaviors that both benefit themselves and contribute to change of social norms.
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Affiliation(s)
- Mi Zhou
- University of California Merced, Merced, United States.
| | | | - Sandie Ha
- University of California Merced, Merced, United States
| | - Dean Schillinger
- University of California San Francisco, San Francisco, United States
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Coleman PC, Hanson P, van Rens T, Oyebode O. A rapid review of the evidence for children’s TV and online advertisement restrictions to fight obesity. Prev Med Rep 2022; 26:101717. [PMID: 35141122 PMCID: PMC8814640 DOI: 10.1016/j.pmedr.2022.101717] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 12/31/2022] Open
Abstract
The relationship between obesity and exposure to food advertising meets all criteria commonly used to demonstrate the presence of a causal relationship in epidemiology. Younger children (≤8 years of age) are more susceptible to the impacts of food marketing, in terms of quantity and quality of calories consumed, than older children and adults, although emerging evidence suggests that adolescents (10–19 years) may be most susceptible to the impacts of online advertisements. Children from socio-economically disadvantaged and ethnic minority backgrounds are disproportionately exposed to unhealthy food advertisements. Statutory regulation is a potentially cost-effective policy option, in terms of healthcare savings outweighing the costs of implementing the policy. However, advertising restrictions must be accompanied by community-based interventions that address other causes of poor diet and sedentary behaviour; this is because online and TV advertisements represent one small dimension in the wider obesogenic environment. Voluntary bans are ineffective. Exposure to unhealthy food advertising is similar before and after the introduction of voluntary food advertisements.
The World Health Organisation has urged all governments to address rising rates of obesity by implementing population-based interventions, such as restrictions on the marketing to children of unhealthy food and beverage items. However, the relationship between unhealthy food advertisements and childhood obesity is disputed by industry-sponsored reports, which recommend promoting physical activity and weight loss campaigns rather than policies to limit exposure to advertisements. We aimed to elucidate this debate by providing a narrative review of the evidence on the relationship between unhealthy TV and online food advertisements, short-term food consumption and childhood obesity. We also examined the impact of unhealthy food advertisements on vulnerable groups and identified which policy interventions are supported by current evidence. We conducted a rapid overview of reviews published since 2006. From a synthesis of 18 reviews meeting the inclusion criteria, we conclude that exposure to unhealthy TV and online food advertising is a contributing factor to childhood obesity. Evidence of a relationship between exposure to unhealthy food advertisements and childhood obesity was evident at all stages of the causal pathway, including a clear dose-response relationship. The evidence base was particularly strong for children aged 3–12 years of age and for children from socio-economically disadvantaged and minority ethnic backgrounds. The introduction of statutory regulation is a potentially cost-effective policy option, in terms of healthcare savings outweighing the costs of implementing the policy, although voluntary codes were shown to be ineffective, with exposure to unhealthy food advertisements similar in countries before and after their introduction. Food advertising, however, is just one factor in the wider obesogenic environment and further advertising restrictions must be implemented alongside population-based interventions that aim to address systemic causes of poor diet.
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Driessen C, Kelly B, Sing F, Backholer K. Parents' Perceptions of Children's Exposure to Unhealthy Food Marketing: a Narrative Review of the Literature. Curr Nutr Rep 2022; 11:9-18. [PMID: 35278205 PMCID: PMC8942884 DOI: 10.1007/s13668-021-00390-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review A key driver of unhealthy diets in children is the marketing of unhealthy foods and beverages. Attempts to regulate children’s exposure to unhealthy food marketing through government-led policies are challenged by commercial interests. Parents shoulder the responsibility of counteracting the effects of omnipresent unhealthy food marketing that children are exposed to within the food environment. In this narrative review we aimed to synthesise the evidence over the last 10 years on parents' perceptions of children’s exposure to unhealthy food marketing and parents support for policies to restrict this marketing. Recent Findings The evidence indicates that unhealthy food marketing leads parents to feel undermined in their ability to provide healthy foods to their children. Despite this concern, parents tend to underestimate the levels of exposure to, and impacts of, unhealthy food marketing to their children, especially in the digital ecosystem. Summary The voices and support of parents represent a significant opportunity to accelerate policy action on food marketing. Increasing awareness among parents and caregivers to the high levels and harmful impacts of children’s exposure to unhealthy food marketing, focusing on their right not to be undermined by such action, may drive support for policy change. Further research is needed to understand parents’ attitudes and perceptions related to their children’s exposure to contemporary unhealthy food marketing, specifically in digital environments, and the perspectives of fathers and parents from low and middle-income countries.
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Affiliation(s)
- Christine Driessen
- Deakin University, Institute for Health Transformation, Global Obesity Centre, Geelong, Australia.
| | - Bridget Kelly
- Early Start, School of Health & Society, University of Wollongong, Wollongong, Australia
| | - Fiona Sing
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kathryn Backholer
- Deakin University, Institute for Health Transformation, Global Obesity Centre, Geelong, Australia
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Nisbett N, Harris J, Backholer K, Baker P, Jernigan VBB, Friel S. Holding no-one back: The Nutrition Equity Framework in theory and practice. GLOBAL FOOD SECURITY 2022; 32:100605. [PMID: 36873709 PMCID: PMC9983632 DOI: 10.1016/j.gfs.2021.100605] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Equity remains poorly conceptualised in current nutrition frameworks and policy approaches. We draw on existing literatures to present a novel Nutrition Equity Framework (NEF) that can be used to identify priorities for nutrition research and action. The framework illustrates how social and political processes structure the food, health and care environments most important to nutrition. Central to the framework are processes of unfairness, injustice and exclusion as the engine of nutrition inequity across place, time and generations, ultimately influencing both nutritional status and people's space to act. The NEF illustrates conceptually how action on the socio-political determinants of nutrition is the most fundamental and sustainable way of improving nutrition equity for everyone everywhere, through 'equity-sensitive nutrition'. Efforts must ensure, in the words of the Sustainable Development Goals, that not only is "no one left behind" but also that the inequities and injustices we describe do not hold anyone back from realising their right to healthy diets and good nutrition.
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Affiliation(s)
- Nicholas Nisbett
- Institute of Development Studies at the University of Sussex, UK
| | - Jody Harris
- Institute of Development Studies at the University of Sussex, UK.,World Vegetable Centre, Thailand
| | - Kathryn Backholer
- Deakin University, Geelong, Institute for Health Transformation, Victoria, Australia
| | - Philip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Australia
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Hoe C, Weiger C, Minosa MKR, Alonso F, Koon AD, Cohen JE. Strategies to expand corporate autonomy by the tobacco, alcohol and sugar-sweetened beverage industry: a scoping review of reviews. Global Health 2022; 18:17. [PMID: 35164801 PMCID: PMC8845406 DOI: 10.1186/s12992-022-00811-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Noncommunicable diseases contribute to over 70% of global deaths each year. Efforts to address this epidemic are complicated by the presence of powerful corporate actors. Despite this, few attempts have been made to synthesize existing evidence of the strategies used to advance corporate interests across industries. Given this, our study seeks to answer the questions: 1) Is there an emergent taxonomy of strategies used by the tobacco, alcohol and sugar-sweetened beverage (SSB) industries to expand corporate autonomy? 2) How are these strategies similar and how are they different? METHODS Under the guidance of a framework developed by Arksey and O'Malley, a scoping review was carried out whereby six databases were searched in June 2021 to identify relevant peer-reviewed literature. To be included in this review, studies had to explicitly discuss the strategies used by the tobacco, alcohol, and/or sugar-sweetened beverage multinational corporations and be considered review articles aimed to synthesize existing evidence from at least one of the three industries. Eight hundred and fifty-eight articles were selected for full review and 59 articles were retained for extraction, analysis, and categorization. RESULTS Results identified six key strategies the industries used: 1) influencing government policy making and implementation, 2) challenging unfavorable science, 3) creating a positive image, 4) manipulating markets, 5) mounting legal challenges, and 6) anticipating future scenarios. Despite these similarities, there are few but important differences. Under the strategy of influencing government policy making and implementation, for example, literature showed that the alcohol and SSB industries have been "privileged with high levels of participation" within international public health organizations. CONCLUSIONS Understanding how industries resist efforts to control them is important for public health advocates working to reduce consumption of and death and diseases resulting from harmful commodities. Moreover, there is a greater need for the public health community to generate consensus about how to ethically engage or not engage with industries that produce unhealthy commodities. More studies are also needed to build the evidence base of industry tactics to resist regulation, particularly in the case of SSB, and in low-and middle-income countries.
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Affiliation(s)
- Connie Hoe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Caitlin Weiger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Marela Kay R Minosa
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Fernanda Alonso
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Adam D Koon
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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