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.     

Consumer alcohol exposure in supermarkets: legislatively adherent,but a societal problem

Objective : The Sale and Supply of Alcohol Act 2012 came into force to promote the safe and responsible sale, supply, and consumption of alcohol in New Zealand. The Act was intended to minimise harm caused by excessive consumption of alcohol and reduce exposure to alcohol promotion. This study assessed supermarket adherence to sections 112–114 of the Act related to the display and advertisement of alcohol. It also assessed consumer exposure to alcohol marketing in these businesses. Methods : This paper reports on an audit of nine supermarkets in a major New Zealand city. Results : Supermarkets exhibited high average adherence with the Act (86% adherence across audit fields); despite this, exposure to alcohol displays, promotions and advertisements remained an issue regardless of supermarket geographic location, size or chain affiliation. Conclusions : Supermarkets are an increasingly popular source of off‐licence alcohol sales. Exposure to alcohol marketing in these businesses will likely influence consumer purchasing behaviour. Implications for public health : As an important public health challenge, based on this study, it would appear that supermarkets mostly meet the provisions of the Sale and Supply of Alcohol Act 2012, but not the intent. Additional work is required to strengthen their response to the Act.     

父母饮酒与儿童青少年饮酒的关联分析

目的 探讨父母饮酒与儿童青少年饮酒的关系,为儿童青少年饮酒的防控政策制定提供科学依据。方法 采用方便整群抽样的方法,选取济南市城区8~17岁儿童青少年,通过调查问卷获取儿童青少年及其父母饮酒的相关信息,共获得有效样本量2 785人。采用多因素logistic回归模型分析父母饮酒与儿童青少年饮酒的关系。结果 儿童青少年饮酒者占11.2%（311名）,父亲饮酒者占58.6%（1 633名）,母亲饮酒者占7.3%（204名）。与父亲从不饮酒者相比,父亲现在饮酒（OR=1.36,95% CI：1.03~1.80）和重度饮酒（OR=2.09,95% CI：1.44~3.05）与儿童青少年饮酒存在关联。与母亲从不饮酒者相比,母亲现在饮酒也与儿童青少年饮酒存在关联（OR=2.72,95% CI：1.89~3.91）。与父母均不饮酒者相比,父母仅一方饮酒（OR=1.58,95% CI：1.20~2.09）和父母双方均饮酒（OR=4.12,95% CI：2.73~6.20）与儿童青少年饮酒存在关联。按照性别、年龄组分层分析,男生组及13~17岁组的结果与总体结果类似,但是仅父亲重度饮酒或父母双方均饮酒与女生、8~12岁儿童饮酒存在关联。结论 父母饮酒可能是儿童青少年饮酒的重要影响因素。今后儿童青少年饮酒的防控政策制定应该考虑父母饮酒因素。     

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.     

Methodological problems related to alcohol research among Turks and Moroccans living in the Netherlands: findings from semi-structured interviews

Objectives. To identify factors related to alcohol use among Turks and Moroccans living in the Netherlands. Furthermore, to reveal methodological problems related to research among Turks and Moroccans in general and to alcohol research among these groups in particular.

Design. Individual face‐to‐face interviews were carried out with Dutch researchers (n=9), Turkish and Moroccan (health) practitioners working in the field with Turks (n=4) or Moroccans (n=2), and members of the target population with a Turkish (n=3) or a Moroccan background (n=2). Furthermore, focus‐group interviews were held with Turkish women (n=4), Turkish men (n=3), Moroccan women (n=4) and Moroccan men (n=3) working as health professionals.

Results. Alcohol use seems prevalent particularly among second‐generation Turks and Moroccans and is related to: upbringing, influence of peer groups, integration and the degree in which Islamic rules are practised. Written questionnaires seem more appropriate for second‐generation Turks and Moroccans, because they have fewer language problems and are more familiar with Western bureaucratic society. However, both generations may prefer face‐to‐face interviews since both groups fear that ‘written’ answers about the sensitive subject ‘alcohol use’ may somehow become known among community members. Similarly, an interviewer with a Dutch background may elicit more reliable answers about alcohol use than an interviewer with a Turkish or Moroccan background.

Conclusion. In alcohol research special attention should be paid to second‐generation Turks and Moroccans. Although it is probably easier to conduct alcohol studies in this group than in first‐generation Turks and Moroccans, quantitative research is needed to test the hypothesis that written questionnaires elicit more reliable answers about alcohol use than face‐to‐face interviews. Furthermore, the influence of ethnic matching on response and data quality should be tested further.     

Who ‘likes’ alcohol? Young Australians' engagement with alcohol marketing via social media and related alcohol consumption patterns

Objective: To describe patterns of ‘liking’ alcohol marketing social media pages, and determine related alcohol consumption patterns among young Australians. Methods: Participants were 1,001 Australians aged 15–29 years who completed a cross‐sectional online survey. Logistic regression and ordinal logistic regression were used. Results: A quarter (249/1001, 24.9%) liked at least one of the alcohol marketing social media pages, most commonly brands of spirits, cider and alcohol retailers. Underage participants were as likely as older participants to report liking these pages. Alcohol marketing social media use was significantly and independently associated with male gender, living outside a major city, ever using illegal drugs and early age of first alcohol consumption (all p<0.05). Alcohol marketing social media use (OR 2.1, 95% CI 1.5–2.8, p=<0.001) was independently associated with higher categories on the AUDIT‐C, indicating riskier alcohol consumption. Conclusions: Liking or following alcohol marketing pages is common regardless of age, and associated with riskier alcohol consumption, among young Australians. Implications: There is a need to develop strategies to reduce the exposure to, and potential impact of, alcohol marketing social media pages on young Australians, and ensure these pages are neither accessible to nor targeting underage social media users.     

Efectividad de programas formativos orientados al consumo de alcohol en atención primaria: revisión sistemática

ObjectiveTo evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems.DesignA systematic review of randomised controlled trials.Data sourcesTrip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017.Study selectionThe final sample was n = 3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included.Data extractionThe main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required.ResultsThree Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention.ConclusionThe development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques.     

Mental Disorders in Self-Cutting Adolescents

PurposeSelf-cutting as a form of self-harm is common in general population adolescents. The aim of this study was to investigate the prevalence of mental disorders and associated factors among self-cutting community-dwelling adolescents.MethodsA sample of adolescents who reported current self-cutting (n = 80) was drawn from a large sample of community adolescents (n = 4205). Of these 80 individuals, 44 consented to further detailed assessment. An age- and gender-matched control subject was selected for each study subject. Data collection included Structured Clinical Interviews for DSM-IV-TR, the Beck Depression Inventory, the Alcohol Use Disorders Identification Test (AUDIT), and the Youth Self-Report for adolescents aged 11–18 years (YSR).ResultsMajor depressive disorder (63% vs. 5%), anxiety disorders (37% vs. 12%), and eating disorders (15% vs. 0%) were more common among self-cutting girls (n = 41) than among controls. None of the self-cutting boys (n = 3) had a DSM-IV-TR Axis I mental disorder. In multivariate model, the presence of major depressive disorder, the AUDIT score and the YSR internalizing subscale score were the factors that were independently associated with the presence of self-cutting in girls.ConclusionsMajor depressive disorder, signs of alcohol misuse, and internalizing behavior strongly associate with self-cutting in community-dwelling adolescents, especially in girls.     

A systematic review of the influence on alcohol use of community level availability and marketing of alcohol

PurposeExposure to a high number of alcohol outlets and adverts within a community may lead to higher alcohol use by local residents. The aim of this systematic review was to explore evidence on the influence on alcohol use of community level availability and marketing of alcohol.Results26 studies met the eligibility criteria. While the findings were not conclusive, there was some indication that higher outlet density and greater exposure to advertising in a local community may be associated with an increase in alcohol use, particularly among adolescents.ConclusionsThis review disentangled the existing evidence on the overall relationships between availability, marketing and alcohol use at a community level. Further studies are required to better understand the influence of these factors on alcohol use.     

Evidence That Changes in Community Food Environments Lead to Changes in Children’s Weight: Results from a Longitudinal Prospective Cohort Study

BackgroundStrategies to improve the community food environment have been recommended for addressing childhood obesity, but evidence substantiating their effectiveness is limited.ObjectiveOur aim was to examine the impact of changes in availability of key features of the community food environment, such as supermarkets, small grocery stores, convenience stores, upgraded convenience stores, pharmacies, and limited service restaurants, on changes in children’s body mass index z scores (zBMIs).DesignWe conducted a longitudinal cohort study.Participants/settingTwo cohorts of 3- to 15-year-old children living in 4 low-income New Jersey cities were followed during 2- to 5-year periods from 2009 through 2017. Data on weight status were collected at 2 time points (T1 and T2) from each cohort; data on food outlets in the 4 cities and within a 1-mile buffer around each city were collected multiple times between T1 and T2.Main outcome measuresWe measured change in children’s zBMIs between T1 and T2.Statistical analysisChanges in the food environment were conceptualized as exposure to changes in counts of food outlets across varying proximities (0.25 mile, 0.5 mile, and 1.0 mile) around a child’s home, over different lengths of time a child was exposed to these changes before T2 (12 months, 18 months, and 24 months). Multivariate models examined patterns in relationships between changes in zBMI and changes in the food environment.ResultsIncreased zBMIs were observed in children with greater exposure to convenience stores over time, with a consistent pattern of significant associations across varying proximities and lengths of exposure. For example, exposure to an additional convenience store over 24 months within 1 mile of a child’s home resulted in 11.7% higher odds (P = 0.007) of a child being in a higher zBMI change category at T2. Lower zBMIs were observed in children with increased exposure to small grocery stores selling an array of healthy items, with exposure to an additional small grocery store within 1 mile over 24 months, resulting in 37.3% lower odds (P < 0.05) of being in a higher zBMI change category at T2. No consistent patterns were observed for changes in exposure to supermarkets, limited service restaurants, or pharmacies.ConclusionsIncreased availability of small grocery stores near children’s homes may improve children’s weight status, whereas increased availability of convenience stores is likely to be detrimental.     

Quality of life,alcohol detoxification and relapse: Is quality of life a predictor of relapse or only a secondary outcome measure?

Purpose

To estimate variations in Overall Quality Of Life (OQOL) within 12 months following alcohol detoxification and to evaluate the predictive value of OQOL for relapse and alcohol use severity.

Methods

Alcohol use disorders and four OQOL domains (physical health, psychological health, social relationships and environment) were assessed in 199 patients entering in-patient alcohol detoxification. Follow-up assessments were performed at 6 and 12 months after discharge. Cross-sectional and longitudinal analyses explored the relationship between OQOL and alcohol use severity, examining differences between abstinent and relapsed patients. The predictive value of OQOL was analyzed by logistic and linear regression.

Results

Correlation between OQOL and Alcohol Use Disorders Identification Test scores was confirmed at all stages of observation. Abstinent patients showed a significant improvement in all OQOL domains at 6 months after discharge, whereas OQOL domains did not undergo any significant change in relapsed patients. Baseline OQOL did not prove to be predictive of either relapse or alcohol use severity.

Conclusions

Overall quality of life changed in parallel with alcohol use severity throughout the duration of the study, confirming it to be a useful and sensitive measure of secondary outcome for alcohol detoxification. Conversely, none of the OQOL baseline scores functioned as predictors of relapse within 12 months following discharge or alcohol use severity in relapsed patients.     

Nutritional Quality and Degree of Processing of Children’s Foods Assessment on the French Market

Food packaging marketing techniques which appeal to children (such as cartoon characters and brand mascots) affect children’s choices, preferences, and eating habits. Several studies have assessed the nutritional quality of food intended to children in various countries and concluded that most were high in fat, salt, and sugar (HFSS) and ultra-processed foods. The aim of this study is to analyse products intended for children over the age of 3 (foods and beverages with relevant marketing elements on the packaging) available on the French market as regards: (1) nutritional quality, based on the Nutri-Score labelling system, (2) compliance with expected nutritional profile suitable for children, according to the criteria of the WHO Europe Nutrient Profile Model, and (3) degree of processing, as defined by the NOVA classification, from packaging collected in 20 stores (hyper/supermarkets, hard-discount retail chains, and organic food stores). The marketing strategies most often used on children’s products are cartoons (97.22%; n = 1120) and mascots (77.78%; n = 896). A total of 1155 products were included in the study, most of which were sugary foods: almost a quarter of the products in the sample (23.81%; n = 275) list a sweetener as the first ingredient, and most of them (89.52%; n = 1034) contain free sugars according to the WHO definition. All the products included in our study feature marketing elements targeting on the packaging, yet 94.88% do not meet the criteria of the WHO Europe Nutrient Profile Model. Most (58.68%; n = 676) belong to Nutri-Score groups D and E, with the highest proportion in group D (39.32%; n = 453) and are ultra-processed (87.97%; n = 1016), especially through the use of flavourings and ultra-processed sugars. Using the Nutri-Score, the WHO Europe Nutrient Profile Model, and the NOVA classification, this study suggests that a significant share of pre-packaged foods marketed to children do not have an adequate nutritional profile. As such, measures are needed to regulate what marketing elements aimed at children can be included on packaging, based on these criteria.     

Food Outlet Density,Distance, and Food Quality Offered to Preschool-Aged Children at Family Child Care Homes

ObjectiveTo examine how food environments around family child care homes (FCCHs) are associated with the healthfulness of foods served to children.DesignCross-sectional data from a mail survey of FCCH providers, InfoUSA.ParticipantsThe study included 132 Mississippi FCCHs (26% response).Main Outcome MeasuresDependent: compliance with nutrition best practices for 9 food categories; composite healthfulness score. Independent: counts of supermarkets, small-medium grocery stores, produce stores, convenience stores within 5 miles; distance to supermarket.AnalysisLogistic regression estimated associations between best-practice compliance and food environment. Linear regression estimated associations between composite food healthfulness and food environment. Models stratified by rural/urban location.ResultsRural FCCHs with higher counts of supermarkets, convenience stores, and produce stores had lower compliance with selected best practices (fried/prefried potatoes, high-sugar/high-fat foods). Urban FCCHs with more supermarkets had higher compliance with fruit not canned in syrup; those with more small-medium grocery stores and convenience stores had lower compliance with selected best practices (fried/prefried potatoes, vegetables, low-fat meats).Conclusions and ImplicationsFood environment measures were associated with some nutrition best practices, though not consistently in the expected direction. Future research could examine food quality at stores near rural FCCHs. Programs that improve local food environments may improve foods served at FCCHs.     

Main Retailers In Which Mexican Households Acquire Their Food Supply

ObjectiveTo describe the frequency of food and beverages purchased made by Mexican households at different types of grocery retailers.DesignA national cross-sectional survey.SettingMexico.ParticipantsA representative sample of Mexican households (n = 70,311).Main Outcome Measure(s)Household food and beverages purchases.AnalysisThe association between amounts of food and beverages supply bought in different food retailers (as outcome) and households’ sociodemographic characteristics (as covariates) was assessed using logistic and linear regression models.ResultsMexican households acquired their food and beverages primarily from abarrotes stores, followed by supermarkets and mercados and tianguis. Abarrotes stores and supermarkets were sources of unprocessed and processed foods. Specialized stores, mercados, and tianguis were primary sources of unprocessed foods. Households with low socioeconomic status and those in the central or southern regions acquired more foods from abarrotes stores, mercados and tianguis, and specialized stores. Households with high socioeconomic status and living in the northern region acquired more foods from supermarkets and convenience stores.Conclusions and ImplicationsAbarrotes stores are the primary source of food and beverages for Mexican households; however, some interventions are needed to increase their supply of unprocessed foods. Public health interventions aiming at increasing access to unprocessed foods could be done through traditional retailers.     

How does alcohol advertising influence underage drinking? The role of desirability,identification and skepticism

PurposeTo investigate, using an information processing model, how persuasive media messages for alcohol use lead to concurring beliefs and behaviors among youths.MethodsData were collected in 2000–2001 using computer-assisted, self-administered interviews with youths aged 9–17 years (n = 652).ResultsLatent variable structural equations models showed that skepticism was negatively associated with positive affect toward alcohol portrayals and positively with the desire to emulate characters portrayed in alcohol advertisements. These, in turn, predicted expectancies and liking of/desire for beer toys and brands, which predicted alcohol use. Parental guidance decreased alcohol use directly and indirectly by lessening influences of positive affect toward advertising.ConclusionsMedia alcohol portrayals influence children’s drinking through a progressive decision-making process, with its influence underestimated by typical exposure-and-effects analyses.     

Use of alcohol before suicide in the United States

PurposeFew studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol before suicide compared with an estimate of acute use of alcohol in a living sample.MethodsPooled 2003–2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (blood alcohol content >0.0 g/dL) and intoxication (blood alcohol content ≥0.08 g/dL). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions.ResultsCompared with the living sample, male and female suicide decedents showed, respectively, a 1.83-fold (95% confidence interval [CI], 1.73–1.93) and 2.40-fold (95% CI, 2.24–2.57) increased risk of alcohol ingestion before their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18-fold (95% CI, 5.57–6.86) and a 10.04-fold (95% CI, 8.67–11.64) increased risk of being intoxicated before their death after confounders were considered.ConclusionsThe findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize the use of alcohol, particularly drinking to intoxication.     

Nutrition Marketing on Food Labels

ObjectiveThis research sought to determine how often nutrition marketing is used on labels of foods that are high in saturated fat, sodium, and/or sugar.Design and SettingAll items packaged with food labels (N = 56,900) in all 6 grocery stores in Grand Forks, ND were surveyed.Main Outcome Measure(s)Marketing strategy, nutrient label information, if the product was fruit/or milk based, and target age.AnalysisFrequency distributions were computed.ResultsForty-nine percent of all products contained nutrition marketing and of those, 48% had both nutrition marketing and were high in saturated fat, sodium and/or sugar (11%, 17%, and 31% respectively). Seventy-one percent of products marketed to children had nutrition marketing. Of those, 59% were high in saturated fat, sodium and/or sugar content, with more than half being high in sugar. The most commonly used nutrition marketing statements were “good source of calcium”, “reduced/low/fat free”, and “food company's health symbol”.Conclusions and ImplicationsNutrition marketing is commonly used on products high in saturated fat, sodium and/or sugar and is more often used on products marketed toward children than products marketed toward adults. Current food industry symbols may not be helping consumers select foods low in saturated fat, sodium or sugar.     

Impact of a Capacity-Building Intervention on Food Marketing Features in Recreation Facilities

ObjectiveTo explore the impact of a capacity-building intervention (CBI) to support implementing provincial nutrition guidelines on food marketing in recreation facilities (RFs).DesignRandomized controlled trial within a natural experiment: food marketing in RFs from 3 guideline provinces randomly assigned to intervention (GL+CBI) or comparison (GL-ONLY) was compared with facilities in 1 province without guidelines (NO-GL). Food marketing was assessed by the Food and Beverage Marketing Assessment Tool for Settings.SettingCanadian provinces with/without voluntary nutrition guidelines for RFs.Participants51 RFs.Intervention18-month CBI.Main Outcome MeasuresChange in Food and Beverage Marketing Assessment Tool for Settings scores and marketing features between baseline and follow-up across groups.AnalysisKruskal–Wallis with post hoc Mann–Whitney U tests.ResultsNo significant differences in food marketing features between baseline and follow-up across groups except for a change in food marketing frequency (P = 0.045). The increase in frequency in NO-GL (median, 6.0; interquartile range, −2.0 to 8.5) was significantly greater than changes in the GL+CBI (P = 0.033) and GL-ONLY sites (P = 0.049).Conclusions and ImplicationsCapacity-building was not associated with improved food marketing features potentially because of nonmandated nutrition guidelines, low priority for change, and vague or narrow facility goals and guidelines. Nutrition guidelines with specific unhealthy food marketing restrictions should be mandated and supported.     

The Effect of Smoking and Sex on the Association Between Long-term Alcohol Consumption and Metabolic Syndrome in a Middle-aged and Older Population

BackgroundThe effect of smoking and sex on the relationship between alcohol consumption and risk of developing metabolic syndrome (MetS) and its components has not been investigated.MethodsA total of 5,629 Korean adults aged 40–69 years without MetS were recruited at baseline. Alcohol consumption was assessed biennially, and participants were classified as never, light, moderate, or heavy drinkers. Smoking status was examined at baseline and categorized into non-smokers and current smokers. Risk of incident MetS and its components according to alcohol consumption was examined by smoking status and sex using a multivariate Cox proportional hazards model.ResultsDuring a follow-up of 12 years, 2,336 participants (41.5%) developed MetS. In non-smokers, light or moderate alcohol drinkers had a lower risk of developing MetS, abdominal obesity, hyperglycemia, hypertriglyceridemia, and low HDL-C compared with never drinkers. Heavy alcohol consumption was associated with a higher risk of incident elevated blood pressure (hazard ratio [HR] 1.48; 95% confidence interval [CI], 1.07–2.06; P = 0.020) in men and abdominal obesity (HR 1.86; 95% CI, 1.06–3.27; P = 0.030) in women. However, in smokers, the inverse association of light or moderate alcohol consumption with hypertriglyceridemia and abdominal obesity was not present, whereas a positive association between heavy alcohol consumption and hyperglycemia (HR 1.39; 95% CI, 1.07–1.80; P = 0.014) was observed.ConclusionsSmoking status and sex strongly affects the association between long-term alcohol consumption and MetS and its components by the amount of alcohol consumed.Key words: long-term alcohol consumption, metabolic syndrome, smoking status, hypertriglyceridemia, prospective study