Ghettoizing outdoor advertising: disadvantage and ad panel density in black neighborhoods

Advertisements of ultra-processed products outside food outlets: field evidence from Montevideo, Uruguay

OBJECTIVES

To evaluate the prevalence of advertisements for ultra-processed products outside food outlets in Montevideo (Uruguay) and explore the patterns of these advertisements across areas with different socio-economic statuses (SES).

DESIGN

Cross-sectional field survey of advertisements of ultra-processed products outside food outlets. The percentage of outlets featuring any type of advertisement of ultra-processed products on the exterior part of the outlets was calculated, at the aggregate level and separately by type of outlet and type of product. Comparisons were made considering the SES of the tract where outlets were located.

SETTING

106 census tracts in Montevideo, differing in geographical location and SES.

PARTICIPANTS

Outlets selling foods and beverages, located within the selected census tracts.

RESULTS

30·7 % of the 1217 food outlets identified in the field survey featured some type of exterior advertisement of ultra-processed products. Sweetened beverages (specifically soda) were the most frequently advertised ultra-processed product category, followed by ice cream. After adjusting for the type of outlet, medium SES tracts exhibited the highest prevalence of ultra-processed product advertisements outside food outlets (36·0 %). Differences in the prevalence of advertisements of specific categories with SES were also found, which may reflect variations in the types and characteristics of food outlets.

CONCLUSIONS

Results from this work suggest the frequent presence of exterior advertisements of ultra-processed products and highlight the need to develop effective policies to reduce their use as part of a comprehensive set of strategies to discourage the consumption of ultra-processed products.

The Association Between Racial Attitudes, Alcohol Use and Mood Disorders Among Black Adolescents

Alcohol is the most widely used substance among adolescents. Although Black adolescents use alcohol at lower rates than White adolescents, Black adolescents tend to have worse outcomes. This includes higher rates of mood disorders and criminal justice involvement associated with alcohol use and misuse compared to any other racial group. Black adolescents are also more likely to experience racial discrimination and be exposed to traumatic events within their communities, which may increase their chances of using substances. Understanding the relationship between racial attitudes (towards one's own group and others) and substance use and mental health can provide unique and meaningful insight into prevention programming for Black adolescents. Yet, these concepts have been understudied. To fill this gap, we examined the association between racial attitudes and alcohol use and mood disorders in Black adolescents in Philadelphia, PA (N = 154). We used the revised Adolescent Survey of Black Life to measure pro-Black (positive attitudes toward being Black and factors related to Black people), anti-White (negative attitudes toward White people due to experiences of racism and discrimination) and racism awareness (recognition of racism) domains. Logistic regression analyses were conducted to test the associations. Results showed that: higher pro-Black attitudes were associated with a lower odds of mood disorder (odds ratio [OR] = 0.72, 95% CI = 0.55, 0.89); and higher racism awareness was associated with an increased odds of alcohol use (OR = 1.18, 95% confidence interval [CI] = 1.06, 1.29). Findings provide preliminary support for interventions and policies for Black adolescents that bolster positive racial identity and eliminate experiences of racism as alcohol use and mood disorder prevention strategies.

Use of environmental scan to assess density, content, and variation of predatory food and beverage marketing in New York City

To explore the presence of predatory food and beverage marketing in different neighborhoods in New York City (NYC), this study describes the methodology of an outdoor environmental scan of the physical environment. The study was conducted in four NYC neighborhoods over a three-week period, in which pairs of trained researchers canvassed designated neighborhoods to document the presence of food and beverage marketing using photographs taken on digital smart phone devices. Commercial areas in the vicinity of NYC Public Schools and NYC Housing Authority campuses located in four neighborhoods with the highest and lowest nutrition related health indicators were studied: South Bronx, Pelham Throggs Neck, Upper West Side, Chelsea/Greenwich Village. Advertisements were coded against 50+ indicators to quantify pertinent variables including the frequency and content of food and beverages advertised and all forms of predatory marketing observed. Comparisons of prevalence and content of food and beverage advertisements and predatory marketing were made across neighborhoods with the highest and lowest health indicators, using chi-squared analysis, and a significance level of p < 0.05. This article demonstrates a disproportionate presence of predatory marketing in low income NYC neighborhoods with negative health outcomes compared to wealthier neighborhoods. Further, this paper demonstrates the benefits and limitations of using an environmental scan methodology to assess predatory food and beverage marketing in a large urban area such as NYC.

Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: A systematic review of the evidence

Children's exposure to advertising of unhealthy food and nonalcoholic beverages that are high in saturated fats, salt and/or sugar is extensive and increases children's preferences for, and intake of, targeted products. This systematic review examines the differential potential exposure and impact of unhealthy food advertising to children according to socio-economic position (SEP) and/or ethnicity. Nine databases (health, business, marketing) and grey literature were searched in November 2019 using terms relating to 'food or drink', 'advertising' and 'socioeconomic position or ethnicity'. Studies published since 2007 were included. Article screening and data extraction were conducted by two independent reviewers. Quality of studies was assessed using the Newcastle-Ottawa quality scale. Of the 25 articles included, 14 focused on exposure to unhealthy food advertising via television, nine via outdoor mediums and two via multiple mediums. Most studies (n = 19) revealed a higher potential exposure or a greater potential impact of unhealthy food advertising among ethnic minority or lower SEP children. Few studies reported no difference (n = 3) or mixed findings (n = 3). Children from minority and socio-economically disadvantaged backgrounds are disproportionately exposed to unhealthy food advertising. Regulations to restrict unhealthy food advertising to children should be implemented to improve children's diets and reduce inequities in dietary intake.

African-American Women's Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions

BACKGROUND

Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African-Americans. Substance use may be shaped by social contextual influences from families and peers in African-American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African-American women.

OBJECTIVES

This study explores the effects of African-American women's social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use.

METHODS

Survey data was collected in-person from 521 African-American women. Multivariate logistic models identified the significant correlates of women's daily use of tobacco and marijuana in the past six months.

RESULTS

52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one's health was protective against daily marijuana use.

CONCLUSIONS

Findings stress the need for prevention and intervention efforts for African-American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.

Billboard advertising: an avenue for communicating healthcare information and opportunities to disadvantaged populations

Background

Healthcare communications directed toward the disadvantaged have the potential to elevate the health status of these underprivileged and highly-challenged individuals. From conveying advice which encourages healthy lifestyles to communicating the location and availability of various medical resources, healthier lives and communities can be realized. Success on this front first requires establishing an effective communications link, something that is made more difficult as communications options available to the disadvantaged are more limited than those available to advantaged populations.

Discussion

One avenue which shows exceptional promise for successfully engaging the disadvantaged is that of billboard advertising. Willis-Knighton Health System’s experiences and insights indicate that the characteristics and qualities of billboards, paired with the environmental circumstances typically faced by the less fortunate, create unique combinations which amplify consumption of billboard advertising content. Further, research suggests that the less privileged place greater reliance on the medium than do their more privileged counterparts, escalating the value and impact potential of billboard advertising directed toward the disadvantaged.

Conclusions

Given the value afforded by health and wellness information successfully reaching the disadvantaged, opportunities to better distribute content to targeted audiences could very well improve community health. Billboard advertising appears to be well suited to engage the less fortunate, providing a productive pathway for the conveyance of helpful, supportive details, yielding healthier populations, enhanced opportunities, and better communities.

A longitudinal study of the relationship between receptivity to e-cigarette advertisements and e-cigarette use among baseline non-users of cigarettes and e-cigarettes, United States

BACKGROUND

We investigated the relationship between receptivity to electronic cigarette (e-cigarette) advertisements at baseline and e-cigarette use at follow-up among adult baseline non-users of cigarettes and e-cigarettes.

METHODS

A nationally representative online panel was used to survey non-users of cigarettes and e-cigarettes (n = 2191) at baseline and 5-month follow-up. At baseline, respondents were shown an e-cigarette advertisement and asked if they were aware of it (exposure). Among those exposed, receptivity was self-rated for each ad using a validated scale of 1 to 5 for agreement with each of six items: "worth remembering," "grabbed my attention," "powerful," "informative," "meaningful," and "convincing." Logistic regression was used to measure the relationship between receptivity at baseline and e-cigarette use at follow-up.

RESULTS

Among baseline non-users of cigarettes and e-cigarettes, 16.6% reported exposure to e-cigarette advertisements at baseline; overall mean receptivity score was 2.77. Among baseline non-users who reported exposure to e-cigarette advertisements, incidence of e-cigarette use at follow-up was 2.7%; among baseline non-users who reported not being exposed to e-cigarette advertisements, incidence of e-cigarette use at follow-up was 1.3%. The attributable risk percentage for e-cigarette initiation from e-cigarette advertisement exposure was 59.3%; the population attributable risk percentage from e-cigarette advertisement exposure was 22.6%. Receptivity at baseline was associated with e-cigarette use at follow-up (aOR = 1.57; 95% CI = 1.04-2.37).

CONCLUSIONS

Receptivity to e-cigarette advertisements at baseline was associated with greater odds of e-cigarette use at follow-up among baseline non-users of cigarettes and e-cigarettes. Understanding the role of advertising in e-cigarette initiation could help inform public health policy.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.

Associations between retail food store exterior advertisements and community demographic and socioeconomic composition

This paper examines the association between the prevalence of various types of outdoor food and beverage advertising found on the building exteriors and properties of retail food outlets and community racial/ethnic and socioeconomic composition in a nationwide sample of food outlets in the U.S. Our major finding from multivariable analysis is that food stores in low-income communities have higher prevalence of all food and beverage ads, including those for unhealthy products such as regular soda, controlling for community racial/ethnic composition and other covariates. This adds to growing research pointing to socioeconomic disparities in food and beverage marketing exposure.

"I just use it for weed": The modification of little cigars and cigarillos by young adult African American male users

Little cigar and cigarillo (LCC) use has received increased attention, but research on their modification is limited. Qualitative interviews with 17 young adult African American male LCC users investigated tobacco use behaviors and patterns, including LCC modification. The modification of LCCs for use as blunts emerged as a very prominent aspect of LCC users' tobacco use. Four subthemes regarding marijuana and blunt use are explored in this article, including participants' explanations of how blunts are made and used, concurrent use of marijuana and tobacco, perceptions and reasons for smoking marijuana and blunts, and perceptions of the risks of blunt use.

Socioeconomic differences in outdoor food advertising at public transit stops across Melbourne suburbs

OBJECTIVE

To assess and compare the number and type of outdoor food advertisements at public transit stops within suburbs of varying levels of socioeconomic disadvantage.

METHOD

An observational audit tool was developed and implemented to assess the number and type of food advertisements at public transit stops within Melbourne, Victoria. A total of 20 Melbourne neighbourhoods (suburbs) from across the least and the most socioeconomically disadvantaged areas were selected. All public transit stops, including train stations and bus and tram stops with a shelter were audited. 

RESULTS

A similar proportion of transit stops in the least and most-disadvantaged suburbs displayed food advertisements (total n=203). However, some differences in the type of advertisements across suburbs were noted with advertisements for fast food restaurants, flavoured milk and fruit juice more common in the most-disadvantaged neighbourhoods (all p<0.05) and advertisements for diet soft drink, tea, coffee and convenience stores more common in the least-disadvantaged neighbourhoods (all p<0.05).

CONCLUSION

This exploration of outdoor food advertising at Melbourne transit stops found 30% displayed food advertisements, with those in more disadvantaged suburbs more frequently promoting chain-brand fast food and less frequently promoting diet varieties of soft drinks. These findings may help raise awareness of unhealthy environmental exposures.

Changes in alcohol consumption: United States, 2001-2002 to 2012-2013

BACKGROUND

Documenting changes in alcohol consumption is critical for assessing future health service and alcohol treatment needs, evaluating efforts to modify drinking behavior and understanding the impact of shifting demographics and social norms. For the period since 2000, published data on drinking trends have been scarce and inconsistent.

METHODS

Using data from two large, nationally representative surveys of U.S. adults (2001-2002 and 2012-2013) that contained virtually identical questions on consumption, we assessed differences by period in the prevalence of drinking, volume of intake, frequency of drinking and prevalence of ≥monthly heavy episodic drinking (HED) and determined whether changes in consumption were consistent across beverage types and in population subgroups.

RESULTS

Between 2001-2002 and 2012-2013, the prevalence of drinking increased, as did volume and frequency of drinking and prevalence of ≥monthly HED among drinkers. Increases were greater for women than men for all measures and smaller among the formerly married for consumption among drinkers. The increase in overall drinking prevalence was magnified among all race-ethnic minorities, whereas the increase in ≥monthly HED was magnified only among Blacks (all relative to Whites).

CONCLUSIONS

Our findings are suggestive of a "wetter" drinking climate in 2012-2013 than in 2001-2002, indicating the need for continued and expanded efforts to prevent chronic and episodic heavy alcohol consumption. Given the across-the-board increases in alcohol consumption in recent years, policy efforts that address drinking at the population level are supported, even if specific drinking behaviors and subgroups of drinkers are additionally targeted for individualized approaches.

Strategies employed by inner-city activists to reduce alcohol-related problems and advance social justice

This study explored strategies employed by activists engaged in efforts to change policies and laws related to selling and promoting alcoholic beverages based on in-depth interviews with 184 social activists in seven U.S. major cities. Nine strategies aimed at improving local conditions and influencing policy were described by activists across regional contexts. Grassroots mobilization was central to all other strategies, which included the creation or enforcement of laws, meeting with elected officials, media advocacy, working with police/law enforcement, education and training, direct action, changing community norms, and negotiating with store owners.

Examination of spatial polygamy among young gay, bisexual, and other men who have sex with men in New York City: the P18 cohort study

The few previous studies examining the influence of the neighborhood context on health and health behavior among young gay, bisexual, and other men who have sex with men (YMSM) have predominantly focused on residential neighborhoods. No studies have examined multiple neighborhood contexts among YMSM or the relationships between sociodemographic characteristics, psychosocial factors, social support network characteristics, health behaviors, and neighborhood concordance. In this study, we assessed spatial polygamy by determining the amount of concordance between residential, social, and sex neighborhoods (defined as boroughs) in addition to examining individual-level characteristics that may be associated with neighborhood concordance. These data come from the baseline assessment of Project 18, a cohort of racially and ethnically diverse YMSM residing in the New York City metropolitan area. Participants (N = 598) provided information on their residential, social, and sex boroughs as well as information on their sociodemographic characteristics, psychosocial factors, social support network characteristics, and health behaviors (e.g., substance use and condomless sex). Descriptive analyses were conducted to examine the distribution of boroughs reported across all three contexts, i.e., residential, social, and sex boroughs. Next, concordance between: (1) residential and social boroughs; (2) residential and sex boroughs; (3) social and sex boroughs; and (4) residential, social, and sex boroughs was assessed. Finally, bivariable analyses were conducted to examine the relationships between sociodemographic characteristics, psychosocial factors, social support network characteristics, and health behaviors in relation to borough concordance. Approximately two-thirds of participants reported concordance between residential/socializing, residential/sex, and sex/socializing boroughs, whereas 25% reported concordance between all three residential/socializing/sex boroughs. Borough concordance varied by some individual-level characteristics. For example, White YMSM and YMSM reporting lower perceived socioeconomic status were significantly more likely to report residential/socializing/sex borough concordance (p < 0.001). With regard to psychosocial factors, YMSM who reported experiencing gay-related stigma in public forums were more likely to report discordant socializing/sex and residential/socializing/sex boroughs (p < 0.001). Greater frequency of communication with network members (≥weekly) was associated with less residential/social borough concordance (p < 0.05). YMSM who reported residential/socializing/sex borough concordance were more likely to report recent (last 30 days) alcohol use, recent marijuana use, and recently engaging in condomless oral sex (all p < 0.05). These findings suggest that spatial polygamy, or an individual moving across and experiencing multiple neighborhood contexts, is prevalent among urban YMSM and that spatial polygamy varies by multiple individual-level characteristics. Future research among YMSM populations should consider multiple neighborhood contexts in order to provide a more nuanced understanding of how and which neighborhood contexts influence the health and well-being of YMSM. This further examination of spatial polygamy (and individual-level characteristics associated with it) may increase understanding of the most appropriate locations for targeted disease prevention and health promotion interventions (e.g., HIV prevention interventions).

Havens of risks or resources? A study of two Latino neighborhoods in New York City

Research has been mixed on the potential risks and resources that ethnic enclaves may confer upon residents: whereas some authors characterize racial and ethnic minority neighborhoods through the lens of segregation and risk, others argue that these minority neighborhoods are ethnic enclaves that can improve the availability of resources to residents. In this study, we sought to assess two predominantly Latino New York City neighborhoods (one enclave neighborhood and one comparison) in the areas of structural resources (e.g., grocers, parks), cultural resources (e.g., botanicas, hair salons), and risks (e.g., empty lots, bars) by street-level coding in 20 census tracts (streets N = 202). We used Poisson generalized linear models to assess whether enclave status of a neighborhood predicted the numbers of risks and resources on streets within those neighborhoods. Enclave status did not predict the number of risks (Rate ratio = 1.08(0.83, 1.42), χ (2)(1, N = 202) = 0.35, p = n. s.) or cultural resources (Rate ratio = 0.87(0.54, 1.40), χ (2)(1, N = 202) = 0.34, p = n. s.), yet it was associated with a higher number of structural resources (Rate ratio = 1.90(1.48, 2.43), χ (2)(1, N = 202) = 25.74, p < 0.001). The results suggest that while living in an ethnic enclave may not reduce risks, it may help residents cope with those risks through an increased number of structural resources. These findings support theories that conceptualize ethnic enclaves as neighborhoods where greater resources are available to residents. The focus on resources within this work was instrumental, as no difference would have been found if a solely risk-focused approach had been employed.

Trends in exposure to pro-tobacco advertisements over the Internet, in newspapers/magazines, and at retail stores among U.S. middle and high school students, 2000-2012

BACKGROUND

Most tobacco use begins during youth. Thus, this study assessed the prevalence, trends, and correlates of pro-tobacco advertising among United States students in grades 6-12 during 2000-2012.

METHODS

Data from the 2000-2012 National Youth Tobacco Survey were analyzed to assess self-reported exposure to pro-tobacco advertisements through three media: over the Internet, in newspapers/magazines, and at retail stores. Trends during 2000-2012 were assessed in a binary logistic regression model (P<0.05).

RESULTS

Among all middle and high school students, the overall prevalence of exposure to Internet pro-tobacco advertisements increased from 22.3% to 43.0% during 2000-2012 (P<0.001 for linear trend). During the same period, declines were observed in the overall prevalence of exposure to pro-tobacco advertisements in newspapers/magazines (65.0% to 36.9%) and at retail stores (87.8% to 76.2%) (P<0.001 for all linear trends).

CONCLUSION

Exposure to pro-tobacco advertisements over the Internet increased significantly during 2000-2012 among United States middle and high school students, while a decline in exposure to advertisements in newspapers or magazines, and at retail stores occurred during the same period. However, over two-thirds of students still reported retail store exposure to pro-tobacco advertisements in 2012. Enhanced and sustained efforts would be beneficial to reduce even more exposure to all forms of pro-tobacco advertisements among youths.

Factors associated with small cigar use among college students

OBJECTIVE

To assess small cigar use among college students in the southeastern United States.

METHODS

Data from a 2010 online survey were analyzed to examine small cigar smoking and its sociodemographic and psychosocial correlates among 4388 college students, aged 18-30.

RESULTS

Small cigar users were more likely to be younger, male, black, and current cigarette, cigar, hookah, or marijuana smokers (p's < .05). They reported lower perceived harm of smoking and greater sensation seeking and perceived stress. Menthol cigarette smokers were more likely to smoke small cigars.

CONCLUSIONS

Small cigar use and the co-occurrence of other tobacco and substance use should be addressed among college students.

Retailer adherence to Family Smoking Prevention and Tobacco Control Act, North Carolina, 2011

Introduction

The Family Smoking Prevention and Tobacco Control Act regulates the sales and marketing of tobacco products in the United States; poor adherence by tobacco retailers may reduce the effectiveness of the Act’s provisions. The objectives of this study were 1) to assess whether and to which provisions retailers were adherent and 2) to examine differences in adherence by county, retailer neighborhood, and retailer characteristics.

Methods

We conducted multivariate analysis of tobacco retailers’ adherence to 12 point-of-sale provisions of the Tobacco Control Act in 3 North Carolina counties. We conducted observational audits of 324 retailers during 3 months in 2011 to assess adherence. We used logistic regression to assess associations between adherence to provisions and characteristics of each county, retailer neighborhood, and retailer.

Results

We found 15.7% of retailers did not adhere to at least 1 provision; 84.3% adhered to all provisions. The provisions most frequently violated were the ban on sales of cigarettes with modified-risk labels (eg, “light” cigarettes) (43 [13.3%] retailers nonadherent) and the ban on self-service for cigarettes and smokeless tobacco (6 [1.9%] retailers nonadherent). We found significant differences in rates of nonadherence by county and type of retailer. Pharmacies and drug stores were more than 3 times as likely as grocery stores to be nonadherent.

Conclusion

Most tobacco retailers have implemented regulatory changes without enforcement by the US Food and Drug Administration. Monitoring rates of adherence by store type and locale (eg, county) may help retailers comply with point-of-sale provisions.

Outdoor advertising, obesity, and soda consumption: a cross-sectional study

Background

Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity.

Methods

To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18–98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements.

Results

The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 - 1.093, p<0.03) greater odds of being overweight or obese, controlling for other factors. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30% of ads were for food would have a 2.6% increase in the probability of being obese.

Conclusions

There is a relationship between the percentage of outdoor food advertising and overweight/obesity.

Store and restaurant advertising and health of public housing residents

OBJECTIVES

To determine relationships between food and beverage signs and health.

METHODS

In 12 public housing neighborhoods, food and alcohol signs were counted for stores and restaurants. Health and demographic data were from 373 adults.

RESULTS

Multilevel modeling showed higher BMI was related to more store and restaurant alcohol signs, higher blood pressure, nonsmokers, and females. Higher dietary fat consumption was related to more store and restaurant alcohol and fewer low-calorie healthy signs, lower fruit consumption, fewer minutes walked, and white and Hispanic/Latino ethnicity.

CONCLUSIONS

Signs in stores and restaurants are related to BMI and dietary fat consumption among residents.

Socio-economic differences in outdoor food advertising in a city in Northern England

OBJECTIVE

To explore differences in the prevalence of outdoor food advertising, and the type and nutritional content of advertised foods, according to an area-based marker of socio-economic position (SEP) in a city in Northern England.

DESIGN

All outdoor advertisements in the city were identified during October-December 2009, their size (in m2) estimated and their location determined using a global positioning system device. Advertisements were classified as food or non-food. Food advertisements were classified into one of six food categories. Information on the nutritional content of advertised foods was obtained from packaging and manufacturer's websites. An area-based marker of SEP was assigned using the location of each advertisement, grouped into three affluence tertiles for analysis.

SETTING

A city in Northern England.

SUBJECTS

None.

RESULTS

In all, 1371 advertisements were identified; 211 (15 %) of these were for food. The advertisements covered 6765 m2, of which 1326 m2 (20 %) was for food. Total advertising and food advertising space was largest in the least affluent tertile. There was little evidence of socio-economic trends in the type or nutritional content of advertised foods.

CONCLUSIONS

Despite an absence of socio-economic differences in the type and nutritional content of advertised foods, there were socio-economic differences in food advertising space. There may also be socio-economic differences in exposure to outdoor food advertising.

Behavior matters

Behavior has a broad and central role in health. Behavioral interventions can be effectively used to prevent disease, improve management of existing disease, increase quality of life, and reduce healthcare costs. A summary is presented of evidence for these conclusions in cardiovascular disease/diabetes, cancer, and HIV/AIDS as well as with key risk factors: tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. For each, documentation is made of (1) moderation of genetic and other fundamental biological influences by behaviors and social-environmental factors; (2) impacts of behaviors on health; (3) success of behavioral interventions in prevention; (4) disease management; (5) quality of life, and (6) improvements in the health of populations through behavioral health promotion programs. Evidence indicates the cost effectiveness and value of behavioral interventions, especially relative to other common health services as well as the value they add in terms of quality of life. Pertinent to clinicians and their patients as well as to health policy and population health, the benefits of behavioral interventions extend beyond impacts on a particular disease or risk factor. Rather, they include broad effects and benefits on prevention, disease management, and well-being across the life span. Among priorities for dissemination research, the application of behavioral approaches is challenged by diverse barriers, including socioeconomic barriers linked to health disparities. However, behavioral approaches including those emphasizing community and social influences appear to be useful in addressing such challenges. In sum, behavioral approaches should have a central place in prevention and health care of the 21st century.

Racial/ethnic differences in US health behaviors: a decomposition analysis

OBJECTIVE

To quantify contributions of individual sociodemographic factors, neighborhood socioeconomic status (NSES), and unmeasured factors to racial/ethnic differences in health behaviors for non-Hispanic (NH) whites, NH blacks, and Mexican Americans.

METHODS

We used linear regression and Oaxaca decomposition analyses.

RESULTS

Although individual characteristics and NSES contributed to racial/ethnic differences in health behaviors, differential responses by individual characteristics and NSES also played a significant role.

CONCLUSIONS

There are racial/ethnic differences in the way that individual-level determinants and NSES affect health behaviors. Understanding the mechanisms for differential responses could inform community interventions and public health campaigns that target particular groups.

Complexity of measuring "cigar use" in adolescents: results from a split sample experiment

INTRODUCTION

Inclusion of brand-specific examples (BE) in health surveys assessing lifetime and current cigar use has been shown to impact response rates. A split sample experimental design was used to investigate whether these rates are consistent by race, gender, and geographic locale.

METHODS

The 2009 Cuyahoga County Youth Risk Behavior Survey was conducted among 20 randomly selected high schools. Two versions of the survey were created; the first included items assessing lifetime and current cigar use with no brand-specific examples (NBE) while the second included BE in the items assessing cigar use. Both survey versions were distributed randomly within selected classrooms in participating schools.

RESULTS

Within the City, both White and Black BE respondents reported higher lifetime cigar product use prevalence and current cigar product use compared to the NBE group; however, the difference was only significant among Black respondents (odds ratio [OR] = 1.45, 95% CI 1.02-2.06). In the Outer Ring, White BE respondents were significantly less likely to report lifetime cigar use (OR = 0.73, 95% CI: 0.54 - 0.98) and current cigar use (OR = 0.66, 95% CI: 0.44-0.99) when compared with White NBE respondents.

CONCLUSIONS

Inclusion of BE in current measures of cigar product use may improve product use estimates in at-risk groups. However, better estimation of cigar product use may be accomplished by creating additional items to assess the use of subtypes of cigars.

A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising

CONTEXT

Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient-dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities.

METHODS

Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia.

FINDINGS

Large variations were observed in the amount, type, and value of advertising in the selected zip code areas. Living in an upper-income neighborhood, regardless of its residents' predominant ethnicity, is generally protective against exposure to most types of obesity-promoting outdoor advertising (food, fast food, sugary beverages, sedentary entertainment, and transportation). The density of advertising varied by zip code area race/ethnicity, with African American zip code areas having the highest advertising densities, Latino zip code areas having slightly lower densities, and white zip code areas having the lowest densities.

CONCLUSIONS

The potential health and economic implications of differential exposure to obesity-related advertising are substantial. Although substantive legal questions remain about the government's ability to regulate advertising, the success of limiting tobacco advertising offers lessons for reducing the marketing contribution to the obesigenicity of urban environments.

Understanding African American men's perceptions of racism, male gender socialization, and social capital through photovoice

In this study we used a participatory qualitative research approach--photovoice--to collect information about African American men's perceptions of the factors that influenced their own health and the health of their communities. Photovoice was conducted as part of the "Men as Navigators (MAN) for Health" project, an evaluation of a male lay health advisor (LHA) intervention in central North Carolina. Twelve African American men living in both urban and rural communities took photographs and discussed the photos in six photo discussion sessions. Analysis involved identifying recurring themes from the photos and transcriptions of photo discussions. The results suggest that race and racism, male gender socialization, and social networks and social capital all have important influences on African American men's health. The implications for further research and public health practice are discussed.

Examining the interaction between food outlets and outdoor food advertisements with primary school food environments

Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students' exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.

Association between residential exposure to outdoor alcohol advertising and problem drinking among African American women in New York City

We evaluated the association between residential exposure to outdoor alcohol advertising and current problem drinking among 139 African American women aged 21 to 49 years in Central Harlem, New York City. We found that exposure to advertisements was positively related to problem drinking (13% greater odds), even after we controlled for a family history of alcohol problems and socioeconomic status. The results suggest that the density of alcohol advertisements in predominantly African American neighborhoods may add to problem drinking behavior of their residents.

O impacto da publicidade de bebidas alcoólicas sobre o consumo entre jovens: revisão da literatura internacional

OBJETIVO: Problemas relacionados ao consumo de álcool são freqüentes, especialmente entre a população jovem. A publicidade de bebidas alcoólicas é um dos fatores passíveis de modificação com impacto no aumento do consumo de álcool. MÉTODO: Foi realizada uma revisão bibliográfica de trabalhos que investigaram de diversos pontos de vista o impacto da publicidade do álcool sobre o consumo. A busca foi feita nas bases de dados Medline, SciELO, PsychoInfo e Google Scholar no período entre 1990 e 2008 e utilizou-se a técnica de " bola de neve" para a indicação de autores mais profícuos na área. Obtiveram-se mais de uma centena de artigos. RESULTADOS: O conjunto de trabalhos aponta que fatores como exposição à publicidade e atratividade da publicidade de bebidas alcoólicas estão relacionados com uma maior expectativa de consumo futuro e com um consumo maior e mais precoce, principalmente entre adolescentes e adultos jovens. Apesar das dificuldades metodológicas, estudos econométricos mais recentes consideram que a redução e/ou banimento de publicidade teria efeito de redução do consumo de álcool. Questões referentes às bases neurofisiológicas do processo de tomada de decisões e da liberdade de escolha no contexto da exposição à publicidade também são discutidas. CONCLUSÕES: O conhecimento atual sobre o tema indica que a redução da exposição à publicidade tem impacto sobre o consumo de álcool, principalmente entre os mais jovens.

Alcohol Advertising on Billboards, Transit Shelters, and Bus Benches in Inner-City Neighborhoods

We describe the structure, content, and neighborhood characteristics of outdoor alcohol advertisements (n=246) in inner-city neighborhoods in ten U.S. cities from 2003 to 2005. We conducted observations of alcohol advertisements on billboards, transit shelters, and bus benches in all ten cities to describe the structure and content of outdoor alcohol advertising. We also created geo-spatial maps to describe the neighborhood characteristics where alcohol billboards were located in San Francisco, CA and Atlanta, GA. Alcohol advertisements were more common on billboards than transit shelters or bus benches, usually featured beer products, emphasized product quality, had a discreet or moderate (vs. blatant) visual impact, and rarely used human models. Outdoor advertisements on transit shelters and bus benches were rare. In Atlanta (but not San Francisco), alcohol billboards were more prevalent in African-American neighborhoods and in neighborhoods with higher percentages of female-headed households. Results suggest that billboards continue to be the mainstay of outdoor alcohol advertising in inner cities.

Prevalence, proximity and predictors of alcohol ads in Central Harlem

AIMS

This study examined the prevalence of alcohol ads, the spatial relationship between alcohol ads and schools, churches and playgrounds, and area-level determinants of alcohol ad density in Central Harlem, New York City.

METHODS

Alcohol advertising was quantified using street observation. Data on city demographics and infrastructure were obtained from the census and municipal databases.

RESULTS

Alcohol ads were densely distributed; almost half of ads fell within a 152 m buffer of schools, churches and playgrounds; and ad density was positively associated with retail liquor outlet density.

CONCLUSIONS

Predominantly Black neighbourhoods continue to face high exposure to outdoor alcohol advertising, including around sites at which youth congregate.