Unhealthy Food and Beverage Marketing to Children in the Digital Age: Global Research and Policy Challenges and Priorities

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Menu Labeling and Calories Purchased in Restaurants in a US National Fast Food Chain

Importance

Menu labeling has been implemented in restaurants in some US jurisdictions as early as 2008, but the extent to which menu labeling is associated with calories purchased is unclear.

Objective

To estimate the association of menu labeling with calories and nutrients purchased and assess geographic variation in results.

Design, Setting, and Participants

A cohort study was conducted with a quasi-experimental design using actual transaction data from Taco Bell restaurants from calendar years 2007 to 2014 US restaurants with menu labeling matched to comparison restaurants using synthetic control methods. Data were analyzed from May to October 2023.

Exposure

Menu labeling policies in 6 US jurisdictions.

Main Outcomes and Measures

The primary outcome was calories per transaction. Secondary outcomes included total and saturated fat, carbohydrates, protein, sugar, fiber, and sodium.

Results

The final sample included 2329 restaurants, with menu labeling in 474 (31 468 restaurant-month observations). Most restaurants (94.3%) were located in California. Difference-in-differences model results indicated that customers purchased 24.7 (95% CI, 23.6-25.7) fewer calories per transaction from restaurants in the menu labeling group in the 3- to 24-month follow-up period vs the comparison group, including 21.9 (95% CI, 20.9-22.9) fewer calories in the 3- to 12-month follow-up period and 25.0 (95% CI, 24.0-26.1) fewer calories in the 13- to 24-month follow-up period. Changes in the nutrient content of transactions were consistent with calorie estimates. Findings in California were similar to overall estimates in magnitude and direction; yet, among restaurants outside of California, no association was observed in the 3- to 24-month period. The outcome of menu labeling also differed by item category and time of day, with a larger decrease in the number of tacos vs other items purchased and a larger decrease in calories purchased during breakfast vs other times of the day in the 3- to 24-month period.

Conclusions and Relevance

In this quasi-experimental cohort study, fewer calories were purchased in restaurants with calorie labels compared with those with no labels, suggesting that consumers are sensitive to calorie information on menu boards, although associations differed by location.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

COVID-19-Related Changes to Drug-Selling Networks and Their Effects on People Who Use Illicit Opioids

OBJECTIVE

The COVID-19 pandemic has significantly affected people's ability to buy, sell, and obtain items that they use in their daily lives. It may have had a particularly negative effect on the ability of people who use illicit opioids to obtain them because the networks they relied on are illicit and not part of the formal economy. Our objective in this research was to examine if, and how, disruptions related to COVID-19 of illicit opioid markets have affected people who use illicit opioids.

METHOD

We collected 300 posts--including replies to posts--related to the intersection of COVID-19 and opioid use from Reddit.com, a forum that has several discussion threads (i.e., subreddits) dedicated to opioids. We then coded posts from the two most popular opioid subreddits during the early pandemic period (March 5, 2020-May 13, 2020) using an inductive/deductive approach.

RESULTS

We found two themes related to active opioid use during the early pandemic: (a) changes in drug supply and difficulty obtaining opioids, and (b) buying less-trustworthy drugs from lesser-known sources.

CONCLUSIONS

Our findings suggest that COVID-19 has created market conditions that place people who use opioids at risk of adverse outcomes, such as fatal overdose.

Food and Beverage Product Appearances in Educational, Child-Targeted YouTube Videos

Background: Food advertisement exposure is associated with children's increased caloric intake, but little is known about food/beverage placements in child-oriented educational YouTube videos. We aimed to quantify the prevalence of food/beverages in these videos and assess their nutritional quality. Methods: Researchers identified child-oriented educational YouTube videos from 2020, using keyword searches. We coded the names of featured food/beverages, coded how the food/beverages were interacted with, quantified the number of minutes the food/beverages appeared, and assessed the nutritional quality of the food/beverages. Results: A sample of 400 videos with the highest number of views was identified, 165 of which featured food/beverages. These 165 videos were collectively viewed over 1.1 billion times. Among these videos, 108 (67.4%) featured unhealthy foods and 86 (52.1%) featured branded products. Most food/beverages were used in experiment/tutorials (n = 143, 86.7%). Of the 165 videos featuring food/beverages, 91 (55.2%) did not depict food/beverages in their video thumbnail. Conclusions: While unhealthy food/beverages appear frequently in child-oriented educational YouTube videos, parents and teachers may not be aware of the presence of branded food/beverage products in these videos that could influence their children's food and brand preferences. The Federal Trade Commission should collect data on food and beverage company sponsorship of educational videos aimed at children and adolescents.

Food industry donations to patient advocacy organisations focussed on non-communicable diseases

OBJECTIVE

This study used publicly available Form 990 tax documents to quantify food industry donations to patient advocacy organisations (PAO) dedicated to supporting patients with non-communicable diseases.

DESIGN

Observational, cross-sectional assessment of significant national and international food industry donations to US-based non-communicable disease-focussed PAO between 2000 and 2018. Researchers recorded and categorised the: (1) frequency and value of donations; (2) reason for donation; (3) name and type of PAO recipient and (4) non-communicable disease focus of the PAO.

SETTING

Form 990 tax documents.

PARTICIPANTS

Nine food and beverage companies that donated to non-communicable disease-focussed PAO.

RESULTS

Adjusting for inflation, nine food and beverage companies collectively donated $10 672 093 (n 2709) to the PAO between 2001 and 2018. The largest category of donations was ‘matching gifts’ (67·9 %, median amount = $115·16), followed by ‘general operations support’ (25·8 %, median amount = $107·79). Organisations focussing on cancer received the largest number and amount of donations ($6 265 861, n 1968). Eight of the nine companies made their largest monetary value of donation to PAO focussed on cancer.

CONCLUSIONS

Publicly available tax data provide robust information on food industry donation practices. Our findings document the food industry’s role in supporting patient advocacy organisations and raise questions regarding conflicts of interest. Increased awareness of food industry donation practices involving PAO may generate pressure for policies mandating transparency or encourage donors and recipients to voluntarily disclose donations. If public disclosure becomes widespread, constituents, advocates, researchers and policymakers can better supervise and address potential conflicts of interest.

Beverage Availability and Price: Variations by Neighborhood Poverty Level in New York City

Objective:

To describe the variability in the availability and price of sugary drinks, low-calorie drinks, and water/seltzer across high- and low-poverty census tracts in the five boroughs of New York City (NYC).

Design:

Cross-sectional study. Our primary analysis compared the overall sample of beverages. Secondary analyses included tests for differences in the availability of beverage categories by neighborhood poverty level.

Setting:

We collected data from 106 stores (31 supermarkets, 29 convenience stores, 29 pharmacies, 9 Targets, and 8 Dollar Trees) in NYC. Fifty-four stores were located in high-poverty census tracts and 52 were located in low-poverty census tracts.

Results:

The mean Price per 0.03-liter of sugary drinks across the sample was $0.08, which was significantly higher than the price of low-calorie drinks ($0.07, p=0.01) but not different from water/seltzer ($0.08, p=0.65). Sugary drinks and water/seltzer were available in 91% of retailers, and low-calorie drinks were available in 87% of retailers. There was no statistical difference in availability of sugary drinks compared with low-calorie drinks or water/seltzer overall or within high- or low-poverty census tracts. Analyzed by store type, the mean price per ounce of sugary drinks differed significantly from water/seltzer at convenience stores, pharmacies, and Target stores (bodegas: $0.08 vs. $0.09, p=0.03; pharmacies: $0.11 vs. $0.08, p=0.02; Target stores: $0.07 vs. $0.09, p=0.01).

Conclusions:

Sugary drinks were available in most food retail settings in NYC, with little variation by census tract poverty level. Interventions that raise the price of sugary drinks to make healthier alternatives, such as water, the more affordable option should be considered.

COVID-washing in U.S. food and beverage marketing on Twitter: A content analysis (Preprint)

Background

Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages.

Objective

We aimed to document the types and frequencies of COVID-19–related themes in US food and beverage companies’ Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets.

Methods

Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and “retweets”; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content.

Results

Our final sample included 874 COVID-19–themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products.

Conclusions

Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19.

Comparisons of Culturally Targeted Food and Beverage Advertisements in Caribbean-American Neighborhood and Non-Latinx White Neighborhood in New York City

Purpose:

This descriptive study aimed to (1) compare the number of food and beverage advertisements (ads) located in a Caribbean-American neighborhood and non-Latinx white neighborhood in New York City (NYC), and (2) qualitatively assess and compare the culturally targeted marketing themes of the food and beverage advertisements in both neighborhoods.

Methods:

Three research assistants photographed all outdoor food and beverage advertisements (n=361) across a 1.6 kilometer distance on a high-retail street in a Caribbean-American neighborhood and a non-Latinx white neighborhood. We used content analysis to evaluate advertising themes, and sorted food into nutritional categories (e.g., fast food and alcohol). We identified two neighborhoods with similar income levels in Queens, NYC, USA—South Ozone Park residents are predominantly non-white Caribbean Americans based on data from the NYC Department of City Planning, whereas residents of Steinway are predominantly non-Latinx white.

Results:

We identified a significantly higher proportion of fast-food advertisements in the Caribbean-American neighborhood (19.78%, n=36) compared with the non-Latinx white neighborhood (5.03%, n=9; p<0.001). Among beverage advertisements, 30.77% (n=56) featured alcohol brands in the Caribbean-American neighborhood, whereas 22.91% (n=41) featured alcohol brands in the non-Latinx white neighborhood. In the Caribbean-American neighborhood, 24.18% (n=44) of food and beverage advertisements referenced Caribbean culture.

Conclusions:

The Caribbean-American neighborhood in this study had more fast-food advertisements relative to non-Latinx white neighborhoods. More research is needed to understand the effects of culturally targeted ads on Caribbean-American communities.

Comparing the Prevalence of Alcohol, Combustible and Electronic Cigarettes, Hookah, and Marijuana, in Music Videos across 6 Genres of Popular Music from 2014-2020

OBJECTIVES

To determine the frequency of alcohol, marijuana, cigarettes/cigars, e-cigarettes, and hookah portrayals in popular music lyrics and videos on YouTube across 6 genres over 7 years; assess percent change over the years, document brand placement, and determine frequency of promotion of substances/devices by Teen Choice Award celebrities.

METHODS

We analyzed 699 songs from the Billboard Hot 100 between 2014 and 2020. Two raters coded 10% of the songs to establish inter-rater reliability and remaining songs were reviewed by one rater.

RESULTS

The majority of songs (59.2%) on YouTube included either lyrical or video depictions and 20.6% included both. Songs that featured substances/devices were viewed 148 billion times on YouTube as of February 2021. Nearly 25% of videos depicting substances/devices featured branding. Forty-three (18.22%) of the music celebrities who featured substances/devices in their videos received one or more Teen Choice Awards during the study period.

CONCLUSIONS

Popular music celebrities promote substance use in their lyrics and music videos, which are easily accessible to children and adolescents. Some of these celebrities are highly popular and influential among adolescents.Policy Implications. Findings support the need to limit promotion of these substances to youth by influencers to reduce substance use and misuse.

Informal coping strategies among people who use opioids during COVID-19: A thematic analysis of Reddit forums

BACKGROUND

The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use.

OBJECTIVE

This qualitative study aimed to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic.

METHODS

We extracted data from two major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5, 2020 to May 13, 2020 that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed.

RESULTS

Of the 300 subreddit posts, 100 discussed at least one type of informal coping strategy. Those strategies included: psychological and behavioral coping skills, adopting healthy habits, and using substances to manage withdrawal symptoms. Twelve subreddit posts explicitly mentioned using social distancing as an opportunity for cessation or reduction of opioid use.

CONCLUSIONS

Reddit discussion forums provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance related harms.

A Qualitative Analysis of Black and White Adolescents' Perceptions of and Responses to Racially Targeted Food and Drink Commercials on Television

Food and beverage marketing is a major driver of childhood obesity, and companies target their least nutritious products to Black youth. However, little is known about adolescents' perceptions of and responses to racially targeted food marketing. In this qualitative study, we investigated how Black and White adolescents perceived and responded to racially targeted television commercials for food and beverages. We recruited 39 adolescents aged 12-17 years in New York City to watch a series of commercials and then participate in an in-depth interview using a semi-structured interview guide. The research team recorded, transcribed, and analyzed interviews using ATLAS.ti. Overall, participants responded positively to commercials that featured celebrities. They were also able to recognize the commercials and reported they had been exposed to marketing from these companies on social media and in subways/buses. Many participants considered the advertised brands as healthy or able to enhance athletic performance because of their endorsement by or association with athletes. Participants also understood that marketers were using racial targeting in their ads but that targeting did not translate into improved perceptions or responses towards advertised products. These findings suggest the need to empirically evaluate and further explore Black and White adolescents' responses to racially targeted food marketing.

Social Media Accounts of Food and Beverage Brands Have Disproportionately More Black and Hispanic Followers than White Followers

Introduction: On television, food companies promote their least nutritious products to Black and Hispanic youth more than White youth, but little is known about the extent to which Black and Hispanic adolescents may disproportionately engage with unhealthy food and beverage brands on social media relative to White adolescents. Methods: In 2019, we purchased and analyzed demographic data of social media users who followed 27 of the most marketed food/beverage brands on Instagram and Twitter. We used one-sample t-tests to compare percentages of Black, Hispanic, and White followers of the selected brands' accounts versus all social media accounts, and independent samples t-tests to compare followers of sugary versus low-calorie drink brands. We also used linear regression to examine associations between racially targeted marketing practices and the percentages of Black, Hispanic, and White followers on social media. Results: On Instagram, the percentage of Black followers of the selected brands (12.7%) was higher than the percentage of Black followers of any account (7.8%) (p<0.001). On Twitter, findings were similar for Hispanic users but opposite for White users. A higher racially targeted ratio was positively associated with the percentage of Black followers, and negatively associated with the percentage of White followers. Sugary drink brands had more Hispanic followers than low-calorie drink brands (p<0.001). Conclusions: Unhealthy food/beverage brands that target Black adolescents have a disproportionately higher percentage of Black followers on social media relative to White followers. These findings support the 2019 proposal to restrict racially targeted advertising through the Children's Online Privacy and Protection Act.

Waste generation and carbon emissions of a hospital kitchen in the US: Potential for waste diversion and carbon reductions

This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitchen generated 1515.15 kg (1.7 US tons) of solid waste daily or 0.23 kg of total waste per meal served. Extrapolating to all meals served in 2019, the hospital kitchen generates over 442,067 kg (487 US tons) of waste and emits approximately 294,466 kg of CO2e annually from waste disposal. Most of this waste (85%, 376,247 kg or 415 US tons annually) is currently sent to landfill. With feasible changes, including increased recycling and moderate composting, this hospital could reduce landfilled waste by 205,245 kg (226 US tons, or 55% reduction) and reduce GHG emissions by 189,025 kg CO2e (64% reduction). Given NYC's ambitious waste and GHG emission reduction targets outlined in its OneNYC strategic plan, studies analyzing composition, emissions, and waste diversion potential of large institutions can be valuable in achieving city sustainability goals.

"How will I get my next week's script?" Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemic

BACKGROUND

The COVID-19 pandemic poses significant challenges to people with opioid use disorder (OUD). As localities enforce lockdowns and pass emergency OUD treatment regulations, questions arise about how these changes will affect access and retention in care. In this study, we explore the influence of COVID-19 on access to, experiences with, and motivations for OUD treatment through a qualitative analysis of public discussion forums on Reddit.

METHODS

We collected data from Reddit, a free and international online platform dedicated to public discussions and user-generated content. We extracted 1000 of the most recent posts uploaded between March 5th and May 13th, 2020 from each of the two most popular opioid subreddits "r/Opiates" and "r/OpiatesRecovery" (total 2000). We reviewed posts for relevance to COVID-19 and opioid use and coded content using a hybrid inductive-deductive approach. Thematic analysis identified common themes related to study questions of interest.

RESULTS

Of 2000 posts reviewed, 300 (15%) discussed topics related to the intersection of opioid use and COVID-19. Five major themes related to OUD treatment were identified: Concern about closure of OUD treatment services; transition to telehealth and virtual care; methadone treatment requirements and increased exposure to COVID-19; reactions to changing regulations on medications for OUD; and influences of the pandemic on treatment motivation and progress.

CONCLUSION

In the face of unprecedented challenges due to COVID-19, reactions of Reddit opioid forum users ranged from increased distress in accessing and sustaining treatment, to encouragement surrounding new modes of treatment and opportunities to engage in care. New and less restrictive avenues for treatment were welcomed by many, but questions remain about how new norms and policy changes will be sustained beyond this pandemic and impact OUD treatment access and outcomes long-term.

An online randomized trial of healthy default beverages and unhealthy beverage restrictions on children's menus

•

Healthy default beverage policies have been enacted in several U.S. municipalities.

•

Effects of such policies or beverage restrictions on children’s menus are unknown.

•

Parents viewed and ordered children’s meals from one of three menu conditions.

•

Defaults and restrictions did not reduce beverage calories ordered in our experiment.

•

More robust legislation may be needed, such as implementing healthy food defaults.

Several U.S. jurisdictions have adopted policies requiring healthy beverage defaults on children’s menus, but it is unknown whether such policies or restrictions leads to fewer calories ordered. We recruited 479 caregivers of children for an online choice experiment and instructed participants to order dinner for their youngest child (2–6 years) from two restaurant menus. Participants were randomly assigned to one type of menu: 1) standard beverages on children’s menus (Control; n = 155); 2) healthy beverages on children’s menus (water, milk, or 100% juice), with unhealthy beverages available as substitutions (Default; n = 162); or 3) healthy beverages on children’s menus, with no unhealthy beverage substitutions (Restriction; n = 162). We used linear regression with bootstrapping to examine differences between conditions in calories ordered from beverages. Secondary outcomes included percent of participants ordering unhealthy beverages (full-calorie soda, diet soda, and/or sugar-sweetened fruit drinks) and calories from unhealthy beverages. Calories ordered from beverages did not differ across conditions at Chili’s [Default: 97.6 (SD = 69.8); p = 0.82; Restriction: 102.7 (SD = 71.5); p = 0.99; Control: 99.4 (SD = 72.7)] or McDonald’s [Default: 90.2 (SD = 89.1); p = 0.55; Restriction: 89.0 (SD = 81.0); p = 0.94; Control: 96.5 (SD = 95.2)]. There were no differences in the percent of orders or calories ordered from unhealthy beverages. Though Restriction participants ordered fewer calories from full-calorie soda [(3.0 (SD = 21.6)] relative to Control participants [13.4 (SD = 52.1); p = 0.04)] at Chili’s, we observed no such difference between Default and Control participants, or across McDonald’s conditions. Overall, there was no effect of healthy default beverages or restrictions in reducing total calories ordered from unhealthy beverages for children in our experiment.

Understanding the Extent of Adolescents' Willingness to Engage With Food and Beverage Companies' Instagram Accounts: Experimental Survey Study

Background

Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents’ online relationships with unhealthy food brands.

Objective

We aimed to understand the extent to which adolescents’ preferences for Instagram food ads are shaped by the presence of comments and varying numbers of “likes.” We hypothesized that adolescents would show the highest preferences for ads with more “likes” and comments. We predicted that these differences would be greater among adolescents who were “heavy social media users” (ie, >3 hours daily) vs “light social media users” (ie, <3 hours daily).

Methods

We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of “likes.” Adolescents reported ad preferences and willingness to engage with the brand.

Results

Adolescents rated ads with medium or high numbers of “likes” higher than ads with few “likes” (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001).

Conclusions

Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many “likes,” demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children’s Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years.

Trends in Store-Level Sales of Sugary Beverages and Water in the U.S., 2006-2015

INTRODUCTION

Previous research on sugar-sweetened beverage trends has focused on self-reported consumption from surveys. Few studies used objective store sales or explored differences by area-level demographics and store type.

METHODS

The average volume of beverages sold per store per 3-digit zoning improvement plan code from 2006 to 2015 was calculated using national Nielsen Retail Scanner point-of-sale data from 24,240 stores. A multilevel regression model analyzed annual trends, with random intercepts for state and separate models for beverage type (regular soda, no/low-calorie soda, other sugary drinks, 100% fruit juice, bottled water). Differences by store type (convenience, supermarkets, drug stores, mass merchandisers) and area-level demographics (categorized as tertiles) were examined. Data were analyzed in 2019.

RESULTS

The model-based estimates indicated that sales of regular soda (-11.8%), no/low-calorie soda (-19.8%), and 100% fruit juice (-31.9%) decreased over time, whereas sales of bottled water (+34.4%) increased and sales of other sugary drinks remained stable (+2.4%). Decreases in sugar-sweetened beverage sales were largely concentrated in supermarkets and larger in areas with high income and education levels and a high percentage of black and Hispanic people. There were also relatively larger increases in bottled water sales in states located in the South and Midwest.

CONCLUSIONS

The finding that sales of sugar-sweetened beverages decreased over time, whereas sales of bottled water increased is encouraging because sugar-sweetened beverage consumption is linked to obesity and other chronic conditions. This study provides a novel, rigorous assessment of U.S. beverage sales trends and differences by community and store characteristics.

Fast food, beverage, and snack brands on social media in the United States: An examination of marketing techniques utilized in 2000 brand posts

BACKGROUND

Exposure to food advertisements is associated with poor diet among youth, and food and beverage companies are increasingly advertising on social media sites that are popular among youth.

OBJECTIVE

To identify the prevalence of social media advertising among fast food, beverage, and snack companies and examine advertising techniques they use on Instagram, Facebook, Twitter, Tumblr, and Vine.

METHODS

We quantified the increase in the creation of social media accounts from 2007 to 2016 among 200 fast food, beverage, and snack brands from the United States. We conducted content analyses to examine the marketing themes and healthfulness of products featured in 2000 posts from a subset of 20 brands and used multilevel regression to assess associations between marketing themes (eg, adolescents socializing) and interactive tools (eg, hashtags).

RESULTS

Two hundred brands collectively managed 568 accounts in 2016. Content analyses revealed that unique social media features (eg, geo-tags) appeared in 74.5% (n = 1489) of posts, and 31.5% (n = 630) were interactive. Posts featuring adolescents were more likely to be interactive than posts featuring adults (P < 0.001). Two-thirds (67.9%; n = 362) of foods shown were unhealthy, and 61.2% (n = 435) of beverages were sugar sweetened.

CONCLUSIONS

Social media food advertising is pervasive and uses interactive tools to engage with users.

Ubiquity of Sugary Drinks and Processed Food Throughout Food and Non-Food Retail Settings in NYC

Sugary drinks and processed foods are associated with negative health outcomes in adults, including weight gain, and their consumption should be limited. However, they may be difficult to avoid if they are ubiquitously available in the retail environment. This study aimed to quantify the availability of such products for sale throughout New York City (NYC) at both food and non-food retailers. In 2018, ten one-mile retail-dense NYC street segments were selected for the sample. Data collectors canvassed each segment and visited all retailers, recording the type (food/non-food) and presence of processed food and beverages for sale. Descriptive statistics were analyzed for availability of products sold in retailers overall and by retailer type. In total, 491 retailers were identified (191 food, 300 non-food). Sugary drinks were available at 83% of food retailers and 19% of non-food retailers, while processed foods were available at 61% of food retailers and 16% of non-food retailers. Eighty-five percent of food retailers and 21% of non-food retailers sold sugary drinks and/or processed foods. This study supports and builds on results of previous research examining the availability of food and beverages in the retail environment. Sugary drinks and processed foods are ubiquitous at food and non-food retailers, providing pervasive cues to consume energy-dense, nutrient-poor products. Restrictions on where such products can be sold merit consideration.

Examining the Relationship between Youth-Targeted Food Marketing Expenditures and the Demographics of Social Media Followers

Background: To determine how many adolescents follow food/beverage brands on Instagram and Twitter, and examine associations between brands’ youth-targeted marketing practices and percentages of adolescent followers. Methods: We purchased data from Demographics Pro to characterize the demographics of Twitter and Instagram users who followed 27 of the most highly advertised fast food, snack, and drink brands in 2019. We used one-sample t-tests to compare percentages of adolescent followers of the selected brands’ accounts versus all social media accounts, independent samples t-tests to compare followers of sugary versus low-calorie drink brands, and linear regression to examine associations between youth-targeted marketing practices and the percentages of adolescent followers. Results: An estimated 6.2 million adolescents followed the selected brands. A higher percentage of adolescents followed the selected brands’ accounts (9.2%) compared to any account on Twitter (1.2%) (p < 0.001), but not Instagram. A higher percentage of adolescents followed sugary (7.9%) versus low-calorie drink brands (4.3%) on Instagram (p = 0.02), but we observed the opposite pattern for adults on Twitter and Instagram. Television advertising expenditures were positively associated with percentages of adolescent followers of the selected brands on Twitter (p = 0.03), but not Instagram. Conclusions: Food and sugary drink brands maintain millions of adolescent followers on social media.

Evaluating the influence of racially targeted food and beverage advertisements on Black and White adolescents' perceptions and preferences

INTRODUCTION

The present study measures how racially-targeted food and beverage ads affect adolescents' attitudes toward ads and brands, purchase intentions for advertised products, and willingness to engage with brands on social media.

METHODS

Black and White adolescents were recruited through Survey Sampling International in 2016. Participants completed an online survey in which they were randomized to view either four food and beverage ads (e.g., soda, candy commercials) featuring Black actors or four food and beverage ads featuring White actors.

RESULTS

For the two components of the attitudinal outcome, Black participants were more likely to report a positive affective response toward racially-similar ads compared to Whites. However, White participants were more likely to like ads that were racially-dissimilar compared to Black participants. Data were analyzed in 2016-2017, and we used an alpha level of 0.05 to denote statistical significance.

CONCLUSIONS

Both Black and White adolescents reported more positive affective responses to ads that featured Blacks compared to ads that featured Whites. Because there were no differences on two outcomes, future research should examine the influence of racially-targeted marketing in real-world contexts (e.g., social media) and longitudinal exposure to targeted advertising on dietary behavior.

Sports Sponsorships of Food and Nonalcoholic Beverages

BACKGROUND

Food and nonalcoholic beverage companies spend millions of dollars on professional sports sponsorships, yet this form of marketing is understudied. These sponsorships are valuable marketing tools but prompt concerns when unhealthy products are associated with popular sports organizations, especially those viewed by youth.

METHODS

This descriptive study used Nielsen audience data to select 10 sports organizations with the most 2-17 year old viewers of 2015 televised events. Sponsors of these organizations were identified and assigned to product categories. We identified advertisements promoting food and/or nonalcoholic beverage sponsorships on television, YouTube, and sports organization Web sites from 2006 to 2016, and the number of YouTube advertisement views. The nutritional quality of advertised products was assessed.

RESULTS

Youth watched telecasts associated with these sports organizations over 412 million times. These organizations had 44 food and/or nonalcoholic beverage sponsors (18.8% of sponsors), second to automotive sponsors (n = 46). The National Football League had the most food and/or nonalcoholic beverage sponsors (n = 10), followed by the National Hockey League (n = 7) and Little League (n = 7). We identified 273 advertisements that featured food and/or nonalcoholic beverage products 328 times and product logos 83 times (some advertisements showed multiple products). Seventy-six percent (n = 132) of foods had unhealthy nutrition scores, and 52.4% (n = 111) of nonalcoholic beverages were sugar-sweetened. YouTube sponsorship advertisements totaled 195.6 million views.

CONCLUSIONS

Sports sponsorships are commonly used to market unhealthy food and nonalcoholic beverages, exposing millions of consumers to these advertisements.

Marketing Food and Beverages to Youth Through Sports

Food and beverage marketing has been identified as a major driver of obesity yet sports sponsorship remains common practice and represents millions of dollars in advertising expenditures. Research shows that food and beverage products associated with sports (e.g., M&M's with National Association for Stock Car Auto Racing logo) generate positive feelings, excitement, and a positive self-image among adults and children. Despite this, self-regulatory pledges made by food companies to limit exposure of unhealthy products to children have not improved the nutritional quality of foods marketed to children. We reviewed the literature about sports-related food marketing, including food and beverage companies' use of sports sponsorships, athlete endorsements, and sports video games. This review demonstrates that sports sponsorships with food and beverage companies often promote energy-dense, nutrient-poor products and while many of these promotions do not explicitly target youth, sports-related marketing affects food perceptions and preferences among youth. Furthermore, endorsement of unhealthy products by professional athletes sends mixed messages; although athletes may promote physical activity, they simultaneously encourage consumption of unhealthy products that can lead to negative health outcomes. We argue that more athletes and sports organizations should stop promoting unhealthy foods and beverages and work with health experts to encourage healthy eating habits among youth.

Comparison of online marketing techniques on food and beverage companies' websites in six countries

Food and beverage marketing contributes to poor dietary choices among adults and children. As consumers spend more time on the Internet, food and beverage companies have increased their online marketing efforts. Studies have shown food companies' online promotions use a variety of marketing techniques to promote mostly energy-dense, nutrient-poor products, but no studies have compared the online marketing techniques and nutritional quality of products promoted on food companies' international websites. For this descriptive study, we developed a qualitative codebook to catalogue the marketing themes used on 18 international corporate websites associated with the world's three largest fast food and beverage companies (i.e. Coca-Cola, McDonald's, Kentucky Fried Chicken). Nutritional quality of foods featured on those websites was evaluated based on quantitative Nutrient Profile Index scores and food category (e.g. fried, fresh). Beverages were sorted into categories based on added sugar content. We report descriptive statistics to compare the marketing techniques and nutritional quality of products featured on the company websites for the food and beverage company websites in two high-income countries (HICs), Germany and the United States, two upper-middle-income countries (UMICs), China and Mexico, and two lower-middle-income countries (LMICs), India and the Philippines. Of the 406 screenshots captured from company websites, 67·8% depicted a food or beverage product. HICs' websites promoted diet food or beverage products/healthier alternatives (e.g. baked chicken sandwich) significantly more often on their pages (25%), compared to LMICs (14·5%). Coca-Cola featured diet products significantly more frequently on HIC websites compared to LMIC websites. Charities were featured more often on webpages in LMICs (15·4%) compared to UMICs (2·6%) and HICs (2·3%). This study demonstrates that companies showcase healthier products in wealthier countries and advertise their philanthropic activities in lower income countries, which is concerning given the negative effect of nutrition transition (double burden of overnutrition and undernutrition) on burden of non-communicable diseases and obesity in lower income countries.

Geospatial clustering in sugar-sweetened beverage consumption among Boston youth

The objective was to detect geospatial clustering of sugar-sweetened beverage (SSB) intake in Boston adolescents (age = 16.3 ± 1.3 years [range: 13-19]; female = 56.1%; White = 10.4%, Black = 42.6%, Hispanics = 32.4%, and others = 14.6%) using spatial scan statistics. We used data on self-reported SSB intake from the 2008 Boston Youth Survey Geospatial Dataset (n = 1292). Two binary variables were created: consumption of SSB (never versus any) on (1) soda and (2) other sugary drinks (e.g., lemonade). A Bernoulli spatial scan statistic was used to identify geospatial clusters of soda and other sugary drinks in unadjusted models and models adjusted for age, gender, and race/ethnicity. There was no statistically significant clustering of soda consumption in the unadjusted model. In contrast, a cluster of non-soda SSB consumption emerged in the middle of Boston (relative risk = 1.20, p = .005), indicating that adolescents within the cluster had a 20% higher probability of reporting non-soda SSB intake than outside the cluster. The cluster was no longer significant in the adjusted model, suggesting spatial variation in non-soda SSB drink intake correlates with the geographic distribution of students by race/ethnicity, age, and gender.

A content analysis of outdoor non-alcoholic beverage advertisements in Ghana

OBJECTIVES

This was a two-part descriptive study designed to (1) assess the marketing themes and sugar content of beverages promoted in outdoor advertisements (ads) within a portion of Accra, Ghana and (2) quantify the types of ads that appeared along the Accra-Cape Coast Highway.

SETTING

A 4.7 km² area of Accra, Ghana and a 151 km region along the highway represented the target areas for collecting photos of outdoor beverage ads.

PRIMARY AND SECONDARY OUTCOME MEASURES

Number and types of beverage ads, sugar content of beverage products featured in ads and marketing themes used in ads.

DESIGN

Two researchers photographed outdoor beverage ads in a 4.7 km² area of Accra and used content analysis to assess marketing themes of ads, including the portrayal of children, local culture, music, sports and health. Researchers also recorded the number and type of ads along a 151 km stretch of the Accra-Cape Coast Highway. Researchers assessed the added sugar content to determine which beverages were sugar-sweetened beverages (SSBs).

RESULTS

Seventy-seven photographed ads were analysed. Seventy-three per cent (72.7%) of ads featured SSBs, and Coca-Cola accounted for 59.7% of ads. Sixty-five per cent (64.9%) of all ads featured sodas, while 35.1% advertised energy drinks, bottled or canned juice drinks and coffee-based, milk-based and water-based beverages. Thirteen per cent (13%) of ads featured children and 5.2% were located near schools or playgrounds. Nine per cent (9.1%) of ads contained a reference to health and 7.8% contained a reference to fitness/strength/sport. Along the Accra-Cape Coast Highway, Coca-Cola accounted for 60% of branded ads.

CONCLUSION

This study demonstrates the frequency of outdoor SSB ads within a 4.7 km² area of Accra, Ghana. Coca-Cola was featured in the majority of ads, and the child-targeted nature of some ads indicates a need to expand the Children's Food and Beverage Advertising Initiative pledge to reduce child-targeted marketing on a global scale.

Popular Music Celebrity Endorsements in Food and Nonalcoholic Beverage Marketing

BACKGROUND

Food and beverage marketing has been associated with childhood obesity. We quantified the number and type of food or beverage brands promoted by music celebrities, assessed the nutritional quality of the products, and examined Teen Choice Award data to assess the celebrities' popularity among adolescents.

METHODS

This was a descriptive study. A list of music celebrities associated with the 2013 and 2014 Billboard Hot 100 Chart, which ranks songs according to sales and radio impressions, was compiled. Data on celebrity endorsements were gathered from official company Web sites, YouTube commercials, an advertising database, and media reports. Nutritional quality of foods was assessed according to the Nutrient Profile Index, whereas nonalcoholic beverages were evaluated based on calories from added sugar. Teen Choice Award nominations were used to measure the celebrities' popularity among adolescents.

RESULTS

Of the 590 endorsements made by the 163 celebrities in the sample, consumer goods (eg, fragrances, makeup) represented the largest endorsement category (26%), followed by food and beverage (18%) and retail (11%). Sixty-five celebrities were collectively associated with 57 different food and beverage brands owned by 38 parent companies. Of these 65 celebrities, 53 (81.5%) had ≥1 Teen Choice Award nomination. Forty-nine (71%) of the 69 nonalcoholic beverage references promoted sugar-sweetened beverages. Twenty-one (80.8%) of the 26 endorsed foods were energy dense and nutrient poor. Baauer, will.i.am, Justin Timberlake, Maroon 5, and Britney Spears had the most food and beverage endorsements.

CONCLUSIONS

This study demonstrates that music celebrities who are popular among adolescents endorse energy-dense, nutrient-poor products.

Perceived spatial stigma, body mass index and blood pressure: a global positioning system study among low-income housing residents in New York City

Previous research has highlighted the salience of spatial stigma on the lives of low-income residents, but has been theoretical in nature and/or has predominantly utilised qualitative methods with limited generalisability and ability to draw associations between spatial stigma and measured cardiovascular health outcomes. The primary objective of this study was to evaluate relationships between perceived spatial stigma, body mass index (BMI), and blood pressure among a sample of low-income housing residents in New York City (NYC). Data come from the community-based NYC Low-income Housing, Neighborhoods and Health Study. We completed a crosssectional analysis with survey data, which included the four items on spatial stigma, as well objectively measured BMI and blood pressure data (analytic n=116; 96.7% of the total sample). Global positioning systems (GPS) tracking of the sample was conducted for a week. In multivariable models (controlling for individual-level age, gender, race/ethnicity, education level, employment status, total household income, neighborhood percent non-Hispanic Black and neighborhood median household income) we found that participants who reported living in an area with a bad neighborhood reputation had higher BMI (B=4.2, 95%CI: -0.01, 8.3, P=0.051), as well as higher systolic blood pressure (B=13.2, 95%CI: 3.2, 23.1, P=0.01) and diastolic blood pressure (B=8.5, 95%CI: 2.8, 14.3, P=0.004). In addition, participants who reported living in an area with a bad neighborhood reputation had increased risk of obesity/overweight [relative risk (RR)=1.32, 95%CI: 1.1, 1.4, P=0.02) and hypertension/pre-hypertension (RR=1.66, 95%CI: 1.2, 2.4, P=0.007). However, we found no differences in spatial mobility (based GPS data) among participants who reported living in neighborhoods with and without spatial stigma (P>0.05). Further research is needed to investigate how placebased stigma may be associated with impaired cardiovascular health among individuals in stigmatised neighborhoods to inform effective cardiovascular risk reduction interventions.

Athlete endorsements in food marketing

OBJECTIVE

This study quantified professional athletes' endorsement of food and beverages, evaluated the nutritional quality of endorsed products, and determined the number of television commercial exposures of athlete-endorsement commercials for children, adolescents, and adults.

METHODS

One hundred professional athletes were selected on the basis of Bloomberg Businessweek's 2010 Power 100 rankings, which ranks athletes according to their endorsement value and prominence in their sport. Endorsement information was gathered from the Power 100 list and the advertisement database AdScope. Endorsements were sorted into 11 endorsement categories (eg, food/beverages, sports apparel). The nutritional quality of the foods featured in athlete-endorsement advertisements was assessed by using a Nutrient Profiling Index, whereas beverages were evaluated on the basis of the percentage of calories from added sugar. Marketing data were collected from AdScope and Nielsen.

RESULTS

Of 512 brands endorsed by 100 different athletes, sporting goods/apparel represented the largest category (28.3%), followed by food/beverages (23.8%) and consumer goods (10.9%). Professional athletes in this sample were associated with 44 different food or beverage brands during 2010. Seventy-nine percent of the 62 food products in athlete-endorsed advertisements were energy-dense and nutrient-poor, and 93.4% of the 46 advertised beverages had 100% of calories from added sugar. Peyton Manning (professional American football player) and LeBron James (professional basketball player) had the most endorsements for energy-dense, nutrient-poor products. Adolescents saw the most television commercials that featured athlete endorsements of food.

CONCLUSIONS

Youth are exposed to professional athlete endorsements of food products that are energy-dense and nutrient-poor.

Examining the Relationship Between Soda Consumption and Eating Disorder Pathology

OBJECTIVE

This study aimed to compare diet soda drinkers, regular soda drinkers, and individuals who do not regularly consume soda on clinically significant eating disorder psychopathology, including binge eating, overeating, and purging.

METHOD

Participants (n=2077) were adult community volunteers who completed an online survey that included the Eating Disorder Examination Questionnaire and questions regarding binge eating behaviors, purging, current weight status, and the type and frequency of soda beverages consumed.

RESULTS

Diet soda drinkers (34%, n=706) reported significantly higher levels of eating, shape, and weight concerns than regular soda drinkers (22%, n=465), who in turn reported higher levels on these variables than non-soda drinkers (44%, n=906). Diet soda drinkers were more likely to report binge eating and purging than regular soda drinkers, who were more likely to report these behaviors than non-soda drinkers. Consumption of any soda was positively associated with higher BMI, though individuals who consumed regular soda reported significantly higher BMI than diet soda drinkers, who in turn reported higher weight than those who do not consume soda regularly.

CONCLUSIONS

Individuals who consume soda regularly reported higher BMI and more eating psychopathology than those who do not consume soda. These findings extend previous research demonstrating positive associations between soda consumption and weight.

Evaluation of consumer understanding of different front-of-package nutrition labels, 2010-2011

Introduction

Governments throughout the world are using or considering various front-of-package (FOP) food labeling systems to provide nutrition information to consumers. Our web-based study tested consumer understanding of different FOP labeling systems.

Methods

Adult participants (N = 480) were randomized to 1 of 5 groups to evaluate FOP labels: 1) no label; 2) multiple traffic light (MTL); 3) MTL plus daily caloric requirement icon (MTL+caloric intake); 4) traffic light with specific nutrients to limit based on food category (TL+SNL); or 5) the Choices logo. Total percentage correct quiz scores were created reflecting participants’ ability to select the healthier of 2 foods and estimate amounts of saturated fat, sugar, and sodium in foods. Participants also rated products on taste, healthfulness, and how likely they were to purchase the product. Quiz scores and product perceptions were compared with 1-way analysis of variance followed by post-hoc Tukey tests.

Results

The MTL+caloric intake group (mean [standard deviation], 73.3% [6.9%]) and Choices group (72.5% [13.2%]) significantly outperformed the no label group (67.8% [10.3%]) and the TL+SNL group (65.8% [7.3%]) in selecting the more healthful product on the healthier product quiz. The MTL and MTL+caloric intake groups achieved average scores of more than 90% on the saturated fat, sugar, and sodium quizzes, which were significantly better than the no label and Choices group average scores, which were between 34% and 47%.

Conclusion

An MTL+caloric intake label and the Choices symbol hold promise as FOP labeling systems and require further testing in different environments and population subgroups.

Facts up front versus traffic light food labels: a randomized controlled trial

BACKGROUND

The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thousands of food products.

PURPOSE

To test consumer understanding of the Facts Up Front system (Facts Up Front) compared to the Multiple Traffic Light system (Traffic Light). Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients; Traffic Light uses an interpretive color-coded scheme to alert consumers to low, medium, and high levels of certain nutrients.

DESIGN

Participants in an Internet-based study were randomized to one of five front-of-package label conditions: (1) no label; (2) Traffic Light; (3) Traffic Light plus information about protein and fiber (Traffic Light+); (4) Facts Up Front; or (5) Facts Up Front plus information about "nutrients to encourage" (Facts Up Front+).

SETTING/PARTICIPANTS

A total of 703 adults recruited through an online database in May 2011 participated in this study, and data were analyzed in June 2011.

MAIN OUTCOME MEASURES

Total percentage correct quiz scores were generated reflecting participants' ability to compare two foods on nutrient levels, based on their labels, and to estimate amounts of saturated fat, sugar, sodium, fiber and protein in the foods.

RESULTS

The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes (p<0.05). The control group did not differ from the Facts Up Front group on the saturated fat quiz, or from the Facts Up Front+ group on the sugars quiz. Those in the Traffic Light+ group had the best overall performance (>80% on all quizzes).

CONCLUSIONS

Overall, those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov NCT01626729.

Low-income children's reported motivators of and barriers to healthy eating behaviors: a focus group study

BACKGROUND

Despite national attention to the childhood obesity epidemic, there are few US-based studies that directly ask children--especially children from low-income families and from multiple racial/ethnic groups--why they do or do not engage in healthy eating behaviors.

OBJECTIVE

The purpose of this study was to identify motivators of and barriers to healthy eating behaviors, as reported by black, Hispanic, and white children from low-income families.

METHOD

Six gender- and race/ethnicity-concordant focus groups were conducted with 37 children who were aged 9 to 12 years and from families with an annual household income of $40000 or less. Multiple strategies were used to employ a culturally sensitive approach to both data collection and data analysis (eg, a team of culturally diverse researchers utilized inductive qualitative analysis to analyze focus group transcripts).

RESULTS

The motivators of and barriers to healthy eating behaviors most commonly reported across the 6 focus groups included social influence, taste, issues of availability, weight concerns, and the desire to be healthy. A variety of less commonly reported motivators and barriers were also discussed. Findings were generally similar across gender and race/ethnicity.

CONCLUSIONS

Children in this age range can indeed identify a variety of motivators and barriers that influence their engagement in healthy eating behaviors. Interventions targeting obesity and eating behaviors should include an assessment of children's own perceived motivators of and barriers to healthy eating.

Choosing front-of-package food labelling nutritional criteria: how smart were 'Smart Choices'?

OBJECTIVE

The 'Smart Choices' programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as 'Smart Choices' could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard.

DESIGN

A total of 100 packaged products that qualified for a 'Smart Choices' designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method.

RESULTS

In all, 64 % of the products deemed 'Smart Choices' did not meet the NPM standard for a healthy product. Within each 'Smart Choices' category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed 'Smart Choices' were considered healthy according to the NPM standard.

CONCLUSIONS

The 'Smart Choices' programme is an example of industries' attempts at self-regulation. More than 60 % of foods that received the 'Smart Choices' label did not meet standard nutritional criteria for a 'healthy' food choice, suggesting that industries' involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.

Motivators of and Barriers to Engaging in Physical Activity: Perspectives of Low-Income Culturally Diverse Adolescents and Adults

Background

Obesity rates are rising in the United States, especially among low-income and racial/ethnic minority individuals. Exploring motivators and barriers relative to engaging in physical activity is imperative.

Purpose

The purpose of this study was to identify motivators and barriers relative to engagement in physical activity as reported by culturally diverse low-income adolescents and adults.

Methods

A total of 91 adolescent (11 to 15 years of age) and adult (18 years of age or older) participants who self-identified as African American, Hispanic, or non-Hispanic White engaged in age group-, race/ethnicity-, and gender-concordant focus groups.

Results

Qualitative data analysis indicated that the motivators and barriers most commonly identified among the adolescent and adult focus groups were: social influence; time and priorities; physical environment; fun and enjoyment; inherently physical activities; weight concerns; fatigue, physical discomfort and current fitness level; and immediate positive feelings.

Discussion

Findings were generally similar across age group, gender and race/ethnicity. Age group-specific, gender-specific and race/ethnicity-specific motivators and barriers were related to how commonly the motivators and barriers were identified among each group.

Translation to Health Education Practice

Implications for increasing physical activity among low-income culturally diverse adolescents and adults are discussed.