Awareness of marketing for high fat, salt or sugar foods, and the association with higher weekly consumption among adolescents: a rejoinder to the UK government's consultations on marketing regulation

Objective: Exposure to marketing for foods high in fat, salt, or sugar (HFSS) reportedly influences consumption, nutritional knowledge, and diet-related health among adolescents. In 2018/2019, the United Kingdom (UK) Government held two consultations about introducing new restrictions on marketing for HFSS foods. To reinforce why these restrictions are needed, we examined adolescents’ awareness of marketing for HFSS foods, and the association between past-month awareness and weekly HFSS food consumption. Design: Cross-sectional survey that measured past-month awareness of 10 marketing activities for HFSS foods (1=Everyday–6=Not in last month). Frequencies were converted into aggregate past-month awareness across marketing activities and grouped into three categories (low/medium/high). Consumption was self-reported for 15 foods (12 HFSS) (1=Few times per day–9=Never). For each, frequency was divided into higher/lower weekly consumption. Setting: UK. Participants: 11-19 year olds (n=3,348). Results: Most adolescents (90.8%) reported awareness of a least one marketing activity for HFSS foods, and at least half reported seeing >70 instances in the past month. Television, social media, and price offers were the activities most frequently reported. Awareness was associated with higher weekly consumption for 10 of the 12 HFSS foods. For example, those reporting medium awareness were 1.5 times more likely to report higher weekly consumption of cakes/biscuits versus low awareness (Odds Ratio=1.54, p=0.012). Likelihood of higher weekly HFSS food consumption increased relative to level of marketing awareness. Conclusion: Assuming there is a causal relationship between marketing awareness and consumption, the restrictions proposed by the UK Government are likely to help reduce HFSS consumption

Alcohol marketing and consumption in young people in the UK

Objectives: To explore awareness of alcohol marketing and ownership of alcohol branded merchandise in adolescents and young adults in the United Kingdom (UK), what factors are associated with awareness and ownership, and what association awareness and ownership has with alcohol consumption, higher-risk drinking, and susceptibility. Design: Online cross-sectional survey conducted April–May 2017. Setting: UK. Participants: Adolescents and young adults aged 11-19 years old in the UK (n=3,399). Main outcome measures: Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) (0-12) and indication of higher-risk consumption (>5 AUDIT-C) in current drinkers. Susceptibility to drink (Yes/No) in never drinkers. Results: Eighty-two percent of respondents were aware of at least one form of alcohol marketing in the past month and 17% owned branded merchandise. Chi-square tests found that awareness of marketing and ownership of branded merchandise varied within drinking variables. For example, higher awareness of alcohol marketing was associated with being a current drinker (χ2=114.04, p < 0.001), higher-risk drinking (χ2=85.84, p < 0.001), and perceived parental (χ2=63.06, p < 0.001) and peer approval of consumption (χ2=73.08, p < 0.001). Among current drinkers, multivariate regressions (controlling for demographics and covariates) found that marketing awareness and owning branded merchandise was positively associated with AUDIT-C score and higher-risk consumption. For example, current drinkers reporting medium marketing awareness were twice as likely to be higher-risk drinkers as those reporting low awareness (AOR=2.18, 95% CI: 1.39-3.42,

Social media, higher-risk consumption, and brand identification

Aim: To explore participation with alcohol marketing (i.e. commenting on brand statuses) and user-created promotion on social media (i.e. photos of peers drinking) by young people in the United Kingdom (UK), and what association this has with higher-risk consumption and brand identification. Method: Online cross-sectional survey with 11–19-year olds in the UK (n = 3,399) (average age: 15 years old). Past-month participation was measured for five forms of alcohol marketing on social media and one form of user-created promotion (all Yes/No). Past-month awareness of nine wider alcohol marketing activities, social media apps used at least weekly, and ownership of branded merchandise were included as covariates. Outcomes included higher-risk consumption in current drinkers (≥5 AUDIT-C) and brand identification in all respondents (8 pictures with brand names removed). Results: Over one-in-ten respondents (13.2%) had participated with at least one form of marketing on social media or participated with user-created promotion (12.2%). For both, participation was greater in current drinkers and those of legal purchasing age. A logistic regression found that participation with two or more forms of marketing on social media (AOR = 1.96, p < .01) and participation with user-created promotion (AOR = 3.46, p < .001) were associated with higher-risk drinking. Respondents, on average, identified 2.58 (SD = 2.12) alcohol brands. A linear regression found participation with marketing on social media was not associated with brand identification (β = 0.01, p =.42) but participation with user-created promotion was (β = 0.05, p < .001). Conclusion: Social media provides opportunities for adolescents to participate with commercial marketing and user-created promotion and this is associated with higher-risk consumption and brand identification

YOPS Poster

Background: Marketing for food and drinks high in fat, salt and sugar (HFSS) are known to negatively influence dietary-related knowledge, attitudes and health outcomes such as overweight and obesity. It is crucial to address the alarming UK childhood obesity rates; a child with obesity is five times more likely to become an adult with obesity, and overweight and obesity causes 13 types of cancer. Digital marketing is now as, or more, prevalent in young people’s lives than TV advertising. More evidence is needed to understand the mechanisms by which the influence of HFSS marketing occurs, and to underpin policy action to ensure marketing regulation is fit for purpose in the current marketing landscape. Aims: To explore trends over time in children and young people’s dietary perceptions and attitudes and behaviours across all forms of HFSS marketing, particularly digital. Methods: A nationally representative online cross-sectional UK survey of 11–19 year olds (n=3286), is being performed. This survey builds on the first wave of the YOPS (conducted in 2017), updated to reflect the 2019 policy context and to focus specifically on digital HFSS marketing. A qualitative scoping study of focus groups with 11–19 year olds was conducted by ScotCen to inform survey design for the digital HFSS marketing component. Survey recruitment is being conducted by YouGov through their online panel. Linear regression will be performed, controlling for demographic factors, to test for associations between different forms of HFSS marketing exposure and HFSS consumption. Data collection will be complete by August 2019. Results: Data will give self-reported consumption of HFSS products, HFSS marketing exposure across platforms, and digital media use and engagement. Results will provide insight into whether the impact of HFSS marketing has changed over the past two years, and build the evidence on the impact of digital HFSS marketing. Discussion: This study builds a picture of how the impact that HFSS marketing has on children and young people’s dietary-related behaviours and health outcomes may have changed over time. It will explore the link between digital marketing and young people’s dietary behaviours, and support policy-making around HFSS marketing regulation.Output Type: Poste

Adolescents' reactions to adverts for fast-food and confectionery brands that are high in fat, salt, and/or sugar (HFSS), and possible implications for future research and regulation: Findings from a cross-sectional survey of 11-19 year olds in the United Kingdom

The influence that marketing for foods high in fat, salt, and/or sugar (HFSS) has on adolescents extends beyond a dose-response relationship between exposure and consumption. It is also important to explore how marketing shapes or reinforces product/brand attitudes, and whether this varies by demography and Body Mass Index (BMI). To examine this, a cross-sectional survey was conducted with 11–19 year olds in the United Kingdom (n = 3348). Participants watched 30 s video adverts for a fast-food and confectionery brand. For each advert, participants reported reactions on eight measures (e.g., 1 = Makes [product] seem unpopular choice–5 = Makes [product] seem popular choice), which were binary coded based on whether a positive reaction was reported (Yes/No). At least half of adolescents had positive reactions to both adverts for 5/8 measures. Positive reactions had associations with age, gender and, to a lesser extent, BMI. For example, 11–15 year olds were more likely than 16–19 year olds to report appeal to their age group for the fast-food (OR = 1.33, 95% CI: 1.13–1.58) and confectionery advert (OR = 1.79, 95% CI: 1.51–2.11). If these reactions are typical of other HFSS products, future research and regulatory change should examine whether additional controls on the content of HFSS marketing, for example mandated health or nutritional information and revised definitions of youth appeal, offer additional protection to young people

Weight management assessment and advice in primary care

Background: Although primary care settings provide a large-scale and high-reach opportunity for weight management and obesity prevention, the proportion of adults in the United Kingdom (UK) who report receiving weight management advice is limited. This study examines the self-reported frequency of assessing weight and providing weight management advice by General Practitioners (GPs) and Practice Nurses (PNs) working in primary care in the UK, and differences by practitioner characteristics. Methods: Cross-sectional survey with GPs and PNs in the UK (n = 2020), conducted January–March 2017. A mock consultation exercise assessed what factors led to calculating a patient’s Body Mass Index (BMI) and whether weight management advice was given after determining the patient had an obese BMI. For all patients, practitioners were asked how often they calculated BMI, how often they gave weight management advice to patients with an obese BMI, and how often they utilised different advice or referral options (each: Always/Often vs. Less often/Never). Binary logistic regressions examined whether frequency of assessing weight and providing advice was associated with practitioner characteristics. Results: In the mock consultation, physical cues (40%) were most likely to prompt calculation of BMI, and half of practitioners (56%) provided weight management advice after determining the patient had an obese BMI, with GPs less likely to do so than PNs (Odds Ratio [OR] = 0.59, 95% CI: 0.47–0.75). Half of practitioners (58%) said they calculated the BMI of all patients Always/Often, with GPs less likely to do so than PNs (OR = 0.27, 95% CI: 0.21–0.34). Three quarters (78%) said they provided weight management advice to patients with an obese BMI Always/Often, with GPs less likely to do so than PNs (OR = 0.63, 95% CI: 0.47–0.85). Weight management advice was provided more frequently than referrals, particularly suggesting increased physical activity (93%) and diet modification (89%). Conclusions: Consistent with previous research, the findings suggest that opportunities to provide weight management advice in primary care, including to patients with an obese BMI, are potentially missed. Future research should test alternative mechanisms to increase weight assessment and advice provision, examine the effectiveness of advice frequently given, and seek solutions to reported barriers for providing weight management advice

Awareness of product-related information, health messages and warnings on alcohol packaging among adolescents: A cross-sectional survey in the United Kingdom

Background: Alcohol packaging can be used to communicate product-related information, health messages, and health warnings to consumers. We examined awareness and recall of such information and messaging among adolescents in the United Kingdom. Method: A cross-sectional survey was conducted with 11-19 year olds in the United Kingdom (n=3,399), with participants asked if they had seen any information, health messages or warnings on alcohol packaging in the past month (Yes/No) and, if so, what they recalled. We also assessed higher-risk drinking among current drinkers (>5 Alcohol Use Disorders Identification Test-Consumption) and susceptibility to consume among never-drinkers. Results: One-third (32%) of participants had seen information, health messages or warnings on alcohol packaging. Chi-Square tests showed awareness was greater for current drinkers than never-drinkers (46% vs. 19%; p < 0.001), higher-risk drinkers than lower-risk drinkers (55% vs. 39%; P < 0.001), and susceptible never-drinkers than non-susceptible never-drinkers (21% vs. 16%; P = 0.01). Ten messages were recalled, with drinking responsibly (18%) and not drinking during pregnancy (13%) most recalled. Conclusion Most young drinkers, including almost half of higher-risk drinkers, did not recall seeing any information, health messages or warnings on alcohol packaging in the past month, suggesting that current labelling is failing to reach this key audience

Digital Feast: Narrative review

First paragraph: Overweight and obesity is the second leading cause of cancer in the UK after smoking. Overweight and obesity causes 13 different types of cancer and over 22,000 cancer cases each year in the UK. It is estimated that each year, obesity costs the NHS in England £6.1bn and the wider UK economy £27bn

Youth engagement with alcohol brands in the UK

Report from Cancer Research UK, University of the West of England and University of Stirling which explores how young people engage with alcohol brand