changes in household food and drink purchases following restrictions on the advertisement CORD-Papers-2022-06-02 (Version 1)

Title: Changes in household food and drink purchases following restrictions on the advertisement of high fat salt and sugar products across the Transport for London network: A controlled interrupted time series analysis
Abstract: BACKGROUND: Restricting the advertisement of products with high fat salt and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions implemented across the London (UK) transport network in February 2019 on HFSS purchases. METHODS AND FINDINGS: Over 5 million take-home food and drink purchases were recorded by 1970 households (London [intervention] n = 977; North of England [control] n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex socioeconomic position and body mass index. Using a controlled interrupted time series design we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1001.0 kcal 95% CI 456.0 to 1546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g 95% CI 22.1 to 93.7) saturated fat (26.4 g 95% CI 12.4 to 40.4) and sugar (80.7 g 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual with corresponding relative reductions in fat (13.1 g 95% CI 7.5 to 18.8) saturated fat (8.7 g 95% CI 5.7 to 11.7) sugar (41.4 g 95% CI 27.4 to 55.4) and salt (0.2 g 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. CONCLUSIONS: This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy sugar and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.
Published: 2022-02-17
Journal: PLoS Med
DOI: 10.1371/journal.pmed.1003915
DOI_URL: http://doi.org/10.1371/journal.pmed.1003915
Author Name: Yau Amy
Author link: https://covid19-data.nist.gov/pid/rest/local/author/yau_amy
Author Name: Berger Nicolas
Author link: https://covid19-data.nist.gov/pid/rest/local/author/berger_nicolas
Author Name: Law Cherry
Author link: https://covid19-data.nist.gov/pid/rest/local/author/law_cherry
Author Name: Cornelsen Laura
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cornelsen_laura
Author Name: Greener Robert
Author link: https://covid19-data.nist.gov/pid/rest/local/author/greener_robert
Author Name: Adams Jean
Author link: https://covid19-data.nist.gov/pid/rest/local/author/adams_jean
Author Name: Boyland Emma J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/boyland_emma_j
Author Name: Burgoine Thomas
Author link: https://covid19-data.nist.gov/pid/rest/local/author/burgoine_thomas
Author Name: de Vocht Frank
Author link: https://covid19-data.nist.gov/pid/rest/local/author/de_vocht_frank
Author Name: Egan Matt
Author link: https://covid19-data.nist.gov/pid/rest/local/author/egan_matt
Author Name: Er Vanessa
Author link: https://covid19-data.nist.gov/pid/rest/local/author/er_vanessa
Author Name: Lake Amelia A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lake_amelia_a
Author Name: Lock Karen
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lock_karen
Author Name: Mytton Oliver
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mytton_oliver
Author Name: Petticrew Mark
Author link: https://covid19-data.nist.gov/pid/rest/local/author/petticrew_mark
Author Name: Thompson Claire
Author link: https://covid19-data.nist.gov/pid/rest/local/author/thompson_claire
Author Name: White Martin
Author link: https://covid19-data.nist.gov/pid/rest/local/author/white_martin
Author Name: Cummins Steven
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cummins_steven
sha: 1079d39656e91cf841e462c3d0f8eba199b7dc8d
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 35176022
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/35176022
pmcid: PMC8853584
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853584
url: https://www.ncbi.nlm.nih.gov/pubmed/35176022/ https://doi.org/10.1371/journal.pmed.1003915
has_full_text: TRUE
Keywords Extracted from Text Content: network fat 1,970 households sugar London (UK TfL 13,990.8 −20.3 vegetables UK Food Standards Agency land London high (AB) SDIL [47] UK children body UK [29] �1 Food policy-a TfL network puddings 317.9 London transport network 95,413 Box 1 £ sugar London)-who biscuits people post-2007 sugary 435.8 multipacks out-of-home London ( Valentine's sodium sugary snacks �4 savoury [19] [20] [21] London's outdoor × Chilean food TfL's HFSS fruit S20 Table UK participants sugary cereals Fig 2 zeros [39] HFSS products B, C1 vegetable 23,564 NPM London participants brain line S15 Table London (TfL) network Savoury snacks fat purchased National Readership Survey −0.3 children [1] [2] [3] [4 � 15,697.3 Puddings 90,694 1,970 households −7.4 fat TfL Rail network C1C2 Brandbank NRS children COVID-19 UK Soft Drinks Industry Levy (SDIL £152.1 Valentine's Day confectionery Fig 1 × London 139,193 household-week female −2.2 −2.9 S14 Table −7.8 grocery biscuits purchased Halloween Take-home grocery food purchased SDIL P~0.001 Patients Out-of-home
Extracted Text Content in Record: First 5000 Characters:Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, PLOS Medicine | https://doi. socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products. Why was this study done? • Many governments and local authorities are considering advertising restrictions to reduce consumption of high fat, salt, and sugar (HFSS) products as part of obesity prevention strategies. • Evidence of the effectiveness of such policies in reducing purchases of HFSS products is limited, especially outside of broadcast media. • The introduction of an outdoor advertising policy across a large transport network provided an opportunity to evaluate a natural experiment assessing whether implementation of such a policy is associated with changes in household food and drink purchases. What did the researchers do and find? • We compared average weekly household purchases of HFSS products by households in the intervention area (n = 977) to an estimation of what would have happened without the policy-a counterfactual scenario estimated by extrapolating the pre- The advertisement of foods and drinks with high fat, salt, and sugar (HFSS) content is known to be associated with poor diet and obesity, particularly in children [1] [2] [3] [4] . There is a high prevalence of exposure to HFSS food and drink advertising across a variety of media, especially among disadvantaged groups and in more deprived areas [5] [6] [7] [8] [9] . In children, exposure to advertising of HFSS foods and drinks has been associated with preferences for HFSS products, requests for purchases, and higher consumption of HFSS products [1, 2, 4] . Associations in adults are not as well-studied, and findings are inconsistent. However, some studies have found exposure to advertising of HFSS foods and drinks to be positively associated with purchasing and consumption of HFSS products and body mass index (BMI) [10] [11] [12] [13] [14] . Evidence suggests that advertisement of HFSS foods and drinks can influence food behaviours by changing dietary norms and shifting population-level food and drink preferences [15] . Policies that restrict the advertising of HFSS products have been promoted as potentially effective tools to reduce the purchase and consumption of HFSS products, with the aim of improving diet, reducing obesity and diet-related diseases, and tackling health inequalities [16, 17] . Policies on HFSS advertising have been implemented in many countries, but most policies have been limited in scope, with a focus on broadcast advertising and a reliance on voluntary agreements by the food and advertising industries [18, 19] . These vol
Keywords Extracted from PMC Text: grocery sugary UK's Box 1 sugar out-of-home C1C2 post-2007 Patients NPM NRS 35,40 Take-home grocery brain sodium [18,24] 13,990.8 purchased × −7.4 −7.8 zeros [39] −0.3 confectionery [18,20,28 ≥1 female UK children body vegetables London (TfL) network SDIL SDIL [47–49 Fig 2 COVID-19 vegetable TfL S20 Table fat TfL network fruit participants Chilean food 23,564 sugary snacks London participants −2.9 £ children multipacks biscuits purchased Valentine's 1,970 households 90,694 S15 Table 435.8 's [19–21] Out-of-home [20,21,26,28,51] ≥4 [19]. [56,68] Brandbank × London London 's NPM puddings Fig 1 London)—who 139,193 household-week National Readership Survey UK ≤80 children's S14 Table B, C1 TfL Rail network ≥ savoury sugary cereals 317.9 high (AB) biscuits ≤40 −20.3 HFSS products −2.2 1–80 London ( land 95,413 line 15,697.3
Extracted PMC Text Content in Record: First 5000 Characters:The advertisement of foods and drinks with high fat, salt, and sugar (HFSS) content is known to be associated with poor diet and obesity, particularly in children [1–4]. There is a high prevalence of exposure to HFSS food and drink advertising across a variety of media, especially among disadvantaged groups and in more deprived areas [5–9]. In children, exposure to advertising of HFSS foods and drinks has been associated with preferences for HFSS products, requests for purchases, and higher consumption of HFSS products [1,2,4]. Associations in adults are not as well-studied, and findings are inconsistent. However, some studies have found exposure to advertising of HFSS foods and drinks to be positively associated with purchasing and consumption of HFSS products and body mass index (BMI) [10–14]. Evidence suggests that advertisement of HFSS foods and drinks can influence food behaviours by changing dietary norms and shifting population-level food and drink preferences [15]. Policies that restrict the advertising of HFSS products have been promoted as potentially effective tools to reduce the purchase and consumption of HFSS products, with the aim of improving diet, reducing obesity and diet-related diseases, and tackling health inequalities [16,17]. Policies on HFSS advertising have been implemented in many countries, but most policies have been limited in scope, with a focus on broadcast advertising and a reliance on voluntary agreements by the food and advertising industries [18,19]. These voluntary commitments have been limited in effectiveness [19–21]. In 2007, the United Kingdom (UK) implemented statutory regulations to limit children's exposure to HFSS food and drink advertising through television [22]. Ofcom, the UK's communications regulator, estimated that children saw 34% fewer HFSS advertisements as a result [23]. However, as the regulations only applied to programmes targeting children, evidence suggests that there was displacement of advertising to television programmes aimed at a mixed audience. Independent research estimated that the policy had no effect on children's overall exposure to HFSS advertising and that it increased exposure for the population as a whole [24]. Studies of advertising restrictions from other countries and regions provide evidence of statutory regulations reducing the volume of, or exposure to, HFSS advertising [21,25,26] and reducing purchases of HFSS products [19,27]. However, limited evidence exists on the effectiveness of policies that restrict advertising of HFSS products outside of broadcast media [18,20,28]. One study evaluating restrictions on fast food advertising across multiple print and electronic media in Quebec, Canada, found a 13% decrease in likelihood of purchasing following the introduction of the policy [27]. In November 2018, restrictions on the outdoor advertising of HFSS foods and drinks across the Transport for London (TfL) network were announced by the Mayor of London, UK (Box 1) [29,30]. The TfL advertising estate includes the London Underground (rapid transit) network, the TfL Rail network, transport vehicles run by TfL (including some buses, trains, and taxis), and outdoor spaces owned by TfL (e.g., bus stops and land outside train stations) [29]. The restrictions were fully implemented on 25 February 2019. A full description of the policy guidance is available from the TfL website [31]. Though these restrictions formed part of a childhood obesity strategy, they may impact food behaviours (such as purchasing and consumption) across the whole population. We hypothesised that this policy may contribute to improvements in diet by reducing energy and nutrients purchased from HFSS products. In the absence of longitudinal dietary data, we used household purchase data to evaluate the impact of the intervention. This study aimed to estimate the changes in household purchases of energy and nutrients from HFSS products associated with the TfL advertising policy. Research investigating the implementation process [32] and the media representation of opposition to the policy [33] has been published. Take-home grocery food and drink purchase data were available from households in the Kantar Fast Moving Consumer Goods (FMCG) panel from 18 June 2018 to 29 December 2019 (80 weeks), with 36 pre-intervention weeks and 44 post-intervention weeks. Kantar (a commercial consumer data company) recruits households to a live panel via email or post using quota sampling, and maintains a nationally representative sample of approximately 32,000 households annually. For this study, households (n = 2,118) were randomly sampled for inclusion from London (intervention group) and the North of England (control group), based on postcode of residence. The North of England sample consisted of households in the North West, North East, and Yorkshire and the Humber regions (Fig 1). The North of England was chosen as a location-based control group due to its distance from London, redu
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