Nutrient Composition of Foods Marketed to Children or Adolescents Sold in the Spanish Market: Are They Any Better?

Healthy eating is essential for the growth and development of children and adolescents. Eating habits established in childhood continue into adulthood. In Spain, the frequent promotion of foods with low nutritional value is already considered a threat to the health of the population, particularly to children and adolescents. In this work, we analyse 3209 foods from the Food Database, BADALI. Foods were classified as marketed to children or adolescents according to the advertising on the packaging, television or internet. We found that 17.5% of foods in the database were marketed to this population and 97% of those were considered unhealthy following the Pan American Health Organization Nutrient Profile Model (PAHO-NPM). In the total of foods for children or adolescents, 61.5% were high in fat, 58.5% in free-sugar, 45.4% in saturated fat and 45% in sodium. Foods marketed to them presented higher amounts of carbohydrates and sugar, while lower protein and fibre content than the rest. There was also considerable variability in levels of the other nutrients found in these products, which depended largely on the food group. According to our findings, there is a tendency for products marketed to children or adolescents to be unhealthy and of a poorer nutritional quality than those not targeted at them.

Testing the Effects of Hookah Tobacco Social Media Risk Communication Messages Among Young Adults

BACKGROUND

Hookah tobacco is commonly used among young adults, and use is driven in part by widespread misperceptions about risks. Social media use, particularly Instagram, is prominent in this population and exposure to commercial and user-generated content promoting hookah commonly occurs.

AIMS

This study tested the effects of hookah tobacco risk messaging for delivery via Instagram as a strategy to offset exposure to content promoting hookah use among young adults.

METHOD

Young adult hookah smokers were recruited online for a 2 × 3 between-subjects experiment (n = 601). Participants completed preexposure measures and were randomized to view hookah tobacco Instagram ads (commercial or user generated) with risk messages (none, risk education, or graphic risk). Stimuli were presented as a simulated Instagram feed. After viewing the stimuli, participants completed postexposure outcome measures.

RESULTS

There was a statistically significant main effect of risk message type but no significant main effect of Instagram ad type or risk message type by ad type interactions. Exposure to the graphic risk and risk education messages were associated with lower intentions to engage with hookah tobacco ads on Instagram. Graphic risk and risk education messages produced greater negative emotional response and the graphic messages increased motivation to quit compared with Instagram ads alone.

DISCUSSION

Findings provide preliminary evidence that hookah tobacco risk messages delivered via Instagram can offset the influence of content promoting the use of hookah tobacco.

CONCLUSION

This study represents an example of risk message testing and the results suggest the messages warrant further testing via social media delivery.

Hot topic: Health and welfare challenges in the marketing of male dairy calves-Findings and consensus of an expert consultation

A diverse group of Canadian experts was convened for a focused 2-d discussion on potential health and welfare problems associated with the marketing (i.e., transportation and sale) of male dairy calves. Written notes and audio recording were used to summarize the information provided on transport times and marketing practices. Content analysis was used to develop a consensus statement on concerns, possible solutions, and recommendations to improve male dairy calf marketing. The group noted that calves across all Canadian regions are commonly transported at 3 to 7 d of age and undergo transport for 12 to 24 h or longer depending on the location of their dairy farm of origin. Calves in some regions are marketed almost exclusively through auction markets, whereas others have more direct sales. A need was identified for better criteria for calf fitness for transport, maintaining farm biosecurity, reducing the use of antimicrobial therapy in calf production, and improving education for farmers and veterinarians on the importance of neonatal care for male dairy calves before transportation. Experts noted that major changes in male dairy calf marketing will be required to comply with amendments to the federal Health of Animals Regulations (Part XII) on animal transportation; collaborative effort will be needed to safeguard animal health and welfare as this transition is made.

Influence of Food and Beverage Companies on Retailer Marketing Strategies and Consumer Behavior

The retail food environment plays an important role in shaping dietary habits that contribute to obesity and other chronic diseases. Food and beverage manufacturers use trade promotion-incentives paid to retailers-to influence how products are placed, priced, and promoted in stores. This review aims to: (1) catalogue trade promotion practices that manufacturers use to influence retailer marketing strategies, and (2) describe how these retailer marketing strategies affect consumer purchasing behavior and attitudes. Researchers searched five databases, Academic Search Ultimate, Business Source Ultimate, PsycINFO, PubMed, and Web of Science, to identify literature from industry and academic sources published in English through November 2019. Twenty articles describing manufacturer trade promotion practices were synthesized and provided insight into four types of trade promotion practices: category management, slotting allowances, price discounts, and cooperative advertising. Fifty-four articles describing the impact of retailer marketing on consumers were synthesized and graded for quality of evidence. While comparison across studies is challenging, findings suggest that retailer marketing strategies, such as price promotions and prominent placement, lead to increased sales. Results can guide efforts by policymakers, public health practitioners, and food retailers to design retail environments that improve healthy eating while maintaining retailer financial interests. Additional research should measure the impact of retailer marketing strategies on consumer diet quality and retailer outcomes (e.g., return-on-investment).

The Application of Neuromarketing Techniques in the Spanish Advertising Industry: Weaknesses and Opportunities for Development

Neuromarketing has aroused great interest in scientific research about consumer behavior and, consequently, in the advertising industry, which is searching for an alternative to traditional techniques for measuring efficacy. However, despite its development in the academic world, in the professional sector, its use is still very limited. The aim of this work was to find out the perception of advertising professionals as regards neuromarketing techniques for identifying its advantages and disadvantages compared to other research techniques, as well as the reasons why the use of neuromarketing is so much lower than expected in the Spanish market. The technique chosen for data gathering was the semi-structured interview, which made it possible to go into more depth with the subjects that came up. The interview, after a pre-selection of 100 professionals who matched the set criteria, was carried out individually, face-to-face, with a sample of 30 people with considerable professional experience in the field of marketing, sales communication, and market research; all of them belonged to leading companies from the sector. Once the information had been categorized into units with common themes, the results obtained were interpreted to explain how neuromarketing techniques are being used in the field of advertising. The results obtained led us to the conclusion that, even though neuromarketing provides more objective data and it is closer to what really happens to consumers when they are exposed to an advertising message, the ignorance of its true possibilities, the inability of suppliers of these techniques to transmit the value they add to research, its complexity, its high cost and time requirements explain why it has had scarce use in advertising research. The results revealed the real reasons for the rejection of neuromarketing techniques which, in turn, will make it possible to introduce both technological and formative solutions, allowing it to be incorporated into future research designs.

The Devil is in the Detail: Challenging the UK Department of Health's 2019 Impact Assessment of the Extent of Online Marketing of Unhealthy Foods to Children

Background: How much unhealthy marketing do children see on digital devices? Marketing of unhealthy food and beverages has long been identified as a factor in children’s preferences, purchase requests and consumption. Rising global obesity mandates States to craft environments that protect children and young people’s health, as recommended by the World Health Organization, among others. However, assessing the impact of marketing restrictions is particularly challenging: the complexity of digital advertising markets means that measurement challenges are profound. In 2019, the UK Department of Health published an Impact Assessment that applied a novel method aiming to calculate costs and benefits of restricting unhealthy food and beverage advertising on digital devices (planned for implementation by 2022). It estimated UK digital unhealthy marketing to children at 0.73 billion advertising impressions annually, compared to television impacts of 3.6 billion. Aim and Method: We assessed this conclusion by reviewing the UK Department of Health/Kantar Consulting’s Online Baseline Methodology (the “Government Model”). We examined the model’s underlying premise and specified the seven analytic steps undertaken. For each step, we reviewed industry and academic evidence to test its assumptions and the validity of data applied. Results: We found that, in each step, the Government Model’s assumptions, and the data sources selected, result in underestimates of the scale of digital advertising of unhealthy foods—at least tenfold, if not substantially more. The model’s underlying premise is also problematic, as digital advertising spend data relate poorly to digital advertising exposure, leading to further underestimation of market scale. Conclusion: We conclude that the Government Model very substantially underestimates the impact of digital unhealthy food advertising restrictions on health. This analysis has relevance for global policy and for the impact of regulation on children’s health and well-being.

Comparing football bettors' response to social media marketing differing in bet complexity and account type - An experimental study

BACKGROUND AND AIMS

The current study aimed to assess how sports bettors respond to advertised bets on social media and whether this differs dependent upon bet complexity and social media account type.

METHODS

Employing a 3 × 2 repeated measures design, 145 regular football bettors were recruited to take part in an online study requiring them to rate bets advertised upon social media, providing indications of their likelihood to bet, confidence in the bet and how much they would stake on the bet. Advertised bets differed in terms of complexity (low, medium and high) and each bet was presented separately on both an operator account and an affiliate account.

RESULTS

Data analysis highlighted a significant interaction between bet complexity and account type, with bettors rating themselves as being more likely to bet and more confident in bets which were presented on an affiliate account for medium complexity bets but not for low or high complexity bets.

DISCUSSION AND CONCLUSIONS

This study provides initial evidence that affiliate marketing of sports betting increases bettor's confidence in certain types of bets. This heightens previously addressed concerns around affiliate marketing, given that affiliates are financially incentivised to attract custom toward gambling operators. Future research should explore risk factors for increased uptake of affiliate marketing, and the impact on gambling behaviour.

Social Networking Sites and Perceived Content Influence: An Exploratory Analysis from Focus Groups with French Adolescents

Social networking sites (SNSs) are invested in heavily by marketers aiming to reach a growing number of consumers. Concerns regarding the influence of posts displayed on SNSs in relation to behaviour were raised, in particular the promotion of ill-health behaviour directed to adolescents who may be at risk from suggestible practices. Although adolescents tend to be critical towards traditional forms of advertising, little is known about their perception of influencing strategies developed online, especially where sponsor- and user-generated content coexist. This exploratory study aims to gather information directly from adolescents about their use of SNSs their awareness of the influence that SNS content may have, particularly when it comes to tobacco and alcohol messages. Ten focus groups were conducted with 39 adolescents (11-16 years old; 56.4% male). Qualitative analysis documents the differences associated with adolescents' favourite SNSs. The different parameters linked to each SNS and the expectation to find entertaining content and values associated with friendship may decrease adolescents' perception of potential risk for health associated with SNS use. Authors advocate for the development of educational programs based on eHealth literacy and the use of social marketing techniques to facilitate and motivate adolescents to develop their competences.

'It's a tradition to go down to the pokies on your 18th birthday' - the normalisation of gambling for young women in Australia

OBJECTIVE

To understand the range of factors that may influence the normalisation of gambling for young women in Victoria, Australia.

METHODS

In-depth qualitative telephone interviews with 45 women aged 18-34 years.

RESULTS

Young women were exposed to gambling environments and some were gambling from an early age. Family members were the key facilitators of these activities. Once reaching the legal age of gambling, peers and boyfriends were instrumental in young women's gambling practices. Women attributed the normalisation of gambling to excessive marketing, feminised gambling environments, and the widespread availability of gambling in the community.

CONCLUSIONS

This study found several factors that influenced and encouraged young women to gamble, such as the feminisation of gambling products and environments, and determined that gambling is becoming a socio-culturally accepted activity for young women. Implications for public health: Researchers and policymakers should be increasingly focused on how different forms of gambling may be normalised for young women. Attention should be given to how young women may become a target market for the gambling industry, and how to implement strategies aimed at preventing any future potential harm posed by these industries and their marketing tactics and products.

Obstacles against the Marketing of Curcumin as a Drug

Among the extensive public and scientific interest in the use of phytochemicals to prevent or treat human diseases in recent years, natural compounds have been highly investigated to elucidate their therapeutic effect on chronic human diseases including cancer, cardiovascular disease, and neurodegenerative disease. Curcumin, an active principle of the perennial herb Curcuma longa, has attracted an increasing research interest over the last half-century due to its diversity of molecular targets, including transcription factors, enzymes, protein kinases, growth factors, inflammatory cytokines, receptors, and it's interesting pharmacological activities. Despite that, the clinical effectiveness of the native curcumin is weak, owing to its low bioavailability and rapid metabolism. Preclinical data obtained from animal models and phase I clinical studies done in human volunteers confirmed a small amount of intestinal absorption, hepatic first pass effect, and some degree of intestinal metabolism, might explain its poor systemic availability when it is given via the oral route. During the last decade, researchers have attempted with new pharmaceutical methods such as nanoparticles, liposomes, micelles, solid dispersions, emulsions, and microspheres to improve the bioavailability of curcumin. As a result, a significant number of bioavailable curcumin-based formulations were introduced with a varying range of enhanced bioavailability. This manuscript critically reviews the available scientific evidence on the basic and clinical effects and molecular targets of curcumin. We also discuss its pharmacokinetic and problems for marketing curcumin as a drug.

Neuromarketing Applied to Educational Toy Packaging

This research work comes in response to the question of which aspects are more relevant for consumers when purchasing educational toys as opposed to other toys that are focused solely on leisure. This empirical research focuses on an educational toy distributed in Spain by the Educa brand (Conector family, reference "I learn English"), which is the product best-selling product of its brand in this area, and analyses how consumers make decisions concerning this product in relation to other products designed by competitors. The research looks into customer reactions while looking at these products, measuring brain activity generated by different aspects of product design and its influence on choice. The aim of the present study was to propose a model that optimizes the design of educational toy packaging. Through the use of neuromarketing techniques -attention through eye tracking, and emotion using galvanic skin response- as well as qualitative research techniques, the objective of this research is to determine the motivations in the processes of buying educational toys. The packaging design elements analyzed are brand, product family, toy name, recommended age, game image, number of questions/topics, and additional texts. The results suggest that the most important elements are the graphic details of the packaging, obtaining a perception of a higher educational level as more questions are addressed by the game. The simultaneous combination of qualitative techniques monitored with galvanic skin response (neuro-qualitative study) allows additional conclusions to be aligned with the end user of the product, including a prominent social component when the product is purchased as a gift for a third party.

Differentiation in a market of imitation: The evolving world of aesthetic dermatology

This commentary examines the recent general movement in the field of cosmetic dermatology toward imitation and reproduction. The issues of medical spas, nonphysician operators, and counterfeit products have recently garnered interest in aesthetic dermatology. As physicians, it is our professional and bioethical responsibility to ensure that our patients are educated on the presence of medical spas, nonphysician operators, and counterfeit products in our field, especially given the discrepancies in patient safety and outcomes. There are also actions that dermatologists can take in order to help differentiate themselves in this current market. This will not only protect our field, but also our patients, who we are obligated to provide high-quality care for as physicians.

Spotlight on avian pathology: can we reduce the pandemic threat of H9N2 avian influenza to human and avian health?

COVID-19 should be a "call to arms" for the poultry industry to reassess containment of the H9N2 subtype of low pathogenicity avian influenza viruses. Strains of this virus are a human pandemic threat and a severe economic burden on poultry production. Over the past 20 years they have spread throughout Asia, Africa, Middle East and parts of Europe. As a global industry, a critical need is to re-imagine production and marketing chains, especially in low and middle-income countries, where the structure of much of the industry facilitates virus transmission, especially, but not only, in improperly managed live poultry markets and related value chains. Better, appropriately matched vaccines are needed to support this process but such vaccines cannot, alone, overcome the existing defects in biosecurity, including high farm densities. None of this will occur unless the threat posed by this virus to global health security is recognized.

Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements

Background

The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences.

Objective

The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television.

Methods

In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC).

Results

In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively.

Conclusions

The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.

Access to Medicines, Access to Markets

This article explores some uses by the pharmaceutical industry of language from the "access to medicines" movement in global health, sometimes for goals almost completely opposite to those of the movement. Important in the context of extremely expensive treatments, the industry draws on the idealistic discourse around access to medicines to create a very specific continuity between the needs of the Global South and its own marketing needs. By focusing on "access," the industry can promote the opening up of markets in relatively wealthy countries with important public or highly regulated payers.

Pester Power: Examining Children's Influence as an Active Intervention Ingredient

OBJECTIVE

To determine if children's pester power related to a classroom-based nutrition program, Together, We Inspire Smart Eating (WISE), is related to familial dietary habits and parental food purchases and practices.

METHODS

Classroom teachers delivered weekly WISE lessons at 7 Head Start sites across 2 states in the southern US. Before and after the intervention, parents were interviewed on the consumption of WISE fruits and vegetables, intake of nutrient-poor foods, parenting practices related to food, and exposure to WISE through the child's pester power.

RESULTS

After controlling for baseline levels of outcome variables, child willingness to try new foods at baseline, and the effect of state, pester power predicated significant variance in the outcomes of consumption of WISE foods (F3, 229 = 34.7, P < .001, ΔR2 = 0.03, P = .002) and parenting practices that support healthy dietary intake and attitudes for young children (F2, 264 = 77.2, P < .001, ΔR2 = 0.02, P = .006).

CONCLUSIONS AND IMPLICATIONS

The findings of this study highlight the potential for children's influence on food consumption and habits at home.

Comparing Four Question Formats in Five Languages for On-Line Consumer Surveys

Question formats are critical to the collection of consumer health attitudes, food product characterizations, and perceptions. The information from those surveys provides important insights in the product development process. Four formats based on the same concept have been used for prior studies: Check-All-That-Apply (CATA), Check-All-Statements (CAS), Rate-All-That-Apply (RATA), and Rate-All-Statements (RAS). Data can vary depending on what question format is used in the research, and this can affect the interpretation of the findings and subsequent decisions. This survey protocol compares the four question formats. Using a modified version of the Eating Motivation Survey (EMS) to test consumer eating motivations for five food items, each question format was translated and randomly assigned to respondents (N = 200 per country per format) from Brazil (Portuguese), China (Mandarin Chinese), India (Hindi or English), Spain (Spanish), and the USA (English). The results of this survey should provide more understanding of the differences and similarities in distribution of data for the four scale formats. Also, the translations and findings of this survey can guide marketers, sensory scientists, product developers, dieticians, and nutritionists when designing future consumer studies that will use these question formats.

Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development

Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost‐effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front‐of‐pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost‐effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front‐of‐pack nutritional labelling is likely to be highly cost‐effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child‐directed advertising are likely to be highly cost‐effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.

The Advertising Policies of Major Social Media Platforms Overlook the Imperative to Restrict the Exposure of Children and Adolescents to the Promotion of Unhealthy Foods and Beverages

There have been global calls to action to protect children (aged <18) from exposure to the marketing of unhealthy foods and beverages (‘unhealthy foods’). In this context, the rising popularity of social media, particularly amongst adolescents, represents an important focus area. This study aimed to examine the advertising policies of major global social media platforms related to the advertising of unhealthy foods, and to identify opportunities for social media platforms to take action. We conducted a desk-based review of the advertising policies of the 16 largest social media platforms globally. We examined their publicly available advertising policies related to food and obesity, as well as in relation to other areas impacting public health. The advertising policies for 12 of the selected social media platforms were located. None of these platforms adopted comprehensive restrictions on the advertising of unhealthy foods, with only two platforms having relevant (but very limited) policies in the area. In comparison, 11 of the 12 social media platforms had policies restricting the advertising of alcohol, tobacco, gambling, and/or weight loss. There is, therefore, an opportunity for major social media platforms to voluntarily restrict the exposure of children to the marketing of unhealthy foods, which can contribute to efforts to improve populations’ diets.

Marketing the Research Missions of Academic Medical Centers: Why Messages Blurring Lines Between Clinical Care and Research Are Bad for both Business and Ethics

Academic Medical Centers (AMCs) offer patient care and perform research. Increasingly, AMCs advertise to the public in order to garner income that can support these dual missions. In what follows, we raise concerns about the ways that advertising blurs important distinctions between them. Such blurring is detrimental to AMC efforts to fulfill critically important ethical responsibilities pertaining both to science communication and clinical research, because marketing campaigns can employ hype that weakens research integrity and contributes to therapeutic misconception and misestimation, undermining the informed consent process that is essential to the ethical conduct of research. We offer ethical analysis of common advertising practices that justify these concerns. We also suggest the need for a deliberative body convened by the Association of American Medical Colleges and others to develop a set of voluntary guidelines that AMCs can use to avoid in the future, the problems found in many current AMC advertising practices.

What Is Accounting for the Rapid Decline in Cigarette Sales in Japan?

This study describes how trends in the sale of cigarettes in Japan between 2011 and 2019 correspond to the sales of heated tobacco products (HTPs) that were introduced into the Japanese market in late 2015. Data used for this study come from the Tobacco Institute of Japan and Philip Morris International. The findings show that the accelerated decline in cigarette only sales in Japan since 2016 corresponds to the introduction and growth in the sales of HTPs.

A Marketing Approach to a Psychological Problem: Problematic Smartphone Use on Adolescents

Background: Smartphones have become an indispensable part of the daily lives of adolescents in the 21st century, which is characterized by a highly digitized modern world. Besides their many advantages, smartphones might pave the way to compulsive usage and addictive experiences. To remedy this problem, this study proposes an authentic approach which integrates consumer behavior theories and techniques such as unhook and gamification. An education program has been designed based on these approaches to decrease the problematic smartphone use. Method: The participants of the education program consisted of 305 students (48.2% girls and 51.8% boys) with a mean age of 14.57 (SD = 0.74). The Demographic Form and Smartphone Addiction Scale for Adolescents (SASA) were conducted before the education program and three weeks after the education. Results: The results of the paired sample t-test analysis before and after the education program revealed that the SASA total scores decreased significantly (p < 0.01). There are significant differences in terms of gender, mothers’ education and class levels. Conclusion: This research emphasizes the role of an interdisciplinary approach to the addiction problem. The content used in the education program includes strategies that originally aimed at increasing consumption. The effectiveness of the program can be enhanced further in the future along with self-regulatory additions.

Public perception of predictive cancer genetic testing and research in Oregon

The potential for using widespread genetic testing to inform health care has become a viable option, particularly for heritable cancers. Yet, little is known about how to effectively communicate the benefits and risks of both personal genetic testing and participation in biorepositories that aid scientific advancements. Nationwide efforts are engaging communities in large genetic studies to better estimate the population-wide prevalence of heritable cancers but have been met with hesitance or declination to participate in some communities. To successfully engage an Oregon population in longitudinal research that includes predictive genetic testing for pathogenic or likely pathogenic variants associated with an increased risk for cancer, researchers conducted 35 focus groups (two of which were held in Spanish) in 24 of Oregon's 36 counties to better understand knowledge and attitudes related to genetic testing and willingness to participate in longitudinal genetic research. A total of 203 adults (mean = 45.6 years; range 18-88), representing a range of education levels and prior knowledge of genetic research, participated in the focus groups. The majority (85%) of participants reported personal or family diagnoses of cancer (e.g., self, family, friends). A majority (87%) also reported a strong interest in cancer genetic testing and receiving genetic information about themselves. Nearly all focus groups (94%, 33 of 35 sites) included participant discussion citing their families (e.g., children, close relatives, and extended family members) as key motivators for participation in genetic research. For example, participants reported interest in increasing personal knowledge about their own and their families' cancer risks in order to respond proactively, if a pathogenic variant was found. While most focus groups (94%, 33 of 35 sites) included participant discussion describing barriers to predictive genetic, testing such as concerns about outcomes, the desire to learn about health risks in oneself mitigated or outweighed those fears for many participants. Other commonly reported concerns were related to potential mistrust of insurance companies, researchers, or institutions, or lack of knowledge about genetics, genetic testing, or genetic research. Participants, particularly in rural areas, highlighted critical factors for research recruitment, such as trust, personal interaction, public education about genetic research, and clear communication about study goals and processes. Our statewide findings reflect that public interest in predictive cancer genetic testing and cancer genetic research can surpass lack of knowledge of the complex topics, particularly when benefits for self and family are emphasized and when study considerations are well articulated.

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

Media-saturated digital environments seek to influence social media users’ behaviour, including through marketing. The World Health Organization has identified food marketing, including advertising for unhealthy items, as detrimental to health, and in many countries, regulation restricts such marketing and advertising to younger children. Yet regulation rarely addresses adolescents and few studies have examined their responses to social media advertising. In two studies, we examined adolescents’ attention, memory and social responses to advertising posts, including interactions between product types and source of posts. We hypothesized adolescents would respond more positively to unhealthy food advertising compared to healthy food or non-food advertising, and more positively to ads shared by peers or celebrities than to ads shared by a brand. Outcomes measured were (1a) social responses (likelihood to ‘share’, attitude to peer); (1b) brand memory (recall, recognition) and (2) attention (eye-tracking fixation duration and count). Participants were 151 adolescent social media users (Study 1: n = 72; 13–14 years; M = 13.56 years, SD = 0.5; Study 2: n = 79, 13–17 years, M = 15.37 years, SD = 1.351). They viewed 36 fictitious Facebook profile feeds created to show age-typical content. In a 3 × 3 factorial design, each contained an advertising post that varied by content (healthy/unhealthy/non-food) and source (peer/celebrity/company). Generalised linear mixed models showed that advertisements for unhealthy food evoked significantly more positive responses, compared to non-food and healthy food, on 5 of 6 measures: adolescents were more likely to wish to ‘share’ unhealthy posts; rated peers more positively when they had unhealthy posts in their feeds; recalled and recognised a greater number of unhealthy food brands; and viewed unhealthy advertising posts for longer. Interactions with sources (peers, celebrities and companies) were more complex but also favoured unhealthy food advertising. Implications are that regulation of unhealthy food advertising should address adolescents and digital media.

Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System

Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) (p < 0.001) and sodium (−20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.

Trends of r-tPA (Recombinant Tissue-Type Plasminogen Activator) Treatment and Treatment-Influencing Factors in Acute Ischemic Stroke

Background and Purpose- Frequencies of treatment with r-tPA (recombinant tissue-type plasminogen activator) are increasing over the past 15 years. However, published data on the influence of various demographic and clinical factors on r-tPA treatment as well as estimates of future trajectories are limited. We evaluated time trends and future trajectories of r-tPA treatment in patients with acute stroke and the influence of various factors on r-tPA treatment by analyzing data of 103 970 patients enrolled in the Austrian Stroke Unit Registry from 2006 to 2018, of which 18 953 were treated with r-tPA. Methods- Time trends of r-tPA-treatment were investigated in predefined subgroups (minor/major stroke, age, anterior/posterior circulation stroke); limited exponential time series models were calculated to estimate future trends of r-tPA-treatment. Logistic regression models were calculated to estimate the influence of clinical variables on r-tPA-treatment. Results- Overall, r-tPA treatment frequencies increased from 9.9% in 2006 to 21.8% in 2018. We observed a particular increase in patients >80 years, patients presenting with a National Institutes of Health Stroke Scale Score of 2 to 3, patients with posterior circulation stroke, patients with wake-up stroke, and patients without atrial fibrillation. Forecast of overall r-tPA frequencies predicted a further but flattened increase up to 24% by 2025. Logistic regression of time-dependent associations of clinical variables with r-tPA-treatment revealed increasing odds of r-tPA-treatment in patients with a posterior circulation stroke and decreasing odds of r-tPA-treatment in patients with atrial fibrillation. Conclusions- We observed a positive development of r-tPA-treatment frequencies mirroring increasing confidence with intravenous thrombolysis in clinical practice; however, decreasing odds of r-tPA-treatment over time in patients with atrial fibrillation deserve particular attention.

The Art of Influencing Consumer Choices: A Reflection on Recent Advances in Decision Neuroscience

In recent years, our knowledge concerning the neurobiology of choice has increased tremendously. Research in the field of decision-making has identified important brain mechanisms by which a representation of the subjective value of an option is built based on previous experience, retrieved and compared to that of other available options in order to make a choice. One body of research, in particular, has focused on simple value-based choices (e.g., choices between two types of fruits) to study situations very similar to our daily life decisions as consumers. The use of neuroimaging techniques has deepened and refined our knowledge of decision processes. Additionally, computational approaches have helped identifying and describing the mechanisms underlying newly found components of the decisional process. They provide mechanistic explanations for diverse biases that can drive decision makers away from their own preferences or from rational choices. It is now clear that both attentional and affective factors can exert robust effects on an individual's decisions. Because these factors can be manipulated externally, academic research and theories are of great interest to the marketing industry. This approach is becoming increasingly effective in manipulating consumer behavior and has the potential to become even more effective in the future. Another line of research has revealed differences in the decision-making neural circuitry that underlie sub-optimal choice behavior, rendering some individuals particularly vulnerable to marketing strategies. As neuroscientists, we wonder whether relevant institutions should direct their efforts toward raising citizens' awareness, demanding more transparency on marketing applications and regulate the most pervasive communication techniques in marketing, in view of their current use and of recent research progress.

The influence of front-of-pack portion size images on children's serving and intake of cereal

BACKGROUND

Consumption of large portions of energy-dense foods promotes weight gain in children. Breakfast cereal boxes often show portions much larger than the recommended serving size.

OBJECTIVE

This experimental study investigated whether front-of-package portion size depictions influence children's self-served portions and consumption.

METHODS

In a between-subjects design, 41 children aged 7-11 years (M= 9.0 ± 1.5y) served themselves breakfast cereal from a box, the front of which depicted either a recommended serving size of cereal (30g) or a larger, more typical front-of-pack portion (90g). Cereal served and consumed and total caloric intake (including milk) was recorded. Height and weight, demographic information and measures of children's food responsiveness and enjoyment of food were collected.

RESULTS

MANOVA revealed that children exposed to the larger portion size served themselves (+7g, 37%) and consumed (+6g, 63%) significantly more cereal than those exposed to the smaller portion. Despite this, overall caloric intake (milk included) did not differ between conditions, and no other measured variables (hunger, BMI) significantly affected the outcomes.

CONCLUSION

This study provides novel evidence of the influence portion-size depictions on food packaging have on children's eating behaviour. This offers possible avenues for intervention and policy change; however, more research is needed.

Follow-Up Investigation on the Promotional Practices of Electric Scooter Companies: Content Analysis of Posts on Instagram and Twitter

Background

Electric scooters (e-scooters) have become a popular mode of transportation in both the United States and Europe. In the wake of this popularity, e-scooters have changed the commuting experience in many metropolitan areas. Although e-scooters offer an efficient and economical way to travel short distances in traffic-congested areas, recent studies have raised concerns over their safety. Bird and Tier Mobility are 2 popular e-scooter companies in the United States and Europe, respectively. Both companies maintain active social media accounts with hundreds of posts and tens of thousands of followers. Recent studies have shown that consumer behavior may be influenced by the content posted to popular social media platforms, such as Instagram and Twitter.

Objective

This study aimed to examine the official Instagram and Twitter accounts of Bird and Tier Mobility to determine whether these companies promote and demonstrate the use of safety gear in their posts to their consumers.

Methods

Posts to Bird’s (n=287) and Tier Mobility’s (n=190) official Instagram accounts, as well as Bird’s (n=313) and Tier Mobility’s (n=67) official Twitter accounts, were collected from November 9, 2018, to October 7, 2019. Rules for coding content of posts were informed by previous research.

Results

Among posts to Bird’s Instagram account, 69.3% (199/287) had a person visible with an e-scooter, 9.1% (26/287) contained persons wearing protective gear, and there were no mentions of protective gear in captions corresponding to the post. Among posts to Tier Mobility’s Instagram account, 84.7% (161/190) contained a person visible with an e-scooter, 36.3% (69/190) contained persons wearing protective gear, and 4.2% (8/190) of captions corresponding to posts mentioned protective gear. Among posts to Bird’s Twitter account, 71.9% (225/313) had an image, of which 44.0% (99/225) contained a person visible with an e-scooter and 15.1% (34/225) contained persons wearing protective gear. Among posts to Tier Mobility’s Twitter account, 78% (52/67) had an image, of which 52% (27/52) contained a person with an e-scooter and 21% (11/52) contained persons wearing protective gear.

Conclusions

Findings show that modeling and promoting safety is rare on Bird’s and Tier Mobility’s official social media accounts, which may contribute to the normalization of unsafe riding practices. Social media platforms may offer a potential avenue for public health officials to intervene with rider safety campaigns for public education.

Cigarette and E-Cigarette Retail Marketing on and Near California Tribal Lands

Introduction. Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal lands. The resulting evidence is important, especially given that American Indian/Alaska Native (AI/AN) youth and adults have the highest smoking prevalence of any racial/ethnic group in the United States. In this study, we examined cigarette, e-cigarette, and vape/vaporizer availability, advertising, and price-reducing promotions in retail settings on and within a 1-mile radius of Tribal lands in California. Method. Trained AI/AN community health representatives (n = 8) conducted store observations (n = 96) using a checklist adapted from the Standardized Tobacco Assessment for Retail Settings observation tool. Chi-square analyses were performed to look for potential differences in availability, exterior advertising, and price promotions for cigarettes, e-cigarettes, and vapes between stores. Results. All stores sold cigarettes and over 95% sold menthol cigarettes. Nearly 25% of stores on Tribal lands were located inside a casino, and 40.4% of stores on Tribal lands offered a Tribal member discount. Stores within a 1-mile radius of Tribal lands sold significantly (p < .01) more e-cigarettes (69.8%), including flavored e-cigarettes (53.4%), compared to stores on Tribal lands (37.7% and 28.3%, respectively). Price promotions for cigarettes were significantly (p < .01) more common in stores located within a 1-mile radius of Tribal lands (46.5%) than stores on Tribal lands (22.6%). Discussion. To our knowledge, this study is the first to use store observations to examine cigarette and e-cigarette availability, advertising, and price promotions in retail settings on and near California Tribal lands. We recommend future studies build on our initial efforts to take an AI/AN Tribal community-engaged approach in assessing and documenting tobacco marketing practices on and near Tribal lands. Tribal governments can consider tobacco policies to help reduce smoking disparities and advance health equity for their communities.

Informing iQOS Regulations in the United States: A Synthesis of What We Know

The tobacco industry offers various products, including heated tobacco products (HTPs). Philip Morris International's (PMI) "iQOS" has the greatest HTP market share, as well as research on its use and impact. iQOS was released in 2014 and is now in more than 40 countries. The U.S. Food and Drug Administration announced permission for PMI to sell iQOS in the United States in April 2019, and iQOS was launched in October 2019. Decisions pending its modified risk tobacco product (MRTP) application will occur subsequently. The U.S. regulatory efforts regarding iQOS could be informed by examining (a) Philip Morris USA other product marketing efforts and (b) the iQOS market in countries where it is available. This article briefly addresses these two points with extant literature and suggests that future research should address important gaps in what is currently known, including strategic international collaborations and research, which historically has been critical for advancing tobacco control globally.

Prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on shopper purchasing behaviour: A systematic review of the literature

Policies to restrict unhealthy food and beverage price promotions have been recommended, as part of a broader strategy to reduce obesity, but little evidence underpins such recommendations. We aimed to synthesize the literature on the prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on purchasing behaviour. Eight scientific databases (covering health, business, and marketing) and grey literature were systematically searched using search terms related to "food and beverage price promotions" up until July 2019. Articles were included if they examined prevalence of, and/or consumer response to, food and non-alcoholic beverage price promotions, from a nutritional perspective. Of the 16 included studies, eight examined the prevalence of price promotions and eight examined the potential influence of price promotions on purchasing behaviour. Seven of the "prevalence" studies found that price promotions were more common for unhealthy foods and beverages. Seven "influence" studies found a greater proportion of price-promoted purchases were for unhealthy compared with healthy products. Policies that reduce the prevalence and/or influence of price promotions on unhealthy foods and beverages may shift consumer purchasing away from unhealthy foods and beverages. Empirical studies are required to better understand how consumers and industry may respond to such policies.

Internet Alcohol Marketing Recall and Drinking in Underage Adolescents

OBJECTIVE

Evidence suggests that adolescents are exposed to alcohol marketing in digital media. We aimed to assess recall of Internet alcohol marketing and its association with underage drinking.

METHODS

New England adolescents age 12 to 17 years (N = 202) were recruited from a pediatric clinic. Subjects completed an online survey assessing: 1) general simple recall of Internet alcohol marketing and 2) image-prompted recall of specific Internet alcohol marketing channels (display ads, commercials, brand websites, and brand social media pages). Cross-sectional associations between recall (simple and image-prompted) and ever-drinking were each assessed in regression analysis adjusting for age, gender, race, parent education, ever-smoking, media use, sensation-seeking, peer/parent drinking, parent monitoring/responsiveness, and parent Internet monitoring.

RESULTS

In this sample (Mage = 14.5 years; 55% female; 89% white; high parent education), 20% reported ever-drinking and 87% recalled Internet alcohol marketing. Of the latter, 67% recalled display ads, 67% Internet commercials, 5% websites, and 5% social media pages. In logistic regression, higher simple Internet alcohol advertising recall was independently associated with higher odds of ever-drinking for simple (adjusted odds ratio: 2.66 [1.04,6.83]) but not for image-prompted recall.

CONCLUSIONS

Despite controlling for potential confounders, simple recall of Internet alcohol marketing was significantly associated with underage drinking whereas image-prompted recall was significant only in bivariate analysis, likely due to small sample and a more limited range of specific channels assessed than those accessed by adolescents. Further longitudinal studies using image-prompted recall and capturing a broader range of internet platforms could be used to better understand adolescent engagement with alcohol marketing and guide policy and prevention efforts.

How Branded Marketing and Media Campaigns Can Support a Healthy Diet and Food Well-Being for Americans: Evidence for 13 Campaigns in the United States

This report summarizes the available evidence for strategies used in large-scale, branded marketing campaigns to promote healthy dietary behaviors to Americans between 1990 and 2016. An adapted health-branding framework guided the 3-step mixed-methods approach to identify evidence for campaigns using a scoping review, comprehensive literature review, and key-informant interviews (n = 11). Results show that industry, government, and nongovernmental organizations supported 13 campaigns that used various health-branding strategies. The authors suggest opportunities that may inform the design and evaluation of diet-related campaigns to improve understanding and application of health-branding strategies to promote a healthy diet and to advance consumer health and well-being.

The Relationship between Self-Reported Exposure to Sugar-Sweetened Beverage Promotions and Intake: Cross-Sectional Analysis of the 2017 International Food Policy Study

Sugar-sweetened beverage (SSB) consumption is independently associated with several non-communicable diseases, so policymakers are increasingly implementing measures, such as marketing regulation, to reduce intake. To help understand how such measures work, this study examined the association between SSB consumption and self-reported exposure to SSB promotions, both overall and by type of promotion, and whether these relationships vary between the UK, USA, Canada, Mexico, and Australia. Cross-sectional analysis of the online 2017 International Food Policy Study was performed (n = 15,515). Participants were grouped into 5265 (34%) non-, 5117 (33%) low-, and 5133 (33%) high-SSB consumers. Multinomial logistic regression models examined whether SSB consumption varied by exposure to total SSB promotion and by type: traditional, digital, recreational environment, and functional environment. Multiplicative interactions were included to investigate international variations. An additional unit of total self-reported SSB promotion exposure increased the likelihood of participants being low SSB consumers (relative risk ratio (RRR) = 1.08, 95% confidence interval (CI) = 1.06–1.10) and high SSB consumers (RRR = 1.13, 95% CI = 1.11–1.16). Only exposure to traditional and digital promotion increased the likelihood of participants being SSB consumers, though this may be explained by degree of exposure, which was not measured in this study. Some evidence illustrated international variation in these relationships.

Ensuring Effective Utilization of Biospecimens: Design, Marketing, and Other Important Approaches

A number of studies have shown that underutilization of biospecimens from bioresources (biobanks and biorepositories) is a significant concern. In addition, biospecimen underutilization has been identified as an ethical as well as practical concern. The utilization of biospecimens is affected by many factors, including the establishment of a scientific need for the biospecimens, the design of the bioresource, strategic planning, biospecimen quality and fitness for purpose, informed consent considerations, access policies and procedures, and marketing. This article discusses the impact of these factors on biospecimen utilization and provides suggestions for how bioresources can optimize biospecimen utilization from their collections.

Media food marketing and eating outcomes among pre-adolescents and adolescents: A systematic review and meta-analysis

The media marketing's effect on child and adult eating has been extensively researched, yet, little is known about its effect on adolescents. The aim of this review is to synthesize available research on the relation between media food marketing and eating-related cognitions, attitudes, and behaviors among pre-adolescents (8-11) and adolescents (12-19). We systematically screened and retrieved 9324 articles, of which 28 were included in the review-analysis and 19 in the meta-analysis. Robust variance estimation with random effect weights indicated a positive small standard effect size (d = 0.26, P < .001) of media food marketing on all unhealthy eating outcomes, and a subgroup analysis revealed a small effect size (d = 0.26, P < .001) on unhealthy eating behaviors specifically. Another subgroup analysis among adolescents revealed an effect of marketing (d = 0.22, P < .05) on unhealthy eating outcomes. This review demonstrates the significance of media marketing on eating in pre-adolescents and adolescents, and highlights limitations in the food marketing and adolescent eating literature specific to eating outcomes and marketing media studied and research designs utilized. We call for properly designed food marketing research exploring digital media's effect on eating attitudes and cognitions, especially among older adolescents.

A Baby Formula Designed for Chinese Babies: Content Analysis of Milk Formula Advertisements on Chinese Parenting Apps

Background

China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing.

Objective

This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding.

Methods

We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure.

Results

The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure.

Conclusions

The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors.

Assessing the Appeal of Instagram Electronic Cigarette Refill Liquid Promotions and Warnings Among Young Adults: Mixed Methods Focus Group Study

Background

While marketing for electronic cigarette refill liquids (e-liquids) is widespread on Instagram, little is known about the post elements that create appeal among young adult Instagram users. Further information is needed to help shape regulatory strategies appropriate for social media.

Objective

This study examined young adult Instagram user perceptions of actual e-liquid marketing posts and US Food and Drug Administration (FDA)–mandated nicotine addiction warning statements on Instagram.

Methods

A series of 12 focus groups (n=69) were held with non–tobacco users, vapers, smokers, and dual users in Wisconsin between September and December 2018. Participants discussed the elements of posts that they found appealing or unappealing, in addition to completing a survey about each post and e-liquid. Focus group transcripts were analyzed by smoking status using a framework analysis approach.

Results

Although willingness to try e-liquids was highest among nicotine users, focus group discussions indicated that Instagram posts promoting e-liquids held appeal for individuals across smoking statuses. The primary elements that created appeal were the perceived trustworthiness of the Instagram account, attractive design and flavor visuals, and promotion of flavors and nicotine levels that met personal preferences. Post appeal was reduced by references to vaping subcultures, indicators that the post creator did not take nicotine addiction seriously, and FDA-mandated nicotine warning statements. Non–tobacco users were particularly drawn to posts featuring nicotine-free e-liquids with attractive visual designs and flavors known from foods.

Conclusions

Young adults consider a broad range of elements in assessing the appeal of e-liquid marketing on Instagram, with minor but notable distinctions by smoking status. Non–tobacco users are uniquely drawn to nicotine-free e-liquids and are more deterred by the FDA’s mandated nicotine addiction warning statements than those from other smoking statuses. This suggests that it may be possible to tailor policy interventions in a manner that helps to reduce novel uptake of vaping without significantly diminishing its potential harm-reduction benefits.

What Do Adolescents See on Social Media? A Diary Study of Food Marketing Images on Social Media

Food marketing influences eating preferences and choices, especially among adolescents, contributing to the rise of overweight, obesity, and other chronic health disorders. Recent social media advancements have provided food marketers with platforms to reach out to many in more personal and authentic ways as compared to classical media advertising. Such personalized and borderless social media platforms allow marketers to easily use owned, paid, and earned (word-of –mouth) marketing strategies, including paid and non-paid influencers to reach younger target audiences. This study therefore aims to explore food messages adolescents (12–18 years old) encounter on social media, and assess these messages for their sources, the presence of core and non-core food, and the marketing strategies employed. To attain an in-depth understanding of the food messages that adolescents are continuously exposed to, we carried out a diary study with 21 Flemish adolescents who took screenshots of food images they encountered on their social media platforms for the duration of one week. A quantitative and qualitative content analysis of 611 images revealed that adolescents are mostly exposed to messages of non-core (67% of images) and branded (49% of images) food, often (49% of images) presented in association with a social context such as hanging around with friends, eating at restaurants and celebrating with food. Adolescents often encounter branded food images through peers and social media influencers, the majority of which are part of earned (49% of branded images) or paid (40% of branded images) media food marketing. This research provides an in-depth understanding of the social media messages that adolescents encounter on a daily basis and sheds light on food norms typically communicated on social media by marketers, peers, and influencers. Study findings highlight prominent social media food messages that should be tested for their persuasiveness, providing insights for future research that aims to assess the effects of social media food marketing on adolescents. Based on the study findings, we call for relevant policy actions that address current social media marketing strategies targeted at adolescents.

Nearly 20 000 e-liquids and 250 unique flavour descriptions: an overview of the Dutch market based on information from manufacturers

OBJECTIVES

Flavours increase attractiveness of electronic cigarettes and stimulate use among vulnerable groups such as non-smoking adolescents. It is important for regulators to monitor the market to gain insight in, and regulate the range of e-liquid flavours that is available to consumers. E-liquid manufacturers are required to report key product information to authorities in the European Member States in which they plan to market their products. This information was used to provide an overview of e-liquid flavour descriptions marketed in the Netherlands in 2017.

METHODS

Two researchers classified 19 266 e-liquids into the 16 main categories of the e-liquid flavour wheel, based on information from four variables in the European Common Entry Gate system. Flavour descriptions were further specified in subcategories.

RESULTS

For 16 300 e-liquids (85%), sufficient information was available for classification. The categories containing the highest number of e-liquids were fruit (34%), tobacco (16%) and dessert (10%). For all e-liquids, excluding unflavoured ones, 245 subcategories were defined within the main categories. In addition to previously reported subcategories, various miscellaneous flavours such as sandwich, buttermilk and lavender were identified.

CONCLUSIONS

In 2017, ~20 000 e-liquids were reported to be marketed in the Netherlands, in 245 unique flavour descriptions. The variety of marketed flavour descriptions reflects flavour preference of e-cigarette users as described in literature. Our systematic classification of e-liquids by flavour description provides a tool for organising the huge variety in market supply, serves as an example for other countries to generate similar overviews and can support regulators in developing flavour regulations.

Assessing Vitamins, Minerals and Supplements Marketed to Children in Canada

Given the growth of supplements specifically designed for children in Canada, this study examines the nutrient levels of these products, and evaluates them in light of the US Health and Medical Division (HMD)—formerly the Institute of Medicine—and Health Canada’s recommendations. Content analysis was used to document the nutrient levels of child-targeted vitamins, minerals and fish oils/omega-3s (n = 80) in Calgary, Alberta, Canada. Products were assessed according to HMD and Health Canada dosage recommendations for children, and the percentage of Estimate Average Requirements (EAR), Adequate Intakes (AI), and Tolerable Upper Intakes Level (UL) calculated. Median EAR/AI/UL percentages and quartiles were calculated for each nutrient, and estimates for the adequate intake recommendations plotted with box plots. Sixty five percent of the products assessed were multivitamins; the median dose was higher than AI recommendations for vitamins A, B6, B12, and C, as well as thiamin, riboflavin, pantothenic acid, and biotin. Substantial variation in vitamin, mineral, or fish oil dosage was found between similar supplements—with nutrients such as vitamin B12 ranging from 83% to 5557% of AI. Such findings matter because the very existence of these products suggests that children should be taking them, yet more research is needed on their potential (adverse) effects over both the short and long term. The substantial variation in dosages between products also raises questions about the (perhaps unnecessary) fortification of our children, as well as the expectations that parents know—or are even aware of—appropriate nutrient levels for their kids.

Nearly 20 000 e-liquids and 250 unique flavour descriptions: an overview of the Dutch market based on information from manufacturers

OBJECTIVES

Flavours increase attractiveness of electronic cigarettes and stimulate use among vulnerable groups such as non-smoking adolescents. It is important for regulators to monitor the market to gain insight in, and regulate the range of e-liquid flavours that is available to consumers. E-liquid manufacturers are required to report key product information to authorities in the European Member States in which they plan to market their products. This information was used to provide an overview of e-liquid flavour descriptions marketed in the Netherlands in 2017.

METHODS

Two researchers classified 19 266 e-liquids into the 16 main categories of the e-liquid flavour wheel, based on information from four variables in the European Common Entry Gate system. Flavour descriptions were further specified in subcategories.

RESULTS

For 16 300 e-liquids (85%), sufficient information was available for classification. The categories containing the highest number of e-liquids were fruit (34%), tobacco (16%) and dessert (10%). For all e-liquids, excluding unflavoured ones, 245 subcategories were defined within the main categories. In addition to previously reported subcategories, various miscellaneous flavours such as sandwich, buttermilk and lavender were identified.

CONCLUSIONS

In 2017, ~20 000 e-liquids were reported to be marketed in the Netherlands, in 245 unique flavour descriptions. The variety of marketed flavour descriptions reflects flavour preference of e-cigarette users as described in literature. Our systematic classification of e-liquids by flavour description provides a tool for organising the huge variety in market supply, serves as an example for other countries to generate similar overviews and can support regulators in developing flavour regulations.

Development of a Teen-Informed Coding Tool to Measure the Power of Food Advertisements

The food-related information environment, comprised of food and beverage advertising within one’s surroundings, is a growing concern for adolescent health given that food marketing disproportionately targets adolescents. Despite strong public interest concerning the effects of food marketing on child health, there is limited evidence focused on outdoor food advertising in relation to teenage diets, food purchasing, and perceptions. Further, limited research has considered both the exposure to and influence of such advertisements. This study used a novel multi-method approach to identify and quantify the features of outdoor food and beverage advertisements that are most effective at drawing teenagers into retail food establishments. An environmental audit of outdoor advertisements and consultations with youth were used to: (1) identify teen-directed food marketing techniques; (2) validate and weigh the power of individual advertising elements; and, (3) develop a teen-informed coding tool to measure the power of food-related advertisements. Results indicate that marketing power is a function of the presence and size of teen-directed advertisement features, and the relative nature of each feature is an important consideration. This study offers a quantitative measurement tool for food environment research and urges policymakers to consider teen-directed marketing when creating healthy communities.

Insect Food Products in the Western World: Assessing the Potential of a New 'Green' Market

Although two billion people already eat insects in the world and the benefits of edible insects are well known, these 'green' sources of protein are neither treated as conventional food products nor widely incorporated into Western diets. Using a school-based investigation surveying 161 children, aged 6-15, and 114 of their parents in London, and an online consumer survey with mainly British and French consumers (N = 1,020), this research provides insights into the potential of the insect market in the West. This work supports the idea that incorporating insect food into our diets makes not only environmental but also business sense. A nonnegligible segment of the population surveyed is willing to pay for mealworm minced meat and young children and pre-teens could represent a substantial market segment, as yet unexplored. This analysis points to multiple marketing strategies, such as early exposure, education, reducing the visibility of insect parts, celebrity endorsement, or peer-to-peer marketing, all of which could facilitate the adoption of insect food in the 'mainstream' arena, according to the consumer segment being targeted. Generalizations from these results are restricted to an educated and youthful subset of the potential consumer pool and further work remains to understand the patterns of Western consumer acceptance for the range of insect foods.

Direct-To-Consumer Advertising of Over-the-Counter Sinonasal Remedies: A History of Mixed Messages

Sinus, cold, and allergy remedies comprise the most widely used sector of the over-the-counter (OTC) drug market. Direct-to-consumer advertising (DTCA) of pharmaceutical products has increased over the past 30 years, including the promotion of OTC drugs. The influence of DTCA on OTC sinonasal remedies comprises several positive and negative effects. Favorable aspects of this influence include empowerment and promotion of autonomy among patients, avoidance of low-value clinical encounters, self-directed education, and decreased healthcare expenditures. This is balanced by potential concerns, including the lack of rigorous regulation of OTC drugs, the burden of self-diagnosis, the risk of unsupervised use resulting in adverse effects or drug interactions, and redistribution of pharmacy costs to the consumer. Despite the proliferation of product options and consumer-directed information, healthcare utilization and cost of treating sinonasal disease remains high. Moreover, the availability of OTC sinonasal remedies and exposure to DTCA has had mixed effects without apparent overall benefit to patient and consumer health. Laryngoscope, 130:2114-2119, 2020.

Recruiting the "Heavy-Using Loyalists of Tomorrow": An Analysis of the Aims, Effects and Mechanisms of Alcohol Advertising, Based on Advertising Industry Evaluations

Restricting alcohol advertising and marketing is a cost-effective intervention for reducing alcohol harms. However, the alcohol industry maintains that advertising does not affect consumption, claiming that its purpose is to help consumers choose brands, it is not aimed at young people, it only promotes "responsible consumption", and any relationships with consumption are not causal. We reviewed 39 case studies (1981-2016) published by the advertising industry, which evaluate the effects of alcohol advertising campaigns. We used these to examine these industry claims. 30/39 (77%) of the case studies mentioned increasing/maintaining market share as an objective, or used this to assess the effectiveness of advertising campaigns. Most (25/39, 64%) found that campaigns increased consumption-related outcomes. Some campaigns targeted women, and heavy drinkers (e.g., Stella Artois lager, Famous Grouse whisky). Campaigns often (13/39, 33%) targeted younger drinkers. These data show that advertising does influence market share. Other effects reported in the case studies include changing the consumer profile towards: younger drinkers, women, new/lapsed drinkers, and heavy drinkers. They also present evidence of a causal relationship between advertising and consumption. In conclusion, this analysis, based on industry data, presents significant new evidence on (i) the effects of alcohol advertising on consumption-related outcomes, and (ii) the mechanisms by which it achieves those effects.

Bidirectional associations between young adults' reported exposure to e-cigarette marketing and e-cigarette use

AIMS

To examine bidirectional associations between self-reported exposure to electronic nicotine delivery system (ENDS) marketing and ENDS use, over four 6-month follow-up surveys, among young adults.

DESIGN

The Marketing and Promotions Across Colleges in Texas project (M-PACT) is a cohort study that examined exposure to tobacco marketing and tobacco use behaviors among college students in Texas, United States.

SETTING AND PARTICIPANTS

Participants were 5478 students from 24 2-year and 4-year Texas colleges. Approximately 64% (n = 3506) of the cohort were non-white, 64% were female and the average age was 20 years.

MEASUREMENTS

Students completed a baseline survey in Fall 2014/Spring 2015 and three subsequent surveys 6 months apart. Items assessed current ENDS use and self-reported exposure to ENDS marketing through the point-of-sale, on television, on the radio, on the internet and on billboards. A multi-level cross-lagged path model was used to examine the bidirectional associations between self-reported exposure to ENDS marketing and current ENDS use across the four waves, controlling for socio-demographics.

FINDINGS

Self-reported exposure to ENDS marketing at each previous wave predicted ENDS use at each subsequent wave (β = 0.07-0.10, P < 0.001). ENDS use at waves 2 and 3 predicted self-reported exposure to ENDS marketing at wave 3 and 4, respectively (β = 0.07-0.09, P < 0.001). Although ENDS users were more likely than non-users to report exposure to ENDS marketing, self-reported exposure to ENDS marketing predicted subsequent ENDS use controlling for prior ENDS use.

CONCLUSION

Self-reported exposure to electronic nicotine delivery system (ENDS) marketing was bidirectionally associated with past 30-day use of ENDS among young adult college students in Texas, USA from 2014/15 to 2016.