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Rummo PE, Seet C, Reimold AE, Duffy EW, Prestemon CE, Hall MG, Bragg MA, Taillie LS. Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial. Pediatr Obes 2024; 19:e13150. [PMID: 38993007 DOI: 10.1111/ijpo.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease. OBJECTIVE To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households. METHODS Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10-$30 on three beverages for their child aged 1-5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks). RESULTS On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (β = -253.5 g (95% CI: -286.3, -220.6)) and added sugar (β = -287.8 g (95% CI: -323.1, -252.5)) purchased from sugary drinks. CONCLUSION Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.
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Affiliation(s)
- Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Carla Seet
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alexandria E Reimold
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily W Duffy
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carmen E Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marie A Bragg
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Vaillancourt C, Ahmed M, Kirk S, Labonté MÈ, Laar A, Mah CL, Minaker L, Olstad DL, Potvin Kent M, Provencher V, Prowse R, Raine KD, Schram A, Zavala-Mora D, Rancourt-Bouchard M, Vanderlee L. Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021. Int J Behav Nutr Phys Act 2024; 21:18. [PMID: 38373957 PMCID: PMC10875887 DOI: 10.1186/s12966-024-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.
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Affiliation(s)
- Caroline Vaillancourt
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Sara Kirk
- School of Health and Human Performance, Dalhousie University, 6230 South Street, Kjipuktuk (Halifax), NS, B3H 4R2, Canada
| | - Marie-Ève Labonté
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Catherine L Mah
- School of Health Administration, Dalhousie University, 5850 College Street, Halifax, NS, B3H 4R2, Canada
| | - Leia Minaker
- School of Planning, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3T1, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Véronique Provencher
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 11405 87 Ave Northwest, Edmonton, AB, T6G 1C9, Canada
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), ANU College of Asia & the Pacific, The Australian National University, 8 Fellows Road, Canberra, Australian Capital Territory, 2600, Australia
| | - Daniela Zavala-Mora
- Science Library, Université Laval, 1045 Avenue de La Médecine, Québec, QC, G1V 0A6, Canada
| | - Maryka Rancourt-Bouchard
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada.
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3
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Okoli CB, Arrington N, Hall J, Paulus T, Miles I, Shieh J, Sharpe K, Cotwright CJ. Black Parents' Perceptions and Barriers to Limiting Sugar-Sweetened Beverages Among Young Children: A Social Cognitive Theory Application. Child Obes 2024; 20:23-34. [PMID: 36576994 DOI: 10.1089/chi.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. Objective: This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. Methods: Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. Results: Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. Conclusion: Findings from this study will inform interventions to reduce SSB intake among Black families with young children.
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Affiliation(s)
- Chisom B Okoli
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | | | - Jori Hall
- College of Education, University of Georgia, Athens, GA, USA
| | - Trena Paulus
- Division of Family Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Isa Miles
- Isa Miles Consulting, Atlanta, GA, USA
| | - Josephine Shieh
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Kassidy Sharpe
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Caree J Cotwright
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
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Soares Guimarães J, Pauzé E, Potvin Kent M, Barquera S, Jáuregui A, Sacks G, Vanderlee L, Hammond D. 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. J Nutr Sci 2023; 12:e123. [PMID: 38155804 PMCID: PMC10753451 DOI: 10.1017/jns.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023] Open
Abstract
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.
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Affiliation(s)
| | - Elise Pauzé
- School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Simón Barquera
- Center for Nutrition and Health Research, INSP, Cuernavaca, Mexico
| | | | - Gary Sacks
- School of Health and Social Development, Deakin University, Victoria, Australia
| | - Lana Vanderlee
- School of Nutrition, Université of Laval, Quebec City, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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5
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Forde H, Penney TL, White M, Levy L, Greaves F, Adams J. Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019. Int J Health Policy Manag 2022; 11:2618-2629. [PMID: 35219285 PMCID: PMC9818127 DOI: 10.34172/ijhpm.2022.5465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends that countries implement fiscal policies to reduce the health impacts of sugary drinks. Few studies have fully examined the responses of industry to these policies, and whether they support or undermine health benefits of sugary drinks taxes. We aimed to explore the changes that sugary drinks companies may make to their marketing, and underlying decision-making processes, in response to such a tax. METHODS Following introduction of the UK Soft Drinks Industry Levy (SDIL) in 2018, we undertook one-to-one semi-structured interviews with UK stakeholders with experience of the strategic decision-making or marketing of soft drinks companies. We purposively recruited interviewees using seed and snowball sampling. We conducted telephone interviews with 6 representatives from each of industry, academia and civil society (total n=18), which were transcribed verbatim and thematically analysed. Four transcripts were double-coded, three were excluded from initial coding to allow comparison; and findings were checked by interviewees. RESULTS Themes were organised into a theoretical framework that reveals a cyclical, iterative and ongoing process of soft drinks company marketing decision-making, which was accelerated by the SDIL. Decisions about marketing affect a product's position, or niche, in the market and were primarily intended to maintain profits. A product's position is enacted through various marketing activities including reformulation and price variation, and non-marketing activities like lobbying. A soft drinks company's selection of marketing activities appeared to be influenced by their internal context, such as brand strength, and external context, such as consumer trends and policy. For example, a company with low brand strength and an awareness of trends for reducing sugar consumption may be more likely to reformulate to lower-sugar alternatives. CONCLUSION The theoretical framework suggests that marketing responses following the SDIL were coordinated and context-dependent, potentially explaining observed heterogeneity in responses across the industry.
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Affiliation(s)
- Hannah Forde
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Tarra L. Penney
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
- Global Food Systems and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Louis Levy
- The Faculty of Health and Social Care, University of Chester, Chester, UK
- Public Health England, London, UK
| | - Felix Greaves
- Public Health England, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Excellence, London, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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6
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Potvin Kent M, Pauzé E, Bagnato M, Guimarães JS, Pinto A, Remedios L, Pritchard M, L’Abbé MR, Mulligan C, Vergeer L, Weippert M. Food and beverage advertising expenditures in Canada in 2016 and 2019 across media. BMC Public Health 2022; 22:1458. [PMID: 35915428 PMCID: PMC9340686 DOI: 10.1186/s12889-022-13823-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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7
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Jones CP, Armstrong-Moore R, Penney TL, Cummins S, Armitage S, Adams J, White M. Adolescents' perspectives on soft drinks after the introduction of the UK Soft Drinks Industry Levy: A focus group study using reflexive thematic analysis. Appetite 2022; 179:106305. [PMID: 36089123 DOI: 10.1016/j.appet.2022.106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/23/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, is a fiscal policy to incentivise reformulation of eligible soft drinks. We aimed to explore perceptions of sugar, sugary drinks and the SDIL among adolescents in the UK post-implementation. METHODS 23 adolescents aged 11-14 years participated in four focus groups in 2018-2019. A semi-structured topic guide elicited relevant perspectives and included a group task to rank a selection of UK soft drinks based on their sugar content. Braun and Clarke's reflexive thematic analysis was used to undertake inductive analysis. RESULTS Four main themes were present: 1) Sweetened drinks are bad for you, but some are worse than others; 2) Awareness of the SDIL and ambivalence towards it 3) The influence of drinks marketing: value, pricing, and branding; 4) Openness to population-level interventions. Young people had knowledge of the health implications of excess sugar consumption, which did not always translate to their own consumption. Ambivalence and a mixed awareness surrounding the SDIL was also present. Marketing and parental and school restriction influenced their consumption patterns, as did taste, enjoyment and consuming drinks for functional purposes (e.g., to give them energy). Openness to future population-level interventions to limit consumption was also present. CONCLUSIONS Our findings suggest that adolescents are accepting of interventions that require little effort from young people in order to reduce their sugar consumption. Further education-based interventions are likely to be unhelpful, in contexts where adolescents understand the negative consequences of excess sugar and SSB consumption.
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Affiliation(s)
- Catrin P Jones
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, United Kingdom.
| | | | - Tarra L Penney
- Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Canada
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Sofie Armitage
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, United Kingdom
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8
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Hammond D, Vanderlee L, White CM, Acton RB, White M, Roberto CA, Cameron A, Sacks G, Kirkpatrick S, Dubin J, Adams J, Jauregui A, Thrasher JF. The Conceptual Framework for the International Food Policy Study: Evaluating the Population-Level Impact of Food Policy. J Nutr 2022; 152:1S-12S. [PMID: 35274695 PMCID: PMC9188864 DOI: 10.1093/jn/nxac042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labeling, and taxation of less healthy foods. There is a need to evaluate and inform the implementation of these policies, including their impacts on marginalized population subgroups. The International Food Policy Study (IFPS) consists of repeated cross-sectional surveys conducted in 5 high- and upper-middle-income countries: Australia, Canada, Mexico, the United Kingdom, and the United States. In each country, approximately 4000 adults and 1200 children and youth (aged 10-17) were recruited from a global commercial panel to complete an online survey using consistent measures and methodologies across countries. The first annual IFPS surveys were conducted in 2017 with adults; annual surveys for young people aged 10-17 were launched in 2019 in the same countries, as well as in Chile. The design of the IFPS surveys creates a framework for evaluating "natural experiments" in food policies, including comparisons over time within countries implementing the policy and comparisons with countries in which the policy was not implemented. IFPS surveys have 3 primary areas of focus: 1) knowledge, attitudes, and beliefs associated with specific policies; 2) diet-related behaviors; and 3) dietary intake, including 24-hour dietary recalls for adults in 4 of the 5 countries. Surveys also assess food insecurity, income adequacy, sex and gender, race/ethnicity, and a range of other measures to assess trends among priority subgroups. Overall, the IFPS project has the potential to address important gaps in national monitoring surveys for dietary patterns, and to evaluate the impacts of novel food policies implemented in any of the 5 countries over the study period.
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Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrian Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sharon Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- Department Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alejandra Jauregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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9
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Ganson KT, Nagata JM, Rodgers RF, Cunningham ML, Lavender JM, Murray SB, Hammond D. Weight gain attempts and substance use behaviors among adults across five countries. Body Image 2022; 41:375-383. [PMID: 35525156 DOI: 10.1016/j.bodyim.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
Weight gain attempts are common among adolescents, yet a paucity of research has explored these behaviors among adults, particularly in relation to substance use behaviors. To address this gap in the literature, pooled data from the 2018 and 2019 International Food Policy Study (N = 42,108) were analyzed. The association of weight gain attempts in the past 12 months with four important and relatively common substance use behaviors (alcohol use, binge-drinking, cigarette smoking, marijuana use) was examined using multiple modified Poisson regression analyses that adjusted for theoretically relevant covariates. Among men and women, weight gain attempts were associated with a higher likelihood of cigarette smoking in the past 30 days, marijuana use in the past 12 months, and binge-drinking one or more times per month in the past 12 months among men only. Among women, weight gain attempts were associated with a lower likelihood of alcohol use one or more times per month in the past 12 months. Our findings contribute to the literature demonstrating that substance use behaviors are more prevalent among adults who report weight gain attempts in a large international sample.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | | | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA; Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA; Metis Foundation, San Antonio, TX, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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10
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Demers-Potvin É, White M, Potvin Kent M, Nieto C, White CM, Zheng X, Hammond D, Vanderlee L. Adolescents' media usage and self-reported exposure to advertising across six countries: implications for less healthy food and beverage marketing. BMJ Open 2022; 12:e058913. [PMID: 35589343 PMCID: PMC9121490 DOI: 10.1136/bmjopen-2021-058913] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/27/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The study objectives were to examine: (1) adolescents' media viewing habits, (2) associations with media viewing and self-reported exposure to unhealthy food and beverage advertising and (3) differences in trends among younger and older adolescents in six high and upper middle-income countries. DESIGN Repeat cross-sectional online survey. SETTING Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States of America (USA). PARTICIPANTS Respondents to the International Food Policy Study who provided information on all variables of interest in November-December 2019 aged 10-17 years (n=9171). OUTCOME MEASURES Self-reported exposure to screen-based media (screen time by media channel), use of social media platforms and self-reported location and frequency of exposure to unhealthy food and beverage advertising. RESULTS The average amount of time spent in front of various screens ranged from 7.6 hours to 10.2 hours across countries per week day, which may include possible viewing of multiple media channels simultaneously. Overall, Instagram was the most popular social media platform (52%-68% by country), followed by Facebook (42%-79%) and Snapchat (28%-52%). The percentage of respondents who self-reported having seen unhealthy food advertisements in the past 30 days was highest on television (43%-69%), followed by digital media (27%-60%) and gaming applications (10%-17%). Self-reported daily exposure to advertising varied between countries for sugary drinks (10%-43%) and fast food (19%-44%) and was positively associated with self-reported screen time. Self-reported exposure to screen-based media and social media platforms differed by sociodemographic characteristics and was higher among older adolescents than younger adolescents. CONCLUSIONS The important amount of time spent on screen-based media reported by adolescents and large percentage of adolescents reporting social media usage, coupled with high rates of self-reported advertising exposure, support the need for policies to restrict marketing of unhealthy food and beverages appealing to adolescents on screen-based media.
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Affiliation(s)
- Élisabeth Demers-Potvin
- École de nutrition, Centre NUTRISS - Nutrition, santé et société, Institut sur la nutrition et les aliments fonctionnels, Université Laval, Quebec City, Quebec, Canada
| | - Martin White
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Christine M White
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Xueying Zheng
- Health Education East of England, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- École de nutrition, Centre NUTRISS - Nutrition, santé et société, Institut sur la nutrition et les aliments fonctionnels, Université Laval, Quebec City, Quebec, Canada
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11
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Ganson KT, Nagata JM, Vanderlee L, Rodgers RF, Lavender JM, Hazzard VM, Murray SB, Cunningham M, Hammond D. Weight gain attempts and diet modification efforts among adults in five countries: a cross-sectional study. Nutr J 2022; 21:30. [PMID: 35562831 PMCID: PMC9102257 DOI: 10.1186/s12937-022-00784-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent research has emphasized a growing trend of weight gain attempts, particularly among adolescents and boys and young men. Little research has investigated these efforts among adults, as well as the specific diet modifications individuals who are trying to gain weight engage in. Therefore, the aims of this study were to characterize the diet modification efforts used by adults across five countries who reported engaging in weight gain attempts and to determine the associations between weight gain attempts and concerted diet modification efforts. METHODS Cross-sectional data from the 2018 and 2019 International Food Policy Study, including participants from Australia, Canada, Mexico, the United Kingdom, and the United States (N = 42,108), were analyzed. In reference to the past 12 months, participants reported on weight gain attempts and diet modification efforts related to increased consumption of calories, protein, fiber, fruits and vegetables, whole grains, dairy products, all meats, red meat only, fats, sugar/added sugar, salt/sodium, and processed foods. Unadjusted (chi-square tests) and adjusted (modified Poisson regressions) analyses were conducted to examine associations between weight gain attempts and diet modification efforts. RESULTS Weight gain attempts were significantly associated with higher likelihood of each of the 12 forms of diet modification efforts among male participants, and 10 of the diet modification efforts among female participants. Notably, this included higher likelihood of efforts to consume more calories (males: adjusted prevalence ratio [aPR] 3.25, 95% confidence interval [CI] 2.94-3.59; females: aPR 4.05, 95% CI 3.50-4.70) and fats (males: aPR 2.71, 95% CI 2.42-3.03; females: aPR 3.03, 95% CI 2.58-3.55). CONCLUSIONS Overall, the patterns of association between weight gain attempts and diet modification efforts may be indicative of the phenomenon of muscularity-oriented eating behaviors. Findings further highlight the types of foods and nutrients adults from five countries may try to consume in attempts to gain weight.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Jason M Nagata
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, 550 16th Street., Box 0110, San Francisco, CA, 94158, USA.
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé Et Société (NUTRISS), Université Laval, Quebec City, QC, Canada
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Vivienne M Hazzard
- Sanford Center for Bio-Behavioral Research, Sanford Health, Fargo, ND, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | | | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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12
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Nieto C, Jáuregui A, Contreras-Manzano A, Potvin Kent M, Sacks G, White CM, Pauzé E, Vanderlee L, Thrasher JF, Barquera S, Hammond D. Adults' Exposure to Unhealthy Food and Beverage Marketing: A Multi-Country Study in Australia, Canada, Mexico, the United Kingdom, and the United States. J Nutr 2022; 152:25S-34S. [PMID: 35544288 PMCID: PMC9188858 DOI: 10.1093/jn/nxab449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Elise Pauzé
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, South Carolina, USA,Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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13
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Yau A, Berger N, Law C, Cornelsen L, Greener R, Adams J, Boyland EJ, Burgoine T, de Vocht F, Egan M, Er V, Lake AA, Lock K, Mytton O, Petticrew M, Thompson C, White M, Cummins S. Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis. PLoS Med 2022; 19:e1003915. [PMID: 35176022 PMCID: PMC8853584 DOI: 10.1371/journal.pmed.1003915] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. METHODS AND FINDINGS Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. CONCLUSIONS This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.
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Affiliation(s)
- Amy Yau
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (AY); (SC)
| | - Nicolas Berger
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Epidemiology and Public Health, Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Cherry Law
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Greener
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emma J. Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Applied Research Collaboration West, Bristol, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vanessa Er
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amelia A. Lake
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Fuse–The Centre for Translational Research in Public Health, Newcastle upon Tyne, United Kingdom
| | - Karen Lock
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oliver Mytton
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Claire Thompson
- Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (AY); (SC)
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14
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Finlay AH, Lloyd S, Lake A, Armstrong T, Fishpool M, Green M, Moore HJ, O’Malley C, Boyland EJ. An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England. Public Health Nutr 2022; 25:1-12. [PMID: 34974851 PMCID: PMC9991712 DOI: 10.1017/s1368980021005048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people. DESIGN Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation. SETTING Middlesbrough and Redcar and Cleveland in South Teesside. PARTICIPANTS N/A. RESULTS Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation. CONCLUSIONS Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.
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Affiliation(s)
| | - Scott Lloyd
- Public Health South Tees, Middlesbrough, UK
- School of Health & Life Sciences, Teesside University and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Amelia Lake
- SHLS Allied Health Professions Centre for Public Health, Teesside University, and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Thomas Armstrong
- SHLS Allied Health Professions Centre for Public Health, Teesside University, Middlesbrough, UK
| | | | - Mark Green
- Department of Geography and Planning, University of Liverpool, Liverpool, UK
| | - Helen J Moore
- SHLS Allied Health Professions Centre for Public Health, Teesside University, and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Claire O’Malley
- SHLS Allied Health Professions Centre for Public Health, Teesside University, and Fuse – Centre for Translational Research in Public Health, London, UK
| | - Emma J Boyland
- Department of Psychology, University of Liverpool, LiverpoolL69 7ZA, UK
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15
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Ganson KT, Nagata JM, Lavender JM, Rodgers RF, L Cunningham M, Murray SB, Hammond D. Prevalence and correlates of weight gain attempts across five countries. Int J Eat Disord 2021; 54:1829-1842. [PMID: 34415082 DOI: 10.1002/eat.23595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the prevalence and correlates of weight gain attempts in a pooled sample of adults aged 18 and older from Canada, Australia, the United Kingdom, the United States, and Mexico. METHOD Data collected during 2 years (2018 and 2019) of the International Food Policy Study (N = 42,108) were analyzed. Unadjusted 12-month prevalence of weight gain attempts was estimated based on body mass index (BMI; kg/m2 ), weight perception, country, survey year, and sex. Logistic regression analyses were estimated to determine the sociodemographic correlates (age, race/ethnicity, education, BMI, weight perception, weight perception accuracy, and self-rated mental health) of weight gain attempts among the pooled sample stratified by sex. RESULTS Men (10.4%) were significantly more likely than women (5.4%) to report weight gain attempts (p < .001). Nearly one in five (17.1%) men with a BMI in the "normal" range (≥18.5 to <25.0) reported weight gain attempts. Among both men and women, minority group identity was associated with higher odds, while older age and higher BMI category were associated with lower odds, of reporting weight gain attempts. Country differences over the two survey years showed the prevalence of weight gain attempts in 2019 (vs. 2018) was higher among women in Australia (p < .05) and men in the United States (p < .01). DISCUSSION Weight gain attempts are more common among men, compared to women, across five countries, potentially reflecting the global salience of the pursuit of a muscular body.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, Maryland, USA.,Metis Foundation, San Antonio, Texas, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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16
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Eisenberg MD, Avery RJ, Mathios A, Ernst P, Cawley J. Disparities in exposure to television advertising of sugar-sweetened and non-nutritive sweetened beverages among U.S. adults and teens, 2007-2013. Prev Med 2021; 150:106628. [PMID: 34019929 DOI: 10.1016/j.ypmed.2021.106628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to estimate disparities in exposure to television advertising of sugar-sweetened and non-nutritive sweetened beverages among U.S. adults and teens. Data (2007-2013) came from the National Consumer Survey and included 115,510 adult respondents (age 18+) and 8635 teen respondents (age 12-17). The data was originally accessed in 2018 and analyzed in 2019-2020. The main outcomes were individual-level estimated exposure to advertisements for regular soda, diet soda, and energy/sport drinks. The main exposures were by race/ethnicity, household income, and educational attainment. Non-white adults (teens) were exposed to an estimated (per year) 101.5 (190.1) regular soda ads, 49.5 (61.2) diet soda ads, and 157.1 (279.6) energy/sport ads per year while white respondents were exposed to 97.5 (127.7) regular soda ads, 45.8 (44.2) diet soda ads, and 123.9 (192.0) energy/sport ads per year. Adult (teen) respondents who were non-white with low incomes and with low educational attainment were exposed to 4.7% (53.7%) more regular soda ads, 6.6% (43.8%) more diet ads, and 23.2% (56.2%) more energy/sport ads than respondents who were white with high incomes and high educational attainment. Demographic and socio-economic groups with a higher prevalence of obesity were exposed to significantly more advertisements for sugar-sweetened beverages. When evaluating potential policies to regulate marketing of sugar-sweetened and non-nutritive sweetened beverages, policymakers should consider the disparate exposure of at-risk populations to advertising of sugar-sweetened and non-nutritive sweetened beverages.
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Affiliation(s)
- Matthew D Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
| | - Alan Mathios
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
| | - Peter Ernst
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States of America
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17
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Roesler A, Rojas N, Falbe J. Sugar-Sweetened Beverage Consumption, Perceptions, and Disparities in Children and Adolescents. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:553-563. [PMID: 34246410 PMCID: PMC8388314 DOI: 10.1016/j.jneb.2021.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the association between sugar-sweetened beverage (SSB) perceptions-knowledge, attitudes, and norms and media literacy-and beverage consumption, and to identify differences in beverage consumption and SSB perceptions by race/ethnicity and socioeconomic status. DESIGN Cross-sectional. SETTING Diverse California school district. PARTICIPANTS A total of 992 fifth-grade (elementary), seventh-grade (middle), and ninth-12th-grade (high school) students. MAIN OUTCOME MEASURES Questionnaire-assessed continuous beverage consumption and perceptions. ANALYSIS Linear regression adjusting for school, grade, gender, race/ethnicity, and free and reduced-price meal (FRPM) eligibility. RESULTS Knowledge, attitudes, and norms, and media literacy items were associated with SSB consumption in expected directions (P < 0.05). Among elementary students, FRPM-eligible and Black students had higher SSB consumption (P < 0.01). In middle/high school, non-Hispanic White students consumed fewer SSBs than all other racial/ethnic groups (P < 0.01). There were differences in SSB-related perceptions by race/ethnicity and socioeconomic status (eg, Black students perceived sugary drinks as less unhealthy); Black, Hispanic, and FRPM-eligible students expressed less distrust of food/beverage advertisements; and Black, Hispanic, Asian, multirace, and FRPM-eligible students perceived more frequent SSB consumption among their peers (P < 0.05). CONCLUSIONS AND IMPLICATIONS Sugar-sweetened beverage perceptions were associated with SSB consumption. There were racial/ethnic and socioeconomic disparities in SSB consumption and perceptions. Sugar-sweetened beverage perceptions and related social and commercial determinants like marketing may be useful targets for reducing SSB consumption.
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Affiliation(s)
- Athena Roesler
- Department of Human Ecology, University of California Davis, Davis, CA
| | | | - Jennifer Falbe
- Department of Human Ecology, University of California Davis, Davis, CA.
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18
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Vanderlee L, Czoli CD, Pauzé E, Potvin Kent M, White CM, Hammond D. A comparison of self-reported exposure to fast food and sugary drinks marketing among parents of children across five countries. Prev Med 2021; 147:106521. [PMID: 33744330 DOI: 10.1016/j.ypmed.2021.106521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/28/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
Exposure to unhealthy food and beverage marketing is an important environmental determinant of dietary intake. The current study examined self-reported exposure to marketing of unhealthy foods and beverages across various media channels and settings among parents of children younger than 18 years in five high and upper-middle income countries. Data from 4827 parents living with their children were analyzed from the International Food Policy Study (2017), a web-based survey of adults aged 18-64 years from Canada, the United States (US), the United Kingdom (UK), Australia, and Mexico. Respondents reported their exposure to marketing of fast food and of sugary drinks across media channels/settings overall and how often they see fast food and sugary drink marketing while viewing media with their children. Regression models examined differences across countries and correlates of marketing exposure. Parents in Mexico and the US reported greater exposure to marketing for fast food and sugary drinks compared to parents in Australia, Canada, and the UK. Patterns of exposure among parents were generally consistent across countries, with TV, digital media, and radio being the most commonly reported media channels for both fast food and sugary drinks. Exposure to marketing of fast food and sugary drinks was associated with a variety of sociodemographic factors, most strongly with ethnicity and education, and sociodemographic trends differed somewhat between countries. The findings demonstrate differences in self-reported parental exposure to marketing of fast food and sugary drinks between countries, and may help to evaluate the impact of marketing restrictions implemented over time.
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Affiliation(s)
- Lana Vanderlee
- École de Nutrition, Centre de nutrition, santé et société (NUTRISS), Université Laval, 2425 rue de L'Agriculture, Québec, Québec G1V 0A6, Canada.
| | - Christine D Czoli
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada; Heart and Stroke Foundation of Canada, Ottawa, 110-1525 Carling Avenue, Ottawa, Ontario, K1Z 8R9, Canada
| | - Elise Pauzé
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada.
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada.
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
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19
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Rubin LH, Gustafson DR, Warrior L, Sheira L, Fitzgerald KC, Dastgheyb R, Weber KM, Tien PC, French A, Spence AB, Sharma A, Williams DW, White CJ, Seaberg EC, Frongillo EA, Weiser SD. Dietary intake is associated with neuropsychological impairment in women with HIV. Am J Clin Nutr 2021; 114:378-389. [PMID: 33829235 PMCID: PMC8246600 DOI: 10.1093/ajcn/nqab038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/02/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diet is a modifiable risk factor that may influence cognition in people with HIV. OBJECTIVES We examined the association between dietary intake and cognition in women with HIV (WWH) and HIV-seronegative women. METHODS An 18-item dietary National Cancer Institute screener was completed by 729 WWH and 346 HIV-seronegative Women's Interagency HIV Study participants. Daily intake frequencies of processed meats, sweet beverages, fish, whole milk, and vegetables were calculated. Participants completed biennial neuropsychological (NP) testing. NP domains included attention/working memory, executive function, processing speed, memory, learning, fluency, and motor function. NP impairment was defined as demographically adjusted T-scores (mean = 50; SD = 10) ≤40 at ≥1 visit after completing the dietary screener. Multivariable logistic regression, stratified by HIV serostatus, examined associations between intake frequency tertile (referent = lowest intake) and NP performance. RESULTS Dietary intake frequencies of individual food line items were similar between WWH and HIV-seronegative women, except for sweet beverages, for which HIV-seronegative women reported higher intake frequencies than WWH (P values < 0.05). In WWH, multivariable-adjusted models indicated higher odds of NP impairment with higher intake frequencies of processed meat [P = 0.006; ORupper tertile = 1.91 (95% CI: 1.23-2.95; P = 0.003); ORmiddle tertile = 1.66 (95% CI: 1.14-2.42; P = 0.01)], sweet beverages [P = 0.02; ORupper tertile = 1.75 (95% CI: 1.17-2.64; P = 0.007)], fish [P = 0.01; ORupper tertile = 1.70 (95% CI: 1.10-2.64; P = 0.02)], and whole milk [P = 0.029; ORupper tertile = 1.66 (95% CI: 1.14-2.42; P = 0.008)]. Lower odds of NP impairment [P = 0.005; ORupper tertile = 0.65 (95% CI: 0.45-0.95; P = 0.02); ORmiddle tertile = 0.42 (95% CI: 0.24-0.73; P = 0.002)] were associated with higher vegetable intakes. In HIV-seronegative women, multivariable-adjusted models did not show associations between food line items/diet quality score and NP outcomes. CONCLUSIONS Intakes of processed meat, sweet beverages, whole milk, fish, and vegetables may be associated with NP functions among WWH. Associations among WWH are not directly comparable to those among HIV-seronegative women, because models were conducted on each group separately given controls for HIV-specific covariates in WWH. Further studies are needed using more rigorous dietary assessment methods and lengthier longitudinal follow-ups.
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Affiliation(s)
| | | | | | - Lila Sheira
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen M Weber
- Division of Neurology, Cook County Health, Chicago, IL, USA,Cook County Health, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Audrey French
- Division of Neurology, Cook County Health, Chicago, IL, USA,Cook County Health, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cory J White
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Sheri D Weiser
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
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20
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Yau A, Adams J, Boyland EJ, Burgoine T, Cornelsen L, de Vocht F, Egan M, Er V, Lake AA, Lock K, Mytton O, Petticrew M, Thompson C, White M, Cummins S. Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data. BMJ Open 2021; 11:e048139. [PMID: 33827849 PMCID: PMC8031692 DOI: 10.1136/bmjopen-2020-048139] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI). DESIGN Cross-sectional survey. SETTING UK. PARTICIPANTS 1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England. OUTCOME MEASURES Self-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics. RESULTS Overall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18-34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity. CONCLUSIONS Exposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.
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Affiliation(s)
- Amy Yau
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jean Adams
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Emma J Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Thomas Burgoine
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Frank de Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West, Bristol, UK
| | - Matt Egan
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Vanessa Er
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Amelia A Lake
- Centre for Public Health Research, Teesside University, Middlesbrough, UK
- Centre for Translational Research in Public Health (Fuse), Newcastle upon Tyne, UK
| | - Karen Lock
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Mytton
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Mark Petticrew
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Claire Thompson
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Martin White
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
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21
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Sigala DM, Stanhope KL. An Exploration of the Role of Sugar-Sweetened Beverage in Promoting Obesity and Health Disparities. Curr Obes Rep 2021; 10:39-52. [PMID: 33411311 PMCID: PMC7788552 DOI: 10.1007/s13679-020-00421-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The mechanistic role of sugar-sweetened beverage (SSB) in the etiology of obesity is undetermined. We address whether, compared to other foods, does consumption of SSB (1) automatically lead to failure to compensate for the energy it contains? (2) fail to elicit homeostatic hormone responses? (3) promote hedonic eating through activation of the brain's reward pathways? We followed the evidence to address: (4) Would restriction of targeted marketing of SSB and other unhealthy foods to vulnerable populations decrease their prevalence of obesity? RECENT FINDINGS The data are lacking to demonstrate that SSB consumption promotes body weight gain compared with isocaloric consumption of other beverages or foods and that this is linked to its failure to elicit adequate homeostatic hormone responses. However, more recent data have linked body weight gain to reward activation in the brain to palatable food cues and suggest that sweet tastes and SSB consumption heightens the reward response to food cues. Studies investigating the specificity of these responses have not been conducted. Nevertheless, the current data provide a biological basis to the body of evidence demonstrating that the targeted marketing (real life palatable food cues) of SSB and other unhealthy foods to vulnerable populations, including children and people of color and low socioeconomic status, is increasing their risk for obesity. While the mechanisms for the association between SSB consumption and body weight gain cannot be identified, current scientific evidence strongly suggests that proactive environmental measures to reduce exposure to palatable food cues in the form of targeting marketing will decrease the risk of obesity in vulnerable populations.
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Affiliation(s)
- Desiree M. Sigala
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California (UC), Davis, 2211 VM3B, Davis, CA 95616 USA
| | - Kimber L. Stanhope
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California (UC), Davis, 2211 VM3B, Davis, CA 95616 USA
- Basic Sciences, Touro University of California, Vallejo, CA USA
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22
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Digital food marketing to children: Exploitation, surveillance and rights violations. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2020. [DOI: 10.1016/j.gfs.2020.100423] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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