The Effects of Digital Marketing of Unhealthy Commodities on Young People: A Systematic Review

The impacts of alcohol marketing and advertising, and the alcohol industry's views on marketing regulations: Systematic reviews of systematic reviews

ISSUES

Advertising and marketing affect alcohol use; however, no single systematic review has covered all aspects of how they affect alcohol use, and how the alcohol industry views alcohol marketing restrictions.

APPROACH

Two systematic reviews of reviews were performed according to the Preferred Reporting Items on 2 February 2023. Results were analysed using a narrative synthesis approach.

KEY FINDINGS

Twenty-three reviews were included in the systematic reviews. The first systematic review examined youth and adolescents (11 reviews), digital or internet marketing (3 reviews), alcohol marketing's impact on cognition (3 reviews), and alcohol marketing and policy options (2 reviews). The second systematic review focused on alcohol industry (i.e., importers, producers, distributors, retailers and advertising firms) response to advertising restrictions (four reviews). The reviews indicated that there is evidence that alcohol marketing (including digital marketing) is associated with increased intentions to drink, levels of consumption and harmful drinking among youth and young adults. Studies on cognition indicate that advertisements focusing on appealing contexts and outcomes may be more readily accepted by adolescents, and may be less easily extinguished in this population. The review of the alcohol industry found a strong desire to self-regulate alcohol advertising.

IMPLICATIONS

We found alcohol advertising and marketing is associated with increased drinking intentions, consumption and harmful drinking. Thus, policies which restrict advertising may be an effective way to reduce alcohol use.

CONCLUSION

More research is needed to assess all aspects of the observed associations, especially as to how marketing policies impact women and people with alcohol dependence.

No- and low-alcohol beer and the sponsorship of sport in Australia: An audit of sponsorship partnerships and analysis of marketing tactics

INTRODUCTION

Alcohol sponsorship of sport is associated with increased alcohol consumption. Little research to date has examined the sponsorship of sport by no- and low-alcohol (NoLo) beverage brands, despite concern that the marketing of these products might be harmful to young people. This study had dual aims: to identify sporting partnerships between NoLo beers and Australian sport, and examine marketing tactics used in social media advertising to promote these partnerships.

METHODS

Our sample included NoLo beers sold online from three large Australian alcohol retailers. First, we performed a qualitative content analysis of partnerships between NoLo beers and sport using publicly available online information. We then analysed the 118 social media posts of NoLo brands linked to these partnerships using a coding framework adapted from the alcohol literature.

RESULTS

Of 34 brands, 13 had sporting sponsorship partnerships across a range of spectator and participatory sports. Key marketing tactics identified on social media were activations, time-and event-specific drinking, influencer marketing, competitions, and corporate social responsibility. In particular, NoLo brands aim to disrupt the sports drink market by advertising their products as healthy recovery drinks, or 'sports beers', through activation events. Brands are also using influencer marketing and competitions, two tactics shown to be particularly persuasive for young people.

DISCUSSION AND CONCLUSIONS

NoLo beer brands strategically align with Australian sports to promote NoLo consumption. As they are classified as soft drinks in Australia, NoLo beverages are not regulated like alcohol. Future discussions around sports sponsorship and advertising regulation must consider NoLo products.

Unhealthy Food and Beverage Marketing to Children in the Digital Age: Global Research and Policy Challenges and Priorities

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Digital Alcohol and Cannabis Ads, Consumption Frequency, and Driving Under the Influence

OBJECTIVE

Little is known about the consequences of substance-related advertising on driving under the influence of alcohol (DUIA) or cannabis (DUIC). This study seeks to estimate associations between substance-related digital advertising exposures and DUIA and DUIC in a sample of young adults.

METHOD

The Rhode Island Young Adult Survey 2022 was a cross-sectional web-based survey of 1,022 adults ages 18-25 years. Analyses were conducted among lifetime alcohol users (n = 824) and lifetime cannabis users (n = 471). Prevalence of past-30-day digital ad exposure to alcohol and cannabis was assessed, as well as the prevalence of past-month DUIA and DUIC. Multivariable logistic regressions examined the association between digital ad exposure and substance use among lifetime users, and ad exposure and DUI among current users.

RESULTS

In all, 54.4% of participants reported past-30-day exposure to digital alcohol advertising, and 33.5% reported exposure to digital cannabis advertising. Exposure to social media alcohol advertising was associated with higher odds of DUIA after adjustment for sociodemographic variables (odds ratio [95% CI] = 2.14 [1.07, 4.28]) but not after accounting for frequency of use. Odds of DUIC remained significantly higher for those exposed to app-based cannabis advertising after adjusting for sociodemographic variables (odds ratio [95% CI] = 4.36 [1.76, 10.8]) and frequency of use (odds ratio [95% CI] = 3.96 [1.53, 10.2]).

CONCLUSIONS

Since social media alcohol ad exposure may be indirectly linked with DUIA, and app-based cannabis ad exposure may be directly linked to frequency of use and DUIC, legislators should consider comprehensive substance-related ad regulations and bans.

Dietary Intake of Adolescents and Alignment with Recommendations for Healthy and Sustainable Diets: Results of the SI.Menu Study

BACKGROUND

The SI.Menu study offers the latest data on the dietary intake of Slovenian adolescents aged 10 to 17. The purpose of this study is to comprehensively assess their dietary intake (energy and nutrients) and compare their food intakes with dietary recommendations for healthy and sustainable diets.

METHODS

The cross-sectional epidemiological dietary study SI.Menu (March 2017-April 2018) was conducted on a representative sample of Slovenian adolescents aged 10 to 17 years (n = 468) (230 males and 238 females). Data on dietary intake were gathered through two non-consecutive 24 h recalls, in line with the European Food Safety Authority (EFSA) EU Menu methodology. The repeated 24 h Dietary Recall (HDR) and Food Propensity Questionnaire (FPQ) data were combined to determine the usual intakes of nutrients and food groups, using the Multiple Source Method (MSM) program.

RESULTS

Adolescents' diets significantly deviate from dietary recommendations, lacking vegetables, milk and dairy products, nuts and seeds, legumes, and water, while containing excessive meat (especially red meat) and high-sugar foods. This results in insufficient intake of dietary fibre, and nutrients such as vitamin D, folate, and calcium.

CONCLUSIONS

The dietary intake of Slovenian adolescents does not meet healthy and sustainable diet recommendations. This study provides an important insight into the dietary habits of Slovenian adolescents that could be useful for future public health strategies.

My feed is what I eat? A qualitative study on adolescents' awareness and appreciation of food marketing on social media

BACKGROUND

Adolescents spend much of their time online and hence are exposed to a lot of non-core (energy-dense, nutrient-poor) social media food marketing (SMFM). This may influence their dietary choices and health. This present study aimed to investigate adolescents' perceptions towards SMFM; that is, their recognition and appreciation of SMFM.

METHODS

Semi-structured one-on-one interviews were conducted with Dutch adolescents aged 13-16 years (n = 16), on Skype. Examples of food promotions on Instagram, Snapchat, TikTok and YouTube were discussed with adolescents.

RESULTS

Adolescents' reasons for recognising and appreciating or liking SMFM were often related to the level of product integration. Factors that determined participants' recognition of SMFM included product focus (e.g., brand or product prominence), sponsorship disclosure, type of content (paid, influencer and peer-generated content) and promotional strategy (e.g., discounts, promotional texts, layout). Participants' appreciation of SMFM was determined by the format of a post (image, video, text, pop-up), trustworthiness of the source (brand, celebrity, friend/peer), type of product promoted (core, non-core) and appearance or layout of a post (e.g., professionalism, appeal).

CONCLUSIONS

The present study contributes to the ongoing debate on how to increase adolescents' resilience to commercial messages that promote non-core foods. Adolescents mostly enjoy watching non-core video content from peers or influencers and do not perceive this as food marketing. It is recommended that future studies investigate the effects of earned social media marketing formats (i.e., unpaid peer and influencer endorsements) promoting non-core foods on adolescents' dietary intake, and how they can be made more critical towards such types of SMFM.

Ecological momentary assessment of digital food and beverage marketing exposure and impact in young adults: A feasibility study

Unhealthy food marketing is contributing to the obesity epidemic, but real-time insights into the mechanisms of this relationship are under-studied. Digital marketing is growing and following food and beverage (F&B) brands on social media is common, but measurement of exposure and impact of such marketing presents novel challenges. Thus, this study aimed to evaluate the feasibility of collecting data on exposure and impact of digital F&B marketing (DFM) using a smartphone-based ecological momentary assessment (EMA) methodology. We hypothesized that DFM-induced food cravings would vary based on whether (or not) participants engaged with F&B brands online. Participants were Singapore residents (n = 95, 21-40 years), recruited via telephone from an existing cohort. Participants were asked to upload screenshots of all sightings of online F&B marketing messages for seven days, and answer in-app contextual questions about sightings including whether any cravings were induced. Participants provided a total of 1310 uploads (median 9 per participant, Q1-Q3: 4-21) of F&B marketing messages, 27% of which were provided on Day 1, significantly more than on other days (P < 0.001). Followers of food/beverage brands on social media encountered 25.6 percentage points (95% CI 11.4, 39.7) more marketing messages that induced cravings than participants who were not followers. University education was also associated with more (18.1 percentage points; 95% CI 3.1, 33.1) encounters with marketing messages that induced cravings. It was practical and acceptable to participants to gather insights into digital F&B marketing exposure and impact using EMA in young adults, although a shorter study period is recommended in future studies. Followers of food and beverage brands on social media appear to be more prone to experience cravings after exposure to digital F&B marketing.

More than a Nuisance: Implications of Food Marketing for Public Health Efforts to Curb Childhood Obesity

Fifteen years ago, public health experts urged industry, governments, and advocates to take action to dramatically improve the unhealthy food-marketing environment surrounding children in order to address the global childhood obesity crisis. Since then, research has confirmed that food marketing to children has far-reaching negative effects on their diets and health, takes advantage of adolescent vulnerabilities, and contributes to health disparities. In addition, digital marketing has profoundly changed young people's engagement with brands. Moreover, reliance on industry self-regulation as a solution has proven ineffective. Government-led policies have been more successful, but they remain limited in scope and challenging to adopt and implement. New approaches are necessary to increase public and policy maker awareness that food marketing is more than a nuisance, that it threatens the long-term health of children and adolescents worldwide, and that meaningful governmental action is urgently required to curtail industry's negative impact on young people's well-being.

Associations between everyday exposure to food marketing and hunger and food craving in adults: An ecological momentary assessment study

Food marketing in television and digital media negatively affects appetitive sensations and eating behaviour in children, but effects are less well understood for outdoor food advertising and adults. This research used Ecological Momentary Assessment (EMA) to explore associations between exposures to food advertising in various contexts (television, digital, outdoors) and adults' hunger and craving for highly advertised food categories. Over one week, participants provided ratings of cravings for types of food (fast food, soft drinks, snacks/confectionery, other) and hunger on a smartphone app up to six times per day when they saw a food advertisement (reactive assessment) and at random intervals (random assessment). Fifty-four participants (70.4 % female; 21.24 ± 3.84 years) provided 1223 assessments (24.7 % reactive, 75.3 % random). Data were analysed in R using multilevel multivariable linear regression models. Participants reported feeling hungrier (X2(1) = 5.85, p = .016, ΔAIC = 3.9) and having stronger cravings (X2(1) = 20.64, p < .001, ΔAIC = 318.6) after seeing food advertisements vs. random assessments. This was driven by greater hunger following television advertising exposure vs. random assessments (β = 1.58, SE = 0.61, p = .010, 95 %CIs 0.38 to 2.78), food advertising via digital devices or outdoors was not associated with hunger. Participants experienced stronger craving after seeing a food advertisement on television (β = 0.52, SE = 0.19, p = .006, 95 %CIs 0.15 to 0.89), outdoors (β = 0.39, SE = 0.12, p < .001, 95 % CIs 0.16 to 0.62) and in digital media (β = 0.36, SE = 0.14, p = .012, 95 % CIs 0.08 to 0.64), vs. random assessments. Cravings were (largely) specific to the advertised food category. EMA can be effective for assessing food marketing associations in adults. The current study provides evidence that food marketing is associated with hunger and craving in adults, which may, with replication, have implications for public health policy.

The Role of Social Media Advertisement and Physical Activity on Eating Behaviors among the General Population in Saudi Arabia

Over the past few decades, people in Saudi Arabia have become less inclined to adopt active lifestyles and healthy eating habits due to the increasing use of digital technologies such as social media. The objective of this online-based cross-sectional study was to assess the role of social media food advertisements and physical activity on eating behaviors among the general population in Saudi Arabia (n = 471). Data were collected through a structured questionnaire, which consisted of four parts: (i) sociodemographic information, (ii) attitude towards social media, (iii) eating behaviors-related information, and (iv) exposure to and engagement with social media advertisements. The study's outcome variable, eating behaviors (healthy vs. unhealthy), was assessed using the following question: "Are you on a healthy diet (such as a balanced diet, keto, or low carb)?" A multiple binary logistic regression analysis was performed to investigate the factors that influence unhealthy eating behaviors. Approximately 79.6% of the participants had unhealthy eating behaviors. Participants who were not involved in daily physical activity were more likely to have unhealthy eating behaviors compared to their counterparts (adjusted odds ratio, AOR = 4.86). Participants who watched food ads on social media channels 1-3 times a week (AOR = 2.58) or daily (AOR = 3.49) were more likely to have unhealthy eating behaviors than their counterparts. Participants whose appetite to try foods increases always (AOR = 1.42) or usually (AOR = 2.88) after viewing ads on social media were more likely to have unhealthy eating behaviors. These findings suggest that policymakers should take immediate action to regulate food advertising policy to promote a healthy food environment across the country. Saudis should be encouraged to engage in more physical activity, which could support the maintenance of healthy eating patterns and lifestyles.

Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products

ISSUE ADDRESSED

This study assessed Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products.

METHODS

An online survey was undertaken by Australian adults aged 18-64 recruited via two national panels in December 2019 (N = 2044).

RESULTS

Most respondents (69%) agreed the Government should protect children from unhealthy food and drink marketing and advertising broadly. Those who agreed most commonly indicated children should be protected up to age 16 (34%) or 18 (24%). There was widespread support for government actions to stop unhealthy food and drink marketing on digital platforms (e.g., internet sites) (68%-69%) and various digital marketing techniques (e.g., advertising by brands on social media) (56%-71%). A total ban on targeting unhealthy food and drink marketing to children online received the highest level of support (76%). Most respondents (81%) disagreed unhealthy food and drink companies should be able to collect children's personal information for marketing purposes. Support for examined actions was generally higher among older adults, more educated adults and more frequent internet users, lower among males, and similar between parents and non-parents.

CONCLUSIONS

There is public perception that the government is responsible for protecting children, well into adolescence, from unhealthy food and drink marketing broadly. Widespread public support extends to specific actions to reduce children's exposure to digital marketing of unhealthy food and drink products. SO WHAT?: Implementation of policies to protect children from digital marketing of unhealthy food and drink products would be well received by the Australian public.

Food and non-alcoholic beverage marketing in children and adults: A systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies

Food marketing impacts the food behaviors of children and adults, but the underpinning neural mechanisms are poorly understood. This systematic review and meta-analysis pooled evidence from neuroimaging studies of exposure to food marketing stimuli (vs. control) on brain activations in children and adults to clarify regions associated with responding. Databases were searched for articles published to March 2022. Inclusion criteria included human functional magnetic resonance imaging (fMRI) studies employing a contrast between a food marketing stimulus and a non-food/non-exposure control, published in English in a peer-reviewed journal, reporting whole brain (not Region of Interest [ROI] only) co-ordinates. Eleven studies met inclusion criteria, of which eight were included in the quantitative synthesis (Activation Likelihood Estimation [ALE] meta-analysis). Food marketing exposures (vs. controls) produced greater activation in two clusters lying across the middle occipital gyrus, lingual gyrus, and cuneus (cluster 1), and the postcentral gyrus, precentral gyrus, and the inferior parietal lobule/supramarginal gyrus (cluster 2). Brain responses to food marketing are most consistently observed in areas relating to visual processing, attention, sensorimotor activity, and emotional processing. Subgroup analyses (e.g., adults vs. children) were not possible because of the paucity of data, and sensitivity analyses highlighted some instability in the clusters; therefore, conclusions remain tentative pending further research.

Could Google Help Curb Online Advertising of Unhealthy Foods to U.S. Children?

INTRODUCTION

In 2020, Google took voluntary action to restrict food and beverage advertising through its online channels in the European Union/United Kingdom using Google's own nutrient profiling model to identify products eligible to be marketed to children through its Google Display Network. The objective of this study was to evaluate the potential impact of the Google policy, if applied to the U.S. market, on restricting online advertising of the top-selling packaged foods and beverages in the U.S.

METHODS

The top 25 U.S. food and beverage manufacturers were identified. Nutrient data for products from these manufacturers were sourced from Label Insight (a Nielsen IQ company) in 2021. Each product was examined against four nutrient profiling models: the Google nutrient profiling model, the WHO Europe nutrient profiling model, the Pan American Health Organization nutrient profiling model, and the Chilean government nutrient profiling model.

RESULTS

Under Google's nutrient profiling model, 18% of 14,188 products were eligible to be advertised to children, representing $44 billion in revenue for the top 25 U.S. manufacturers of the >$240 billion generated annually. The Google nutrient profiling model permitted the most products to be advertised to children of all four nutrient profiling models examined.

CONCLUSIONS

U.S. children engage extensively with online media. In place of government regulation, the Google advertising policy and related nutrient profiling model would limit online advertising of the most unhealthful products to children, if the policy were to be applied to the U.S. market. The effectiveness of the policy would be strengthened by refining the Google nutrient profiling model to better align with nutrient profiling models developed by authoritative health agencies, including the WHO.

Testing a conceptual Hierarchy of Effects model of food marketing exposure and associations with children and adolescents' diet-related outcomes

OBJECTIVE

Children's exposure to unhealthy food marketing contributes to poor diets by influencing the foods that children like, request, buy and consume. This study aimed to use confirmatory mediational analyses to test a hypothetical model of marketing effects, to better understand the mechanisms behind food marketing's impacts on children.

DESIGN

Children responded to a cross-sectional online survey about their attitudes towards, and purchase and consumption behaviours of, ten frequently promoted food/beverage brands and their media use. Structural equation modelling tested a priori potential pathways for the effects of food marketing exposure on children's diets.

PARTICIPANTS

10-16-year-old children (n 400).

SETTING

Australia.

RESULTS

There was a significant positive correlation between children's commercial screen media use and their attitudes towards brands (related to perceived social norms) and their brand purchasing behaviours, including their own purchases and requests to parents. The use of strategies to avoid advertising in commercial screen media reduced but did not remove the association between media use and brand purchases. Other brand exposures (on clothing, outdoor advertising, sponsorships) had a positive association with children's perceived social norms about brands and their brand purchases and requests. Non-commercial screen media use was not associated with any brand-related outcomes.

CONCLUSIONS

Commercial screen media use and other brand exposures were strongly positively associated with children's perceptions and purchasing behaviours of frequently marketed food/beverages. Regulations to restrict children's exposures to food marketing on-screen and through other media are required to reduce the effect of marketing exposure on children's food purchasing behaviours.

The relationship between parent's self-reported exposure to food marketing and child and parental purchasing and consumption outcomes in five countries: findings from the International Food Policy Study

Food and beverage marketing influences children's food preferences and dietary intake. Children's diets are also heavily influenced by their family environment. The aim of this study was to assess the relationship between parent's self-reported exposure to unhealthy food marketing and a range of outcomes related to children's desire for and intake of unhealthy foods and beverages. The study also sought to examine whether these outcomes varied across different countries. The analysed data are from the International Food Policy Study and were collected in 2018 using an online survey. The sample included 5764 parents of children under 18, living in Australia, Canada, Mexico, the United Kingdom, or the United States. Binary logistic regressions assessed the link between the number of parental exposure locations and children's requests for and parental purchases of unhealthy foods. Generalized ordinal regression gauged the relationship between the number of exposure locations and children's consumption of such items. Interaction terms tested if these associations varied by country. Parental exposure to unhealthy food marketing was positively associated with parents reporting child purchase requests and purchase outcomes; and differed by country. Increased parental exposure to unhealthy food marketing was associated with slightly lower odds of children's weekly consumption of unhealthy foods, and this association varied by country. In conclusion, parental report of a greater range of food marketing exposure was associated with a range of outcomes that would increase children's exposure to unhealthy food products or their marketing. Governments should consider developing more comprehensive restrictions on the marketing of unhealthy foods.

A systematic review of the adolescent-directed marketing strategies of transnational fast food companies in low- and middle-income countries

INTRODUCTION

Fast food consumption is associated with excessive intake of energy-dense foods; a major determinant of childhood obesity. The lack of data on the marketing strategies used to promote fast food to adolescents in low and middle-income countries (LMICs) acts as a barrier to global efforts to reduce the marketing of unhealthy foods to young people around the world.

OBJECTIVES

This systematic review aimed to identify the adolescent-directed marketing strategies of transnational fast food corporations in LMICs.

METHODS

A systematic search of eight scientific databases (PubMed, CINAHL, Medline, Embase, ProQuest, PsycInfo, Scopus and Google Scholar) was conducted. Following PRISMA guidelines, primary research articles written in English were included if they were published between 1 January 2010 and 30 December 2022, and reported any adolescent-directed marketing activity undertaken by a transnational fast food company operating in a LMIC. Articles were excluded if they were not peer reviewed. The quality of the included articles was assessed using a condensed version of the Consolidated Criteria for Reporting Qualitative Research tool.

RESULTS

Twelve articles met the eligibility criteria and were included in this review. A narrative synthesis of these articles revealed that the most documented strategies used to promote fast food to adolescents in LMICs were the use of incentives or premium offers, product appeals, promotional characters and brand familiarity. These strategies were mostly observed on social media, suggesting that there are serious concerns about adolescent exposure to fast food via social media in developing settings, especially as contextual differences in the nature of such marketing were identified.

DISCUSSION

The promotion of fast food to adolescents in LMICs is contextual in nature, with the nature of marketing strategies employed by transnational fast food corporations varying greatly across cultural and socio-economic contexts. These findings are crucial for the development of guidelines and regulations restricting the marketing of fast food to adolescents in lower income settings, contributing to global efforts to reduce adolescent exposure to unhealthy food promotion.

Adolescent Use of Dating Applications and the Associations with Online Victimization and Psychological Distress

In this study, we examined the relationships between the use of online dating applications (apps), online victimization, and psychosocial distress among adolescents. This study was conducted in 2020. A sample of 2595 seventh-grade students from 30 Taiwanese middle schools was surveyed. We conducted a self-administered survey. Overall, 15% of the adolescents reported using online dating apps in the past year, while 78% reported having seen dating app advertisements on the internet in the past year. Multivariate analysis results indicated that adolescents' exposure to the marketing of dating apps and poor academic performance were both associated with the use of online dating apps. Adolescents who used dating apps were more likely to experience online privacy victimization, cyberbullying victimization, and online sexual harassment. The use of dating apps by adolescents, online privacy victimization, cyberbullying victimization, and online sexual harassment were associated with higher levels of depression, anxiety, and stress. In conclusion, adolescent use of dating apps is related to online victimization and psychological distress.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Is it ethical to advertise unhealthy foods to children?

The marketing of foods and non-alcoholic beverages (hereafter: food) high in fats, salt and/or sugar (HFSS) has been strongly implicated in the rising levels of childhood obesity worldwide. Multiple ethical concerns arise from the practice of exposing children to such marketing and efforts to monitor and restrict it through regulatory policies. There is considerable evidence that exposure to powerful food marketing messages affects children's food behaviours in ways that are detrimental to good dietary health. Children are particularly vulnerable to being exploited and deceived by food marketing messages based on their cognitive and developmental immaturity. HFSS food marketing also affects numerous child rights enshrined within the UN Convention on the Rights of the Child (of which the UK is a signatory) including the right to the enjoyment of the highest attainable standard of health. The debate has become somewhat polarised between the public health community's evidence-based assertion that all marketing is inherently exploitative and the rebuttal from food and marketing industry stakeholders that provided the marketing is 'accurate and truthful' and there is no ethical need to regulate. This polarisation is reflected in the complexity of policymaking decisions regarding the rationale for mandatory government-led policies or industry self-regulation. There are also ethical considerations inherent in the monitoring of children's food marketing exposure, particularly in the digital sphere, by researchers for the purposes of informing policy design, scope and implementation. This review paper will explore the latest evidence on these issues and consider the implications for public health research, policy, and practice.

The influence of food vloggers on social media users: A study from Vietnam

Influencer marketing has become an outstanding method that entrepreneurs use to enhance their value by collaborating with popular social media users. Numerous researchers have explained that influencer marketing's success relates to consumers' strong perception of information credibility and advertisement. The researchers conducted an online survey of 328 Vietnamese social media users to investigate how food vloggers impact their followers. The major practical technique for data analysis was structural equation modeling (Smart PLS-SEM), and eight key hypotheses were tested. The findings indicate that advertising content value positively impacts viewers' attitudes. Influencers' attractiveness affects viewers' attitudes toward videos, and influencers' expertise and similarity impact viewers' attitudes toward the featured brand. Viewers' attitudes positively influence their social commerce intentions. This study shapes the performance of food vloggers in advertising content value and information credibility, providing an in-depth analysis of the impact of food vloggers on their followers. The results of this study provide advertisers and marketers with insights into the performance of food vloggers.

Establishing the Minimum Media Time Sample Required to Obtain Reliable Estimates of Children's Digital Media Food Marketing Exposures

Background

The ubiquitous nature of food marketing on digital media likely has a profound effect on children's food preferences and intake. Monitoring children's exposure to digital marketing is necessary to raise awareness of the issue, inform policy development, and evaluate policy implementation and effect.

Objectives

This study aimed to establish whether smaller time samples (less time and/or fewer days captured) would provide robust estimates of children's usual exposures to food marketing.

Methods

Using an existing data set of children's digital marketing exposures, which captured children's total screen use over 3 d, a reliability assessment was performed.

Results

A subsample of 30% of children's usual screen time was found to provide reliable estimates of digital food marketing exposure compared with the full sample (intraclass correlation coefficient: 0.885; Cronbach α: 0.884). There was no difference in the rates of marketing (exposures/h) between weekdays and weekend days.

Conclusions

These findings enable researchers to reduce the time and resource constraints that have previously restricted this type of monitoring research. The reduced media time sample will further lessen participant burden.

Recall of food marketing on videogame livestreaming platforms: Associations with adolescent diet-related behaviours and health

Digital media has become an integral part of adolescents' lives. Mirroring this trend, food and non-alcoholic beverage (hereafter: food) brands increasingly promote products in digital media to maximise reach with young consumers. Videogame livestreaming platforms, where individuals can broadcast or watch streamed videogame footage, are a growing form of digital media. The top three platforms (market share by hours watched) are Twitch (72%), YouTube Gaming (13%), and Facebook Gaming Live (9%), with a combined 34.6 billion hours watched in 2021. These platforms represent a hybridisation of two popular digital trends amongst teenagers: viewing online video content and playing videogames. On these platforms, gaming influencers promote food brands and products, with energy drinks and fast-food restaurants representing the most frequently promoted categories. Evidence suggests that food marketing via Twitch is associated with food craving, purchasing and consumption in adults. Yet, despite the evident teenage appeal and prevalence of food marketing on these platforms, research is yet to explore its associations with adolescent eating behaviour. Adolescents (n = 490, M_age = 16.81, 30.2% female) completed an online cross-sectional questionnaire exploring their recall of food marketing on the top three videogame livestreaming platforms, and relevant behavioural (purchase, consumption) and health (Body Mass Index) outcomes. Structural equation modelling was used to explore hierarchical relationships between the key variables. Results showed that recall of unhealthy food marketing on these platforms was significantly associated with purchase and consumption of marketed food categories. Attitudes towards unhealthy foods mediated this relationship. Findings are the first to demonstrate the relationships between unhealthy food marketing via videogame livestreaming platforms and adolescent eating behaviours, which has implications for the design of policies to restrict digital food marketing to young people.

The extent of energy drink marketing on Canadian social media

BACKGROUND

Caffeinated energy drink (CED) consumption among children and adolescents is a growing global public health concern due to its potential to produce adverse effects. CED marketing viewed by children and adolescents contributes to this problem as it increases consumption and favourable attitudes towards these high-caffeine and high-sugar products. This study aimed to describe the social media marketing of CEDs by estimating the frequency of user-generated and company-generated CED marketing and analyzing the marketing techniques used by Canadian CED brands on social media.

METHODS

CED products and brands were identified using the list of CEDs that received a Temporary Marketing Authorization from Health Canada in June 2021. The data on the frequency, reach and engagement of CED-related posts created by users and Canadian CED brands on Facebook, Instagram, Twitter, Reddit, Tumblr, and YouTube were licensed from Brandwatch for 2020-2021. A content analysis was conducted to assess the marketing techniques used in Canadian CED company-generated posts using a coding manual.

RESULTS

A total of 72 Canadian CED products were identified. Overall, there were 222,119 user-level mentions of CED products in total and the mentions reached an estimated total of 351,707,901 users across platforms. The most popular product accounted for 64.8% of the total user-level mentions. Canadian social media company-owned accounts were found for 27 CED brands. Two CED brands posted the most frequently on Twitter and accounted for the greatest reach, together making up 73.9% of the total company-level posts and reaching 62.5% of the total users in 2020. On Instagram/Facebook, the most popular brand accounted for 23.5% of the company-level posts and 81.3% of the reach between July and September 2021. The most popular marketing techniques used by Canadian CED brands were the use of viral marketing strategies (82.3% of Twitter posts and 92.5% of Instagram/Facebook posts) and the presence of teen themes (73.2% of Twitter posts and 39.4% of Instagram/Facebook posts).

CONCLUSION

CED companies are extensively promoting their products across social media platforms using viral marketing strategies and themes that may appeal to adolescents. These findings may inform CED regulatory decision-making. Continued monitoring is warranted.

Online on-demand delivery services of food and alcohol: A scoping review of public health impacts

The increase in availability of online on-demand food and alcohol delivery services has changed the way unhealthy commodities are accessed and understood. We conducted a systematic scoping review of academic and grey literature to map the current knowledge of public health and regulatory/policy outcomes arising from on-demand food and alcohol delivery (defined as delivery within 2 h). We systematically searched three electronic databases and completed supplementary forward citation searches and Google Scholar searches. In total, we screened 761 records (de-duplicated) and synthesised findings from 40 studies by commodity types (on-demand food or alcohol) and outcome focus (outlet, consumer, environmental, labour). Outlet-focused outcomes were most common (n = 16 studies), followed by consumer (n = 11), environmental (n = 7), and labour-focused (n = 6) outcomes. Despite geographical and methodological diversity of studies, results indicate that on-demand delivery services market unhealthy and discretionary foods, with disadvantaged communities having reduced access to healthy commodities. Services that deliver alcohol on-demand can also subvert current alcohol access restrictions, particularly through poor age verification processes. Underpinning these public health impacts is the multi-layered nature of on-demand services and context of the COVID-19 pandemic, which creates ongoing complications as to how populations access food and alcohol. Changing access to unhealthy commodities is an emerging issue in public health. Our scoping review considers priority areas for future research to better inform policy decisions. Current regulation of food and alcohol may not appropriately cover emerging on-demand technologies, necessitating a review of policy.

A Scoping Review of Observational Studies on Food and Beverage Advertising on Social Media: A Public Health Perspective

Popular social media platforms have been actively used by ultra-processed food companies to promote their products. Being exposed to this type of advertising increases the consumption of unhealthy foods and the risk of developing obesity and other non-communicable diseases (NCDs). Thus, monitoring commercial content on social media is a core public health practice. We aimed to characterize the methods used for monitoring food advertising on social media and summarize the investigated advertising strategies via a scoping review of observational studies. This study is reported according to the MOOSE Statement, and its protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration nº. CRD42020187740). Out of the 6093 citations retrieved, 26 met our eligibility criteria. The studies were published from 2014 to 2021, mostly after 2018. They focused on Australia, Facebook, strategies aimed at children and adolescents, and advertising practices of ultra-processed food companies. We grouped strategies in eight classes: post features (n = 18); connectivity and engagement (n = 18); economic advantages, gifts, or competitions (n = 14); claims (n = 14); promotional characters (n = 12); brand in evidence (n = 8); corporate social responsibility or philanthropy (n = 7); and COVID-19 (n = 3). We found similarities in the investigation of strategies regardless of the type of social media. Our findings can contribute to the designing of tools for monitoring studies and regulatory mechanisms to restrict the exposure of food advertising.

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.

Health education via "empowerment" digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain

Increasing health care costs and high economic burden exemplify the impact of chronic diseases on public health. Multifaceted approaches to treating chronic diseases include pharmaceutical drugs, digital therapeutics, and lifestyle medicine. Chronic diseases are largely preventable, and health promotion yields positive outcomes. However, despite positive return on investment (ROI) and cost-to-benefit ratio (CBR) for health promotion (median ROI 2.2, median CBR 14.4), commercial marketing of healthy lifestyles and self-care is limited. The objective of this perspective article is to discuss how digital marketing of consumer goods and services that support therapeutic self-care can also bridge public health and for-profit interests. We describe how "empowerment" marketing campaigns can provide evidence-based associations between products/services and self-care benefits for people living with chronic pain and depression. Such a "health education as marketing" strategy is illustrated by educational ads describing how contact with nature, music, and yoga can improve chronic pain and reduce depressive symptoms. Creating associations between health-related benefits of these activities with products (outdoor and yoga apparel, audio equipment) and services (music streaming services, music mobile apps, eco-tourism, yoga studios) that support them expand their value proposition, thus incentivizing profit-driven companies to engage in public health campaigns. Long-term success of companies that incorporate evidence-based health education as marketing and branding strategies will depend on following ethical considerations and advertising guidelines defined by consumer protection regulatory agencies, such as the Federal Trade Commission (FTC). In conclusion, integration of health education about self-care and commercial marketing can support health care outcomes and disease prevention.

Association between single-channel and cumulative exposure to alcohol advertising and drinking behaviours among Australian adolescents

INTRODUCTION

Widespread commercial promotion of alcohol products in Australia undermines the abstinence message for young people. This study aims to document the frequency of adolescents' exposure to alcohol advertising and examine associations with drinking behaviours.

METHODS

Students aged 12-17 years (n = 3618) participating in a cross-sectional survey self-reported their exposure to alcohol advertising via eight sources. Students also indicated whether they had never consumed alcohol, consumed at least a few sips of alcohol in their lifetime but none in the past month ('irregular drinkers') or consumed more than 10 drinks in their lifetime including at least one drink in the past month ('drinkers'). Multinomial logistic regression analyses examined associations between both single-channel and cumulative exposure to alcohol advertising and drinking status, controlling for sex, age and education sector.

RESULTS

Television (61%), the internet (56%) and at sporting events (50%) were the most common channels through which students reported seeing alcohol advertising. Weekly exposure via each of the eight assessed channels was associated with being a drinker (vs. a non-drinker or an irregular drinker, respectively), whereas only weekly exposure via television and sporting events was associated with being an irregular drinker (vs. a non-drinker). As students' level of cumulative exposure to alcohol advertising increased, so too did their likelihood of being a drinker.

DISCUSSION AND CONCLUSIONS

Alcohol advertising exposure is positively associated with drinking among Australian adolescents. Tighter restrictions on alcohol advertising across all media in Australia may reduce adolescent exposure and help de-normalise alcohol use.

Broadcast Television Is Not Dead: Exposure of Children to Unhealthy Food and Beverage Advertising on Television in Two Policy Environments (Ontario and Quebec). An Observational Study

BACKGROUND

Food marketing can influence children's dietary behaviors. In Canada, Quebec banned commercial advertising to children under the age of 13 y in 1980, whereas advertising to children is self-regulated by industry in the rest of the country.

OBJECTIVES

The objective of this study was to compare the extent and power of food and beverage advertising on television to children (age: 2-11 y) in two different policy environments (Ontario and Quebec).

METHODS

Advertising data for 57 selected food and beverage categories were licensed from Numerator for Toronto and Montreal (English and French markets) from January to December 2019. The 10 most popular stations for children (age: 2-11 y) and a subset of child-appealing stations were examined. Exposure to food advertisements (ads) was based on gross rating points. A content analysis of food ads was conducted, and the healthfulness of ads was assessed using Health Canada's proposed nutrient profile model. Descriptive statistics were tabulated for the frequency of and exposure to ads.

RESULTS

On average, children were exposed to 3.7 to 4.4 food and beverage ads per day, exposure to fast-food advertising was highest (670.7-550.6 ads per year), advertising techniques were used frequently, and the majority (>90%) of advertised products were classified as unhealthy. On the top 10 stations, French children in Montreal were most exposed to unhealthy food and beverage advertising (712.3 ads per year), although they were exposed to fewer child-appealing advertising techniques compared with those in other markets. On the child-appealing stations, French children in Montreal were least exposed to food and beverage advertising (43.6 ads per year per station) and child-appealing advertising techniques compared with the other groups.

CONCLUSIONS

The Consumer Protection Act appears to positively impact exposure to child-appealing stations; yet, it does not sufficiently protect all children in Quebec and requires strengthening. Federal-level regulations restricting unhealthy advertising are needed to protect children across Canada.

Experiences with energy drink consumption among Norwegian adolescents

The objective of the present study was to describe adolescents' habits and experiences with energy drink (ED) consumption and the relation to the amount of ED consumed. We used the national cross-sectional study Ungdata, conducted in 2015-16 in Norway. A total of 15 913 adolescents aged 13-19 years answered questions about ED consumption related to the following topics: reasons for, experiences with, habits and parental attitudes. The sample comprised only adolescents reporting to be ED consumers. We estimated the association between the responses and the average daily consumption of ED in multiple regression models. Those who consumed ED 'to concentrate' or 'to perform better in school' consumed on average 73⋅1 (CI 65⋅8, 80⋅3) and 112⋅0 (CI 102⋅7, 121⋅2) ml more daily, respectively, than those who did not consume ED for these reasons. Up to 80 % of the adolescents reported that 'my parents think it is OK that I drink energy drink', but at the same time almost 50 % reported that 'my parents say that I shouldn't drink energy drink'. Apart from increased endurance and feeling stronger, both desired and adverse effects of ED consumption were reported. Our findings indicate that the expectation created by the ED companies have great influence on the adolescents' consumption rate and that parental attitudes towards ED have little to no influence on the adolescents' consumption rate.

Digital marketing of online food delivery services in a social media platform before and during COVID-19 pandemic in Brazil

OBJECTIVE

To describe the promotion of food and beverage and marketing strategies used by online food delivery services (OFDS) in a social media platform before and during the pandemic in Brazil.

DESIGN

Publicly available data were extracted from OFDS Instagram accounts. Posts published 6 months immediately before and after the first case of COVID-19 in Brazil were randomly sampled. Two independent authors coded the posts' content. Food and beverage items featured in posts were classified according to the NOVA food system classification. Marketing strategies were coded according to protocols from previous studies.

SETTING

Top three OFDS Instagram accounts in Brazil.

PARTICIPANTS

Posts published in the period studied (n 304).

RESULTS

During the pandemic, the proportion of posts featuring at least one food item decreased from 71·6 % to 40·2 %, and the proportion of ultra-processed foods decreased from 57·6 % to 27·9 %. Before the pandemic, the most widely used marketing strategies were branding elements (80·7 %), product imagery (unbranded) (48·9 %) and partnerships/sponsorship (35·2 %). While during the pandemic, branding elements (62·2 %) continued to be the most applied, but were followed by the use of videos/graphics interchange format/boomerangs (34·1 %) and corporate social responsibility (31·7 %). The most frequent COVID-19 marketing strategies were 'social responsibility in the pandemic' (30·5 %), 'combatting the pandemic' (28·0 %) and 'accelerating digitalisation' (20·7 %).

CONCLUSIONS

OFDS advertisements on a social media platform placed less emphasis on food items, but improved the nutritional quality of foods and beverages featured in posts. A COVID-washing approach was highlighted, especially through the use of social responsibility marketing during the pandemic.

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016–18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

Food and beverage advertising expenditures in Canada in 2016 and 2019 across media

Background

Food and beverage advertising has been identified as a powerful determinant of dietary intake and weight. Available evidence suggests that the preponderance of food and beverage advertising expenditures are devoted to the promotion of unhealthy products. The purpose of this study is to estimate food advertising expenditures in Canada in 2019 overall, by media and by food category, determine how much was spent on promoting healthier versus less healthy products and assess whether changes in these expenditures occurred between 2016 and 2019.

Methods

Estimates of net advertising expenditures for 57 selected food categories promoted on television, radio, out-of-home media, print media and popular websites, were licensed from Numerator. The nutrient content of promoted products or brands were collected, and related expenditures were then categorized as “healthy” or “unhealthy” according to a Nutrient Profile Model (NPM) proposed by Health Canada. Expenditures were described using frequencies and relative frequencies and percent changes in expenditures between 2016 and 2019 were computed.

Results

An estimated $628.6 million was spent on examined food and beverage advertising in Canada in 2019, with television accounting for 67.7%, followed by digital media (11.8%). In 2019, most spending (55.7%) was devoted to restaurants, followed by dairy and alternatives (11%), and $492.9 million (87.2% of classified spending) was spent advertising products and brands classified as “unhealthy”. Fruit and vegetables and water accounted for only 2.1 and 0.8% of expenditures, respectively, in 2019. In 2019 compared to 2016, advertising expenditures decreased by 14.1% across all media (excluding digital media), with the largest decreases noted for print media (− 63.0%) and television (− 14.6%). Overall, expenditures increased the most in relative terms for fruit and vegetables (+ 19.5%) and miscellaneous products (+ 5%), while decreasing the most for water (− 55.6%) and beverages (− 47.5%).

Conclusions

Despite a slight drop in national food and beverage advertising spending between 2016 and 2019, examined expenditures remain high, and most products or brands being advertised are unhealthy. Expenditures across all media should continue to be monitored to assess Canada’s nutrition environment and track changes in food advertising over time.

Are Students Paid to Market Sugar-Sweetened Beverages to Peers? A Review of University Pouring Rights Contracts

Background: Many university students regularly consume sugar-sweetened beverages (SSBs), which are associated with obesity and related chronic diseases. Moreover, students are strongly influenced by both their peers and product marketing. Our exploratory study examined pouring rights contracts between universities and beverage companies, focusing on provisions establishing campus/brand ambassador positions and marketing/merchandising manager positions whose jobs are to market SSBs on campus. Methods: For this cross-sectional study conducted in late 2020, two independent coders reviewed 131 pouring rights contracts between Coca-Cola or Pepsi and 124 unique public universities with 20,000 or more students enrolled. Contracts were active in 2018 or 2019. Results: Twenty-six contracts (20%) contained provisions specifically establishing either campus/brand ambassador positions (n = 16), marketing/merchandising manager positions (n = 7), both (n = 1), or unclear language related to these positions (n = 2). Thirteen contracts (10%) required that the position be filled by a current student. The objectives for both types of positions included increasing revenue and driving beverage sales. When stated in the contracts (n = 5), the payments allocated for these positions ranged between $5,000 and $10,000 per year. Conclusions: Given the association between SSBs and obesity and other related health outcomes, combined with the influence that peers and product marketing may have on adolescents' and young adults' attitudes toward consumption of these beverages, universities should be more transparent when these provisions are included in their pouring rights contracts and should carefully consider whether it is appropriate for these contracts to include funding for students to market SSBs.

Gambling, fast food and alcohol sponsorship in elite sport - perspectives from Australian sporting fans

BACKGROUND

Public health bodies in Australia remain concerned about marketing of unhealthy commodities; namely unhealthy food, alcohol and gambling products. Children are particularly susceptible to the influence of unhealthy commodity marketing. This study explored adults' perceptions of unhealthy commodities sponsorship in elite sport and policies to restrict them.

METHODS

Four focus groups of 7-8 frequent sport spectators were recruited, including parents and non-parents, and located in inner and outer suburbs of Sydney, Australia. Results were analysed thematically.

RESULTS

Participants identified the contradictions of healthy messages of sport and unhealthy commodities, while highlighting the commercial value of sport sponsorship to sporting clubs. There is concern around children's exposure to effective and integrated marketing techniques when viewing sport, which encouraged unhealthy habits. Support for restricting sponsorship related to perceived product harm, with gambling viewed as having the greatest health impact. Participants were supportive of policies that reduced exposure of unhealthy commodities to children, but were concerned about the financial risk to sporting clubs. Governments and sports associations were identified as holding responsibility for enacting changes.

CONCLUSION

A number of options were identified for advocates to gain public and political traction to reduce unhealthy commodity sponsorship. There is potential for shifts away from unhealthy sponsorship by both governments and sports associations.

Instabrand courtside: a content analysis of marketing strategies by food and beverage brands during the 2021 Australian Open tennis tournament

OBJECTIVE

To examine the marketing techniques food and beverage brands use on Instagram, as part of their sport sponsorship strategy.

METHODS

We conducted a qualitative content analysis of 31 Instagram accounts during the 2021 Australian Open tennis tournament. Branded food and beverage posts with tennis-linked content were coded based on an initial screening and previously published frameworks.

RESULTS

Of the 152 included posts, 92% were made by food and beverage companies that were official 'partners' of the Australian Open. Products in posts were mostly discretionary foods and alcohol. The most frequently used strategies were 'Engagement' (89%) and 'Branding' (80%) and nearly half (45%) of alcohol posts invited direct consumption of their product.

CONCLUSIONS

The powerful combination of sport and social media are utilised by brands to interact and build relationship with consumers while promoting the consumption of alcohol and discretionary foods - products which impede rather than promote health. The indirect marketing techniques favoured by brands make this form of advertising difficult to identify and control.

IMPLICATIONS FOR PUBLIC HEALTH

These results highlight the need for counter-marketing, policy and regulatory actions to remove unhealthy food and alcohol from sport and reorient sponsorship of sporting events towards products that promote health.

'My Mom Got Influenced by Yours': The persuasiveness of mom influencers in relation to mothers' food assessments and decisions

Childhood obesity is a worldwide health problem with a range of short- and long-term health and social consequences; however, the World Health Organization (WHO) argues that this epidemic is preventable and reversible. The biggest dietary gatekeepers of children are their parents and more specifically mothers, whose attitudes and consumption choices are nowadays often affected by the opinions of influencers on social network sites (SNSs). Using two experimental studies, the current paper investigates how mothers' food assessments and decisions for their children are affected by sponsored posts on social media. The first study adopted a two-level between-subjects experiment (N = 81), which showed that mothers like sponsored Instagram posts better when they are posted by a mom influencer (i.e. a mother who accumulated a large following on social media and often engages in sponsored partnerships with brands) compared to a brand. This consequently positively affected source credibility, post engagement, purchase intention and the child appropriateness of the food. In the second experiment, a two-by-two between-subjects design (N = 169) showed that while a typical mom influencer is perceived as less effective in promoting food compared to an expert (i.e. a pediatric nutritionist) mom influencer due to lower credibility, a typical mom influencer is more efficient in promoting unhealthy foods through higher influencer-brand congruence.

Adolescents' exposure to and evaluation of food promotions on social media: a multi-method approach

Background

Traditional food marketing, mostly involving advertisement of nutrient poor and energy dense foods, has the effect of enhancing attitudes, preferences, and increasing intake of marketed foods in adolescents, with detrimental consequences for health. While the use of social media applications in adolescents has proliferated, little is known about the content of food promotions within these applications. The aim of this study was to investigate adolescents’ exposure to and evaluation of social media food promotions (SMFPs).

Methods

Australian adolescents aged 13–16 years joined one-on-one Zoom meetings with the researcher on the device they normally used for social media. Participants shared their screen and visited up to three of their favourite social media platforms for 10 min each, during which the researcher pointed out examples of SMFPs to participants. Next, participants answered questions about their awareness and appreciation of SMFPs. Screenshots of SMFPs were de-identified and analysed.

Results

The study included 35 adolescents aged 14.4 (± 1.2) years (boys: n = 18; girls: n = 17). Instagram, Snapchat and YouTube were the most favoured social media platforms. During a total of 1000 min of viewing time, 1801 unbranded (n = 1221) and branded (n = 580) SMFPs were identified. Participants viewed a median rate (IQR) of 12.0 (6.3–20) SMFPs per 10 min, with a median rate of 6.0 (3–11) non-core SMFPs per 10 min. A majority of SMFPs (62%) were embedded into celebrity influencer or entertaining content (e.g., vlogs, cooking videos, streamed TV content). In total, 60% of the participants said they had sometimes, rarely or never noticed the SMFPs pointed out by the researcher themselves. Participants largely remembered non-core foods or brands (77%). Almost half (49%) of participants liked SMFPs, while only 6% disliked them.

Conclusions

This study contributes to a relatively unexplored research area. The outcomes show adolescents’ SMFP exposure mostly concerns unhealthy foods, shown in advertisements and other food-related posts, which are integrated into a wide variety of entertainment that is appreciated by adolescents. The results emphasise the need for more research on SMFPs, with particular focus on the impact on adolescent dietary behaviours, and clearer definitions and stricter regulations regarding adolescent-targeted social media food marketing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01310-3.

'Even if you don't pay attention to it, you know it's there': A qualitative exploration of adolescents' experiences with digital food marketing

Adolescents are particularly vulnerable to digital food marketing. However, research on adolescents' recall, awareness, and opinions of this type of marketing is still scarce. Accordingly, the present study aimed to conduct an in-depth examination of adolescents' experiences with digital food marketing. A convenience sample of 209 adolescents was recruited at two private educational institutions and a public health facility in Montevideo, the capital city of Uruguay. Semi-structured group interviews were conducted, recorded in audio and transcribed. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Results showed that participants were highly exposed to digital food marketing, as they all remembered having seen advertisements, with those of fast-food restaurants and food-ordering apps being the most frequently mentioned. According to the adolescents' accounts, images, colors, music, oversized portions, product novelty, price promotions and celebrities were the most memorable aspects of food advertisements. Participants recognized the effect of advertisements on product awareness and wanting, and, to a lesser extent, on actual purchase and consumption behavior. Factors that were thought to mediate the impact of digital marketing on food choice were also identified. In the final part of the interviews, participants proposed strategies to reduce the effect of digital marketing on their food choices, which included both regulatory approaches to reduce exposure to digital marketing of unhealthy foods and behavior change communication. Together, the current findings provide insights for the development of multifaceted strategies to reduce the effects of digital food marketing on the eating habits of adolescents.

Adults' Exposure to Unhealthy Food and Beverage Marketing: A Multi-Country Study in Australia, Canada, Mexico, the United Kingdom, and the United States

BACKGROUND

Food marketing increases product appeal, purchasing, and consumption, using diverse strategies and locations to reach consumers.

OBJECTIVES

The aim of this study was to examine differences in adults' self-reported exposure to various marketing strategies (brand and licensed characters, celebrities, and sponsorship of sports and cultural events) and locations (television, radio, and digital media) across 5 countries: Australia, Canada, Mexico, the United Kingdom, and the United States.

METHODS

We analyzed cross-sectional survey data on self-reported exposure to food marketing strategies and locations collected in 2018 by the International Food Policy Study. Participants (n = 21,678) aged ≥18 years completed an online survey. Exposures to unhealthy food marketing strategies and locations in the prior 30 days were self-reported. Regression models examined differences in marketing exposure and locations across countries.

RESULTS

The average number of unhealthy food marketing strategies to which participants reported being exposed ranged from 0.5 in the United Kingdom to 2.3 in Mexico. Self-reported exposure to strategies across all countries was highest for brand characters (32%), followed by licensed characters (22%). In total, the reported mean exposure of marketing locations was 1.6 in the prior month. Television was the most prevalent location (44%), followed by digital marketing (32%). Adjusted models indicated that the odds of reporting exposure to marketing strategies and marketing locations were higher for Mexico compared to the rest of the countries.

CONCLUSIONS

Adults report a variety of exposures to unhealthy food marketing in all countries, but exposure was highest in Mexico. Special attention should be paid to regulating marketing strategies, such as brand characters and licensed characters, and locations, such as television and digital marketing.

A content analysis of the aims, strategies, and effects of food and nonalcoholic drink advertising based on advertising industry case studies

Background

Placing limitations on advertising of food and nonalcoholic drinks to children is an effective strategy in addressing childhood obesity. The industry maintains that further restrictions are unnecessary.

Aims

To ascertain whether the advertising campaigns were successful according to the industry evaluations and more specifically the effects of marketing on children.

Materials & Methods

A total of 117 case studies (1980-2016) published by the advertising industry which evaluate the effects of advertising campaigns were reviewed. This industry data source had been previously used to analyze the effects of alcohol advertising campaigns. The nutrition profile of the products was assessed by applying the World Health Organisation Nutrition Profile model designed to restrict the marketing of foods and beverages to children.

Results

The food and drink industry advertising campaigns target specific consumers including children, use several persuasive marketing techniques (utilizing celebrities and gamification), often position unhealthy products as healthy, and lead to increased sales of the advertised product with good returns on investment. The health-related claims made, and aspects of the campaigns related to the marketing of the products to children are summarized.

Discussion

Our analysis of food and non-alcoholic drinks case studies aligns with similar analyses of tobacco and alcohol advertising.

Conclusion

This analysis, based on internal industry data, presents important evidence on the effects of advertising on consumption-related outcomes and the mechanisms by which they are achieved.

"You know what, I'm in the trend as well" - Understanding the inter-play between digital and real-life social influences on the food and activity choices of young adults

OBJECTIVE

To understand young adults' perceptions of online and real-life social influences on their food and activity choices.

DESIGN

A qualitative study involving seven focus groups. Thematic analyses using both deductive and inductive techniques were performed.

SETTING

A polytechnic and a university in Singapore.

PARTICIPANTS

A total of 46 full-time students, 19-24 years of age.

RESULTS

Participants revealed that social media meets multiple needs, contributing to its ubiquitous use and facilitating content spread between social networks. Food-related content shared on social media were mostly commercial posts, marketing foods and eateries showcasing price-promotions, emphasizing sensory properties of foods, or creating narratives that activated trends. Subsequently, real-life social activities frequently revolve around marketed foods that were not necessarily healthy. In contrast, physical activity posts were rarely being followed up in real life. Portrayals describing a toxic gym culture could contribute to negative perceptions of peers' physical activity posts and a disinclination towards sharing such posts. Participants expressed that close, supportive social networks in real-life strongly influenced initiating and maintaining healthy lifestyles. However, in a society that highly values academic achievements, participants prioritized studying and socializing over healthy eating and physical activity.

CONCLUSIONS

Overall, our findings reveal that virtual and real-life social influences have complex interactions affecting Asian young adults' behavioral choices and should be considered when designing interventions for this group. Regulations related to the digital marketing of unhealthy food, and improving the availability, accessibility, and affordability of healthier food options, particularly in the foodservice sector, would be of value to consider.

Mapping the digital food environment: A systematic scoping review

Food environments are directly linked to diets and health outcomes such as overweight, obesity, and noncommunicable diseases. The digitalization of food environments is becoming a central issue in public health, yet little is known about this emerging field. We performed a systematic scoping review to map the research on the digital food environment and investigate how the eight dimensions of the food environment, according to an established framework (availability, prices, vendor and product properties, marketing and regulation, accessibility, affordability, convenience, and desirability), might be shifting in the context of a digital society. We searched MEDLINE, EMBASE, Scopus, and Web of Science for studies published between 2000 and 2019, using search terms covering digital technology and food environment, which yielded 13,580 unique records. Our analysis of 357 studies shows that digitalization is taking place in all dimensions of the food environment, and enabling the emergence of new forms of buying and selling food, such as online grocery shopping and online food delivery, which may be changing availability of foods and affecting the physical distance to shops and time allocated for shopping. Systematic reviews identified indicated that digital food marketing and social media can influence food choices, preferences and consumption. Our findings suggest that digital and physical food environments are interconnected and influencing one another, but the impact of the digital on health and nutrition is yet unclear.

Advertising patterns of a fast-food chain on social media in Brazil

OBJECTIVE

To investigate the advertising patterns on the posts of a fast-food chain in Brazil on three social media platforms in 2019.

DESIGN

An exploratory cross-sectional study.

SETTING

Advertising strategies on the posts of a major fast-food chain on their official Facebook, Instagram and YouTube accounts. The strategies were investigated according to the INFORMAS protocol for food promotion monitoring. Principal component analysis (PCA) was employed to identify advertising patterns in each platform.

PARTICIPANTS

305 advertisements.

RESULTS

Four advertising patterns were identified in the PCA of Facebook and Instagram. In both platforms, the components for kids and product exaltation were similar. On Facebook, a pattern corresponding to economic appeal was identified as price and discount, while on Instagram, this pattern also included a practical approach. On Facebook, the fourth component was named celebrity, while on Instagram it was celebrity/innovation since on this second social media the component also included the 'new brand development' variable. On YouTube, three advertising patterns were identified in PCA. Similar to the other platforms, the first and the second patterns were called for kids and price and discount, and the third component referred to both celebrity and commemorative dates.

CONCLUSIONS

The advertising patterns of the fast-food chain on three social media platforms were commonly directed to children and addressed price, discounts and the celebrities' universe. The findings of this study corroborate other data in the literature regarding unhealthy food advertising on social media. This study discusses the urgency of regulating food advertising content on this medium.

Data on the Facebook marketing strategies used by fast-food chains in four Latin American countries during the COVID-19 lockdowns

OBJECTIVES

During the COVID-19 pandemic, most countries implemented lockdowns that motivated changes in the dietary patterns, physical activity, and body mass index (BMI) of consumers worldwide, as well as the emergence of new food marketing strategies in social media. We sought to design and validate a methodology for monitoring and evaluating the Facebook marketing strategies of multinational fast-food chains in response to the COVID-19 pandemic.

DATA DESCRIPTION

We developed three datasets. First, a dataset with the Uniform Resource Locators (URLs) of 1015 Facebook posts of five fast-food chains present in Argentina, Bolivia, Guatemala, and Peru. Second, a dataset of 106 content-analyzed posts we used in a pilot to determine intercoder reliability using statistical tests. Third, a dataset of a final sample of the 1015 content-analyzed posts that we used to determine the variables most frequently used. Following a mixed-methods approach, we developed 29 variables that recorded general information, as well as the marketing strategies we identified in the posts, including 14 COVID-19 specific variables. These data should help to monitor the social media marketing strategies that fast-food chains have introduced during the COVID-19 lockdowns, thus providing initial evidence about how they could be contributing to an unhealthy food environment.

Conceptual model for the evaluation of attractiveness, addictiveness and toxicity of tobacco and related products: The example of JUUL e-cigarettes

Many new tobacco and related products (nTRP) have emerged on the market, with unknown health risks. Here, we present a conceptual model containing the factors and relations between them that contribute to the nTRP's health effects. Factors that determine attractiveness, addictiveness and toxicity of nTRP were defined based on previous assessments, literature, and expert discussions. Our model will aid in identifying key risk factors contributing to increased risk of adverse health effects for a product in a qualitative manner. Additionally, it can gauge attractiveness for specific user groups, as a determinant for population prevalence of use. Our model can be used to identify aspects of nTRP that require attention for public information or product regulation. As an example, we applied this to JUUL, a popular e-cigarette in the US. Aspects of concern for JUUL are its attractive and discrete shape, user-friendly prefilled pods, flavors, high aerosol nicotine levels, and liquids containing nicotine salts instead of free-based nicotine. The addictiveness and especially attractiveness are sufficiently high to have a large potential impact on population health due to its contribution to use and hence exposure. Products and their use can change over time; therefore market research and monitoring are crucial.

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

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

Social media's influence on adolescents' food choices: A mixed studies systematic literature review

Over 90% of adolescents have at least one social media account, and their presence on social media continues to grow. Food and beverage brands capitalize on this trend by marketing their products on social media to adolescents. Depending on the nutrition value of the products being marketed, social media advertisements' influence may contribute to the risk of developing unfavorable health outcomes such as obesity, hypertension, and type 2 diabetes. This review aimed to investigate social media's food and beverage advertisements' role in influencing adolescents' food choices by appraising published literature. A systematic literature review was conducted reporting on social media's role in adolescents' food choices. Articles were searched through CINAHL and PubMed from scholarly journals between 2015 and 2020, using the search terms: social media use, food advertisements, adolescents, and food choices. Eligible articles were selected based on inclusion criteria. PRISMA guidelines were followed, and study quality was assessed using the Mixed Methods Appraisal Tool. The analysis was conducted using narrative analysis to identify key findings. Of the 234 records, six articles met inclusion criteria. The studies revealed two major findings: adolescents were more likely to recall unhealthy food and celebrity influence was a common component of the advertisements. This review suggests that food and beverage companies use social media for marketing their products by targeting the adolescent population. The use of celebrities and influencers and the promotion of "unhealthy" products appear to be commonly used tactics. With these findings, healthcare professionals should consider screening adolescents routinely for social media use and current eating habits and educating the adolescents, parents, and families about health risk. Additionally, implementing legislation and policies may be beneficial in preventing this exposure.

Digital food environment during the coronavirus disease 2019 (COVID-19) pandemic in Brazil: an analysis of food advertising in an online food delivery platform

Online food delivery (OFD) platforms guarantee access to food during the coronavirus disease 2019 (COVID-19) pandemic when commercial food establishments are closed and access to food retail is controlled. The present study aimed to describe the advertisements published in an OFD platform in Brazilian capitals, during the 13th and 14th weeks of the pandemic. Data collection occurred on 1 d of the week and 1 d of the weekend and during lunch and dinner time. A random sample of 25 % of the advertisements (n 1754) published in this period was classified in accordance with the presence of food groups and to the use of marketing strategies. Sandwiches, ultra-processed beverages, traditional meals or pasta were the most common food groups shown in the advertisements. Free delivery prevailed in advertisements of ice cream, candies or salty packages snacks and pizza (P < 0·01). Combos were more frequently shown in the advertising of natural juices or smoothies, ultra-processed beverages, sandwiches and pizzas (P < 0·01). Messages about healthiness were more seen among natural juices or smoothies, vegetables and traditional meals and pasta advertisements (P < 0·01) and less seen in sandwiches (P = 0·02) and pizza advertisements (P < 0·01). Economy messages were rare in advertisements of traditional meals or pasta (P < 0·01) and more common in ultra-processed beverages (P = 0·03) and ice cream, candies or salty packages snacks (P < 0·01) advertisements. The OFD platform promoted unhealthy eating during the COVID-19 pandemic in Brazil due to the expressive presence of unhealthy foods advertising.