Marketing of commercial foods for infant and young children in Uruguay: sugary products, health cues on packages and fun social products on Facebook

Commercial milk formula marketing following increased restrictions in Singapore: A qualitative study

The promotion of commercial milk formula (CMF) negatively impacts breastfeeding outcomes. In 2019, Singapore updated its 1979 Code of Ethics of the Sale of Infant Foods Ethics Committee Singapore (SIFECS) to increase marketing restrictions on CMF for infants 0-12 months. However, little is known about industry tactics to undermine these restrictions. This qualitative study explores health workers' and mothers' experiences with CMF marketing in Singapore following the 2019 restrictions. We conducted a qualitative study, using semistructured interviews with 14 mothers of infants aged less than 5 months and 20 health workers with expertise in antenatal, maternity, or paediatric care. We analysed data thematically using inductive coding. Five themes were identified. Mothers and health workers reported digital marketing, product line extensions with toddlers' milk and milk for mothers, and CMF sponsorships in the healthcare setting. Expert endorsement, competitive price, nutritional claims, and brand reputation influenced mothers' infant formula choices, yet both mothers and health workers appeared to be unaware of the impact of CMF marketing tactics on their own perceptions. The restriction of CMF marketing and infant feeding practices varied widely between hospitals, with private hospitals and practices having less strict controls on CMF marketing. Despite the updated SIFECS restrictions, CMF companies continue to target mothers and health workers in Singapore. SIFECS restrictions should be tightened to align with international guidelines, by increasing their scope to include toddlers' milk and prohibiting cross-promotion, digital marketing, and any sponsorships of events targeting health workers that may create a conflict of interest.

Health first, convenience second: Caregiver perspectives of commercially produced complementary foods in five Southeast Asian capital cities

Caregivers in low- and middle-income countries increasingly feed commercially produced complementary foods (CPCF) to older infants and young children-shaped by factors including industry promotion. The dynamics of CPCF consumption and caregiver knowledge, attitudes and behaviours regarding complementary feeding practices are poorly understood in these settings. We examined how caregiver knowledge/attitudes/behaviours about CPCF shape the feeding of older infants and young children in the capital cities of five countries in Southeast Asia (Bangkok, Hanoi, Jakarta, Kuala Lumpur, Manila). An online, web-based, cross-sectional panel survey was conducted among mothers of a child aged 6-23 months. One hundred participants were included in each of the five capital cities. Questionnaires were undertaken in the official language of each city. Data were analysed in Stata (version 17.0), using χ2 tests to examine difference between variables of interest. All mothers purchased CPCF for their youngest child aged 6-23 months at the time of survey. CPCF were commonly fed to children at least once per day, and in many of the five cities at most or every feeding. While factors such as convenience and affordability influenced CPCF purchase, mothers primarily purchased CPCF for nutritional reasons. The most common source of feeding information was health care professionals, followed by social media. CPCF are ubiquitous in the diets of older infants and young children of educated middle-upper socioeconomic status mothers in capital cities of Southeast Asia, with perceived healthiness a key driver in selecting CPCF. A strong governmental regulatory response to industry marketing/promotion will be critical to addressing CPCF appropriateness, including health and nutritional claim use.

Health-Washing of Ultraprocessed Products on Instagram: Prevalence and Strategies in an Emerging Market

OBJECTIVE

To evaluate the prevalence of health-related cues as part of the digital marketing of ultraprocessed foods on Instagram among food companies in Uruguay.

METHODS

Cross-sectional exploratory study. All content posted by 118 Instagram accounts of companies promoting ultraprocessed foods in Uruguay over 6 months (from August 2020 to February 2021) was retrieved. The content of 1,893 Instagram posts was coded considering visual and textual cues conveying health-related associations. The number and percentage of posts, including cues within each category and theme, were calculated.

RESULTS

More than half of all posts contained at least 1 visual or textual cue conveying health-related associations. Three main themes emerged: i) product composition, ii) healthy lifestyle, and iii) health and health benefits. The prevalence of health-related cues differed dramatically across product categories, ranging from 100% to 1.5%.

CONCLUSIONS AND IMPLICATIONS

Health-washing constitutes an integral part of the digital marketing of ultraprocessed foods on Instagram in Uruguay. The inclusion of health-related cues can potentially undermine public health efforts targeted at reducing consumption of these foods. These findings suggest that strict and comprehensive regulations on the digital marketing of such products are needed in policies promoting healthy eating habits globally.

Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico

BACKGROUND

Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children's feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries.

METHODS

Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software.

RESULTS

Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products.

CONCLUSIONS

Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children's right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making.

The content of Instagram posts featuring ultra-processed products through the lens of the heuristic-systematic model

Digital marketing has seen a rapid rise in the last decade as a consequence of the increased popularity of social media. However, few studies so far have analyzed the prevalence and persuasive power of digital marketing of ultra-processed products. The present study aimed at: (i) analyzing the content of Instagram posts of ultra-processed products through the lens of the heuristic-systematic model, and (ii) evaluating the influence of the content of the posts on user interactions. A search for Instagram accounts of ultra-processed products was performed using a master list of products commercialized in the two most popular online supermarkets in Uruguay. For each of the identified Instagram accounts, all the content posted in a 6-month period was recorded (August 15th, 2020 to February 15th, 2021). The posts were analyzed using content analysis based on inductive coding, and gradient boosting models (GBMs) were used to address the second study objective. A total of 2178 Instagram posts promoting specific ultra-processed products or brands were identified. The posts included a diverse set of cues to trigger both systematic and heuristic processing. References to the pleasure derived from product consumption as well as health-related cues were most prevalent. The GBM showed that references to contests and raffles and invitations to interact encouraged users to engage with the posts through posting comments. Taken together, results stress the need to implement comprehensive regulatory approaches to reduce exposure to and the power of digital marketing of ultra-processed products given the harmful health-related consequences associated with excessive consumption of such products.