To characterise the nature of digital food and beverage advertising in Singapore.

Food and beverage advertisements within twenty clicks on the top twelve non-food websites and all posts on the Facebook and Instagram pages of fifteen major food companies in Singapore were sampled from 1 January to 30 June 2018.

Advertised foods were classified as being core (healthier), non-core or mixed dishes (e.g. burger) using the WHO nutrient profile model and national guidelines. Marketing techniques were assessed using published coding frameworks.

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Advertisements (n 117) on the twelve non-food websites were largely presented as editorial content. Food companies posted twice weekly on average on social media sites (n 1261), with eatery chains posting most frequently and generating the largest amount of likes and shares. Key marketing techniques emphasised non-health attributes, for example, hedonic or convenience attributes (85 % of advertisements). Only a minority of foods and beverages advertised were core foods (non-food website: 16·2 %; social media: 13·5 %).

Top food and beverage companies in Singapore actively use social media as a platform for promotion with a complex array of marketing techniques. A vast majority of these posts were unhealthy highlighting an urgent need to consider regulating digital food and beverage advertising in Singapore.

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

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

10–16-year-old children (n 400).

Australia.

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

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

To assess the quality and quantity of foods and beverages provided to children aged 0–5 years in family day care and identify structural and sociodemographic factors associated with the nutritional quality of food provided.

A cross-sectional study measured the food and beverages provided to children using weighed food records. The number of serves from different food groups was calculated according to the Australian Guide to Healthy Eating, and a healthy food provision index score was created. Associations between structural and sociodemographic factors and healthy food provision index scores were analysed using linear mixed models.

Family day care services in two large geographic areas in New South Wales, Australia.

One hundred and four children in thirty-three family day care services.

During attendance at childcare, most children met recommended servings of fruit but not dairy, vegetables, lean meat and meat alternatives and wholegrains. Discretionary foods exceeded recommendations. Children’s age, socio-economic status and the type of main meal provided were significantly associated with the healthy food provision index score.

Foods provided to children in family day care are aligned with dietary recommendations for fruit but not vegetables, dairy, lean meat and meat alternatives, wholegrains or discretionary foods. Interventions to promote healthy eating are needed to support families and educators to improve the nutritional quality of food provided to children.

To examine the extent to which food and beverage brands exhibit personalities on Twitter, quantify Twitter users’ engagement with posts displaying personality features and determine advertising spending across these brands on Twitter.

We identified 100 tweets from 10 food and beverage brands that displayed a ‘personality’, and 100 ‘control’ tweets (i.e. a post by that brand on the same day). Our codebook quantified the following personification strategies: (1) humour; (2) trendy language and (3) absence of food product mentions. We used media articles to quantify other personification strategies: (4) referencing trending topics; (5) referencing current events; (6) referencing internet memes and (7) targeting niche audiences. We calculated brands’ number of tweets, re-tweets, ‘likes’, and comments and report the relationship between advertising spending and retweets per follower.

Twitter posts.

Ten food and beverage brands that were described in media articles (e.g. Forbes) as having distinct personalities.

Personality tweets earned 123 013 retweets, 732 076 ‘likes’ and 14 806 comments, whereas control tweets earned 61 044 retweets, 256 105 ‘likes’ and 14 572 comments. The strategies used most included humour (n 81), trendy language (n 80) and trending topics (n 47). The three brands that spent the most on advertising had similar or fewer retweets per follower than the four that spent relatively little on advertising.

Some food and beverage brands have distinct ‘personalities’ on Twitter that generate millions of ‘likes’ and retweets. Some retweets have an inverse relationship with advertising spending, suggesting ‘personalities’ may be a uniquely powerful advertising tool for targeting young adults.

To explore parents’ responses to sponsorship of children’s sport by unhealthy food brands and two alternative pro-health sponsorship options.

Between-subjects online experiment with four sponsorship conditions: (i) non-food branding (control); (ii) unhealthy food branding; (iii) healthier food branding; (iv) public health nutrition campaign branding. Participants were shown a short video and a promotional flyer for a fictional junior sports programme, with sponsor content representing their assigned brand. Afterwards, participants were asked a series of questions assessing their brand awareness, brand attitudes and preference for food sponsor branded products.

Australia.

Australian parents (n 1331) of children aged 6–9 years.

Compared with the control condition, unhealthy food sponsorship promoted increased awareness, branded product preferences and favourable attitudes towards unhealthy food sponsor brands. Healthier food sponsorship promoted similar effects for healthier food sponsor brands, except there was no significant increase in positive attitudes towards these brands. Sponsorship by public health nutrition campaigns promoted more negative attitudes towards unhealthy food sponsor brands and increased preference for healthier food sponsor branded products. Overall, healthier food sponsors and public health campaign sponsors were perceived to have better programme–sponsor fit and to be more appropriate sponsors of children’s sport than unhealthy food sponsors.

Restrictions on unhealthy food sponsorship of children’s sport are needed to prevent unhealthy food brands from exploiting junior sport sponsorship to enhance their appeal. Sponsorship of children’s sport by healthier food brands or public health nutrition campaigns could help promote healthier food choices among parents.

The present commentary introduces a Health Evidence Network (HEN) report that synthesises evidence of front-of-pack food labelling (FOPL) policy development and implementation across the European Region.

Countries were identified as having policies on interpretive FOPL from the WHO databases of Member State policies and online repositories of global food policies. For each identified country, evidence published from 1 January 1980 to 31 March 2018 was retrieved from peer-reviewed and grey literature. Extracted data were cross-checked with in-country representatives to ensure completeness and accuracy.

WHO European Region, spanning fifty-three countries.

Fifteen countries had a government-endorsed policy on interpretive FOPL. Thirteen of these countries had introduced endorsement logos, while only three labelling systems provided an indicator for unhealthfulness. Common steps were identified in FOPL policy development, including: establishing FOPL as a nutrition policy priority; engaging stakeholders and the public; and collecting formative evidence on which to base the labelling system. Few countries had outlined formal provisions for evaluation of FOPL systems. The HEN report describes seven considerations for the adoption/review of FOPL policies to ensure these achieve the population nutrition aims of FOPL. These considerations relate to supporting consumer use and understanding of the labelling, policy feasibility and credibility, and ensuring policy implementation and accountability.

The HEN report encourages countries to consider FOPL policy that is applied widely across all products and provides negative evaluative judgements, possibly combined with positive indicators. Implementation provisions should drive widespread uptake of the system and allow for formal evaluation of impact.

The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.

Our objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.

We will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.

These findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.

None.

To determine the degree of food environment policies that have been implemented and supported by the Malaysian Government, in comparison to international best practice, and to establish prioritised recommendations for the government based on the identified implementation gaps.

The Healthy Food-Environment Policy Index (Food-EPI) comprises forty-seven indicators of government policy practice. Local evidence of each indicator was compiled from government institutions and verified by related government stakeholders. The extent of implementation of the policies was rated by experts against international best practices. Rating results were used to identify and propose policy actions which were subsequently prioritised by the experts based on ‘importance’ and ‘achievability’ criteria. The policy actions with relatively higher ‘achievability’ and ‘importance’ were set as priority recommendations for government action.

Malaysia.

Twenty-six local experts.

Majority (62 %) of indicators was rated ‘low’ implementation with no indicator rated as either ‘high’ or ‘very little, if any’ in terms of implementation. The top five recommendations were (i) restrict unhealthy food marketing in children’s settings and (ii) on broadcast media; (iii) mandatory nutrition labelling for added sugars; (iv) designation of priority research areas related to obesity prevention and diet-related non-communicable diseases; and (v) introduce energy labelling on menu boards for fast-food outlets.

This first policy study conducted in Malaysia identified a number of gaps in implementation of key policies to promote healthy food environments, compared with international best practices. Study findings could strengthen civil society advocacies for government accountability to create a healthier food environment.

To examine whether social media and online behaviours are associated with unhealthy food and beverage consumption in children.

A cross-sectional online survey was used to assess Internet and social media use, including engagement with food and beverage brand content, and frequency of consumption of unhealthy foods and beverages. Linear regression models were used to examine associations between online behaviours, including engagement with food and beverage brand content, and consumption of unhealthy foods and beverages, adjusting for age, sex and socio-economic status.

New South Wales, Australia, in 2014.

Children aged 10–16 years (n 417).

Watching food brand video content on YouTube, purchasing food online and seeing favourite food brands advertised online were significantly associated with higher frequency of consumption of unhealthy foods and drinks after adjustment for age, sex and socio-economic status.

Children who have higher online engagement with food brands and content, particularly through online video, are more likely to consume unhealthy foods and drinks. Our findings highlight the need to include social media in regulations and policies designed to limit children’s exposure to unhealthy food marketing. Social media companies have a greater role to play in protecting children from advertising.

By clearly conveying the healthiness of a food, front-of-pack (FOP) labels have the potential to influence the portion size considered appropriate for consumption. The present study examined the how the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL) and Health Star Rating (HSR) FOP labels affect judgements of appropriate portion sizes of unhealthy foods compared with when no FOP label is present.

Respondents viewed mock packages of unhealthy variations of pizzas, cookies, yoghurts and cornflakes featuring the DIG, MTL, HSR or no FOP label, and indicated the portion size they believed should be eaten of each food on a single occasion.

The survey was completed on the respondent’s personal computer.

A total of 1505 Australian adults provided 4166 ratings across 192 mock packages relating to four product categories: pizza, yoghurt, cornflakes and cookies.

Compared with no FOP label, the HSR resulted in a small but significant reduction in the portion size selected as appropriate for consumption of pizzas and cornflakes (P<0·05). The MTL resulted in smaller portions of cornflakes being selected compared with no FOP label (P<0·05).

Respondents perceived smaller portion sizes as appropriate for some, but not all, of the foods tested when FOP labels with more interpretative formats (HSR, MTL) appeared on-pack compared with no FOP label. No effect was found for the less interpretive FOP label (the DIG). Interpretive FOP labels may have the potential to influence portion size judgements, albeit at modest levels.

To explore children’s responses to sponsorship of community junior sport by unhealthy food brands and investigate the utility of alternative, pro-health sponsorship options.

Between-subjects experiment, with four sponsorship conditions: A, non-food branding (control); B, unhealthy food branding; C, healthier food branding; D, obesity prevention campaign branding.

Online experiment conducted in schools. Participants were shown a junior sports pack for their favourite sport that contained merchandise with branding representing their assigned sponsorship condition. Participants viewed and rated the sports pack, completed a distractor task, then completed questions assessing brand awareness, brand attitudes and preference for food sponsors’ products.

Students in grades 1 to 3 (aged 5–10 years; n 1124) from schools in metropolitan Melbourne, Australia.

Compared with the control condition, there were no significant effects of unhealthy food branding on awareness of, attitudes towards or preference for these brands. Exposure to healthier food branding prompted a significant increase in the proportion of children aware of these brands, but did not impact attitudes towards or preference for these brands. Exposure to either healthier food branding or obesity prevention campaign branding prompted a significant reduction in the proportion of children showing a preference for unhealthy food sponsor products.

The sponsorship of children’s sport by healthier food brands may promote awareness of these brands and healthier sponsorship branding may reduce preferences for some unhealthy food products. Establishing and implementing healthy sponsor criteria in sports clubs could forge healthier sponsorship arrangements and help phase out unhealthy food and beverage sponsors.

The formation of food brand associations and attachment is fundamental to brand preferences, which influence purchases and consumption. Food promotions operate through a cascade of links, from brand recognition, to affect, and on to consumption. Frequent exposures to product promotions may establish social norms for products, reinforcing brand affect. These pathways signify potential mechanisms for how children’s exposure to unhealthy food promotions can contribute to poor diets. The present study explored children’s brand associations and attachments for major food brands.

A cross-sectional online survey was conducted. Fourteen study brands were used, with each child viewing a set of seven logos. The questionnaire assessed perceptions of food brands and perceptions of users of brands, using semantic differential scales, and perceived brand ‘personalities’, using Likert scales.

New South Wales, Australia, October–November 2014.

Children aged 10–16 years (n 417).

Children demonstrated strong positive affect to certain brands, perceiving some unhealthy food brands to have positive attributes, desirable user traits and alignment to their own personality. Brand personality traits of ‘smart’ and ‘sporty’ were viewed as indicators of healthiness. Brands with these traits were ranked lower for popularity.

Children’s brand associations and attachments indicate the potential normative social influences of promotions. While children are aware of brand healthiness as an attribute, this competes with other brand associations, highlighting the challenge of health/nutrition messaging to counter unhealthy food marketing. Restricting children’s exposure to unhealthy food marketing and the persuasive nature of marketing is an important part of efforts to improve children’s diet-related health.

To provide an independent monitoring report examining the ongoing impact of Australian self-regulatory pledges on food and drink advertising to children on commercial television.

Analysis of food advertisements across comparable sample time periods in April/May 2006, 2007, 2009, 2010 and 2011. The main outcome measure comprised change in the mean rate of non-core food advertisements from 2006 to 2011.

Sydney free-to-air television channels.

Televised food advertisements.

In 2011 the rate of non-core food advertisements was not significantly different from that in 2006 or 2010 (3·2/h v. 4·1/h and 3·1/h), although there were variations across the intervening years. The rate of fast-food advertising in 2010 was significantly higher than in 2006 (1·8/h v. 1·1/h, P < 0·001), but the same as that in 2011 (1·5/h).

The frequency of non-core food advertising on Sydney television has remained essentially unchanged between 2006 and 2011, despite the implementation of two industry self-regulatory pledges. The current study illustrates the value of independent monitoring as a basic requirement of any responsive regulatory approach.

To determine parents’ and children's attitudes towards food, beverage and alcohol sponsorship of elite and children's sports and the acceptability of policies and alternative funding models to limit this sponsorship.

Telephone surveys were conducted with parents in February–May 2011. One child from each household was invited to complete an online survey. Surveys assessed parents’ perceptions about the influence of sponsorship on children and support for limiting sponsorship, and children's awareness of and attitudes towards sponsors.

Randomly sampled households in New South Wales, Australia.

Parents (n 825) and children aged 10–16 years (n 243).

Three-quarters of parents supported the introduction of policies to restrict unhealthy food, beverage and alcohol sponsorship of children's and elite sports. More parents (81 %) supported the introduction of alternative funding models to allow these companies to sponsor sport provided there was no visible branding. Two-thirds of children recalled sponsors of their favourite elite sports team/athlete, with 428 sponsors recalled. Of these, 11 % were food/beverage companies and 3 % were alcohol-related. For 39 % of sponsors, children reported feeling better about the company after it had sponsored a team/athlete.

Australian parents support restrictions on unhealthy food, beverage and alcohol sport sponsorship. Children's positive associations regarding sponsors are likely to be linked to brand preferences and usage.

Food cost is an important factor influencing the consumption of nutritious foods and subsequent chronic disease risk. The present study compared the cost of branded food products with their generic equivalents across a range of food categories.

The survey was conducted within two major supermarket chains across six locations in Sydney, Australia (n 12).

Price differences were calculated for ‘core’ (nutrient dense and low in energy) and ‘extra’ (high in undesirable nutrients and/or energy) packaged foods (n 22) between generic and branded items.

A cost saving of 44 % was found by purchasing generic over branded products across all food categories. The most significant savings were for core foods, such as bread and cereals, and the smallest cost savings were seen for fruit products. There was little variation in cost saving between branded and generic products by socio-economic status of the supermarket location.

The large price differential between branded and generic food products implies that consumers, particularly those on lower incomes, could benefit financially from purchasing generic items. The promotion of core generic products may be an effective strategy to assist people on lower incomes to meet dietary guidelines.

To investigate nutrition literacy among adult grocery buyers regarding energy-related labelling terms on food packaging.

Qualitative interviews and quantitative surveys to determine shoppers’ understanding of energy terms (‘energy’, ‘calories’ and ‘kilojoules’) and how energy terms affect perceptions of healthiness and intentions to purchase breakfast cereals, muesli bars and frozen meals.

Individual in-depth interviews and surveys in two metropolitan supermarkets, Sydney, Australia.

Australian adults (interview n 40, survey n 405) aged 18–79 years.

The relationship between energy and perceived healthiness of food varied by product type: higher energy breakfast cereals were perceived to be healthier, while lower energy frozen meals were seen as healthier choices. Likewise, intentions to purchase the higher energy product varied according to product type. The primary reason stated for purchasing higher energy products was for sustained energy. Participants from households of lower socio-economic status were significantly more likely to perceive higher energy products as healthier. From the qualitative interviews, participants expressed uncertainty about their understanding of kilojoules, while only 40 % of participants in intercept surveys correctly answered that kilojoules and calories measured the same thing.

Australian consumers have a poor understanding of energy and kilojoules and tend to perceive higher energy products as healthier and providing sustained energy. This has implications regarding the usefulness of industry front-of-pack labelling initiatives and quick service restaurant menu labelling that provides information on energy content only. Comprehensive and widely communicated education campaigns will be essential to guide consumers towards healthier choices.