Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community‐led supportive environment approach

Objective : To create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. Methods : This paper applied qualitative and quantitative methods to evaluate a co‐designed multi‐strategy health promotion initiative, implemented over 12 months from 2017 to 2018. Outcome measures included changes in community readiness, awareness of the social marketing campaign and changes in drink availability. Changes in store drink sales were measured in one community and compared to sales in a control store. Results : Community readiness to address sugary drink consumption increased in two of the three communities. Awareness of social marketing campaign messaging was high (56–94%). Availability of drinking water increased in all communities. Water sales as a proportion of total drink volume sales increased by 3.1% (p<0.001) while sugary drink volume sales decreased by 3.4% (p<0.001). Conclusions : A multi‐component strategy with strong engagement from local government, community leaders and the wider community was associated with positive changes in community readiness, drink availability and sales. Implications for public health : Partnering with community leaders in the co‐design of strategies to create environments that support healthy drink consumption can stimulate local action and may positively affect drink consumption.     

Sponsorship of junior sport development programs in Australia

Objective : This study investigated the nature and extent of unhealthy food, beverage, alcohol and gambling sponsors of children's sport development programs. Methods : Websites of junior development sport programs (n=56) associated with sporting organisations that received funding from the Australian Sporting Commission were analysed. Sponsors were considered unhealthy if they were alcohol or gambling companies or sold food and/or beverages that failed independent nutrition criteria. The websites of the sport development programs were also analysed for types of promotion. Results : There were 246 sponsors identified. Eleven (4.5%) sponsors were food, beverage, alcohol or gambling companies of which 10 (91%) were unhealthy. Surf Lifesaving (n=4) and athletics (n=3) websites had the highest number of unhealthy sponsors. Promotions associated with unhealthy sponsorship included logo placement on homepages (100%), naming rights (31%), logo on sport uniforms (27%) and branded participant packs (31%). Conclusions : The majority of food and beverage company sponsors in sport development programs are companies associated with unhealthy products. Two websites hosting junior development program information included an alcohol company sponsor and a gambling company sponsor. Implications : Unhealthy product sponsorship of children's sport should be addressed as part of a comprehensive regulation designed to reduce exposure to marketing of unhealthy foods.     

Editorial – Time to get tough on unhealthy sponsorships

Health is everybody's business, and the Bangkok Charter placed health promotion firmly in a global context, calling for an integrated policy approach where health is central to global development and a key requirement for good corporate practice. The Charter recognised the potential harms associated with marketing strategies1 and there is a growing recognition that advertising and marketing of unhealthy food and drinks, including alcohol, have a negative impact on children's knowledge, attitudes, preferences and consumption. A recent New Zealand study also found links between alcohol industry sponsorship and higher levels of alcohol consumption among sport participants. In Australia, the National Preventative Health Taskforce placed advertising and marketing of unhealthy products firmly on the national health agenda and concluded that the weight of evidence is now sufficiently compelling to recommend action to control what remains an overwhelmingly self‐regulated industry.     

Trends in food advertising to children on free-to-air television in Australia

Objective: The issue of marketing unhealthy food to children and its contribution to childhood obesity has become a highly politicised debate in Australia. The aim of this study was to compare recent television food advertising patterns in 2008 to previously published Australian research on television advertising from 2006 and 2007, to examine any changes following policy debates. Methods: Television broadcasting was recorded for two weekdays and two weekend days between 6:00 and 22:00 in February 2008 for all three commercial television channels. Food advertisements were classified as core/healthy, non‐core/unhealthy or miscellaneous. Television audience data were obtained to determine broadcast periods corresponding to children's peak viewing times. Results: The overall rate of food advertising decreased over time: from seven food advertisements/hour/channel in 2006/07 to five in 2008. However, the relative contribution of non‐core food advertising to overall food advertising remained stable. In 2008, the proportion of food advertisements for non‐core foods was significantly higher during children's peak viewing times (p<0.01). Conclusions and implications: Australian children remain exposed to a disproportionate volume of television advertisements for unhealthy foods on commercial television, which are shown during time periods when the highest numbers of children are watching. Regulations to limit unhealthy food advertising during the time periods when a significant number of children are watching are required.     

Comparing Sugary Drinks in the Food Retail Environment in Six NYC Neighborhoods

Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke^® or Pepsi^®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.     

Density of outdoor food and beverage advertising around schools in Ulaanbaatar (Mongolia) and Manila (The Philippines) and implications for policy

Children’s exposure to unhealthy food marketing is recognised by leading international health organisations as a probable causal factor for obesity. Outdoor advertising near schools embeds commercial food messages into children’s everyday lives and acts as a cue for food purchases. This project aimed to describe food advertising in the area around schools in two demographically and culturally disparate cities in the Asia Pacific Region. Data on outdoor food advertising were collected from the area within 500?m of 30 primary schools in each of two cities: Ulaanbaatar, Mongolia and Manila, The Philippines. For each food advertisement, information was collected on: distance from the school (within 250 or 500?m); size, setting, type and position of the advertisement; and the food/drink product type promoted (core/healthy, non-core/unhealthy and miscellaneous). Density of advertisements was calculated per 100?m². The density of food advertising was twice as high in the area closest to schools compared to the area further from schools (.9 vs. .5 in Ulaanbaatar and 6.5 vs. 3.3 advertisements per 100?m² in Manila). Almost all food advertisements were for non-core/unhealthy foods/drinks (92% in Ulaanbaatar and 85% in Manila), and soft drinks were most frequently promoted. Children in Ulaanbaatar and Manila are exposed to large numbers of advertisements for unhealthy foods/drinks on their way to and from school, and these are particularly clustered within the immediate vicinity of schools. Clear directions for policy development are outlined to reduce children’s exposure to this marketing, including restricting the placement and content of outdoor advertising.     

Nothing beats taste or convenience: a national survey of where and why people buy sugary drinks in Australia

Objective : There is limited knowledge of what influences sugary drink purchasing decisions in the Australian population. This study aimed to identify the most common locations and reasons across different demographic groups for purchasing sugary drinks in Australia. Methods : A total of 891 respondents (who purchased sugary drinks for personal consumption at least occasionally) from a broader national population telephone survey of Australian adults conducted in 2017 (n=3,430) were included in the analysis. Results : ‘Taste’ was a ubiquitous reason for purchase (94%) and the majority also agreed with ‘easily available’ (76%). Males, younger people and people of lower socioeconomic status (SES) were significantly more likely to agree that sugary drinks were ‘cheap’ and ‘better value than water’. Furthermore, males and younger people were more likely to report buying sugary drinks because they were ‘part of a meal deal’. The most common purchase locations were supermarkets (56%), followed by convenience stores (19%) and food or entertainment venues (17%). Conclusion : Taste is paramount in decisions to purchase sugary drinks, and widespread availability and value for money support consumption. Implications for public health : Policies and interventions targeting point‐of‐sale sugary drink purchasing decisions among the most ‘at risk’ consumers are warranted.     

The distribution of harmful product marketing in public outdoor spaces and the effectiveness of marketing bans

Children's exposure to the marketing of harmful products in public outdoor spaces may influence their consumption of those products and affect health into adulthood. This study aimed to: i) examine the spatial distribution of children's exposure to three types of marketing-related ‘harms’ (alcohol, unhealthy food, and gambling) in outdoor spaces in the Wellington region, New Zealand/Aotearoa; ii) compare differences in the distribution of harms by socioeconomic deprivation; and iii) estimate the effectiveness of different policies that ban such marketing. Data were from 122 children aged 11–13y who wore wearable cameras and GPS devices for four consecutive days from July 2014 to June 2015. Images were analysed to identify harmful product marketing exposures in public outdoor spaces. Eight policy scenarios were examined to identify the effectiveness of marketing bans, for all children and by socioeconomic deprivation. Children's ratio of harmful marketing was higher for children from high deprivation households and was also found to cluster, with hots spots observed around city centers. The effectiveness of marketing bans depended on the target setting and ban area, with banning 400 m around bus stops leading to the largest reduction. Effectiveness varied also by type of harm and socioeconomic deprivation. For example, banning alcohol marketing in residential areas was estimated to have a larger effect on exposure reduction for children from high deprivation households. Our findings suggest that alcohol, unhealthy food and gambling marketing often cluster outdoors and that targeted bans of such marketing would likely improve child health and, for some banning scenarios, promote equity.     

The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study

BackgroundEmerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and “comfort eating” as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how “Big Food” and “Big Alcohol” are capitalizing on the COVID-19 pandemic to market their products and brands.ObjectiveWe aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia.MethodsWe conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia.ResultsNearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice.ConclusionsThis is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. “COVID-washing” by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to “build back better” in a post-COVID-19 world.     

Emerging social media ‘platform’ approaches to alcohol marketing: a comparative analysis of the activity of the top 20 Australian alcohol brands on Facebook (2012-2014)

Social media platforms are important actors in the development of alcohol marketing techniques. While public health research has documented the activities of brands and consumers related to alcohol promotion and consumption on social media, there remains the need to develop an account of the native, participatory and data-driven advertising model of these platforms. This article examines the relationship between alcohol brands, media platforms and their users by analysing the activity of the 20 most popular alcohol brands’ Australian Facebook pages in 2012 and 2014. We report that the number of fans of alcohol brands increased by 52% from 2012 to 2014. While the number of posts dropped 12% from 2012 and 2014, total interactions with posts by users increased by 9%. Overall, brand activity and engagement became more consistent between 2012 and 2014. We argue that the changing character of user engagement with alcohol brands on Facebook can be related to changes in the platform architecture. Facebook is orchestrating a shift from exposure to engagement as its key advertising metric, and thus departing substantially from established mass media advertising paradigms. Effective policy responses to alcohol marketing in the digital era depend on a more rigorous examination of the marketing infrastructure of social media platforms.     

Sports betting marketing during sporting events: a stadium and broadcast census of Australian Football League matches

Objective: Using Australian Football League (AFL) matches as a case study, we investigated the frequency, length and content of marketing strategies for sports betting during two specific settings: 1) at stadiums during four live matches; and 2) during eight televised broadcasts of matches. Methods: Census of sports betting marketing during Round 12 of the 2011 AFL premiership season. Results: Per match, there was an average of 58.5 episodes (median 49.5, s.d 27.8) and 341.1 minutes (median 324.1 minutes and s.d 44.5) of sports betting marketing at stadiums, and 50.5 episodes (median 53.5, s.d 45.2) and 4.8 minutes (median 5.0 minutes, s.d 4.0) during televised broadcasts. A diverse range of marketing techniques were used to: a) embed sports betting within the game; b) align sports betting with fans’ overall experience of the game; and c) encourage individuals to bet live during the game. There were very few visible or audible messages (such as responsible gambling or Gambler's Help messages) to counter‐frame the overwhelmingly positive messages that individuals received about sports betting during the match. Conclusions and Implications: This study raises important questions about the impacts of saturation, integrated and impulse gambling marketing strategies in sporting matches. Future research should explore: 1) how wagering industry marketing strategies may affect the attitudes and behaviours of community sub‐groups (e.g. young male sports fans, and children); and 2) which public health and policy strategies, including regulation and harm minimisation messaging, will be effective in responding to wagering industry marketing strategies during sporting matches.     

A qualitative assessment of US Black and Latino adolescents’ attitudes about targeted marketing of unhealthy food and beverages

ABSTRACT

Food marketing targeted to Black and Latino adolescents primarily promotes energy-dense, nutrient-poor foods and likely contributes to diet-related health disparities. Targeted marketing raises further public health concerns as Black and Latino youth are also exposed to greater amounts of unhealthy food marketing in the media and their communities. However, little is known about Black and Latino adolescents’ attitudes toward brands and marketing that target them directly. Focus groups with Black and Latino adolescents (N= 51) explored their attitudes toward targeted and non-targeted brands of food, beverages, and restaurants. Pile sorting activities using cards printed with targeted and non-targeted brand logos were used as an elicitation technique. Overall, participants indicated more positive attitudes about the targeted brands discussed in the focus groups than the non-targeted brands, and participants often described targeted brands as being for someone most like them. Some participants expressed appreciation for marketing that recognized “someone like them” as potential consumers, while others raised ethical issues regarding targeting of unhealthy foods. Participants’ strong affinity for targeted brands, and ambivalent attitudes about targeted marketing of unhealthy products, highlight an opportunity to increase awareness of food marketing targeting communities of color and address targeted marketing through countermarketing and grassroots advocacy campaigns.     

Unhealthy sponsorship in sport: a case study of the AFL

Objective: To analyse the presence of unhealthy sponsorship on Australian Football League (AFL) club websites and player uniforms. Methods: An audit of AFL club websites and playing uniforms identified sponsors and used a traffic light system to categorise sponsors. Food and beverage sponsors were classified as Red, Amber or Green using nutrient criteria. Alcohol sponsors were classified as Red. Gambling sponsors were classified as Red (wagering companies and casinos) or Amber (venues that provide gambling and other services). Sponsors promoting healthy lifestyle concepts were classified as Green. All other sponsors were classified as Other. Results: Unhealthy sponsorship on AFL club websites and player uniforms is extensive. All 18 clubs had at least one Red sponsor. Fifteen clubs were sponsored by alcohol companies. Five clubs featured Red sponsor logos on their playing uniforms. Twelve clubs had Green sponsors. No clubs displayed Green sponsors on their playing uniforms. Conclusions: This study identified that unhealthy sponsorship is prevalent on AFL club websites and playing uniforms. Implications for public health: Sponsorship offers companies an avenue to expose children and young people to their brand, encouraging a connection with that brand. The AFL could reinforce healthy lifestyle choices by shifting the focus away from the visual presence of unhealthy sponsorship, while taking steps to ensure that clubs remain commercially viable. Policy makers are encouraged to consider innovative health promotion strategies and work with sporting clubs and codes to ensure healthy messages are prominent.     

Gambling advocacy: lessons from tobacco,alcohol and junk food

Objective: To explore the attitudes and opinions of public health experts in gambling and related unhealthy commodity industries towards the tactics used by the gambling industry to prevent reform and the advocacy responses to these tactics. Methods: In‐depth interviews (30–60 minutes) with a convenience sample of 15 public health experts and stakeholders with a public health approach to gambling (n=10), or other unhealthy commodity industries (food, alcohol, tobacco, n=5). Results: Participants described the influences of political lobbying and donations on public policy, and industry framing of problem gambling as an issue of personal responsibility. Industry funding of, and influence over, academic research was considered to be one of the most effective industry tactics to resist reform. Participants felt there was a need to build stronger coalitions and collaborations between independent academics, and to improve the utilisation of media to more effectively shift perceptions of gambling harm away from the individual and towards the product. Conclusions and implications: Gambling industry tactics are similar to the tactics of other unhealthy commodity industries. However, advocacy initiatives to counter these tactics in gambling are less developed than in other areas. The formation of national public health coalitions, as well as a strong evidence base regarding industry tactics, will help to strengthen advocacy initiatives.     

Youth exposure to alcohol advertising on radio--United States, June-August 2004

In the United States, more underage youth drink alcohol than smoke tobacco or use illicit drugs. Excessive alcohol consumption leads to many adverse health and social consequences and results in approximately 4,500 deaths among underage youth each year. Recent studies have emphasized the contribution of alcohol marketing to underage drinking and have demonstrated that a substantial proportion of alcohol advertising appears in media for which the audience composition is youth-oriented (i.e., composed disproportionately of persons aged 12-20 years). To determine the proportion of radio advertisements that occurred on radio programs with audiences composed disproportionately of underage youth and the proportion of total youth exposure to alcohol advertising that occurs as a result of such advertising, researchers at the Center on Alcohol Marketing and Youth (Health Policy Institute, Georgetown University, District of Columbia) evaluated the placement of individual radio advertisements for the most advertised U.S. alcohol brands and the composition of audiences in the largest 104 markets in the United States. This report summarizes the results of that study, which indicate that alcohol advertising is common on radio programs which have disproportionately large youth audiences and that this advertising accounts for a substantial proportion of all alcohol radio advertising heard by underage youth. These results further indicate that 1) the current voluntary standards limiting alcohol marketing to youth should be enforced and ultimately strengthened, and 2) ongoing monitoring of youth exposure to alcohol advertising should continue.     

Remember Me? Exposure to Unfamiliar Food Brands in Television Advertising and Online Advergames Drives Children’s Brand Recognition,Attitudes, and Desire to Eat Foods: A Secondary Analysis from a Crossover Experimental-Control Study with Randomization at the Group Level

BackgroundLimitations in current Australian regulatory provisions may be identified by demonstrating the effect of different marketing methods on children’s recognition and attitudes toward unhealthy food brands.ObjectiveTo investigate how exposure to different marketing techniques from television (TV) and online food advertising affects children’s brand recall, recognition, and attitudinal responses toward brands and brand consumers and children’s desire to eat the advertised products.DesignSecondary analysis of data from a crossover experimental-control study.Participants/settingIn all, 154 children (7 to 12 years) completed the study, conducted at four 6-day holiday camps from April 2016 to January 2017 in New South Wales, Australia. Children were assigned to a single-media (n=76) or multiple-media (n=78) condition.InterventionAll children viewed 10 TV food advertisements in a cartoon on three occasions. For one of the brands, one set of children additionally played online “advergames” featuring the brand.Main outcome measuresChildren’s recognition and attitudes toward brands and brand consumers and children’s desire to eat the product were reported via a brand recognition and attitude survey pre- and postintervention. Marketing techniques were categorized.Statistical analysisPre- and postintervention brand recognition and relationships between brand recognition and attitudes by media condition and desire to eat the product were examined using generalized linear mixed models and linear mixed models.ResultsThere was a significant increase in the number of brands recognized postexposure by children in both media groups (mean difference=3.8, P<0.0001). The majority of brands appealed to children. Children who reported wanting to eat the advertised products rated brands more positively than children who did not express a desire to eat the products. A larger proportion of children who played the advergames (36%) rated brand consumers as “cool” than children who viewed the TV advertisements only (19%) (P<0.001). Anti-adult themes, fun and humor, and parent pleasing were techniques unique to some of the most recognized and favored advertisements.ConclusionsThe marketing communications increased children’s brand recognition and elicited positive attitudinal responses. These findings indicate a need for policy makers to consider additional regulations to protect children from the persuasive influence of unhealthy food advertising.     

Television food advertising in Singapore: the nature and extent of children's exposure

Television advertising is an effective medium for reaching young children and influencing their food choice. Studies have shown that messages conveyed by food advertisements are rarely consistent with healthy eating messages. With the increasing purchasing power of children, food companies are focusing on children as lucrative target audiences. Extensive marketing of energy-dense, nutrient-poor foods to children potentially contributes to the 'obesogenic' environment. This study aims to determine the degree and nature of food advertisements that Singaporean children are exposed to on television. Ninety-eight hours of children's television programmes broadcast by free-to-air stations were recorded and analysed. Advertisements with the intent of selling and sponsorships for programmes were included. Foods advertised were considered healthy if they met the criteria of the Healthier Choice Symbol in Singapore. Of the 1344 advertisements and sponsorships identified, 33% were for food. Of the food advertisements, 38% were considered healthy, while 57% were not. Candy, confectionery and fast food advertisements accounted for 46% of total food advertisements. Significantly more unhealthy food advertisements were screened on weekends compared with weekdays (p < 0.001). This is the first content analysis of television advertisements in Singapore and the results of this study provide background data on the extent of food advertising that children in Singapore are exposed to. Consistent with other countries, unhealthy food advertisements continue to dominate children's television programmes. This study suggests that Singaporean children are exposed to high levels of advertising for unhealthy foods. The study provides a baseline against which measures aimed at reducing children's exposure to television food advertising can be evaluated.     

Discretionary food advertising on television in 2017: a descriptive study

Objective: To describe advertising of discretionary foods on television at times when children watch television. Methods: We randomly sampled 84 days (one of each weekday for every month of the year) for 2017, viewed all food advertisements and categorised them according to type (healthy, discretionary or other). The frequency of advertisements per hour was calculated for times when most children watch television (peak viewing time PVT1) and when C‐rated programs can be broadcast (PVT2). Results: The rate of advertising of discretionary foods during PVT1 was 1.5/hour (95%CI 1.4–1.5), and during PVT2 was 1.7/hour (1.6–1.8). Conclusions: Children continue to be exposed to food advertising. Implications for public health: Voluntary food and grocery industry codes have not prevented children from being exposed to discretionary food advertising on television. From June 2019, all food and beverage advertising is subject to either food industry or advertising industry codes. The data presented here will form the baseline for future evaluation of whether the new arrangements reduce children's exposure to food advertising.     

Relationship between Frequency of Sugary Food and Drink Consumption with Occurrence of Dental Caries among Preschool Children in Titiwangsa, Kuala Lumpur

Dental caries are attributed to various factors including diet. The present crosssectional study determined the frequency of sugary food and drink consumption and defined its relationship to dental caries among preschool children. A total of 50 preschoolers (aged 5-6 years) in three kindergartens of the Department of Community Development (KEMAS) in Titiwangsa, Kuala Lumpur participated in this study. A set of structured questionnaires was used to assess the frequency of sugary food and drink consumption. Dental check ups were performed by a dentist. The dft index (decayed, filled teeth) was used to describe incidence of caries in subjects. Results showed that 62% of the subjects had dental caries. with the mean dft score being 3.72. The frequency of sugary food consumption by the majority of subjects was 2 times a day, while the frequency of sugary drink consumption was more than 3 times a day. There was no significant relationship between frequency of sugary food and drink consumption with incidence of caries. Subjects with high dft scores were more likely to report dental pain. The prevalence of dental caries in preschoolers in this study was high, indicating a need for effective dental health promotion to improve dental health status of this age group.