Association between E-Cigarette Advertising Exposure and Use of E-Cigarettes among a Cohort of U.S. Youth and Young Adults

Youth and young adult (YYA) use of e-cigarettes increased rapidly between 2010 and 2019 in the United States, during which exposure to e-cigarette advertising was also increased. We aimed to examine whether exposure to e-cigarette advertising among YYAs may lead to subsequent e-cigarette use. A cohort of 3886 YYAs ages 13-24 was recruited from two survey panels in 2018 and followed up until 2019. Survey data were collected online and by telephone. The primary outcome was past 30-day use of e-cigarettes at the follow-up survey. Among 2304 YYAs who retained at the follow-up survey and were not past 30-day e-cigarette users at baseline, both youth and young adults exposed to e-cigarette advertising at baseline had elevated odds of past 30-day e-cigarette use at follow-up (Youth adjusted odds ratio (aOR): 2.77, 95% CI: 1.23, 6.24; Young adults aOR: 2.34, 95% CI: 1.08, 5.11) compared with those not reporting baseline advertising exposure. The majority of YYAs reported exposure to e-cigarette advertising at baseline (Youth: 63.7%, 95% CI: 59.8, 67.4; Young adults: 58.3%, 95% CI: 53.6, 62.8). Our findings suggest that exposure to e-cigarette advertising was associated with an increase in subsequent past 30-day use of e-cigarettes among YYAs. Restricting advertising targeted at YYAs may reduce the likelihood of e-cigarette use among YYAs.

Global case study of digital marketing on social media by a top soda brand

The Big Soda segment is central in modern food systems, and they invest heavily in digital marketing, but little is known about it. We aimed to analyze the digital marketing on Facebook of the soda brand with a major worldwide reach. Countries were described in terms of soda brand presence and popularity on Facebook according to countries' socio-demographic index (SDI) and the market share of soda brand (%MS). From 149 countries, 57.0% had soda brand's Facebook page among the top five in the number of followers within the beverage segment. Among them, digital marketing was described by the number of the page followers, the number of posts, and the number of interactions (likes, comments and shares) that each post received by Facebook users. Also, we analyzed the characteristics, and the use of marketing strategies on posts in a random sample of 10% (n = 1217) of all posts. We found that soda brand's popularity on Facebook was higher among countries with higher SDI and higher %MS. Also, the number of users that engaged with soda brand's posts was higher among countries with lower SDI and higher brand's %MS. The brand's posts focus on young adults, display of brand's products and glorification of its attributes. Other identified features include sport-related thematic and appeals to socialization and healthy eating. In addition, posts' characteristics differed with countries' characteristics. Soda brand digital marketing varies according to countries' characterization and maintains the brand position on the global marketing of beverages.

Factors Influencing the Consumption of Seaweed amongst Young Adults

Seaweed has been traditionally consumed in Asian and Pacific cultures, yet aside from sushi, is still not commonly eaten in Western societies. Edible seaweeds offer distinct nutritional benefits to terrestrial crops, particularly with respect to mineral and fibre content. Understanding the motivations that drive young Australians to eat seaweed is necessary for food product development and consumer marketing strategies, as well as informing future sustainable production through seaweed aquaculture and wild-harvest practices. An observational cross-sectional online survey with n = 1403 young (19–30 years) Australian seaweed consumers was conducted. The 19-item survey included closed-ended, open-ended, and Likert scale responses. Most respondents were female (89.0%), with tertiary level education or above (57.7%). Seaweed was eaten mostly as a snack (87.7%) and in home-prepared meals (30.7%). The key advantages to consumption were flavour (89.1%), nutrient content (49.1%), and health benefits (44.6%), whilst the key barriers were poor accessibility (59.5%), unaffordable pricing (46.5%), and undesirable packaging (19.0%). The consumers reported wanting more promotion to improve their knowledge about seaweed, in addition to environmentally sustainable packaging and sourcing. Pathways to overcome barriers and encourage greater seaweed consumption are discussed. Most critically, improving the promotion and environmental sustainability of seaweed products will improve intake amongst current and future consumers.

Moving Complementary Feeding Forward: Report on a Workshop of the Federation of International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) and the World Health Organization Regional Office for Europe

The WHO Regional Office for Europe and the Federation of International Societies for Pediatric Gastroenterology, Hepatology, and Nutrition held a joint workshop, "Moving Complementary Feeding Forward" at the sixth World Congress Pediatric Gastroenterology, Hepatology, and Nutrition in 2021. Here we summarize workshop presentations and discussions. The workshop covered health implications of complementary feeding (CF) including allergies, challenges to meet dietary needs during the CF period, quality of commercial complementary foods (CFD) and respective marketing practices, national CF guidelines in Europe, a nutrient profiling system for CFD, and global policy perspectives on the standards and regulation of marketing for CFD. Adequate CF practices are of critical importance for short and long-term child health, prevention of nutrient deficiencies, normal growth and development, and reducing the risk of allergies. The workshop identified the need to improve feeding practices, harmonize evidence-based information and develop guidance jointly with various stakeholders, improve the composition and marketing practices of commercial CFD and their transparent labeling based on nutrient profiling. Renewed efforts for collaboration between scientists, public health experts, pediatric associations, national governments, and the WHO are necessary for advancing progress.

Perceptions of sugar-sweetened beverages among adolescents in North Carolina

Introduction

Sugar-sweetened beverage (SSB) consumption among adolescents contributes to diet-related chronic disease including obesity, type 2 diabetes, and poor oral health.

Objective

To better understand adolescents' perceptions, attitudes, and consumption behaviors around SSBs by conducting virtual workshop discussions with adolescents in NC.

Materials and methods

Adolescents ages 11-17 in communities with a high proportion of Supplemental Nutrition Assistance Program (SNAP) eligible households were selected to participate in a series of virtual group workshops during summer 2021. A semi-structured discussion guide was used by a workshop facilitator. Workshop discussions centered around general health perceptions, SSB perceptions, and consumption behaviors. A thematic analysis was used to summarize knowledge, beliefs, attitudes, and perceptions around SSBs.

Results

Approximately 36 adolescents participated across four group workshops. Parents and caregivers influenced adolescents most when it came to making beverage choices. Positive SSB perceptions included liking the taste and the association with special times and social events. Negative opinions focused on associated health risks (diet-related chronic disease and poor oral health). Some adolescents acknowledged SSBs were not healthy but suggested they could be consumed occasionally. Very few participants mentioned any benefits from SSBs; those that mentioned benefits stated they provided energy, replaced electrolytes, and tasted good.

Conclusion

Findings provide several key insights that can contribute to the development of messages aimed at curbing SSB consumption among adolescents. For example, messages that focus on catching adolescents' attention and sharing short- and long-term health consequences of high SSB consumption resonated with adolescents, but because occasional SSB intake was not seen as consequential, messages that suggest abstinence from SSBs may not be helpful in reducing consumption.

Drinking Expectancies among Chinese Young Adults: A Qualitative Study from Hong Kong

BACKGROUND

Alcohol expectancies, i.e., the perceived consequences of drinking, have been reported to be important factor in predicting drinking behaviors. However, studies in the Asia region were largely limited to school-based samples. This study aimed to be the first to explore drinking expectancies among urban Chinese young adults.

METHODS

In 2020, eight focus group discussions were conducted with Hong Kong Chinese young adults aged 18-34 (n = 53). The participants included heavy drinkers, light drinkers, and non-drinkers from a wide range of occupations and educational backgrounds. Thematic analysis was conducted to uncover common alcohol expectancies.

RESULTS

Six themes emerged from this study. Four themes that were commonly reported in the literature were the negative consequences of drinking, social bonding, confidence enhancement, and tension reduction. The study also uncovered two culturally relevant alcohol expectancies: health benefits and business drinking expectancies. In contrast to Western samples, Chinese young adults did not report drinking expectancies related to cognitive enhancement or increased sexual interest.

CONCLUSION

Alcohol harm reduction strategies will need to address the positive drinking expectancies uncovered in this study. Future policy discussions in this emerging alcohol market region should consider greater scrutiny of the role of alcohol marketing in the propagation of positive drinking expectancies.

An anatomy of carewashing: Corporate branding and the commodification of care during Covid-19

This article defines 'carewashing' as commercial branding strategies which commodify care and attempt to increase corporate profit, and provides the first theorisation and historicisation of the term. The first section of the article situates 'carewashing' in relation to longer-term strategies of corporate 'social responsibility' and cause-related marketing. The second shows how established corporate practices are being reinvented in an era of Covid-19 and amidst profound neoliberal instability. The third section focuses on specific examples of contemporary carewashing, showing their variation and pinpointing three tendencies: 'opportunistic branding'; 'community resourcing'; and 'reputational steamrolling'. The concluding section argues that carewashing also needs to be understood as a political act which is involved in wider social struggles. It argues that, in the Gramscian sense, carewashing is part of a 'passive revolution' in that it is attempting to claim and demarcate the realm of care for corporate capitalism and against social democracy.

Exploring Factors That Predict Marketing of e-Cigarette Products on Twitter: Infodemiology Approach Using Time Series

Background

Electronic nicotine delivery systems (known as electronic cigarettes or e-cigarettes) increase risk for adverse health outcomes among naïve tobacco users, particularly youth and young adults. This vulnerable population is also at risk for exposed brand marketing and advertisement of e-cigarettes on social media. Understanding predictors of how e-cigarette manufacturers conduct social media advertising and marketing could benefit public health approaches to addressing e-cigarette use.

Objective

This study documents factors that predict changes in daily frequency of commercial tweets about e-cigarettes using time series modeling techniques.

Methods

We analyzed data on the daily frequency of commercial tweets about e-cigarettes collected between January 1, 2017, and December 31, 2020. We fit the data to an autoregressive integrated moving average (ARIMA) model and unobserved components model (UCM). Four measures assessed model prediction accuracy. Predictors in the UCM include days with events related to the US Food and Drug Administration (FDA), non-FDA-related events with significant importance such as academic or news announcements, weekday versus weekend, and the period when JUUL maintained an active Twitter account (ie, actively tweeting from their corporate Twitter account) versus when JUUL stopped tweeting.

Results

When the 2 statistical models were fit to the data, the results indicate that the UCM was the best modeling technique for our data. All 4 predictors included in the UCM were significant predictors of the daily frequency of commercial tweets about e-cigarettes. On average, brand advertisement and marketing of e-cigarettes on Twitter was higher by more than 150 advertisements on days with FDA-related events compared to days without FDA events. Similarly, more than 40 commercial tweets about e-cigarettes were, on average, recorded on days with important non-FDA events compared to days without such events. We also found that there were more commercial tweets about e-cigarettes on weekdays than on weekends and more commercial tweets when JUUL maintained an active Twitter account.

Conclusions

e-Cigarette companies promote their products on Twitter. Commercial tweets were significantly more likely to be posted on days with important FDA announcements, which may alter the narrative about information shared by the FDA. There remains a need for regulation of digital marketing of e-cigarette products in the United States.

Marketing training strategies that pharmaceutical sales managers use to reduce unethical behavior

BACKGROUND

Some pharmaceutical company sales representatives are using bribes to encourage increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge related to bribing doctors to prescribe the company's medications. Using Hunt and Vitell's general theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies some sales managers in the pharmaceutical industry used to improve marketing training to reduce unethical sales representative behavior.

MATERIALS AND METHODS

Data were collected from company reports and documents provided by sales managers and semistructured interviews with five sales managers of different pharmaceutical companies in the northeast region of the United States. Data were analyzed using thematic analysis and Yin's 5-step process of compiling, disassembling, reassembling, interpreting, and concluding thematic data analysis.

RESULTS

Three themes emerged from data analysis: developing ethical standards, developing organizational policy, and implementing training and development programs. A key recommendation is that pharmaceutical sales managers identify ethical standards to inculcate in their business practices to achieve ethical marketing training that can result in sales representatives' ethical behavior. The implications for positive social change include the potential for sales managers to develop strategies to reduce unethical behavior in the pharmaceutical industry.

CONCLUSION

Reducing unethical behavior may lead to more trust between patients and physicians, improving patient satisfaction and promoting prosperity for the community through enhancing the quality of health care.

From the laboratory to the consumer: Innovation, supply chain, and adoption with applications to natural resources

Research on innovation has two strands: institutions undertaking innovation as a research and development process and companies commercializing innovative products. We combine these strands, analyzing a sequence going from an innovation supply chain to a product supply chain from laboratory to market. We argue that these supply chains are symbiotic, and the relationship between entities is affected by economic considerations. Our framework allows an understanding of how research, regulatory policies, and economic conditions affect the emergence of innovations, the creation of institutions (markets, firms, contracts) to carry out these innovations, and the diffusion of the resulting products. Our approach may improve the design of strategies to induce climate change and food security solutions.

We analyze the transition from innovative ideas to final marketed products. This transition occurs through two synergetic supply chains for innovation and products. Basic concepts are developed, tested, upscaled, and introduced to commercial use in the innovation supply chain. Then, the products are produced and delivered to the consumer through the product supply chain. We argue that product markets trace their birth to product innovations. These markets tend to start as noncompetitive, which rewards innovators. Credit access and risk determine the reliance on contracting and product diffusion over space and time. The innovation and product supply chains are encouraged and facilitated by public policies, such as support for research and education, intellectual property rights protection, low barriers to trade, science-based regulation, and well-functioning capital markets. We argue for multidisciplinary research incorporating knowledge from economics, business, and engineering to better understand the evolution of innovative companies and supply chains. This understanding will help the development of policies to address challenges of climate change and food security among others.

Moral Entrepreneurialism for the Hamburger: Strategies for Marketing a Contested Fast Food

Recent research has extended the concept of moral entrepreneurialism to corporate actors. We build on this research to investigate how corporations succeed in this effort by uncovering the strategies and tools they employ as moral entrepreneurs. To do so, we examine the corporate discourse of three prominent fast-food firms to identify how they present hamburgers as good food, in a context where beef is increasingly criticized as morally suspect. Based on a discourse analysis of corporate communications and marketing campaigns, we identify three distinct discursive strategies for managing meat criticisms: (1) global managerialism (McDonald's); (2) aestheticized simplicity (A&W); and (3) nostalgic, personalized appeals (Wendy's). These strategies are realized through the use of informational tools to shape what customers think and know about beef, and affective tools to influence how customers feel about beef. Together, these corporate strategies speak to the skilful ability of corporate actors to respond to socio-environmental criticisms. Our case shows how fast-food market actors are able to incorporate critique and offer messages that seek to allow people to feel good about eating beef. This case is relevant to understanding the tools that corporations use to be effective moral entrepreneurs. It also provides a deeper understanding of marketing discourse at the nexus of social problems and consumption choices.

Sponsorship by food and beverage companies in soccer: an analysis of the 2019 Copa América

OBJECTIVE

To identify the sponsorship by food and beverage companies of the teams participating in the 2019 Copa América Soccer Cup and associate this sponsorship with characteristics of the teams and their respective countries.

METHODS

The sponsors of the 10 teams participating in the 46th edition of the Copa América were identified. These entities were classified into (i) food companies, (ii) alcoholic beverage companies, and (iii) other segments. The food companies were classified according to their products, according to the NOVA classification. In addition, data on the number of titles previously won by the teams in the Copa America and the World Cup were obtained, as well as data on the countries' Human Development Index, annual per capita sales of ultra-processed foods, and annual per capita consumption of alcoholic beverages.

RESULTS

A total of 89 sponsorships were identified for the 10 teams studied, some of these supporting two or more teams. Eighteen percent of the sponsors were food companies, with 12.4% being ultra-processed foods. The alcoholic beverage category represented 7.9% of the sponsors. Ultra-processed beverage and alcoholic beverage companies sponsored seven of the 10 teams studied. We noted higher participation of ultra-processed foods company sponsors in teams from countries with higher Human Development Index, sales of ultra-processed foods, and number of Copa América and World Cup titles. The sponsorship by alcoholic beverage companies was higher for teams from countries with lower Human Development Index, alcohol consumption, and number of Copa América and World Cup titles.

CONCLUSION

A significant presence of ultra-processed food and alcoholic beverage companies as sponsors of South American soccer teams was noted, along with the fact that sport performance characteristics of the teams and socioeconomic and market issues of the countries are associated with the occurrence of sponsorship.

Marketing of Food and Beverages to Children in the Eastern Mediterranean Region: A Situational Analysis of the Regulatory Framework

Marketing of food items high in added saturated and/or trans-fat, sugar, or sodium (HFSS) negatively affect consumption patterns of young children. The World Health Organization (WHO) advised countries to regulate the marketing of foods and non-alcoholic beverages to young populations. The aim of this manuscript is to provide a situational analysis of the regulatory framework of food marketing policies targeting children in the Eastern Mediterranean Region (EMR). A semi structured questionnaire was shared with the focal points of EMR member states inquiring about the reforms and monitoring initiatives in place. Electronic databases were searched for relevant publications between 2005 and 2021. Results revealed that even though 68% of countries discussed the recommendations, progress toward the WHO set goals has been slow with only 14% of countries implementing any kind of restrictions and none executing a comprehensive approach. Reforms have focused on local television and radio marketing and left out several loopholes related to marketing on the internet, mobile applications, and cross border marketing. Recent monitoring initiatives revealed a slight improvement in the content of advertised material. Yet, unhealthy products are the most promoted in the region. This review identified the need to intensify the efforts to legislate comprehensive food marketing policies within and across EMR countries.

China's Changing Alcohol Market and Need for an Enhanced Policy Response: A Narrative Review

This study describes trends in alcohol consumption in the context of an expanding commercial context, current policy responses, and flaws in relation to international best practice for alcohol control in China. We surveyed the literature and other documents in Chinese or English up to December 2020 on policy responses to alcohol consumption and harm, industry structure, and marketing practices in China. Databases searched included PubMed, China National Knowledge Internet, Wanfang Data, Web of Science, and Baidu Scholar. We also scanned the official websites of government organizations and gathered information using snowballing. We analyzed existing alcohol policy against evidence-based, cost-effective policies for reducing alcohol harm. Our findings show that although some restrictive policies have been enacted with potential impacts on alcohol harm, they are not comprehensive, and some are poorly executed. The long history of alcohol use remains an important element in alcohol consumption by the Chinese population. However, alcohol marketing and promotion, ease of access, and affordability have become increasingly prominent. The gaps identified in alcohol policy suggest improved strategies and measures to reduce the harmful use of alcohol are urgently needed in China.

Exposure to e-cigarette advertising and provaping websites, and the social acceptability of their use among nicotine users

Objectives

To evaluate the prevalence of exposure to Internet communications on and advertising of electronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico.

Methods

Data were analyzed from eight surveys (2018-2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites.

Results

The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette advertisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use.

Conclusions

Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regulatory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.

(Not) Communicating the Environmental Friendliness of Food Packaging to Consumers-An Attribute- and Cue-Based Concept and Its Application

While consumer understanding of and preferences for environmentally friendly packaging options have been well investigated, little is known about the environmentally friendly packaging attributes communicated to consumers by suppliers via packaging cues. We thus propose a literature-based attribute-cue matrix as a tool for analyzing packaging solutions. Using a 2021 snapshot of the wafer market in nine European countries, we demonstrate the tool's utility by analyzing the cues found that signal environmentally friendly packaging attributes. While the literature suggests that environmentally friendly packaging is increasingly used by manufacturers, our analysis of 164 wafer packages shows that communication is very limited except for information related to recyclability and disposal. This is frequently communicated via labels (e.g., recycling codes, Green Dot) and structural cues that implicitly signal reduced material use (e.g., less headspace and few packaging levels). Our attribute-cue matrix enables researchers, companies, and policymakers to analyze and improve packaging solutions across countries and product categories. Our finding that environmentally friendly packaging attributes are not being communicated to consumers underscores a pressing need for better communication strategies. Both direct on-pack and implicit communication should help consumers choose more environmentally friendly packaging. Governments are encouraged to apply our tool to identify communication gaps and adopt labeling regulations where needed.

Noise, Fake News, and Tenacious Bayesians

A modeling framework, based on the theory of signal processing, for characterizing the dynamics of systems driven by the unraveling of information is outlined, and is applied to describe the process of decision making. The model input of this approach is the specification of the flow of information. This enables the representation of (i) reliable information, (ii) noise, and (iii) disinformation, in a unified framework. Because the approach is designed to characterize the dynamics of the behavior of people, it is possible to quantify the impact of information control, including those resulting from the dissemination of disinformation. It is shown that if a decision maker assigns an exceptionally high weight on one of the alternative realities, then under the Bayesian logic their perception hardly changes in time even if evidences presented indicate that this alternative corresponds to a false reality. Thus, confirmation bias need not be incompatible with Bayesian updating. By observing the role played by noise in other areas of natural sciences, where noise is used to excite the system away from false attractors, a new approach to tackle the dark forces of fake news is proposed.

Hormonal Male Contraception: Formative Research to Develop and Test Communication Messaging

Male-controlled contraception is limited, yet a promising hormonal male contraceptive (HMC) development in may increase options for men to share in the work of pregnancy prevention. This study examined college-aged (18–26 years) men’s and women’s perceptions of influential marketing strategy for an experimental novel HMC method, a transdermal gel. Six focus groups (n = 29) were conducted to glean insights for ad prototype creation. Ad prototypes were designed and then tested in semi-structured interviews (n = 20) to understand whether the messages were adequately representing the attributes intended while also allowing participants to contribute insights on improving appeal. A constant comparative approach was used for data contextualization and theme identification. Results provided a foundation for the creation of HMC message prototypes, aimed at increasing knowledge and uptake of a novel family planning method for men. Representation of a relatable character, or drawing on authentic experiences, aligned best with participant values. Focus groups illuminated salient concepts for HMC marketing, including humor, destigmatization, information, and credibility. Interview message testing yielded an understanding of elements participants responded most strongly to, including (1) ad sentiment and (2) trustworthiness. Findings provide a basis for understanding the placement of a potential marketing campaign to effectively frame HMC uptake as easy to use, safe, and popular while building on peer norms and group acceptability among a college-aged demographic. Healthcare providers and other practitioners can utilize these findings while engaging in family planning conversations, interventions, and message development.

Shock Wave Therapy for Erectile Dysfunction: Marketing and Practice Trends in Major Metropolitan Areas in the United States

INTRODUCTION

Due to the increasing prevalence of erectile dysfunction (ED) and pronounced distress for patients, a direct-to-consumer market for shock wave therapy (SWT) has emerged. We sought to evaluate trends in marketing and implementation of SWT as a restorative treatment for ED in large metropolitan areas by investigating cost to patients, provider credentials and treatment protocols.

METHODS

SWT providers in 8 of the most populous metropolitan areas were identified using Google search. Search queries included: "Shockwave therapy for erectile dysfunction in [city];" "Shockwave therapy for ED in [city];" and "GAINSWave in [city]." All clinics advertising SWT for ED within the boundaries of the selected metropolitan area were included. Using a "secret shopper" methodology, clinics were contacted by telephone with the goal of identifying the pricing, duration and provider administering the treatment.

RESULTS

Across 8 of the most populous cities in the U.S., 152 clinics offered SWT as a treatment for ED. Comprehensive information was available for 65% of the clinics; 25% of providers offering SWT were urologists while 13% were not physicians. The average price per treatment course was $3,338.28. Treatment duration was highly variable and ranged from 1 to indefinite courses based on individual patient circumstance.

CONCLUSIONS

SWT, as a restorative therapy for ED, is performed primarily by nonurologists and is not standardized. Direct-to-consumer marketing is used to target distressed men. This study highlights concerning trends in major metropolitan markets, given the substantial financial impact for patients and inconsistent credentials among providers. Further, these findings suggest that patients are frequently seeking care for ED from nonurologists.

Can domestic medical tourism contribute to healthcare equity? A commentary

Pupose - This essay uses service marketing concept to discuss how domestic medical tourism (DMT) can contribute to healthcare equity in developed countries. Approach - The authors take up several vital issues. First, the potential benefits of DMT are outlined from a healthcare equity perspective; second, the challenges that DMT confronts in reaching its aim are identified; and finally, a few research areas are suggested. Finding - It is suggested that increased awareness about the healthcare service and proper service delivery are required to improve healthcare equity. Practical implication - This paper raises several research issues from service marketing to deal with delivery, communication, efficiency, and insurance practices regarding healthcare. Social implication - From a societal point of view, it explores how healthcare equity can be improved by DMT.

Nutrition-related claims lead parents to choose less healthy drinks for young children: a randomized trial in a virtual convenience store

BACKGROUND

Consumption of sugar-sweetened beverages, including fruit drinks (i.e., fruit-flavored drinks containing added sugar), contributes to childhood obesity.

OBJECTIVES

We aimed to examine whether nutrition-related claims on fruit drinks influence purchasing among parents and lead to misperceptions of healthfulness.

METHODS

We conducted an experiment in a virtual convenience store with 2219 parents of children ages 1-5 y. Parents were randomly assigned to view fruit drinks displaying 1 of 3 claims ("No artificial sweeteners," "100% Vitamin C," and "100% All Natural") or no claim (i.e., control group). Parents selected among each of 2 drinks for their young child: 1) a fruit drink or 100% juice (primary outcome), and 2) a fruit drink or water.

RESULTS

When choosing between a fruit drink and 100% juice, 45% of parents who viewed the fruit drink with the "No artificial sweeteners" claim, 51% who viewed the "100% Vitamin C" claim, and 54% who viewed the "100% All Natural" claim selected the fruit drink, compared with 32% in the no-claim control group (all P < 0.001). "No artificial sweeteners" (Cohen's d = 0.13, P < 0.05) and "100% All Natural" (d = 0.15, P < 0.05) claims increased the likelihood of parents choosing the fruit drink instead of water but "100% Vitamin C" did not (P = 0.06). All claims made parents more likely to incorrectly believe that the fruit drinks contained no added sugar and were 100% juice than the control (d ranged from 0.26 to 0.84, all P < 0.001), as assessed in a posttest survey. The impact of claims on selection of the fruit drink (compared with 100% juice) did not vary by any of the moderators examined (e.g., race/ethnicity, income; all moderation P > 0.05).

CONCLUSIONS

Nutrition-related claims led parents to choose less healthy beverages for their children and misled them about the healthfulness of fruit drinks. Labeling regulations could mitigate misleading marketing of fruit drinks.This trial was registered at clinicaltrials.gov as NCT04381481.

Tax credits for pharmaceutical research, development and marketing?

BACKGROUND

The pharmaceutical industry is believed to receive considerable support through research and development (R&D) tax credits.

OBJECTIVE

The objectives of this paper are (a) to show that many of the pharmaceutical industry's apparent R&D activities are entangled with marketing efforts, and (b) to argue that supporting these activities through tax credits does not serve public interests in health.

METHODS

The bulk of this paper summarizes the author's extended qualitative mixed-methods approach to following connections between pharmaceutical research and marketing.

RESULTS

The pharmaceutical industry's R&D should be understood as broadly entangled with marketing, and so generally should be understood as integrated research, development and marketing (RD&M).

CONCLUSIONS

R&D tax credits to the pharmaceutical industry largely do not serve public interests.

Use of artificial intelligence to enable dark nudges by transnational food and beverage companies: analysis of company documents

OBJECTIVE

To describe the use of artificial intelligence (AI)-enabled dark nudges by leading global food and beverage companies to influence consumer behaviour.

DESIGN

The five most recent annual reports (ranging from 2014-2018 or 2015-2019, depending on the company) and websites from 12 of the leading companies in the global food and beverage industry were reviewed to identify uses of AI and emerging technologies to influence consumer behaviour. Uses of AI and emerging technologies were categorised according to the Typology of Interventions in Proximal Physical Micro-Environments (TIPPME) framework, a tool for categorising and describing nudge-type behaviour change interventions (which has also previously been used to describe dark nudge-type approaches used by the alcohol industry).

SETTING

Not applicable.

PARTICIPANTS

12 leading companies in the global food and beverage industry.

RESULTS

Text was extracted from 56 documents from 11 companies. AI-enabled dark nudges used by food and beverage companies included those that altered products and objects' availability (e.g., social listening to inform product development), position (e.g., decision technology and facial recognition to manipulate the position of products on menu boards), functionality (e.g., decision technology to prompt further purchases based on current selections) and presentation (e.g., augmented or virtual reality to deliver engaging and immersive marketing).

CONCLUSIONS

Public health practitioners and policymakers must understand and engage with these technologies and tactics if they are to counter industry promotion of products harmful to health, particularly as investment by the industry in AI and other emerging technologies suggests their use will continue to grow.

Patient Influencers: The Next Frontier in Direct-to-Consumer Pharmaceutical Marketing

Social media influencers are becoming an increasingly popular strategic communication tactic used across industry verticals, including entertainment, fashion, and beauty, to engage directly with consumers. Pharmaceutical companies have also recently entered the social media marketing arena and—within the bounds of governmental regulations—have found ways to build relationships directly with patients using covert persuasion tactics like partnering with social media influencers. Due to consumers’ negative perceptions of pharmaceutical companies, it makes sense that new marketing tactics are being used to establish and improve relationships with consumers. Previous research well documents the ethical dilemmas of direct-to-consumer advertising, and there is recent burgeoning literature on online covert marketing tactics. The academic and medical literature, however, is behind in regard to social media influencers used in health and medicine. This paper highlights and defines terms used in industry practice, and also calls for more investigation and sets forward a research agenda. As consumers spend more time online and patients continue to consult social media for health information, it is important that this new marketing trend does not go unnoticed.

Substantiating the Diffusion Model of Innovation Implementation and its Application to Vaccine Propagation

The paper examines prerequisites and assumptions of the classical Bass innovation diffusion model with the aim of applying it in modeling of relevant stochastic processes related to the pandemic. The Bass model has proven its versatility and applicability to various environments. A thorough mathematical substantiation of the model properties is presented based on theories of evolutionary equations and stochastic processes for its further development, as well as search for uncertainty parameters and observable variables. The paper provides realistic estimation results of the Bass model parameters for vaccination in Ukraine and Belarus on weekly data of the first half of 2021. Similar studies are suggested for other countries, as well as regions and districts of Ukraine.

Exposure to Alcohol Marketing and Alcohol-Related Consequences in Young Adults

Exposure to alcohol marketing is positively associated with alcohol consumption. However, few research studies have tested alcohol marketing's effect on other alcohol-related outcomes. Consequently, the current study sought to identify associations between exposure to alcohol marketing and alcohol-related consequences in young adults. Methods: A secondary analysis of the 2020 Rhode Island Young Adult Survey was conducted. Participants were lifetime drinkers (n = 390) who were 18 to 25 years old and lived in Rhode Island for at least part of 2020. Past 30 day exposure to 6 forms of alcohol marketing was assessed. Alcohol consequences were measured using 8 items from the Brief Young Adult Alcohol Consequences Questionnaire. Logistic regression models were adjusted for AUDIT score, age, race/ethnicity, gender, sexual orientation, employment status, and enrollment in school. Results: 92.3% of participants reported past 30 days exposure to any form of alcohol marketing. 43.6% of participants reported experiencing any alcohol-related consequence. Exposure to any form of alcohol marketing was positively associated with experiencing alcohol-related consequences (OR[95% CI] = 3.35 [1.19, 9.44]). After disaggregation by marketing type, only television exposure remained significantly associated with alcohol-related consequences (OR[95% CI] = 1.85 [1.06, 3.24]). Conclusions: Exposure to alcohol advertising on television may be positively associated with experiencing negative alcohol consequences in young adults. If confirmed, the findings may renew interest in strengthening alcohol marketing guidelines and regulations.

"The Perfect Formula:" Evaluating Health Claims, Products and Pricing on Cannabis Dispensary Websites in Two Recently Legalized States

Introduction: Many cannabis dispensaries market and sell their products online through websites designed to attract and maintain customers; often, these websites incorporate a variety of product claims and other marketing tactics. This study evaluated website content, product pricing and discounts on dispensary websites in California and Nevada, states that legalized recreational cannabis in 2016. Methods: We content coded product availability, marketing claims and discounts on cannabis dispensary websites in the San Francisco Bay Area (N = 34) and Reno (N = 15) from March to June 2020 using a web crawler to scrape pricing information for four product types. We conducted bivariate analyses comparing both locations. Results: Prices were significantly lower for flower, edibles, and concentrates in Reno compared to the Bay Area, but not cartridges. In both areas, a range of marketing claims were made regarding the health effects of certain products. The most common were that cannabis products treated pain, nausea/vomiting, spasms, anxiety, insomnia, and depression. Products were also said to promote creativity and euphoria. Other marketing claims related to potency, pleasure enhancement, and improved social interactions. Discounts targeted to senior citizens and veterans were found on over half of all websites. Conclusions: Dispensary websites in the Bay Area and Reno frequently make health-related claims which should not be allowed in absence of scientific evidence. Non-health related claims are similar to those used for selling e-cigarettes and other tobacco products. Monitoring cannabis dispensary websites provides insight into local sales tactics and may help identify subpopulations for research on behavioral impacts of cannabis marketing activities.

Lucy-Novel Flavored Nicotine Gum, Lozenges, and Pouches: Are They Misleading Consumers?

Background: The packaging and marketing of nicotine gums, lozenges, and pouches can influence users' perceptions about which products are evidence-based for tobacco cessation and which are designed for nicotine maintenance-which could keep people nicotine dependent. Lucy, a company that produces flavored nicotine gums, lozenges, and pouches, could cause confusion by mimicking the packaging of traditional chewing gum and using similar marketing for its approved smoking cessation products and non-approved products. Methods: This commentary describes Lucy's marketing practices that could prolong nicotine dependence rather than aid cessation. Results: Lucy's marketing as "FDA approved for smoking cessation" (true for the lozenges but not the gum or pouches) and "PMTA [Premarket Tobacco Product Application] accepted" could create a false narrative of regulatory acceptance. Its scientific conference presentations could imply that it is endorsed by the scientific community. Its colorful pack design, emphasizing flavors and minimizing nicotine warnings, may attract youth and non-nicotine-users to initiate nicotine use. Conclusion: Lucy's promotion of its products as safe alternatives to other forms of tobacco, its packaging that recalls innocuous chewing gum, and its use of social media to advertise its products should be explored by researchers and considered by policymakers for potential population-level health effects.

Promoting Fruit and Vegetable Consumption for Childhood Obesity Prevention

Currently, food marketing for unhealthy foods is omnipresent. Foods high in fat, salt, and sugar (HFSS) are advertised intensively on several media platforms, including digital platforms that are increasingly used by children, such as social media, and can be bought almost everywhere. This could contribute to the obesity epidemic that we are facing. As the majority of children and adolescents do not eat the recommended amount of fruits and vegetables (F&V), which leads to chronic diseases, we need to change the obesogenic environment to a healthogenic environment. Reducing the marketing of energy-dense snacks to children and increasing the promotion of healthier foods, such as fruits and vegetables, may be an effective and necessary instrument to improve the dietary intake of children and reduce the risk of their experiencing some chronic diseases later in life. With this focused narrative review, we provide an overview of how children and adolescents react to food promotions and how food promotional efforts might be a useful tool to increase the attractiveness of fruit and vegetables. This review therefore contributes to the question of how changing the advertising and media environment of children and adolescents could help create a world where the healthy choice is the easier choice, which would reduce childhood obesity and improve children’s health, as well as to make the food system more sustainable.

COVID-19 Vaccine-Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis

Background

There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability.

Objective

We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging.

Methods

A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question “what would you do if a COVID-19 vaccine were available to you?” Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions.

Results

Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions.

Conclusions

These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations.

The Potential for Healthy Checkout Policies to Advance Nutrition Equity

BACKGROUND

As the only place in a store where all customers must pass through and wait, the checkout lane may be particularly influential over consumer purchases. Because most foods and beverages sold at checkout are unhealthy (e.g., candy, sweets, sugar-sweetened beverages, and salty snacks), policymakers and advocates have expressed growing interest in healthy checkout policies. To understand the extent to which such policies could improve nutrition equity, we assessed the prevalence and sociodemographic correlates of purchasing items found at (i.e., from) checkout.

METHODS

We assessed self-reported checkout purchasing and sociodemographic characteristics in a national convenience sample of adults (n = 10,348) completing an online survey in 2021.

RESULTS

Over one third (36%) of participants reported purchasing foods or drinks from checkout during their last grocery shopping trip. Purchasing items from checkout was more common among men; adults < 55 years of age; low-income consumers; Hispanic, non-Hispanic American Indian or Alaska Native, and non-Hispanic Black consumers; those with a graduate or professional degree; parents; and consumers diagnosed with type 2 diabetes or pre-diabetes (p-values < 0.05).

CONCLUSIONS

Purchasing foods or beverages from store checkouts is common and more prevalent among low-income and Hispanic, American Indian or Alaska Native, and Black consumers. These results suggest that healthy checkout policies have the potential to improve nutrition equity.

Stem-cell clinics in the UK: a web-based study

Aim: Explore the nature and extent of web-based promotion of stem cell treatments marketed by clinics in the UK. Materials & methods: Web-based analysis of clinics in the UK using predefined variables, with analysis of eligible clinics according to preset criteria of ethical relevance. Results: A majority (79%) of UK clinics were judged to be problematic. Information was found to be lacking, misleading or otherwise problematic in several respects, including a lack of information on risks of adverse effects, unjustifiably optimistic depictions of therapeutic effectiveness, and questionable presentational approaches such as the use of celebrity patient testimonials. Conclusion: In a majority of cases, commercial clinics in the UK portray stem-cell therapies on their websites in ethically questionable ways.

"It's all About the Colors:" How do Mexico City Youth Perceive Cigarette Pack Design

Objectives: Cigarette packs are relevant to branding strategies, designed to appeal to specific groups. There is little research on how pack features increase product appeal among key constituents such as youth in low- and middle-income countries.

Methods: We conducted 10 focus group discussions (FGDs) with adolescents and 5 FGDs with young adult smokers in Mexico City, separated by age, gender, smoking, and socioeconomic status. Participants separated 23 cigarette packs into “appealing” and “unappealing” groups, and were asked to explain their decisions, describing the features that supported their views. FGDs were video-recorded, transcribed in Spanish, translated into English, and subjected to thematic analysis.

Results: Pack groupings did not differ greatly across FGDs; bold, contrasting colors and elements communicating flavor and promotion increased cigarette pack appeal and desire to try. Participants perceived packs with these features to be used by and designed for youth, like themselves.

Conclusion: Our findings reinforce the importance of packaging design in attracting new consumers and maintaining current ones. Mexico should consider stronger tobacco advertising policies that include packaging color and depiction of flavor to reduce product appeal.

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

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

Congruity of Virtual Reality In-Game Advertising

With virtual reality (VR) video game users beginning to see beta advertisements within game play, this conceptual article adds a needed digital and interactive marketing research foundation to the new construct of VR in-game advertising (IGA) activation. New consumer VR technology continues to disrupt traditional media as a $7.7 billion USD industry, that is expected to reach $57.55 billion by 2027. As such, marketing researchers must continue to evolve and understand the interdisciplinary VR research evolution as many VR users are likely to view IGA as intrusive. IGA and VR are not new constructs, but IGA within VR is unique as VR consumers have not yet experienced VR IGA intrusion. This article utilizes a sport marketing focus to provide an industry specific set of examples for the reader, however this article can be applied to broader fields including communications and interactive marketing. The main contributions of this article are 2-fold. First the development of a VR In-Game Advertising Congruity Framework is developed through a review of the literature and application to VR IGA in the topical areas of congruity of the IGA, interactivity of the IGA, intrusiveness of the IGA, realism of the experience, telepresence, brand awareness, and attitude toward the IGA. Secondly, a proper VR context definition of telepresence is provided through review of the literature that takes into account the interaction of a VR participant. This article aims to aid marketers in making informed IGA development decisions through strategic choice, via a centralized VR IGA congruity framework, that not only enhances brand awareness, but leaves participants with a favorable attitude toward the IGA to increase sales activation.

Success of Various Marketing Strategies for a New-to-the-Area Orthopedic Practice

Background Competition for patients among orthopaedic private practices, multi-specialty groups, and hospital systems continues to persist. An effective marketing campaign is essential for a practice to succeed in this competitive environment. The purpose of this study was to investigate the cost-effectiveness and efficacy of each marketing campaign and the influence of patient demographics on efficacy. Methods The first 300 consecutive, new patients were prospectively surveyed on how they initially discovered and then selected the orthopaedic practice. Demographics and marketing costs were tabulated and categorized to analyze the effectiveness of each marketing strategy. Results A substantial portion of the marketing budget was allocated for traditional (67.0%) and online advertising (25.0%). However, only 56/300 (18.7%) patients surveyed were brought to the practice by these methods combined. In contrast, expenditure on a marketing liaison (8.0%) delivered 128 patients (42.7%) through referrals: 80 (26.7%) from physicians, 28 (9.3%) from urgent cares, 17 (5.7%) from physical therapists, and 3 (1.0%) from attorneys. Conclusion Marketing strategies were not proportionally beneficial during the first six months of the orthopaedic practice start-up period. During this early ramping up period, the most cost-effective marketing strategy was utilization of a liaison for direct in-person visits to various healthcare facilities.

Creating and Delivering Service Value in Medical Imaging Departments, the Marketing Imperative

In an era of increased pressure on reducing expenditure in health care and a rising demand for high-quality, safe, accessible, and payable medicine, one must use more valued models. Marketing is a broad approach to build exchange relationships, including all aspects of the organization’s interfaces.

This opinion article takes a first step in revealing the marketability of imaging departments.

IQOS Marketing in the US: The Need to Study the Impact of FDA Modified Exposure Authorization, Marketing Distribution Channels, and Potential Targeting of Consumers

IQOS, the leading heated tobacco product globally, recently received 'reduced exposure' authorization from the US Food and Drug Administration. Independent research focusing on IQOS marketing and potential impact on consumers' perceptions and behavior, and ultimately public health, is critical. The literature to date has underscored several concerns. First, Philip Morris's (PM's) marketing distribution requires scrutiny, particularly given its innovative promotional strategies. For example, IQOS is distributed via unique points-of-sale (POS; e.g., specialty and pop-up stores, "corners" in convenience stores) and uses various other opportunities (e.g., social media, sponsored events, direct-to-consumer). Second, although PM claims that IQOS' target market is current combustible tobacco users and not young people, the literature indicates that in some populations, IQOS use is equally prominent among smokers and nonsmokers, and that specific subgroups (e.g., young adults, women) are targeted. Third, the impact of IQOS' use of ad content promoting IQOS health benefits must be studied (e.g., how consumers interpret modified exposure messages). In conclusion, surveillance of IQOS marketing, particularly following reduced exposure authorization, is critical for obtaining valuable data to estimate population impact, particularly among population subgroups (e.g., young adults), and inform future tobacco regulation. These considerations have implications beyond IQOS-to other products and companies.

Changes to cigarette packaging influence US consumers' choices: Results of two discrete-choice experiments to inform regulation

INTRODUCTION

While plain packaging of tobacco products has emerged as a policy intervention to reduce smoking, regulators in the US have limited ability to implement plain packaging. We sought to identify the impact of subtle changes to cigarette packaging (Study 1) and how packaging design influenced participant choices based on appeal, harm, and style (Study 2).

METHODS

We conducted two discrete-choice experiments with US adult smokers online in 2018. In Study 1 (n=285), we assessed participants’ selections based on subtle changes to pack design features (dimensions, color saturation, logo size). In Study 2 (n=284), we assessed three choices in which participants selected packs based on appeal, harmfulness, and best match to their personal style. Study 2 packs varied by color hue, design with different levels of organic labeling and natural imagery, and color saturation.

RESULTS

Pack designs influenced smokers’ choices. In Study 1, pack dimensions and color saturation emerged as the most important features, and, in Study 2, design and color hue were the most influential characteristics.

CONCLUSIONS

Regulators should consider how the design of cigarette packages may influence consumers’ perceptions and choices.

Policy Inertia on Regulating Food Marketing to Children: A Case Study of Malaysia

Unhealthy food marketing shapes children’s preference towards obesogenic foods. In Malaysia, policies regulating this food marketing were rated as poor compared to global standards, justifying the need to explore barriers and facilitators during policy development and implementation processes. The case study incorporated qualitative methods, including historical mapping, semi-structured interviews with key informants and a search of cited documents. Nine participants were interviewed, representing the Federal government (n = 5), food industry (n = 2) and civil society (n = 2). Even though the mandatory approach to government-led regulation of food marketing to children was the benchmark, more barriers than facilitators in the policy process led to industry self-regulations in Malaysia. Cited barriers were the lack of political will, industry resistance, complexity of legislation, technical challenges, and lack of resources, particularly professional skills. The adoption of industry self-regulation created further barriers to subsequent policy advancement. These included implementer indifference (industry), lack of monitoring, poor stakeholder relations, and policy characteristics linked to weak criteria and voluntary uptake. These underlying barriers, together with a lack of sustained public health advocacy, exacerbated policy inertia. Key recommendations include strengthening pro-public health stakeholder partnerships, applying sustained efforts in policy advocacy to overcome policy inertia, and conducting monitoring for policy compliance and accountability. These form the key lessons for advocating policy reforms.

Evidence of Violations of the International Code of Marketing of Breast-Milk Substitutes since the Adoption by the World Health Assembly in 1981: A Systematic Scoping Review Protocol

This is the protocol for a scoping review that aims to systematically explore and summarise the published evidence of violations of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent World Health Assembly Resolutions globally. The planned scoping review will seek to identify what research has been conducted on the topic, examine the geographic spread and nature of violations, and summarise knowledge gaps. The Code was adopted in 1981 by the World Health Assembly to protect infant health, in particular from aggressive and inappropriate marketing of breastmilk substitutes including formula and related products. Non-compliance with the Code or violations are described in reports, however, no existing systematic review of the global research appears to have been conducted that encompasses the varied disciplines including health, economics, and gender. The review will inform international and national decision-makers on the nature of violations and potentially highlight the need for new modalities to regulate this marketing. The proposed scoping review will use the six-step process of Arksey and O’Malley which includes defining the research question; identifying the relevant literature; selecting studies; charting the data; collating, summarising and reporting the findings; and will include a consultative group.

Feminine Appeals on Cigarette Packs Sold in 14 Countries

Objective: Limited research has examined feminine marketing appeals on cigarette packs in low-and middle-income countries (LMICs). We reviewed a systematically collected sample of cigarette packs sold across 14 LMICs in 2013 (Wave 1) and 2015–2017 (Wave 2).

Methods: Packs in Wave 1 (n = 3,240) and Wave 2 (n = 2,336) were coded for feminine imagery and descriptors (flowers, fashion, women/girls, color “pink”). We examined trends in feminine appeals over time, including co-occurrence with other pack features (slim or lipstick shape, flavor, reduced harm, and reduced odor claims).

Results: The proportion of unique feminine cigarette packs significantly decreased from 8.6% (n = 278) in Wave 1 to 5.9% (n = 137) in Wave 2 (p < 0.001). Among all feminine packs, flower-and fashion-related features were most common; a substantial proportion also used flavor and reduced odor appeals.

Conclusion: While there was a notable presence of feminine packs, the decline observed may reflect global trends toward marketing gender-neutral cigarettes to women and a general contempt for using traditional femininity to market products directly to women. Plain packaging standards may reduce the influence of branding on smoking among women.

The influence of sociodemographic and donation behaviour characteristics on blood donation motivations

BACKGROUND

The study of donation motivations is essential at blood transfusion centres, because of the impact of these motivations on an individual's decision to donate. The heterogeneity of donor behaviour and the overall lack of consensus on how to assess it (e.g. via terminology, grouping of items in categories) justify this research, which was conducted with the purpose of an integrated analysis of the influence of sociodemographic and donation behaviour characteristics on the prevalence of donation motivations.

MATERIALS AND METHODS

Twenty-five types of motivation were assessed, through an online self-administered questionnaire, in a sample of 5,353 active donors in the Canary Islands (Spain). A series of tests focused on the differences in means was performed in order to analyse how the donor profile affects donation motivations. As a preliminary step, the validity and reliability of the proposed motivation scale, holistic and integrative in nature, were demonstrated.

RESULTS

Variations in donation motivations do exist. Blood transfusion centres should target their efforts on donors who are over 35 years old, highly educated, with a high income and longer careers as donors, given that these are the least motivated subjects n the donor pool.

DISCUSSION

The fact that the prevalence of donation motivations varies according to the donor profile demonstrates the need to identify the most relevant motivations and, furthermore, which population groups are affected by these motivations. Blood transfusion centres should design differentiated marketing actions in order to achieve greater effectiveness and efficiency when using their budgets.

Invited review: Sustainability: Different perspectives, inherent conflict

Consumer definitions of sustainability are largely uninformed by scientific research and may not align with industry definitions. Furthermore, consumers themselves have varied perceptions, definitions, and opinions of sustainability that vary between categories and products within the dairy category. Understanding these differences and developing marketing messaging aligned with consumer sustainability definitions offer an advantage to dairy product producers when strategically positioning their products in a changing marketplace. This review outlines the factors that may affect consumer sustainability perceptions to provide a basis for future marketing and scientific work. Consumer trends and desires for sustainability are explored, including how they are reflected in the rapid growth of plant-based alternatives. Factors that may influence consumer perception of dairy as sustainable are covered in detail, including packaging, labeling, animal welfare, organic status, grass-fed or pasture-raised feeding systems, and local and clean label perceptions. Finally, a discussion of the challenges of marketing dairy foods with sustainability messages is addressed.

Children's exposure to outdoor food advertising near primary and secondary schools in Australia

ISSUE ADDRESSED

Previous research has highlighted children's frequent exposure to advertisements of unhealthy food and beverages on television. However, the food industry is increasingly utilising non-broadcast channels such as outdoor advertising (eg billboards, bus shelters, shop fronts) for product marketing. Few studies have investigated children's exposure to outdoor food advertising around primary and secondary schools. This study aimed to quantify the presence and content of outdoor food advertisements within a 500 m radius of primary and secondary schools in Perth, Western Australia.

METHODS

A cross-sectional design was used to capture outdoor advertisements within a 500 m radial buffer around the school boundary. The INFORMAS protocol for monitoring outdoor advertising around child-serving institutions was used. Sixty-four primary and secondary schools in Perth, Australia, were selected using random sampling within socio-economic and population density strata.

RESULTS

In total, 5636 outdoor advertisements were identified within a 500 m radius of all 64 schools combined and 30% were for food. Of the 1708 food advertisements, 74% were for unhealthy (non-core) food. The most frequently advertised food products were alcohol, fast food and sugar-sweetened beverages. Only 8% of food advertisements featured a healthy product. The majority of schools (75%) had at least one food advertisement within 500 m (mean 36, range 3-190). Schools in lower socio-economic areas had more food advertisements and a significantly higher proportion of unhealthy food advertisements within 250 m.

CONCLUSION

Outdoor advertising around schools constitutes a potential frequent source of children's exposure to unhealthy food and alcohol advertising. SO WHAT?: Policy interventions restricting the content of outdoor food advertising near schools are needed.

New product development and at-home medical tests

The COVID-19 pandemic has impacted every aspect of life and continues to affect individuals and organizations in ways no one anticipated. In an attempt to cope with alternative lifestyle patterns, many companies have formulated products and services to mitigate behavioral adjustments. Specifically, the healthcare industry has increased efforts to cope with the ramifications of this infectious disease. A focus on creating and distributing at-home testing has become a priority as companies attempt to expedite the approval, production and commercialization of tests. This paper addresses the dynamics of producing, distributing, and evaluating at-home medical tests.