Digital food and beverage marketing and its association with the consumption of unhealthy foods and beverages in children and adolescents / Claudia Leticia Nieto Orozco

Tesis (Doctorado en Ciencias en Nutrición Poblacional) - Escuela de Salud Pública de México. INSP, 2023

Abstract
Introduction: Digital food marketing is associated to preference, purchase and intake; however, few countries have been able to assess children’s and adolescents’ digital food marketing exposure. In addition, comparisons between countries for the association between exposure to digital food marketing and food and beverage consumption have not been performed.
Aims: This thesis was divided into two specific objectives that are represented and compiled into two scientific articles. The first objective was to characterise Mexican children and adolescents’ exposure and power to digital food and beverage marketing in their recreational internet use (excluding schoolwork and homework); and the second one was to evaluate the association between youth exposure to digital food marketing and the self-reported consumption of foods and beverages in Australia, Canada, Chile, Mexico, United Kingdom, and United States, and to examine whether this association differs between countries.
Methods: Objective 1: A crowdsourcing strategy was used to recruit 347 participants. Participants completed a survey and recorded 45 minutes of their device’s screentime using screen-capture software. Food marketing was identified and nutrition information for each marketed product was collected. Healthfulness of products was determined using Nutrient Profile Models. A content analysis was undertaken to assess marketing techniques.
Objective 2: Cross-sectional survey data on self-reported exposure to digital food marketing and on consumption of foods and beverages was analyzed. Data were collected in 2020 by the International Food Policy Study. Participants (n = 11,261) aged 10 to 17 years completed an online survey. Participants who self-reported being exposed to unhealthy food marketing on a “website or social media” and/or in “video or computer games” were considered exposed. Consumption of food and beverages categories was examined. Separate logistic regression models were conducted for each beverage or food item, with an indicator variable for digital food marketing exposure and country, and adjusting for age group, sex, ethnicity, and parental perceived income adequacy level.



Results: Objective 1: Overall, 69.5%. of children and adolescents were exposed to digital food marketing. Most frequently marketed foods were ready-made foods. Children and adolescents would typically see a median of 2.7 food marketing exposures per hour. We estimated 47.3 food marketing exposures per week (2,461 per year). The most used marketing technique was product image. Marketing was appealing to children and adolescents yet most of the products were not permitted for marketing to children according to the NPMs (>90%).
Objective 2: Participants from Chile and Mexico self-reported the highest exposure to digital food marketing, 68% and 59% respectively. Overall, digital food marketing exposure was associated with higher consumption of unhealthy foods and beverages (p<0.05 for all models). Associations were stronger for Australia (regular soda OR=2.0) and the United States (regular soda OR=1.9), p<0.05).
Conclusions: Children and adolescents were exposed to unhealthy digital food marketing (considering the objective measure with Mexican children and the self- report from youth of six countries). The evidence shown in both studies indicate that youth are exposed to unhealthy food marketing and that such marketing is associated with the consumption of unhealthy foods and beverages; therefore, they should be protected from digital food marketing exposures.