See, Like, Share, Remember: Adolescents' Responses to Unhealthy-, Healthy- and Non-Food Advertising in Social Media

Examining the impact of social media on youth vaping behavior in China: an analysis of the mediating role of perceptions of policy enforcement

Introduction

Research has established that exposure to media and the perceived enforcement of policies can influence outcomes related to (un)healthy behaviors. However, little is known about the underlying processes that may mediate the relationship. The Knowledge-Attitude-Practice (KAP) model serves as an important framework for examining health cognition and behavior change. It asserts that knowledge underpins beliefs, attitudes drive motivation, and practices reflect behaviors. In the realm of e-cigarette cessation, this study investigates the influence of media exposure on perceptions of policy enforcement, which in turn affects risk-benefit evaluations and behavioral outcomes.

Methods

Data for this study were collected in 2024 from an online questionnaire survey (N = 724) conducted in Guangdong China, with participants aged 18 to 30. We primarily employ methods such as mediating effect testing and regression analysis to conduct our data analysis.

Results

The findings suggest that social media exposure, perceived policy enforcement, and perceptions of risks and benefits collectively influence youth vaping behaviors through various mediating pathways. Specifically, the results indicate that exposure to social media has a positive effect on the perceived enforcement of tobacco control policy. This perception, in turn, positively affects both risk and benefit perceptions, thereby either decreasing the likelihood of vaping through heightened perceived risks or increasing it through enhanced perceived benefits.

Discussion

The study highlights the impact of social media content concerning e-cigarettes, noting that both ambiguous advertising and health education materials can enhance the perceived enforcement of tobacco control policy. Furthermore, we investigate the impact of information shared across various social media platforms on vaping behaviors and perceptions of tobacco control policy enforcement. Implications and limitations are discussed.

Bytes and bites: social media use and dietary behaviours among adolescents across 41 countries

BACKGROUND

To examine the associations of problematic and excessive social media use (SMU) with dietary behaviours of adolescents.

METHODS

We analysed the 2017/2018 Health Behaviour in School-aged Children survey data, involving 222,865 adolescents (51.8% girls) from 41 countries. A dietary intake score was derived using consumption of fruits, vegetables, sweets, and sugary soft-drinks. Breakfast intake was categorised as daily or non-daily. Excessive SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed through symptoms of addiction.

RESULTS

Regression analyses showed that adolescents reporting problematic SMU had 54% lower odds in boys (OR 0.46; 95% CI 0.42-0.51) and 64% lower odds in girls (OR 0.36; 0.33-0.40) of reporting good dietary intake compared with poor intake. Excessive SMU was also associated with lower odds of reporting good dietary intake. Problematic SMU associated inversely with daily fruit and vegetable intake, while excessive SMU was positively associated with daily fruit and vegetable intake across sex. Both types of SMU were linked to increased intake of sweets and sugary drinks and decreased breakfast consumption.

CONCLUSIONS

Problematic SMU was associated with poor dietary habits, while excessive SMU showed mixed findings. Prospective research is warranted to understand the causal mechanisms.

IMPACT

Problematic and excessive social media use (SMU) was associated with poor dietary habits with problematic SMU being more detrimental than excessive SMU. This research contributes to the literature by demonstrating that problematic and excessive SMU correlate differently with adolescent dietary habits, highlighting the need for targeted approaches to promote healthier eating. Adolescents should be encouraged to use social media responsibly, while social media companies should promote local fresh food options to enhance healthy dietary habits.

From Screen to Plate: How Instagram Cooking Videos Promote Healthy Eating Behaviours in Established Adulthood

BACKGROUND

Social media platforms increasingly influence dietary behaviours, with cooking videos emerging as a key tool for promoting healthy eating. However, limited research has examined how such digital content affects adults in established adulthood.

OBJECTIVE

This study investigates the relationships among cooking behaviour, engagement with healthy cooking videos on Instagram, and healthy eating behaviours among Taiwanese adults aged 30 to 45.

METHODS

A cross-sectional online survey collected valid responses from 488 participants (effective response rate = 81.3%) who regularly cook and engage with food-related content on Instagram. Structural equation modelling (SEM) was used to test hypothesised relationships.

RESULTS

Cooking behaviour was positively associated with engagement in healthy cooking multimedia (β = 0.262, p < 0.01). Engagement significantly predicted healthy eating behaviours (β = 0.399, p < 0.001) and mediated the effect of cooking behaviour on dietary outcomes (indirect effect = 0.105, 95% CI [0.044, 0.204]). Cooking behaviour alone was not directly associated with healthy eating behaviours (β = 0.009, n.s.).

CONCLUSIONS

Engagement with healthy cooking videos enhances healthy eating practices among adults in established adulthood. These findings highlight Instagram's potential as a digital health promotion tool and support the integration of culinary media into public nutrition strategies.

'Soft drinks are normal': understanding the lived experiences of Dutch teenagers with respect to sugar-sweetened beverages: a qualitative context-mapping study

BACKGROUND

Despite continuing efforts to reduce teenagers' consumption of sugar-sweetened beverages (SSBs), intake remains high across the globe. Currently, we lack a holistic understanding that also includes the lived experiences of teenagers in today's online and offline environments regarding the role of SSB's. The aim of the present paper is therefore twofold: (1) to gain a holistic understanding of teenagers' perspectives, beliefs, barriers, contextual triggers and latent needs (that is, their lived experiences) in relation to SSB consumption; and (2) to explore their views about which intervention strategies would be most likely to reduce their SSB consumption.

METHODS

A qualitative context-mapping approach, including prior sensitising assignments, was used to gain in-depth insights into the lived experiences with regard to SSB consumption of teenagers attending prevocational-level secondary school (VMBO) and living in low socioeconomic position neighbourhoods in Amsterdam, the Netherlands. From March to April 2021, 48 teenagers, aged 12 to 16, took part in the study. Due to COVID-19 restrictions, data were collected partly online and partly in person. All data were coded and analysed using thematic analysis.

RESULTS

Four main themes were identified that appeared to influence the teenage SSB consumption: (1) social norms - drinking SSBs is normal; (2) attitudes and beliefs with regard to health versus enjoyment; (3) the easy availability and affordability of SSBs; and (4) intense industry marketing efforts. We additionally explored teenage views about changes most likely to reduce their SSB consumption and found that they would be receptive to population-level interventions such as taxation.

CONCLUSIONS

The study provides comprehensive insights into teenagers' lived experiences in relation to SSBs. It highlights the prominent roles of strong social norms, conflicting beliefs, and the pervasive marketing, easy availability and low prices of SSBs. This underlines the need for a systems approach, applying combinations of effective, integrated strategies that can be specifically tailored to the perspectives of today's teenagers.

A scoping review of children's and parents' attitudes to and awareness of digital food marketing

Digital food marketing (DFM) of unhealthy foods and beverages (high in saturated fats, sugar and salt) to children and young people influences brand recall, recognition, purchase intentions and attitudes, and increases consumption of unhealthy foods and beverages. Understanding children's and parents' awareness of, and attitudes toward, such marketing is crucial for developing health-promoting advocacy and policy solutions. This registered systematic scoping review synthesized literature on children's, young people's and parents' attitudes and awareness of DFM. A structured search of Medline, PsycInfo, Academic Search Complete (Ebscohost), Scopus and CINAHL was conducted. Inclusion criteria were peer-reviewed studies focused on children (<18 years), young people (<24 years) or parents, published after 2000, examining attitudes or awareness of online marketing of food or non-alcoholic beverages. Data were extracted and charted in Excel. Forty studies were included for synthesis. Studies of children/young people (n = 31) show varying levels of awareness regarding DFM on social media and other digital media. While some understand social media marketing tactics, others struggle to recognize ads. Preferences lean towards influencer marketing and 'native' advertising styles. There is limited evidence on parents' views (n = 9 studies), but these suggest low parental awareness of digital marketing tactics targeting children, and unclear opinions on regulation. Overall, the findings suggest a need for a versatile, trans-disciplinary research and advocacy agenda to capture the complex and rapidly evolving digital marketing landscape, enhance critical digital literacies (including power inequalities) for both children and parents, increase knowledge-sharing and advocacy, and develop regulatory policies.

Food marketing to teenagers: Examining the digital palate of targeted appeals

Food marketing is a conspicuous part of the digital landscape for teenagers, with the aims of influencing preferences, purchases and consumption. Yet little is known about the nature and persuasive power of such marketing, especially across the platforms most popular with teens. Given this research gap, this exploratory study aimsed to shed light on the "digital palate" being advertised to teenagers and the specific appeals they found salient within that advertising. Teenagers (ages 13-17, n = 468) engaged in participatory research, capturing the teen-targeted food advertising that they encountered over the span of one week. For each ad, they identified the product, brand, platform and specific techniques they felt made the ad teen-targeted. Results reveal the pervasive and expansive nature of teen-targeted food marketing: 3385 advertisements were collected from 557 distinct food and beverage brands from the digital platforms of Instagram, TikTok, Snapchat, and YouTube. Instagram trumped all other platforms when it came to food marketing, but the "digital palate" promoted across all platforms was consistent. Beverages, fast food and candy/chocolate comprised the top categories of foods advertised to teens. Ads for these generally unhealthy (and sweet) products were considered persuasive due to their visual style and special offers-ones that focused on convenience, novelty, bold flavors, limited edition products and (even more) digital engagement. While the digital palate promoted was salient and engaging to teenagers, the food (and food categories) promoted do not work to support long term health.

The relationship between perceptions toward advertising and consumption of energy-dense nutrient-poor foods among adults in the United States: results from a national survey

Introduction

Much of the research on the effects of food advertising has been focused on children and adolescents; however, adults may also be influenced. Prior research has also shown that exposure to food advertisements have impacted the consumption behaviors of adults. The purpose of this study is to explore (1) the differences in perceptions toward and trust in food advertisements between racial/ethnic population subgroups; and (2) the associations between perceptions toward food advertising and the consumption of energy-dense, nutrient poor (EDNP) foods among adults using data from a national data set (n = 1,535).

Methods

Data from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) survey were utilized in this secondary data analysis study. We conducted one-way ANOVAs to evaluate demographic subgroup differences within advertising trust and perceptions, and utilized bivariate and multivariable linear regression models to examine associations between (1) the perceptions toward and trust in food advertisements between racial/ethnic population subgroups; and (2) the associations between perceptions toward food advertising and the consumption of EDNP foods, while controlling for sociodemographic factors.

Results

Results show significant differences between racial/ethnic groups on advertising perceptions (F = 8.59, p < 0.0001). Planned contrasts show that there was a statistically significant and meaningful difference (p = 0.04) between Non-Hispanic Blacks (mean = 2.85) and Non-Hispanic Whites (mean = 2.52) for trust in food advertising. Regression analyses show that as positive perceptions toward food advertising increase among adults, there is an increase in daily frequency of consumption of EDNP foods and drinks (𝛽 = 0.15, p < 0.0001). This pattern was similar for trust in food advertising (𝛽 = 0.13, p < 0.0001).

Discussion

Given that previous studies have shown that ethnic minority groups, particularly Non-Hispanic Blacks, are more likely to be exposed to unhealthy food advertisements across various types of media, such as TV, billboards, and in grocery stores, it is possible that Non-Hispanic Black adults have greater trust in food advertising because of the increased environmental exposure to advertising through various channels of communication. Numerous studies have demonstrated that exposure to food advertisements is linked to consumption of the foods found in those advertisements. Our results provide some initial empirical support for the cognitive mechanisms of how exposure to food advertising may contribute to consumption. Developing advertising literacy interventions to inoculate against the cognitive impacts of food advertising may be a viable strategy to limiting consumption of EDNP foods.

Beyond the screen: Exploring the dynamics of social media influencers, digital food marketing, and gendered influences on adolescent diets

Adolescent obesity remains a public health concern, exacerbated by unhealthy food marketing, particularly on digital platforms. Social media influencers are increasingly utilized in digital marketing, yet their impact remains understudied. This research explores the frequency of posts containing food products/brands, the most promoted food categories, the healthfulness of featured products, and the types of marketing techniques used by social media influencers popular with male and female adolescents. By analyzing these factors, the study aims to provide a deeper understanding of how social media influencer marketing might contribute to dietary choices and health outcomes among adolescents, from a gender perspective, shedding light on an important yet underexplored aspect of food marketing. A content analysis was conducted on posts made between June 1, 2021, and May 31, 2022, that were posted by the top three social media influencers popular with males and female adolescents (13-17) on Instagram, TikTok, and YouTube (N = 1373). Descriptive statistics were used to calculate frequencies for posts containing food products/brands, promoted food categories, product healthfulness, and marketing techniques. Health Canada's Nutrient Profile Model was used to classify products as either healthy or less healthy based on their content in sugar, sodium, and saturated fats. Influencers popular with males featured 1 food product/brand for every 2.5 posts, compared to 1 for every 6.1 posts for influencers popular with females. Water (27% of posts) was the primary food category for influencers popular with females, while restaurants (24% of posts) dominated for males. Influencers popular with males more commonly posted less healthy food products (89% vs 54%). Marketing techniques varied: influencers popular with females used songs or music (53% vs 26%), other influencers (26% vs 11%), appeals to fun or coolness (26% vs 13%), viral marketing (29% vs 19%), and appeals to beauty (11% vs 0%) more commonly. Influencers popular with males more commonly used calls-to-action (27% vs 6%) and price promotions (8% vs 1%). Social media influencers play a role in shaping adolescents' dietary preferences and behaviors. Understanding gender-specific dynamics is essential for developing targeted interventions, policies, and educational initiatives aimed at promoting healthier food choices among adolescents. Policy efforts should focus on regulating unhealthy food marketing, addressing gender-specific targeting, and fostering a healthy social media environment for adolescents to support healthier dietary patterns.

Social Media Influencers, Health Literacy, and Food Literacy: A Correlational Study Among Adolescents

Social media influencers (SMIs) have emerged as a significant alternative source of health-related information for adolescents, apart from their parents, doctors, and schools. It is yet to be determined whether adolescents' use of social media influencers leads to a deterioration or an improvement of their overall health literacy and food literacy. This study (N = 509), for one thing, investigated adolescents' health literacy (using the MOHLAA-Q), food literacy (using the SFLQ), and use of social media influencers as sources of information on healthy lifestyles (mapped through self-report questions). For another, it studied whether correlations appear to exist between SMI use, health literacy, and food literacy. The results show that the more frequently adolescents use SMIs as sources of information, the better their health literacy and food literacy are. Consequently, health promotors, such as schools and healthcare professionals, should use the channels adolescents use to enhance their critical health and food literacy, and ultimately their health.

Youth perspectives on the promotional and public relations strategies of health harming industries

Public health researchers have investigated how youth are exposed to and influenced by traditional forms of commercial marketing from health-harming industries. Limited research has investigated youth opinions about the broader marketing and public relations strategies of these industries. This study aimed to understand youth perceptions of the impact and influence of a range of marketing and public relations strategies used by health harming industries. An online qualitative survey was conducted with n = 518, 16- to 24-year-olds living in Victoria, Australia. Participants were asked to consider the broad influence of marketing from health harming industries on youth, including the impacts of social media promotions, corporate social responsibility strategies including sponsorship and political donations, as well as their views on marketing restrictions. Reflexive thematic analysis was used to construct themes from the data. Participants stated that excessive marketing strategies had a significant influence on youth consumption of health harming products. Most felt that social media marketing had the most appeal and influence on youth. Most were critical of these strategies and were supportive of strong restrictions on marketing for health-harming products. However, many participants held more positive views about corporate social responsibility strategies, which they perceived could offset the negative impacts of these industries on health. Increased focus is needed from the public health and health promotion communities to ensure that youth are protected from the influence of the range of marketing strategies that are used by health-harming industries to promote their products and resist regulatory reform.

The impact of exposure to sugary drink marketing on youth brand preference and recall: a cross-sectional and multi-country analysis

BACKGROUND

Consumption of sugary drinks (SD) among children and adolescents is a prevalent public health issue both within Canada and worldwide. This problem is exacerbated by the powerful marketing of such beverages to youth, which is known to influence a wide range of dietary behaviours.

METHODS

A cross-sectional, secondary analysis of the International Food Policy Survey Youth Wave 2019 was conducted to assess the relationship between self-reported exposure to SD marketing within the past 30 days or SD brand advertisements and brand preference and brand recall among youth aged 10-17 from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Ordinal, multinomial, and binary logistic regression were used as appropriate to examine these associations.

RESULTS

Youth brand preference and recall was positively associated with self-reported exposure to general and brand-specific SD marketing across all countries. No statistical interaction was observed between youth age and SD marketing overall or within countries. Soft drinks, sports drinks, and fruit juice brands were most commonly recalled by all youth.

CONCLUSION

Similar results were observed among children and adolescents within all countries. Global marketing policies should consider older children and adolescents to adequately protect and support child health.

Testing a nutrient composition threshold model to classify brands for marketing restrictions

INTRODUCTION

Food marketing restrictions often apply nutrient profile models (NPM) to distinguish unhealthy products that should not be advertised, however brand-only marketing remains largely unaddressed. We sought to test a threshold method for classifying packaged food, beverage, or fast-food brands as (non)permitted for marketing, based on the nutrient profile of their product-lines.

METHODS

We retrieved nutrient information from the Nutritrack databases for all products sold by the top 51 packaged food, beverage and fast-food brands in New Zealand, selected by market share. All products under each brand were classified as permitted (or not) to be marketed to children, using the NPM for WHO Western Pacific. The 25%, 50%, 75% and 90% threshold of brands' products permitted to market were compared. The 50% and 75% thresholds were compared to the WHO CLICK method, which is based on assessment of the brand's leading product.

RESULTS

The 90% threshold permitted 13% of the brands to be marketed to children. The 25% threshold permitted the marketing of 62% of brands. The 50% and 75% thresholds remained highly sensitive in identifying brands that should not be marketed to children. Comparison to the WHO CLICK method identified that a threshold method is more comprehensive and less arbitrary.

CONCLUSIONS

A threshold model based on product-line nutrient profiling provides a robust and option for brand classification. The 50% and 75% thresholds may be the most politically preferred options for use in regulation, while remaining highly effective.

PRACTITIONER POINTS

Brand marketing (e.g. sponsorship) remains largely unaddressed in existing restrictions on unhealthy food and beverage marketing to children.An established Nutrient Profile Model can be applied to a brand's entire product line, allowing calculation of the proportion of products that would not be permitted to be advertised to children.Restricting brand marketing for food and beverage brands with less than 50% or 75% of their products classified as 'permitted to be marketed to children' is a robust and evidence-based method that can be applied in regulation, with potential to mitigate industry challenges.

Challenges and solutions to banning the advertisement of unhealthy products: a qualitative study

Unhealthy products (food, alcohol, tobacco) are among the main risk factors of non-communicable diseases. To discourage the consumption of these products, Iran has passed a law banning the advertisement of unhealthy products in all media and for all age groups. The purpose of the present study was to identify the challenges of this approach and provide evidence to facilitate the enforcement process and the participation of stakeholders. In this qualitative study participants were selected from the policymakers and experts involved in the banning of advertisements on unhealthy products in Iran. Semi-structured interviews were conducted with 24 specialists and experts. The participants were selected through purposive and snowball sampling. Identified challenges and solutions were divided into three categories and nine themes: external (political, social, and economic); interorganizational (mission and communication); and internal (planning, organization, leadership, and control). Banning the advertisement of unhealthy products involves many challenges due to the existence of key players with different roles and missions. If these challenges are not managed effectively, they will hinder the enforcement and success of this law. Therefore, it is necessary for policymakers and health system managers to take the necessary measures to remove these obstacles.

My feed is what I eat? A qualitative study on adolescents' awareness and appreciation of food marketing on social media

BACKGROUND

Adolescents spend much of their time online and hence are exposed to a lot of non-core (energy-dense, nutrient-poor) social media food marketing (SMFM). This may influence their dietary choices and health. This present study aimed to investigate adolescents' perceptions towards SMFM; that is, their recognition and appreciation of SMFM.

METHODS

Semi-structured one-on-one interviews were conducted with Dutch adolescents aged 13-16 years (n = 16), on Skype. Examples of food promotions on Instagram, Snapchat, TikTok and YouTube were discussed with adolescents.

RESULTS

Adolescents' reasons for recognising and appreciating or liking SMFM were often related to the level of product integration. Factors that determined participants' recognition of SMFM included product focus (e.g., brand or product prominence), sponsorship disclosure, type of content (paid, influencer and peer-generated content) and promotional strategy (e.g., discounts, promotional texts, layout). Participants' appreciation of SMFM was determined by the format of a post (image, video, text, pop-up), trustworthiness of the source (brand, celebrity, friend/peer), type of product promoted (core, non-core) and appearance or layout of a post (e.g., professionalism, appeal).

CONCLUSIONS

The present study contributes to the ongoing debate on how to increase adolescents' resilience to commercial messages that promote non-core foods. Adolescents mostly enjoy watching non-core video content from peers or influencers and do not perceive this as food marketing. It is recommended that future studies investigate the effects of earned social media marketing formats (i.e., unpaid peer and influencer endorsements) promoting non-core foods on adolescents' dietary intake, and how they can be made more critical towards such types of SMFM.

Recreational screen time and obesity risk in Korean children: a 3-year prospective cohort study

BACKGROUND

Studies have shown that prolonged television watching increases obesity risk among children. However, few studies examined the associations with other types of screen time, such as computer and smartphone use, using a prospective cohort study design. Further, little is known about the specific non-screen time activity that may yield the most benefits when reallocating screen time to other activities.

METHODS

We conducted a prospective cohort analysis using 3-year follow-up data from the Korean Children and Youth Panel Survey 2018 (n = 2,023; 4th grade elementary students who were not obese at baseline). Average time spent watching television, using computer and smartphone, and other after-school activities were self-reported at baseline. Weight and height were also self-reported at baseline and follow-up surveys through 2021. We performed multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between screen time and obesity incidence, adjusting for potential confounders. We also performed isotemporal substitution models to examine the associations of reallocating screen time to other non-screen time activities (physical activity, sleeping, hanging out with friends, reading, studying, and chatting with parents) in an equal time-exchange manner.

RESULTS

Longer combined screen time (≥ 240 vs. <120 m/d) was statistically significantly associated with an increased obesity risk (OR [95% CI] = 1.68 [1.03, 2.73]). The direction of associations with television watching (≥ 180 vs. <60 m/d: OR [95% CI] = 2.86 [1.58, 5.20]), computer use (≥ 120 vs. <60 m/d: 1.38 [0.52, 3.64]), and smartphone use (≥ 180 vs. <60 m/d: 1.42 [0.76, 2.65]) were all positive, although the association was most apparent and statistically significant for television watching only. The associations did not change after additional adjustment for other lifestyle factors, including physical activity, sleep, and breakfast skipping. In the isotemporal substitution models, reallocating 1-hour of screen time to reading (OR [95% CI] = 0.67 [0.48, 0.93]) was associated with a decreased obesity risk. Reallocating 1-hour of screen time to physical activity was only marginally significantly associated with obesity risk (0.79 [0.62, 1.01]).

CONCLUSIONS

Our data suggest that more efforts should focus on reducing screen time and increasing time for other non-screen time activities, particularly reading, for obesity prevention in children.

Nigerian adolescents' exposure to fast food marketing via Instagram

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Familiarity with the internet and health apps, and specific topic needs are amongst the factors that influence how online health information is used for health decisions amongst adolescents

BACKGROUND

Many adolescents believe that online health information is reliable, particularly when they are familiar with the source of information.

OBJECTIVE

To analyse the degree of influence of online health information on high school students' health decisions and examine whether socio-demographic characteristics, digital literacy, use of different websites and interest in specific health topics are associated with a stronger influence of online health information on adolescents' health-related decisions.

METHODS

Participants were students from four public high schools in Belgrade, Serbia. Socio-demographic and behavioural questionnaire as well as the e-health literacy scale (eHEALS) were used to collect data.

RESULTS

The study sample comprised 702 students. A total of 79.6% of students reported that online health information influenced their health decisions to a certain extent (from 'a little' to 'a lot'). Being a boy, using the internet since younger age, better self-perceived e-health literacy, using health apps, Google, health forums, websites of health institutions, social media and YouTube, being interested in diet/nutrition, sexually transmitted infections and cigarettes were the characteristics associated with a stronger influence of online health information on students' health decisions.

CONCLUSION

This study provides clues about how online health-related information can be used to adjust and enhance health promotion amongst adolescents.

Is this advertisement designed to appeal to you? Adolescents' views about Instagram advertisements promoting ultra-processed products

OBJECTIVE

Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents.

DESIGN

Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding.

SETTING

One private secondary school and two after-school clubs.

PARTICIPANTS

Convenience sample of 105 Uruguayan adolescents aged 11-17 years.

RESULTS

Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products.

CONCLUSIONS

This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.

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

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

Examining gender differences in adolescent exposure to food and beverage marketing through go-along interviews

This study explores how adolescents engage with unhealthy food and beverage marketing in online settings, from a gender perspective. Employing an online ethnography approach and using go-along interviews, we explored the experiences of adolescent boys and girls aged 13-17 as they navigated their online experiences with digital food and beverage marketing. Notable themes emerged, including the identification of predatory actions by food companies, the role of protective factors such as family, and the influence of social media influencers in shaping adolescent dietary preferences. Importantly, this research unearthed gender disparities in the participants' responses. Girls, in particular, exhibited a heightened awareness of the protective role played by their families, emphasized the influence of color in marketing strategies, recognized the significance of gender in marketing, and reported exposure to alcohol advertisements-findings that boys less frequently echoed. The study underscores the importance of adolescence as a critical phase in development, during which food companies target these impressionable individuals, driven by their independence and potential for brand loyalty. Moreover, it highlights the potential avenue of gender-specific marketing, offering valuable insights into the gendered dimensions of adolescents' food marketing experiences. By examining the interplay between digital food marketing and gender, this research addresses a critical gap in the literature, shedding light on how gender influences adolescents' perceptions, responses, and behaviors in the context of food marketing strategies. These findings have the potential to inform adolescents of the marketing techniques that target them and guide policymakers in developing and implementing evidence-based regulations aimed at safeguarding adolescents from exposure to unhealthy food marketing.

Food marketing on digital platforms: what do teens see?

OBJECTIVE

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

DESIGN

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

SETTING

Online (digital media) with teenagers in Canada.

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Social media influencers and adolescents' health: A scoping review of the research field

Social media influencers (SMIs) have become an important source of health information for adolescents. However, the lack of expertise and commercial interests of SMIs pose challenges for adolescent health. To gain a better understanding of these challenges, this scoping review aimed to synthesize existing research on the role of SMIs in adolescent health. Using the PRISMA-ScR approach, we conducted a comprehensive search of eight databases and screened articles based on predefined criteria. The final sample included 51 articles published between 2012 and 2022. Results revealed inconsistent definitions and classifications of SMIs. The most common topics included appearance, nutrition, and substance use, while mental and sexual health topics were underrepresented. The ability of SMIs to establish trustworthy relationships with their followers was highlighted in the reviewed studies, shedding light on potential benefits and challenges for adolescent health. However, most studies focused on the negative roles of SMIs, such as the promotion of unrealistic body images, unhealthy diets, substance use, and inaccurate diagnosis and treatment advice. In addition, inappropriate advertising of unhealthy products (e.g., junk food, tobacco products and alcohol) was identified as a major challenge. The reviewed studies identified stricter regulation and improved social media and health literacy as important avenues for policy action. Less attention was given to the potential positive impact of SMIs and how to effectively include them in health promotion campaigns. In addition, the majority of studies were conducted in the Global North and relied on quantitative approaches, resulting in a lack of representation of minority populations and male adolescents.

Powerful promotions: An investigation of the teen-directed marketing power of outdoor food advertisements located near schools in Australia

ISSUE ADDRESSED

Adolescents are heavily exposed to unhealthy outdoor food advertisements near schools, however, the marketing power of these advertisements among adolescents has not yet been explored. This study aimed to investigate the teen-directed marketing features present and quantify the overall marketing power of outdoor food advertisements located near schools to explore any differences by content (ie, alcohol, discretionary, core and miscellaneous foods) school type (ie, primary, secondary, K-12) and area-level socio-economic status (SES; ie, low vs high).

METHODS

This cross-sectional study audited every outdoor food advertisement (n = 1518) within 500m of 64 randomly selected schools in Perth, Western Australia, using a teen-informed coding tool to score the marketing power of each advertisement.

RESULTS

Outdoor alcohol advertisements around schools had the highest average marketing power score and number of advertising features present. Outdoor advertisements for alcohol and discretionary foods scored significantly higher in marketing power than core food advertisements (P < .001). Outdoor alcohol advertisements around secondary schools scored significantly higher in marketing power than around primary and K-12 schools (P < .001); and outdoor advertisements for discretionary foods in low SES areas scored significantly higher in marketing power than those in high SES areas (P < .001).

CONCLUSIONS

This study found outdoor advertisements for unhealthy products, such as alcohol and discretionary foods, were more powerful than advertisements for core foods around schools. SO WHAT?: These findings strengthen the need for policies which restrict outdoor advertisements for non-core foods near schools, to reduce adolescents' exposure to powerful alcohol and discretionary food advertisements.

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

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

Do British and Chinese adolescents snack for different reasons? A cross-country study using the Theory of Planned Behaviour and eating styles

Snacking is prevalent in adolescents and can have significant health impacts, but there is considerable individual and cross-country variation in determinants on adolescent snacking. The present study examined the role of eating styles (i.e. restrained eating, emotional eating, external eating, mindful eating) and the constructs of an extended Theory of Planned Behaviour (TPB) (i.e. attitudes, subjective norms, perceived behavioural control, habit strength) in predicting adolescent snacking, and the moderating effects of country. A survey was completed by adolescents aged 16-19 years from China (N = 182; mean age = 16.13, SD = 0.87) and England (N = 96; mean age = 17.04, SD = 0.74). Compared to British adolescents, Chinese adolescents showed higher restrained eating (p = .009), lower external eating (p = .004), less positive attitudes (p < .001) and subjective norms (p = .007) to, and less strong habit strength (p = .005) for unhealthy snacking. Mindful eating significantly predicted lower consumption of unhealthy snacks (p = .008) and beverages (p = .001), while restrained eating predicted higher consumption of fruit (p < .001) and vegetables (p < .001), regardless of country. Country showed significant moderating effects of TPB constructs on unhealthy beverages (p = .008) and fruit (p < .001) consumption, and effects on unhealthy snack (p = .023) and vegetable (p = .015) consumption approaching significance. Subjective norms predicted unhealthy snacking frequency regardless of country (p = .001). Habit strength predicted consumption of beverages (p < .001) and fruit (p < .001) only in English adolescents. Mindful eating may be a positive intervention approach to help reduce adolescent unhealthy snacking. TPB-based snacking interventions should carefully consider the country context. Acknowledging country-specific determinants of snacking are recommended.

Reducing Student Exposure to Digital Food and Beverage Marketing: Policy and Practice Recommendations

Digital marketing of unhealthy foods and beverages to children and adolescents is pervasive, highly effective, undermines healthy eating, and contributes to health inequities. Expanded use of electronic devices and remote learning during the COVID-19 pandemic has increased the urgency for policy interventions to limit digital food marketing in schools and on school-issued devices. The US Department of Agriculture provides little guidance to schools for how to address digital food marketing. Federal and state privacy protections for children are inadequate. Considering these policy gaps, state and local education authorities can incorporate strategies to reduce digital food marketing into school policies for: content filtering on school networks and on school-issued devices; digital instructional materials; student-owned device use during lunch; and school use of social media to communicate with parents and students. Model policy language is provided. These policy approaches can leverage existing policy mechanisms to address digital food marketing from a variety of sources.

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

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

The extent of energy drink marketing on Canadian social media

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

DESIGN

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

SETTING

Twitch chatrooms.

PARTICIPANTS

None.

RESULTS

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

CONCLUSIONS

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

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

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

The nature and extent of food marketing on Facebook, Instagram, and YouTube posts in Mexico

Food and beverage marketing appealing to children and adolescents has an impact on their food preferences, purchases requests, consumption patterns, health outcomes, and obesity. The objective of this study was to assess the nature and extent of food and beverage marketing on Facebook, Instagram, and YouTube posts in Mexico. This was a content analysis that followed the World Health Organization CLICK methodology to comprehend the landscape of digital food marketing campaigns of the top-selling food products and brands and the most popular accounts carried out between September and October 2020. A total of 926 posts from 12 food and beverage products and 8 brands were included. Facebook was the social media platform with the most posts and greatest engagement. The most prevalent marketing techniques were brand logo, image of packaging, image of the product itself, hashtags, and engagement to consume. Fifty percent of the posts were assessed as appealing to children, 66% to adolescents, and 80% to either children or adolescents. Ninety-one percent of products (n = 1250) were classified as unhealthy according to the Mexican warning labels nutrient profile; 93% of the food promoted on posts appealing to either children or adolescents were unhealthy. Hashtags commonly referred to the COVID-19 pandemic. Most of the unhealthy food digital marketing features marketing techniques that appeal to children or adolescents; moreover, the use of the pandemic hashtag reflected brands' responsiveness to the environment at the time of the study. The present data contribute to evidence supporting the strengthening of food marketing regulations in Mexico.

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

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

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

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

Health education via "empowerment" digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain

Increasing health care costs and high economic burden exemplify the impact of chronic diseases on public health. Multifaceted approaches to treating chronic diseases include pharmaceutical drugs, digital therapeutics, and lifestyle medicine. Chronic diseases are largely preventable, and health promotion yields positive outcomes. However, despite positive return on investment (ROI) and cost-to-benefit ratio (CBR) for health promotion (median ROI 2.2, median CBR 14.4), commercial marketing of healthy lifestyles and self-care is limited. The objective of this perspective article is to discuss how digital marketing of consumer goods and services that support therapeutic self-care can also bridge public health and for-profit interests. We describe how "empowerment" marketing campaigns can provide evidence-based associations between products/services and self-care benefits for people living with chronic pain and depression. Such a "health education as marketing" strategy is illustrated by educational ads describing how contact with nature, music, and yoga can improve chronic pain and reduce depressive symptoms. Creating associations between health-related benefits of these activities with products (outdoor and yoga apparel, audio equipment) and services (music streaming services, music mobile apps, eco-tourism, yoga studios) that support them expand their value proposition, thus incentivizing profit-driven companies to engage in public health campaigns. Long-term success of companies that incorporate evidence-based health education as marketing and branding strategies will depend on following ethical considerations and advertising guidelines defined by consumer protection regulatory agencies, such as the Federal Trade Commission (FTC). In conclusion, integration of health education about self-care and commercial marketing can support health care outcomes and disease prevention.

Adolescent exposure to food and beverage marketing on social media by gender: a pilot study

OBJECTIVE

The objective of this research was to determine if, based on gender, adolescents were exposed to different marketing techniques that promoted food and beverages over social media.

DESIGN

A secondary analysis of adolescent boy (n 26) and girl (n 36) exposures (n 139) to food and beverage marketing was conducted. Mann-Whitney U and Fisher's exact tests were conducted to compare the number, healthfulness and the marketing techniques of exposures viewed by boys and girls.

SETTING

Ottawa, Ontario, Canada.

PARTICIPANTS

Sixty-two adolescents aged 12-16 years.

RESULTS

Boys and girls were exposed to similar volumes of food marketing instances (median = 2 for both boys and girls, Mann-Whitney U = 237, P = 0·51) per 10-min period of social media use. More girls viewed products that were excessive in total fat compared to boys (67 % v. 35 %, P = 0·02). Boys were more likely to view instances of food marketing featuring a male as the dominant user (50 % v. 22 %, P = 0·03), appeals to achievement (42 % v. 17 %, P = 0·04), an influencer (42 % v. 14 %, P = 0·02) and appeals to athleticism (35 % v. 11 %, P = 0·03), whereas girls were more likely to view instances of food marketing featuring quizzes, surveys or polls (25 % v. 0 %, P = 0·01).

CONCLUSIONS

Food and beverage companies utilise marketing techniques that differ based on gender. More research examining the relationship between digital food and beverage marketing and gender is required to inform the development of gender-sensitive policies aimed at protecting adolescents from unhealthy food marketing.

Associations between adolescent and young adult External Food Cue Responsiveness (EFCR) and brand recall, product craving and product purchasing in the livestreaming food marketing environment

OBJECTIVE

To evaluate the utility of three validated food responsiveness scales in measuring recall of, and responsiveness to, food marketing exposure on social media.

DESIGN

Cross-sectional survey among adolescents and adults who used the social media platform Twitch.tv (Twitch). Responsiveness to food marketing was self-reported as craving or purchasing any brands participants observed on Twitch. Participants completed three validated scales of food responsiveness: the revised 18-question Three Factor Eating Questionnaire (TFEQ), the external eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ) and the External Food Cue Responsiveness (EFCR) scale. Adjusted linear regression models assessed the predictive ability of each scale on recall and responsiveness outcomes.

SETTING

Online survey.

PARTICIPANTS

Five hundred and sixty-eight Twitch users (90·1 % male, 60·6 % White, 43·7 % aged 18-24, 25·9 % under 18).

RESULTS

In separate adjusted linear regression models, scores on the TFEQ were not related to any outcome, while DEBQ scores related to product cravings (OR: 1·10, 95 % CI 1·01, 1·19, P = 0·02). In contrast, scores on the EFCR scale were significantly associated with higher brand recall (incident rate ratio: 1·42, 95 % CI 1·20, 1·68, P < 0·001), product craving (OR: 3·93, 95 % CI 2·22, 7·17, P < 0·001) and purchasing behaviour (OR: 3·97, 95 % CI 1·99, 8·26, P < 0·001). A subset of three EFCR scale items related to influencer marketing were similarly associated with each outcome with greater precision in the point estimates than the overall EFCR.

CONCLUSIONS

The EFCR scale predicted recall of and responsiveness to food marketing via Twitch, suggesting its utility in monitoring the effects of food marketing on social media.

Inspiration or risk? How social media marketing of plant-based meat affects young people's purchase intention

As an alternative protein product to animal meat, plant-based meat is considered to play an essential role in improving animal welfare and protecting the environment. However, why do a few consumers choose plant-based meat but others do not? Despite the increasing research on plant-based meat marketing, little is known about the psychological mechanism by which plant-based meat marketing affects consumers' purchasing decisions. We utilize dual-system theory to understand how social media marketing of plant-based meat influences cognitive fluency, customer inspiration, perceived risk, and purchase intention. Four studies (i.e., Studies 1, 2, 3, and 4) show that social media marketing can increase young people's purchase intention of plant-based meat more than traditional marketing. In Studies 1 and 2, increased intensity of social media marketing can enhance young people's cognitive fluency and further promote purchase intention. Study 3 explores how cognitive fluency relates to purchase intention through two psychological mechanisms. We suggest that a higher level of cognitive fluency increases customer inspiration and improves purchase intention. However, a lower level of cognitive fluency reduces purchase intention by increasing perceived risk. Study 4 manipulated members' in-group or out-group status to show a boundary condition for the effect of brand community identity on purchase intention. These studies provide insight into how brand marketers can use social media to promote consumer inspiration and advertising engagement, how managers can offer fluency-increasing mechanisms to ensure a low level of perceived risk, and how enterprise practitioners may want to consider brand community publicity to attract out-group members.

Black Community Conversations About Opposing Ethnically Targeted Marketing of Unhealthy Foods and Beverages

Efforts to reduce disparities in obesity prevalence affecting Black Americans are having limited success. One reason for this may be the disproportionate, ethnically targeted marketing of foods and beverages high in fat and sugar (FBHFS) to Black consumers. Such marketing promotes high consumption of FBHFS, leading to excess caloric intake and unintentional weight gain. We convened focus groups with Black men and women (total n = 57) in collaboration with community groups in three localities to elicit their views, as consumers and parents/caregivers, about targeted FBHFS marketing and potential ways to combat it. At each location, trained community members facilitated two sets of focus groups: one for adults aged 18 to 25 years and another for adults aged 26 to 55 years who had a 3-to-17-year-old child at home. Each group met twice to discuss food and beverage marketing practices to Black communities and reviewed a booklet about ethnically targeted marketing tactics in between. A directed content analysis of participant comments identified and explored salient themes apparent from initial summarization of results. Results show how parents are concerned with and critical of pervasive FBHFS marketing. In particular, comments emphasize the involvement of Black celebrities in FBHFS marketing-how and why they engage in such marketing and whether this could be shifted towards healthier foods. These findings suggest a potential role for counter marketing efforts focused on Black celebrity endorsements of FBHFS, possibly with a youth focus. They also underscore the need for additional, qualitative exploration of Black consumer views of ethnically targeted FBHFS marketing more generally.

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

Background

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

Methods

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

Results

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

Conclusions

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

Smartphone Usage Patterns and Dietary Risk Factors in Adolescents

BACKGROUND

Whereas earlier studies have shown that traditional screen time such as TV watching influences dietary behaviors in adolescents, little is known about the effects of modern screen time such as smartphone use.

OBJECTIVES

We examined the associations of smartphone usage duration and content type with dietary risk factors among adolescents.

METHODS

We conducted a cross-sectional analysis using a nationally representative sample of 54,601 middle- and high-school students (aged 12-18 y; 26,928 boys and 27,673 girls) in the Korea Youth Risk Behavior Web-Based Survey 2017. Smartphone use (average duration and most frequently used content type) and dietary intakes [frequent breakfast skipping; less frequent intakes of fruits and vegetables; more frequent intakes of instant noodles, fast food, chips/crackers, and sugar-sweetened beverages (SSBs)] were self-reported via an online-based questionnaire. Multivariable logistic regression was performed to estimate ORs and 95% CIs for the associations of smartphone usage duration and content type with prevalence of dietary risk factors, adjusting for potential confounders. All analyses accounted for complex survey sampling.

RESULTS

Prolonged smartphone use (≥300 compared with 1-59 min/d) was associated with (OR; 95% CI) higher prevalence of frequent breakfast skipping (1.60; 1.45, 1.76); frequent intakes of instant noodles (1.65; 1.47, 1.84), fast food (1.36; 1.20, 1.53), and SSBs (1.92; 1.75, 2.11); and less frequent intakes of fruits (1.44; 1.30, 1.59) and vegetables (1.32; 1.18, 1.47). Adjusting for usage duration, using smartphones mainly for messenger/e-mail, social networking service (SNS)/forum, and games were associated with less frequent intakes of fruits (OR: 1.21; 95% CI: 1.12, 1.31; OR: 1.28; 95% CI: 1.17, 1.40; and OR: 1.20; 95% CI: 1.10, 1.32, respectively) and vegetables (OR: 1.24; 95% CI: 1.12, 1.37; OR: 1.26; 95% CI: 1.13, 1.40; and OR: 1.25; 95% CI: 1.12, 1.40, respectively) than was using smartphones for education/information search. Using smartphones mainly for messenger/e-mail (OR: 1.24; 95% CI: 1.14, 1.35) and SNS/forum (OR: 1.18; 95% CI: 1.08, 1.29) were also associated with more frequent intake of SSBs.

CONCLUSIONS

Our data suggest that both duration and content type of smartphone use are independently associated with dietary risk factors among adolescents.

Examining how framing obesity as disease vs. food addiction influences stigma among fitness practitioners

OBJECTIVE

To determine if framing the etiology of obesity as a disease, food addiction, or caloric imbalance would increase or decrease anti-fat attitudes (AFA) and challenge the belief that obesity is caused by a lack of personal responsibility or willpower.

METHODS

Two hundred and forty-nine fitness practitioners (M_age = 37.49 years) were randomly assigned to one of four experimental conditions and asked to read a short article describing obesity as either: (a) food addiction, (b) disease, or (c) caloric imbalance, while a control group read an unrelated article. All practitioners then completed a measure of AFA.

RESULTS

Practitioners in the food addiction condition recorded significantly lower AFA than practitioners in the disease condition, specifically on the subscale relating to the belief that obesity is a matter of personal responsibility and willpower, or lack thereof. The differing etiologies of obesity had no impact on fitness practitioners' dislike for people with obesity or their personal fears about gaining weight CONCLUSION: Presenting the etiology of obesity as a food addiction may be more effective than the disease or caloric imbalance etiologies at reducing obesity stigma relating to the belief that obesity results from a lack of willpower. Such an understanding can help reduce obesity stigma and may encourage governments to implement obesity reduction policies as recommended by organisations such as the WHO.

Promotion of Food and Beverages by German-Speaking Influencers Popular with Adolescents on TikTok, YouTube and Instagram

The promotion of nutritionally poor food and beverages (F&B) has a proven effect on children's eating preferences and, therefore, plays a significant role in today's childhood obesity epidemic. This study's objective was to assess the prevalence (exposure) and context (power) of the F&B cues in influencer content across three platforms: TikTok, YouTube, and Instagram. The selected influencers were popular with adolescents, with a combined total of more than 34 million followers/subscribers. We employed the YouTube Influencer Marketing Protocol from the World Health Organization (WHO) as our basis for coding. We analysed a total of 360 videos/posts and, of these, 24% contained F&B cues, which is equivalent to 18.1 F&B cues/hour. In total, 77% of the cues were not permitted for children's advertising, according to WHO criteria, and this was stable across all platforms, with chocolate and sugary confectionery (23%) as the most frequently featured products. Not-permitted F&B had a four-times higher chance of being branded, a five-times higher chance of being described positively, and received significantly more 'likes'. In 62% of the analysed presentations, the branded product was mentioned, yet only 6% of the content was labelled as advertising. The present analysis delivers further grounds for discussion for policies and regulations of influencer marketing.

The Use of Social Media in Children and Adolescents: Scoping Review on the Potential Risks

In recent years, social media has become part of our lives, even among children. From the beginning of COVID-19 pandemic period, media device and Internet access rapidly increased. Adolescents connected Internet alone, consulting social media, mostly Instagram, TikTok, and YouTube. During "lockdown", the Internet usage allowed communication with peers and the continuity activities such as school teaching. However, we have to keep in mind that media usage may be related to some adverse consequences especially in the most vulnerable people, such as the young. Aim of the review is to focus on risks correlated to social media use by children and adolescents, identifying spies of rising problems and engaging in preventive recommendations. The scoping review was performed according to PRISMA guidelines, searching on PubMed the terms "social media" or "social network", "health", and "pediatrics". Excluding articles not pertinent, we found 68 reports. Out of them, 19 were dealing with depression, 15 with diet, and 15 with psychological problems, which appeared to be the most reported risk of social media use. Other identified associated problems were sleep, addiction, anxiety, sex related issues, behavioral problems, body image, physical activity, online grooming, sight, headache, and dental caries. Public and medical awareness must rise over this topic and new prevention measures must be found, starting with health practitioners, caregivers, and websites/application developers. Pediatricians should be aware of the risks associated to a problematic social media use for the young's health and identify sentinel signs in children as well as prevent negative outcomes in accordance with the family.

Unhealthy food advertising. A position paper by the AEP Committee on Nutrition and Breastfeeding

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.

An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England

OBJECTIVE

To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people.

DESIGN

Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation.

SETTING

Middlesbrough and Redcar and Cleveland in South Teesside.

PARTICIPANTS

N/A.

RESULTS

Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation.

CONCLUSIONS

Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.

Exploring the potential impact of the proposed UK TV and online food advertising regulations: a concept mapping study

OBJECTIVES

In July 2020 the UK Government announced an intention to restrict advertisements for products high in fat, salt or sugar on live broadcast, catch-up and on-demand television before 21:00 hours; and paid for online advertising. As no other jurisdiction has implemented similar regulations, there is no empirical evidence about how they might perturb the food system. To guide the regulations' implementation and evaluation, we aimed to develop a concept map to hypothesise their potential consequences for the commercial food system, health and society.

METHODS

We used adapted group concept mapping in four virtual workshops with food marketing and regulation experts across academia, civil society, government organisations, and industry (n=14), supported by Miro software. We merged concepts derived from the four workshops to develop a master map and then invited feedback from participants via email to generate a final concept map.

RESULTS

The concept map shows how the reactions of stakeholders to the regulations may reinforce or undermine the impact on the commercial food system, health and society. The map shows adaptations made by stakeholders that could reinforce, or undermine, positive impacts on public health. It also illustrates potential weaknesses in the design and implementation of the regulations that could result in little substantial difference to public health.

CONCLUSIONS

Prior to the regulations' initial implementation or subsequent iterations, they could be altered to maximise the potential for reinforcing adaptations, minimise the potential for undermining adaptations and ensure they cover a wide range of advertising opportunities and foods. The concept map will also inform the design of an evaluation of the regulations and could be used to inform the design and evaluation of similar regulations elsewhere.

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

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

Examining the Factors That Affect Consumers’ Purchase Intention of Organic Food Products in a Developing Country

The purpose of this article is to investigate the factors that influence consumers’ intention to purchase organic food in Egypt. Given the novelty of organic food marketing in developing countries, much of the factors that influence its consumption are still inadequately explored in the marketing literature. A conceptual model of the factors that impact the consumption of organic food was developed based on the theory of planned behaviour and previous literature in the area of food consumption. To test the conceptual model and to validate the research hypotheses, an online questionnaire was adopted to collect data from 363 consumers in Egypt. The partial least square structural equation modelling (PLS-SEM) approach was used to analyse the data. The findings indicated that purchase intention of organic food is influenced by consumers’ attitudes and environmental concern. However, e-WOM, subjective norms, perceived behavioural control and health consciousness did not influence consumers’ purchase intention. Conversely, the results showed that e-WOM had a significant influence on consumers’ attitudes, subjective norms, perceived behavioural control, health consciousness and environmental concern. This article contributes by presenting the factors that affect organic food purchase intention in Egypt, and it provides some recommendations for marketing organic food in developing countries.

Food Insecurity and the Association between Perceptions and Trust of Food Advertisements and Consumption of Ultra-Processed Foods among U.S. Parents and Adolescents

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.