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Transdisciplinary Collaboration to Visually Map Government Policies to Restrict the Marketing of Unhealthy Food and Beverage Products to Children in the Region of the Americas from 2010-2017 to Inform Global Public Health Policy

Background:
The globalization of the food supply has fostered the widespread transnational marketing of highly processed food and beverage products high in fat, added  sugars, and salt (HFSS) to young people worldwide.

The pervasive marketing of unhealthy HFSS food and beverage products to children is associated with poor quality diet and eating patterns, overweight and obesity, and diet-related NCDs including type 2 diabetes, heart diseases, and certain cancers. 3,4 Since 1980, obesity rates have doubled in over 70 countries worldwide, and rates among children have progressed more rapidly than adults. 5 In May 2010, 192 Member States of the World Health Organization (WHO) endorsed the World Health Assembly Resolution WHA63.14 to restrict all forms of marketing of HFSS food and non-alcoholic beverage products to children from birth to 18 years. 6

Objectives:
The regulatory environment that surrounds the marketing of HFSS food and beverage products to children is complex and dynamic. Consequently, the principal objective was to conduct a pilot study with a transdisciplinary research team to develop a Responsible Policy Index (RESPI) for governments and other actors to evaluate the strength and quality of food and beverage marketing policies in 13 countries in the Americas, and to display the results using an interactive web-based platform. A second objective was to develop an interactive visualization framework to represent and test the RESPI for food and beverage marketing to children.

Methods:
We conducted a scoping review 7 of published scientific peer-reviewed evidence and gray literature for voluntary and mandatory government policies related to food and beverage marketing to children in 13 countries from the Americas region. We used a priori definitions from a WHO policy framework and a conceptual model of integrated marketing communications that served as the foundation for creating a 10-item RESPI for food and beverage marketing aimed at children. The RESPI rates the quality of government policies based on two main factors that influence children’s diet-related cognitive, behavioral and health outcomes: (1) marketing strategies, techniques and media channels; and (2) the policy design and characteristics (i.e., government regulatory versus industry self-regulatory). Policies can obtain up to 5 points from each factor or component. A score of 10 indicates the highest quality and 0 the lowest quality for the government RESPI.

A transdisciplinary team (n=7) participated in coding to reach consensus in the formative evaluation processes.

Results:
The highest RESPI scores were aligned with government regulatory policies compared to industry self-regulatory. Three countries (i.e., Bolivia, Chile and El Salvador) had the highest quality policies to restrict unhealthy HFSS food and beverage marketing to children with RESPI scores of 8.3, 7.8 and 8.1, respectively.
The media channels most commonly covered by the government policies were 22% broadcast (i.e., TV, radio and cinema); 22% print; and 19.8% digital and mobile devices. The less common media channels covered by the government policies were 5.5% restaurants and food retailers, and 4.4% campaigns and events. The majority of the policies restricted 17% point-of-sale, 17% use of licensed media characters, and 14.8% premium offers as marketing techniques to advertise unhealthy HFSS food and beverage products to children. The lowest proportion of marketing techniques covered by the RESPI to advertise unhealthy HFSS foods and beverage products to children were branding, sponsorship and direct marketing.

Conclusions:
Regulatory policies to restrict unhealthy food and beverage marketing to children in the Americas Regions are rising and address specific elements of the integrated marketing communications. The combination of the assessed indicators from policies within the RESPI can provide valuable metrics to enable national governments to benchmark and track progress toward the development, implementation, monitoring and evaluation of country progress to restrict unhealthy food and beverage marketing to children. Future testing is needed to determine the feasibility and adaptability of the tool for other countries and regions.

Moreover, the use of simple metrics as the RESPI and interactive visualizations can help to Inform Global Public Health Policy. Despite, the complexity of working in transdisciplinary team it helps to integrate and extend beyond discipline, approaches and methods to build innovations approaches to inform research results to a non-scientific audience.

References:
1. Roberto CA et al. Lancet. 2015 ; 2. Baum FE, et al. Global Health. 2016; 3.Yang L et al. Am J Public Health. 2017; 4. Pries AM et al. Matern Child Nutr. 2017; 5.GBD 2015 Obesity Collaborators. N Engl J Med. 2017; 6. World Health Assembly. Resolution of the Sixty- third World Health Assembly. 21 May 2010; 7.Pham MT et al. Research Synthesis Methods. 2014.

Members:
Vivica I. Kraak, Human Nutrition, Foods, and Exercise (HNFE)
Sofia Rincon Gallardo Patino, Human Nutrition, Foods, and Exercise (HNFE)
Nicholas Polys, Advanced Research Computing (ARC)
Srijith Rajamohan, Advanced Research Computing (ARC)
Eloise Coupey, Pamplin College of Business Marketing (PCBM)
Kathleen Meaney, School of Visual Arts (SOVA)

Collaborative Colleges:
Agricultural and Life Sciences (Human Nutrition, Foods, and Exercise)
Advance Research Computing, Architecture and Business Studies (School of Visual Arts)
Pamplin College of Business (Marketing)

Areas:
Human Nutrition, Foods, and Exercise