Impact of a health marketing campaign on sugars intake by children aged 5-11 years and parental views on reducing children's consumption

The use of food barcode scanner app among women: Associations with orthorexia, diet and emotions

This cross-sectional study investigated the relationship between the use of food barcode scanner app (FBSA) and orthorexia, diet and emotions. A total of 1610 women from the general population were included in this study, 388 of whom were FBSA users. Participants completed questionnaires assessing socio-demographic and health characteristics, food barcode scanner use (Food Barcode Scanner App Questionnaire), orthorexia (Teruel Orthorexia Scale), food choice motivations (Food Choice Questionnaire), health anxiety (Health Anxiety Questionnaire), and emotional competence (Profile of Emotional Competence). The results showed no difference in socio-demographic characteristics between FBSA users and FBSA non-users. However, FBSA users scored higher on healthy orthorexia and health anxiety than non-users. FBSA users' food choice motivations were also more focused on natural food content, health, weight control and ethical concerns than non-users. Although no difference was found between FBSA users and non-users for orthorexia nervosa, orthorexia nervosa and pathological FBSA use scores were positively correlated. Moreover, health anxiety scores were positively correlated with FBSAQ "pathological use" subscale. While FBSA use may promote the adoption of a healthy diet, vigilance is required for individuals with orthorexic symptoms and health concerns. These two dimensions could be risk factors for problematic FBSA use.

Who uses food barcode scanner apps and why? Exploration of users' characteristics and development of the Food Barcode Scanner App Questionnaire

BACKGROUND

Food barcode scanner apps (FBSAs) are increasingly being used to verify food quality. By scanning a product's barcode, they can provide a range of information, including nutritional quality or information on the toxicity of food components. Although they seem to be widely used, no study has yet examined their use in the general population. The objectives of this study were therefore twofold: (a) to identify who the users of FBSA are and (b) to evaluate behaviours and cognitions associated with use of these apps through the development and validation of the Food Barcode Scanner App Questionnaire (FBSAQ).

METHOD

A total of 1626 women (average age of 37.51 years; SD = 12.67) from the general population were included in this study, with 25.7% reporting themselves as using at least one FBSA. Participants completed questionnaires assessing socio-demographic and health characteristics, the use of health apps and the FBSAQ, when relevant.

RESULTS

The users of FBSAs did not differ from nonusers in regard to key socio-demographic characteristics, but they were more likely to use healthcare services and other health apps than nonusers of FBSAs. Psychometric analyses allowed validation of the FBSAQ through three factors: pathological use, dietary concerns and exclusion of unhealthy components.

CONCLUSION

Data showed that the use of FBSAs can be beneficial for many individuals, as they help with food choices. However, some user may develop more problematic behaviours and have difficulties in not using these apps.

Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study

Introduction

The UK Government developed the Change4Life Food Scanner app to provide families with engaging feedback on the nutritional content of packaged foods. There is a lack of research exploring the cost-effectiveness of dietary health promotion apps.

Methods

Through stakeholder engagement, a conceptual model was developed, outlining the pathway by which the Food Scanner app leads to proximal and distal outcomes. The conceptual model informed the development of a pilot randomized controlled trial which investigated the feasibility and acceptability of evaluating clinical outcomes in children and economic effectiveness of the Food Scanner app through a cost-consequence analysis. Parents of 4–11 years-olds (n = 126) were randomized into an app exposure condition (n = 62), or no intervention control (n = 64). Parent-reported Child Health Utility 9 Dimension (CHU9D) outcomes were collected alongside child healthcare resource use and associated costs, school absenteeism and parent productivity losses at baseline and 3 months follow up. Results for the CHU9D were converted into utility scores based on UK adult preference weights. Sensitivity analysis accounted for outliers and multiple imputation methods were adopted for the handling of missing data.

Results

64 participants (51%) completed the study (intervention: n = 29; control: n = 35). There was a mean reduction in quality adjusted life years between groups over the trial period of –0.004 (SD = 0.024, 95% CI: –0.005; 0.012). There was a mean reduction in healthcare costs of –£30.77 (SD = 230.97; 95% CI: –£113.80; £52.26) and a mean reduction in workplace productivity losses of –£64.24 (SD = 241.66, 95% CI: –£147.54; £19.07) within the intervention arm, compared to the control arm, over the data collection period. Similar findings were apparent after multiple imputation.

Discussion

Modest mean differences between study arms may have been due to the exploration of distal outcomes over a short follow-up period. The study was also disrupted due to the coronavirus pandemic, which may have confounded healthcare resource data. Although measures adopted were deemed feasible, the study highlighted difficulties in obtaining data on app development and maintenance costs, as well as the importance of economic modeling to predict long-term outcomes that may not be reliably captured over the short-term.

Clinical trial registration

https://osf.io/, identifier 62hzt.

An experimental investigation of the affect regulating properties of sugar consumption: Examining the roles of socially-oriented positive and negative affect

Obesity is a major public health concern, and sugar consumption is a key risk factor for obesity. Thus, there is a need to identify factors that may increase motivation to consume sugar. One such factor may be negative affect, as research has shown that negative affect increases motivation for and engagement in appetitive behaviors, including sugar consumption. The goal of the present study was to extend past research on the role of negative affect in sugar consumption by examining: (a) the effect of a socially-oriented negative affect induction (i.e., social rejection) on the consumption of flavored beverages with varying levels of sugar, and (b) the negative and positive affect regulating properties of varying levels of sugar consumption. Undergraduate students (N = 116) were randomized to receive either a neutral or socially-oriented negative affect induction. Participants were then presented with three flavored beverages with varying levels of sugar (low, medium, high). Negative and positive affect were assessed prior to and following the affect induction procedure, as well as following consumption of the beverage. Participants exposed to the negative affect induction consumed a larger volume of the high sugar beverage (as well as a larger volume of all sugary beverages) relative to participants in the neutral induction condition. Moreover, these findings could not be attributed to a greater preference for the high sugar beverage among participants in the negative affect condition. Additionally, lower levels of positive affect post-induction across all participants (regardless of condition) were associated with greater consumption of the high sugar beverage, and high sugar beverage consumption was significantly positively associated with post-consumption positive affect. Results provide evidence for an affect-regulating function of sugar consumption following social rejection.

Parents' awareness and perceptions of the Change4Life 100 cal snack campaign, and perceived impact on snack consumption by children under 11 years

Background

Childhood obesity is a pertinent public health problem in the UK. Consumption of free sugars has been associated with the development of obesity. In 2018, the Change 4Life (C4L) 100 cal snack campaign was launched with the slogan ‘100 calorie snacks, two a day max’, aiming to encourage parents to choose lower sugar, fat and calorie snacks for their children. This study aimed to examine how the campaign has been perceived by parents.

Methods

An online survey was developed to explore parent awareness, perceptions and understanding of the C4L 100 cal snack campaign. Respondents were recruited via Leeds City Council, posters displayed at primary schools and children’s centres across Leeds and via social media. Paper surveys were also shared with voluntarily led playgroups. Survey data was analysed using descriptive statistics. Thematic analysis was performed on open text responses.

Results

Three hundred forty-two 342 respondents completed the survey. Just over half of the respondents had come across the campaign, most seeing the leaflet or a television advert. Over two-thirds of respondents ‘agreed’ or ‘strongly agreed’ that the campaign caught their attention. A similar proportion ‘agreed’ or ‘strongly agreed’ that the campaign informed them about 100 cal snacks and just over a half thought it was memorable. Most respondents used positive language to describe the campaign, but there was no clear consensus of a perceived positive impact on healthier snack purchasing, nor preparing more 100 cal snacks at home. Respondents provided examples of how the campaign could be improved to positively impact eating behaviours: better publicity and information delivery; healthier snack examples made more visible; improved nutritional labelling and access to healthier products in supermarkets (availability, promotion, display, choice).

Conclusions

The C4L 100 cal snack campaign was perceived positively by parents and carers, with many agreeing that the campaign was informative and memorable. However, there was no agreement in terms of the parents reporting an impact of the campaign on behaviour change and healthier snack habits. Future social marketing campaigns could be improved through more formal pilot testing to assess the understanding and acceptance of the campaign amongst the target audience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12789-7.

An Assessment of Behavior Change Techniques in Two Versions of a Dietary Mobile Application: The Change4Life Food Scanner

The Change4Life Food Scanner app is a UK Government dietary app designed to provide feedback on the nutritional content of packaged foods to parents and their children. To understand its intended mechanism of behavior change and how Behavior Change Technique (BCT) content evolves with app updates, this research aimed to map out the BCTs of two versions of the Change4Life Food Scanner app. Two coders undertook a descriptive comparative analysis of the use of BCTs in the Food Scanner app using the Behavior Change Technique Taxonomy [both the outdated (v1.6) and updated (v2.0) versions of the app were coded]. Results showed that both versions encompass the BCTs "goal setting (behavior)", "feedback on behavior", "social support (unspecified)", "instruction on how to perform behavior", "salience of consequences", "prompts/cues" and "credible source". The outdated version contained the BCT "behavior substitution" which had been dropped in the updated version. The updated version featured the additional BCTs "information about social and environmental consequences", "information about emotional consequences", "social reward" and "social incentive" and was comparatively more BCT intensive in terms of content and occurrence. The BCT content of the Food Scanner app resembles that of existing dietary apps and incorporates several BCTs which have previously been found to be effective. Future work to evaluate the effectiveness of the app is recommended. This will provide insight into whether the combination of BCTs used in the Change4Life Food Scanner app are effective in improving dietary choices.

Weekday and Weekend Differences in Eating Habits, Physical Activity and Screen Time Behavior among a Sample of Primary School Children: The "Seven Days for My Health" Project

BACKGROUND

Healthy eating and active lifestyle habits are essential for a child's development, wellbeing, and health. School setting and family environment play a crucial role in shaping these habits and this could be reflected in different behavior patterns during weekdays and weekends.

METHODS

We investigated primary school children's lifestyle habits through a cross-sectional analysis of 428 Italian primary school children, with a mean age of 8.99 years (±1.43). Data were collected from May to June 2017 using a weekly diary to assess children's lifestyles.

RESULTS

Children who eat their morning snack and lunch at school three or more times during the weekdays were 5.47 times more likely (95% CI 3.02, 10.2) to consume adequate snacks and 7.79 times more likely (95% CI 4.43, 14.5) to have adequate meals than those who did not.

CONCLUSION

Consumption of vegetables, lunch, and snacks are significantly more adequate during the weekdays as compared to the weekends. Physical activity levels did not differ between weekdays and weekends. Moreover, children spent more time engaged in physical activities than in front of a screen during both the weekdays and the weekends. The present results are good indicators of the importance of the school canteen in defining correct eating habits. Family-based and school-based interventions could represent valuable integrative strategies for promoting a healthy lifestyle in children.

Can Public Health Interventions Change Immediate and Long-Term Dietary Behaviours? Encouraging Evidence from a Pilot Study of the U.K. Change4Life Sugar Swaps Campaign

The aim of this pilot study was to evaluate the effectiveness of the U.K. Change4Life Sugar Swaps campaign for improving nutritional intake in a small sample of families prior to the 2015 nationwide launch. A total of 49 participants from 14 families received information and materials during a two-week intervention period in November 2014 encouraging them to swap high sugar foods and drinks for low sugar alternatives. Daily dietary intake was reported with online food diaries over four stages, each two weeks in length: (i) baseline (no information provided), (ii) intervention when Sugar Swaps materials were accessible, (iii) immediate follow-up, and (iv) one year on from baseline. Data were analysed for sugar, glucose, fructose, sucrose, lactose, fat, saturated fat, carbohydrate, protein, salt, fibre, vitamin C, and energy. During the intervention, significant daily reductions of 32 g sugar, 11 g fat, and 236 kcal for each family member were observed, among others, and 61% of benefits achieved during the intervention period were maintained at immediate follow-up. Encouragingly, for children, reductions in sugar, sucrose, fat, saturated fat, carbohydrate, and energy were observed one year on. The Sugar Swaps Campaign is potentially an effective public health intervention for improving short- and long-term dietary behaviour for the whole family.

Countermarketing About Fruit Drinks, Alone or With Water Promotion: A 2019 Randomized Controlled Trial in Latinx Parents

Objectives. To test whether fruit drink countermarketing messages alone or combined with water promotion messages reduce Latinx parents' purchases of fruit drinks for children aged 0 to 5 years. Methods. We performed a 3-arm randomized controlled online trial enrolling 1628 Latinx parents in the United States during October and November 2019. We assessed the effect of culturally tailored fruit drink countermarketing messages (fruit drink‒only group), countermarketing and water promotion messages combined (combination group), or car-seat safety messages (control) delivered via Facebook groups for 6 weeks on parental beverage choices from a simulated online store. Results. The proportion of parents choosing fruit drinks decreased by 13.7 percentage points in the fruit drink‒only group (95% confidence interval [CI] = -20.0, -7.4; P < .001) and by 19.2 percentage points in the combination group (95% CI = -25.0, -13.4; P < .001) relative to control. Water selection increased in both groups. Conclusions. Fruit drink countermarketing messages, alone or combined with water promotion messages, significantly decreased parental selection of fruit drinks and increased water selection for their children. Public Health Implications. Countermarketing social media messages may be an effective and low-cost intervention for reducing parents' fruit drink purchases for their children. (Am J Public Health. 2021;111(11):1997-2007. https://doi.org/10.2105/AJPH.2021.306488).

Development and usability testing of mobile application on diet and oral health

In several nations, caries in pre-school children remain a significant oral health issue. In an outbreak period such as the Coronavirus disease 2019 (COVID-19), remote contact and education aimed at the prevention of oral diseases and the preservation of children's oral health are more relevant than ever. Currently, the amount of published applications is far higher than the published scientific studies while the problems of usability remains vulnerable. The goal of this paper was to comprehensively document the phase of development and usability testing of a mobile application for diet and oral health, namely Gigiku Sihat, which was primarily intended to be used by parents and guardians of pre-school children. The mobile application was developed using the System Development Life Cycle principle. Apart from searching for the available oral health application on Android platform, the initial requirement gathering process consisted of situational analysis, concept generation, content development, and features and functional requirement determination. The mobile application design and implementation evolved at each phase before being finalised. Gigiku Sihat was successfully developed in the Bahasa Malaysia. Finalised Gigiku Sihat was installed on mobile devices to determine the usability using translated and validated System Usability Scale questionnaire namely Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA). The mean score usability with score of 68 and above was deemed to have good usability. This study found that Gigiku Sihat mean (SD) usability score was 77.0 (14.18). The results were promising as they showed that Gigiku Sihat had a good usability. Thus, the development of this mobile application focusing on diet and oral health served as a new source of oral health education and provided a necessary foundation in developing future improved mobile application development for parents in the prevention of early childhood caries.

The Association between Free Sugars Consumption and Laryngopharyngeal Reflux: A Cross-Sectional Study among Chinese Adolescents

There is a lack of evidence to show prevalence of laryngopharyngeal reflux (LPR) and the association between LPR and dietary factors. Adolescents consume the most amount of free sugars among the Chinese population. We conducted this study to investigate the prevalence of LPR in Chinese adolescents and explore the association between free sugars consumption and LPR. A cross-sectional study was conducted on 1517 middle school students in Hunan, China. An online questionnaire was applied to collect data on the condition of LPR, consumption of free sugars and other self-reported covariates. Height, weight and waist circumference were collected by anthropometric measurements. Logistic regression was applied to assess the association between LPR and free sugars consumption. The mean and standard deviation of free sugars consumption was 53.14 ± 44.75 (g/d). The prevalence of LPR was 8.11%. A positive association was observed between LPR and higher free sugars consumption after adjusted multiple covariates, with adjusted odds ratio (95% confident interval) of 1.656 (1.125–2.438). The prevalence of LPR among Chinese adolescents was high. Further analytic studies with strict design are required to test the association between LPR and free sugar consumption. Systematic strategies and policies should to be developed to reduce the intake of free sugars in order to prevent LPR.

Parental perceptions and practices regarding sugar intake by school-aged children: A qualitative study with Portuguese parents

Excessive sugar intake is one of the factors contributing to the alarming rates of childhood obesity and overweight in Portugal. Children's preferences and food consumption patterns are largely determined by the foods that are more familiar to them. Parents and caregivers are responsible for shaping children's eating habits since they are the ones who choose the food available in the household. The present study explores parental perceptions about sugar and sugar intake and its consequences on children's health. Moreover, we also examined the practices that parents use to regulate their children's diet, namely, to promote the consumption of desired foods (e.g., vegetables) and limit the intake of undesired food (e.g., sweets), and the perceived barriers and facilitators of sugar intake regulation. To this end, 42 interviews were conducted with parents of school-aged children (ages 6-10 years). A thematic analysis revealed that parents perceive sugar as highly negative (e.g., "evil", "poison", "addiction") and its consumption as harmful (e.g., hyperactivity; overweight). Nonetheless, the view that sugary food consumption is not necessarily problematic was also common. Indeed, most parents considered that sugar intake should be regulated but not forbidden. To control the intake of sugary foods (e.g., sodas, cookies), they reported using strategies such as restriction, explanation, or negotiation. Several barriers to sugar intake regulation were identified (e.g., birthday parties, parents' lack of knowledge), but also a few facilitators (e.g., bringing food from home to school). Our findings may inform the development of interventions or policies to promote healthier eating habits in school-age children.

Social Media and E-mail Marketing Campaigns: Symmetry versus Convergence

Companies use social business intelligence (SBI) to identify and collect strategically significant information from a wide range of publicly available data sources, such as social media (SM). This study is an SBI-driven analysis of a company operating in the insurance sector. It underlines the contribution of SBI technology to sustainable profitability of a company by using an optimized marketing campaign on Facebook, in symmetry with a traditional e-mail campaign. Starting from a campaign on SM, the study identified a client portfolio, processed data, and applied a set of statistical methods, such as the index and the statistical significance (T-test), which later enabled the authors to validate research hypotheses (RH), and led to relevant business decisions. The study outlines the preferences of the selected group of companies for the manner in which they run a marketing campaign on SM in symmetry with an e-mail-run campaign. Although the study focused on the practical field of insurance, the suggested model can be used by any company of any industry proving that BI technologies is the nexus of collecting and interpreting results that are essential, globally applicable, and lead to sustainable development of companies operating in the age of globalization. The results of the study prove that symmetrical unfolding (time and opportunity symmetry) of SM marketing campaigns, and using email, could lead to better results compared to two separate marketing campaigns. Moreover, the outcomes of both campaigns showed convergence on SBI platforms, which led to higher efficiency of management of preferences of campaign beneficiaries in the insurance sector.

Beyond the Chair: Public Health and Governmental Measures to Tackle Sugar

Limiting free sugars to <5% of energy intake is a World Health Organization evidence-based recommendation to protect oral health throughout the life course. Achieving this requires a concerted approach with upstream interventions, including legislation underpinning community interventions and health promotion. Global production and trade are the main drivers of sugars consumption, which can be addressed only through prioritization of health impacts in agricultural and trade agreements, including pricing and subsidies. Increasing evidence demonstrates the benefit, including dental benefits, of taxes on sugar-sweetened beverages, a major source of sugars—with taxes based on sugars content being favored due to the dual impact in incentivizing consumers to buy less and encouraging producers to use less through product reformulation. A benefit of product reformulation is that the potential impact on sugars intake occurs independent of consumer behavior change, making the benefits more equitable across social groups. Evidence from meta-analysis indicates that sugars reformulation and portion size reduction could lower energy intake by more than 10% and 16%, respectively. Sophisticated and targeted digital marketing of products high in sugars is another key driver of sugars intake. With the exception of children’s television broadcasting, marketing of products high in sugars is largely unregulated, and increased awareness of modern marketing strategies and more stringent regulation are urgently needed. To ensure a commercial level playing field, mandatory approaches are required. Midstream actions include creating healthier food environments in neighborhoods, community settings (schools, sports centers, hospitals), and workplaces. Only through coalition among authorities responsible for planning and health will “obesogenic and cariogenic” environments be replaced with those that make healthy choices the easiest choice. It is recognized that providing nutrition health education alone is insufficient to achieve necessary sugars reduction; however, education has a key role to play in changing social norms and creating drive for change.