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

Obesity, beverage consumption and sleep patterns in rural African women in relation to advertising of these beverages

BACKGROUND

The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province.

METHODS

A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires.

RESULTS

The mean body mass index (BMI) was 28.5±7.3 kg/m2, with 40% being classified as obese (BMI ≥30 kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased.

CONCLUSIONS

The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.

Children's exposure to television advertising of unhealthy foods and beverages across four countries of WHO European Region

OBJECTIVE

To compare the frequency and healthfulness of foods being advertised to children and adolescents in four countries of WHO European region.

DESIGN

Cross-sectional quantitative study, guided by an adapted version of the WHO protocol. All recorded food advertisements were categorised by categories and as either 'permitted' or 'not permitted' for advertising to children in accordance with WHO Regional Office for Europe Nutrient Profile Model.

SETTINGS

Four countries: Russia, Turkey, Kazakhstan and Kyrgyzstan.

PARTICIPANTS

TV channels most popular among children and adolescents.

RESULTS

Analysis included 70 d of TV broadcasting for all channels, during which time there were 28 399 advertisements. The mean number of advertisements per hour varied from eleven in Turkey and Kazakhstan to eight and two in Russia and Kyrgyzstan. In all countries, the majority of the food and beverages advertised should not be permitted for advertising to children according to the WHO Nutrient Profile Model. The mean number of non-permitted food and beverage advertisements per hour was high in Turkey and Kazakhstan (8·8 and 8·5 ads) compared with Russia (5·1) and Kyrgyzstan (1·9). Turkey was the only country where nutritional information was fully available, and no values were missing that prevented coding for some product categories.

CONCLUSIONS

Results revealed that children and adolescents in four countries are exposed to a considerable volume of food and beverage advertisements, including sugary products on broadcast television. As such, policymakers should consider protecting youth by developing regulations to restrict these marketing activities within media popular with children.

Establishing the Minimum Media Time Sample Required to Obtain Reliable Estimates of Children's Digital Media Food Marketing Exposures

Background

The ubiquitous nature of food marketing on digital media likely has a profound effect on children's food preferences and intake. Monitoring children's exposure to digital marketing is necessary to raise awareness of the issue, inform policy development, and evaluate policy implementation and effect.

Objectives

This study aimed to establish whether smaller time samples (less time and/or fewer days captured) would provide robust estimates of children's usual exposures to food marketing.

Methods

Using an existing data set of children's digital marketing exposures, which captured children's total screen use over 3 d, a reliability assessment was performed.

Results

A subsample of 30% of children's usual screen time was found to provide reliable estimates of digital food marketing exposure compared with the full sample (intraclass correlation coefficient: 0.885; Cronbach α: 0.884). There was no difference in the rates of marketing (exposures/h) between weekdays and weekend days.

Conclusions

These findings enable researchers to reduce the time and resource constraints that have previously restricted this type of monitoring research. The reduced media time sample will further lessen participant burden.

Unhealthy food consumption and its associated factors among infants and young children in Gondar city, northwest Ethiopia: a community based cross sectional study

INTRODUCTION

Many low- and middle-income countries are now shifting toward diets that are higher in added sugars, unhealthy fats, salt, and refined carbohydrates. Childhood obesity and chronic diseases have all been linked to unhealthy food consumption. Despite this, the majority of Ethiopian infants and children consume unhealthy food. There is also a scarcity of evidence. Therefore, the objective of this study was to assess the prevalence of unhealthy food consumption and its associated factors among children ages 6-23 months in Gondar City, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from June 30 to July 21, 2022, in Gondar city. Multistage sampling was used to select 811 mother-child pairs. Food consumption was measured through a 24-hour recall. Data were entered into EpI Data 3.1 before being exported to STATA 14 for further analysis. A multivariable logistic regression analysis was employed to identify the factors associated with unhealthy food consumption. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association.

RESULTS

The percentage of children with unhealthy food consumption was 63.7% (95% CI: 60.4%, 67.2%). Maternal education [AOR = 1.89, 95% CI = 1.05, 3.69], living in an urban residence [AOR = 4.55, 95% CI = 3.61, 7.78], GMP service [AOR = 2.07, 95% CI = 1.48, 3.18], age of the child 18-23 months [AOR = 0.53, 95% CI = 0.34, 0.74], and family size of more than four [AOR = 1.22, 95% CI = 1.07, 2.78] were significantly associated with unhealthy food consumption.

CONCLUSION

In Gondar City, nearly two thirds of infants and children received unhealthy food. Maternal education, urban residence, GMP service, child age, and family size were all significant predictors of unhealthy food consumption. Thus, improving the uptake of GMP services and family planning services is critical to reducing unhealthy food consumption.

Defining and conceptualising the commercial determinants of health

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.

Beverage industry's advertising expenditures and airtimes in South Africa from 2013 to 2019 target children and families

With the growing burden of non-communicable diseases (NCDs), countries across the globe are finding ways to reduce the consumption of ultra-processed food and drinks including sugar-sweetened beverages (SSBs). South Africa implemented a health promotion levy (HPL) in April 2018 as one strategy to reduce sugar intake. Such efforts are frequently countered or mitigated by industry action in various ways, including through marketing and advertising strategies. To better understand trends in the extent of advertising, this paper analyses advertising expenditures and exposure of children to SSB advertisements in South Africa. Using Nielsen's monthly data on advertising expenditure before and after the introduction of the HPL, for the period January 2013 to April 2019, the results show that manufacturers spent ZAR 3683 million to advertise their products. Advertising expenditure on carbonated drinks accounted for over 60% (ZAR 2220 million) of the total expenditure on SSBs. The results also show that companies spend less in advertising powdered SSBs (an average of ZAR 0.05 million per month). Based on expenditure patterns, television (TV) was the preferred medium of advertisements, with companies prioritizing what is often considered children's and family viewing time. Urgent mandatory regulations are needed to prevent child-directed marketing.

Effect of different front-of-package food labels on healthfulness perception of ultraprocessed food and intention to purchase the products- A randomised controlled trial

This study aimed to evaluate the effect of different labels on participants: identifying products high in nutrients of concern; identifying unhealthy products, and intention to purchase unhealthy products. This blinded randomised controlled trial included a representative sample of South African households (n = 1951). Per household we selected a member primarily responsible for food purchases. Participants were randomised into the Warning Label (WL), Guideline Dietary Amounts (GDA) or Multiple Traffic Light (MTL) arms. Each participant answered questions in a no label condition (control) followed by same questions in the label condition (experiment). Complete data were collected and analysed for 1948 participants (WL = 33.7%, GDA = 32.1% and MTL = 34.2%). The probability of correctly identifying products high in nutrients of concern and identifying products as being unhealthy was higher with the WL compared to the GDA or MTL for most items. There was no difference in performance between the GDA and the MTL when considering all items together. A higher percentage of participants reported a lower intention to purchase an unhealthy product after exposure to the WL compared to MTL for 5 out of 6 products; 2 out of 6 products for the WL compared to GDA and 2 out of 6 products for GDA compared to MTL. Compared to the control condition, exposure to each of the labels resulted in better identification of nutrients of concerns, unhealthy products and a lower intention to purchase when considering all specific outcome items together. The WL showed a higher potential to enable South African consumers to identify products high in nutrients of concern, identify unhealthy products and discourage purchasing of unhealthy products.

A realist review of voluntary actions by the food and beverage industry and implications for public health and policy in low- and middle-income countries

The increasing availability of unhealthy processed food products is linked to rising rates of non-communicable diseases and obesity in low- and middle-income countries. Voluntary actions (VAs) are often adopted in lieu of regulating the composition, production, marketing and sale of unhealthy commodities, but their effectiveness is unclear. This realist review examines VAs adopted by the food and beverage industry in low- and middle-income countries. We developed a conceptual framework and followed a three-stage search to identify literature and VAs and, adhering to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines, we produced a synthesized analysis of VAs. VAs, often initiated in response to governments' efforts to introduce regulations, were difficult to evaluate due to vague language and a lack of enforcement mechanisms. The review found no evidence indicating that VAs are effective in safeguarding public health. Yet their implementation has resulted in weaker responses and policy substitution, and so we suggest that VAs have the potential to negatively influence public health and policy. The United Nations should rescind their endorsement of industry involvement and mandatory measures should be favoured over VAs.

The Right to Free Commercial Speech in South Africa and its Tension with Public Health Interventions

Marketing restrictions to promote public health invoke competing rights, including the right to free commercial speech which for-profit entities use to protect their freedom to market products without undue regulation. The right to free commercial speech in South Africa has been developed through case law since the adoption of the first democratic constitution in South Africa in 1996. This article examines the impact of this recent judgment and the lessons for policy makers to ensure effective regulation of marketing practices in South Africa.