Paula Martins Horta

Objective: To analyse the frequency and distribution of alcoholic beverage advertisements and to identify patterns of co-occurring marketing strategies on the three highest-rated broadcast television channels in Brazil between 2018 and 2020. Design: Cross-sectional study based on 1296 h of television programming recorded between 2018 and 2020. Alcoholic beverage advertisements were analysed to assess their frequency and distribution according to day of the week and programme audience ranking, while empirical patterns of co-occurring marketing strategies were identified using principal component analysis (PCA). Setting: The three highest-rated free-to-air television channels in Brazil. Participants: All alcoholic beverage advertisements. Results: Of the advertisements identified ( n 2369), 11·2 % promoted alcoholic beverages ( n 269). Overall, alcoholic beverage advertisements were more frequently aired on weekends than on weekdays and were predominantly aired outside programmes included in the monthly top 10 audience rankings. Four empirical patterns of co-occurring marketing strategies were identified: ‘Brand Characteristics,’ ‘Sports and Well-being,’ ‘Relationships’ and ‘Celebrity and Pleasure.’ Each pattern showed a distinct temporal distribution across the study period, with ‘Celebrity and Pleasure’ being more prominent in 2018 than in 2019, ‘Relationships’ showing the highest representation in 2019, ‘Sports and Well-being’ in 2018 and 2020 and ‘Brand Characteristics’ standing out in 2020. Conclusion: Alcoholic beverage marketing was widely present on Brazil’s major broadcast television channels and showed distinct patterns of co-occurring marketing strategies over time. The limitations of current regulations reinforce the need for stricter policies to reduce exposure to alcohol marketing and its potential impact on alcohol consumption.

Front-of-pack nutrition labeling (FoPNL) and restrictions on food advertising are regulatory strategies to support informed dietary choices and reduce exposure to unhealthy food. These measures are often integrated through a policy package, that employs a Nutrient Profile Model (NPM) for the classification of food. In Brazil, however, these policies remain fragmented, and current food advertising regulations do not fully cover all channels, particularly digital media. This study applied the NPM adopted in Brazil’s FoPNL (RDC No. 429/2020 in conjunction with IN No. 75/2020, hereafter RDC 429) and those proposed by the Pan American Health Organization (PAHO) for identifying foods subject to advertising restrictions on social media posts directed at children and adolescents. The sample included posts from ultra-processed food brands/products on Instagram (n = 623), TikTok (n = 257), and YouTube (n = 114). Both NPM were applied to assess non-compliance at the food-item level and at the advertisement level (considering posts containing at least one non-compliant food). At the food-item level, 61.28% of products exceeded at least one item of RDC 429, with the highest prevalence on TikTok (72.63%), while 93.86% were non-compliant according to PAHO, reaching 100% on TikTok and 98.5% on YouTube. At the advertisement level, 49.53% of posts contained at least one non-compliant food under RDC 429, and 74.13% under PAHO, with YouTube showing the greatest potential for restriction (62.16% RDC; 99.10% PAHO). Both models are feasible for regulating digital food advertising: the PAHO provides a robust framework, while RDC 429 offers a strategic starting point given its current implementation in Brazil.

This study aimed to evaluate the influence of food advertising and television exposure on eating behaviour and nutritional status of children and adolescents. It was a cross sectional study developed among 116 students from a private school in Brazil. Socio-demographic and health conditions were evaluated. Anthropometric data, food consumption, physical activity, television viewing habits and behaviour in relation to food advertising were also investigated. Among the results, a 1:2 relationship was identified between the number of televisions and residents per household. Excessive weight was present in 25.8% of subjects and 66.4% of children watched television while eating. Children were exposed to television for a median of 3.0 hours daily (95% CI: 2.9 to 3.6). There was a direct association between attraction to foods advertised and purchasing the product (p<0.001) and a positive relationship between the number of televisions per household and body weight (r=0.246, p=0.015) and the amount of liquid consumed during meals (r=0.277, p=0.013). Findings also highlighted the association between watching television while eating and the reduced probability of fruit consumption (p=0.032), contrasted with a greater likelihood of daily artificial juice intake (p=0.039). In conclusion, watching television is associated with lower probability of daily consumption of fruits and the number of television at household is positively related to BMI in children and adolescents.

Resumo As Atividades Políticas Corporativas (APC) do setor privado comercial são um obstáculo para a formulação de políticas regulatórias de alimentação. Objetivou-se identificar como as associações do setor de alimentos e comunicação com histórico contrário à regulação da publicidade de alimentos no Brasil se organizam e quais APC realizam nessa temática. As associações tiveram seus websites visitados e foram coletadas informações sobre as empresas associadas. A avaliação das APC foi conduzida utilizando uma estrutura que considera APC instrumentais e discursivas. Sete associações compuseram a amostra. Um total de 413 empresas compõem essas associações, sendo 183 do setor alimentício. Foram identificados 179 exemplos de APC, sendo 73 de estratégias instrumentais e 106 discursivas. As estratégias instrumentais mais frequentes incluíram gerenciamento de informação e gerenciamento de coalizão. Já as estratégias discursivas estavam centradas em narrativas sobre questões relacionadas à dieta e à saúde pública. Conclui-se que associações do setor privado comercial com histórico contrário a regulação da publicidade de alimentos formam uma rede organizada e utilizam APC para cooptar e atrasar essa agenda no Brasil.

Resumo O objetivo do estudo é avaliar o ambiente alimentar e pântanos alimentares no entorno escolar em uma cidade brasileira de grande porte. Estudo transversal realizado em Betim, Minas Gerais, com escolas públicas e privadas e estabelecimentos que comercializavam alimentos para consumo imediato em 2019. A avaliação do ambiente alimentar considerou buffers euclidianos de 250 metros no entorno das escolas, e foram classificados como pântanos alimentares buffers cujo número total de estabelecimentos que vendem predominantemente alimentos ultraprocessados fosse igual ou superior a quatro. Houve maior disponibilidade de restaurantes, bares, lanchonetes e comércios varejistas de doces no entorno das escolas localizadas no maior tercil de renda. No entorno das escolas localizadas no tercil de menor renda, houve maior disponibilidade de minimercados e mercearias. A prevalência de escolas localizadas em pântanos alimentares foi de 52,7%. A prevalência de estabelecimentos que vendem predominantemente alimentos ultraprocessados foi 3,15 vezes maior em áreas de maior renda. Há grande disponibilidade de estabelecimentos que ofertam alimentos ultraprocessados no entorno das escolas, favorecendo o consumo de alimentos não saudáveis pelas crianças.

A potentially powerful strategy for reducing children and adolescents' exposure to unhealthy food marketing is the implementation of mandatory regulatory measures applicable in the digital environment. This study aimed to systematically identify and characterize regulatory measures concerning food marketing directed at children and adolescents within digital spaces. A systematic scoping review was conducted following the PRISMA‐ScR reporting guidelines and registered with the Open Science Framework (OSF). The study assessed the alignment of these measures with the recommendations for regulating food marketing set forth by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Inclusion criteria required regulatory measures to be mandatory, specific to food marketing, applicable at the national level, and relevant to the digital context. Draft laws, general regulatory frameworks not specific to food marketing, and self‐ or co‐regulatory initiatives were excluded. The search identified eight regulatory measures proposed by Argentina, Bolivia, Brazil, Chile, South Korea, Kiribati, Peru, and Portugal. Notably, only the measures from Bolivia and South Korea explicitly state restrictions for individuals under 18 years of age. A rights‐based approach was identified in the texts from Argentina, Bolivia, Brazil, and Peru. Furthermore, the regulatory measures from Argentina, Bolivia, Chile, Kiribati, and Peru present a broad definition of marketing. All measures employ nutritional criteria to classify targeted foods and impose limitations on marketing power. In conclusion, mandatory regulations for food marketing in the digital environment are limited, concentrated in specific geographic regions, and do not fully align with WHO and UNICEF recommendations.

This study aimed to characterize access to food establishments through a meal delivery application in university and non-university settings within a Brazilian metropolis. This cross-sectional study used data from a leading meal delivery platform. All establishments delivering to four public and four private university campuses in Belo Horizonte, Brazil were identified. For comparison, one corresponding non-university location was selected for each campus (yielding eight campus–location pairs). Each location corresponds to a central address within the paired neighborhood that was entered into the app to simulate delivery availability. Pairing criteria were based on geographic region and income levels. Information on establishment categories (classified by keywords), delivery distances, delivery fees, and geographic centrality was collected and analyzed descriptively. The number of available establishments ranged from 7176 to 11,440 across the assessed locations. Most establishments were categorized under keywords referring to snacks (e.g., burgers, savory snacks, pizza), regardless of location. Delivery distances ranged from 0 to 19.6 km, with shorter distances observed for university addresses and corresponding locations situated in central neighborhoods of the city, and longer distances for peripheral areas. Only 4.7% of establishments offered free delivery, and higher delivery fees were more frequent in non-university locations. No significant differences were observed between public and private universities. Food establishments are widely accessible via the app; however, central areas tend to have broader service coverage. Regardless of whether the location is a university or non-university setting, or whether it is central or peripheral, there is a predominance of establishments classified under keywords associated with unhealthy food options.

The community food environment, which encompasses residential and school neighborhoods, is an important determinant of overweight in children and adolescents. This study aimed to investigate the relationship between the co-occurrence of food swamps in residential and school environments and overweight status. This cross-sectional study included 2601 children and adolescents (aged 5–14 years) from 47 schools in a medium-sized municipality in Brazil. The outcome was overweight status, defined as body mass index for age exceeding the mean by at least one z-score. Food swamps in residential and school surroundings were defined as buffers of 250 m with four or more establishments selling ultra-processed foods. The prevalence of being overweight was 30.4%. Food swamps were present in 22.5% and 22% of the residential and school areas, respectively, and 16.2% of the participants were exposed to food swamps in both residential and school environments. Children and adolescents simultaneously exposed to food swamps in both residential and school areas had a higher likelihood of being overweight (odds ratio: 1.22; 95% confidence interval: 1.02–1.45). The simultaneous presence of food swamps in residential and school environments is associated with overweight in children and adolescents.

This is the first study to analyze the coverage and profile of establishments registered on a meal delivery application (MDA) in small and medium-sized cities in Brazil. The app serves 497 municipalities across 22 states, offering 28,325 establishments. App coverage was measured as the ratio of cities served to the total small and medium-sized cities in each Brazilian region. The establishments were categorized using keyword analysis into six groups: International Cuisine, Snacks, Bakery Products, Complete Meals and Side Dishes, Sweets, Ice Creams and Desserts, and Healthy Options. Greater app coverage was observed in the South (13.68%) and Southeast (13.63%) regions. In contrast, lower coverage was noted in the North (2.46%) and Northeast (2.30%) regions. The keyword category ‘Snacks’ was the most used across all Brazilian regions, while ‘Healthy Options’ was the least utilized. Positive correlations were identified between the number of establishments on the app and the Municipal Human Development Index (r = 0.30; p < 0.001), demographic density (r = 0.23; p < 0.001), and urban population (r = 0.55; p < 0.001). The use of keyword categories varied across municipalities based on their demographic and socioeconomic characteristics. Our findings reveal significant asymmetries in app coverage and the types of registered establishments, which may further exacerbate inequalities in food access.

The establishments present in meal delivery apps (MDA) and the coverage of these services are little known, especially after the COVID-19 pandemic. Objective: To analyze the establishments registered in two MDA in Belo Horizonte, Brazil, in 2019 and 2021. Methods: The sample consisted of the best rated establishments within the MDA in 18 neighborhoods in 2019 (n=357) and 2021 (n=308). Establishments were classified according to the predominance of meals present on their menus. The coverage of the establishments was calculated by dividing the number of neighborhoods served by each establishment and the number of neighborhoods. The Health Vulnerability Index (HVI) was used as a proxy of the social vulnerability of neighborhoods. Results: Fast-food restaurants were the most frequent establishment in the MDA in both periods and the percentage of neighborhoods served by these services was higher in 2021 (17.50%) than in 2019 (13.54%), although their participation in the sample was lower in 2019 (44.26% vs. 30.84%). The coverage of MDA establishments in the neighborhoods differed according to HVI. Conclusion: Coverage and participation of the establishments present in MDA in Belo Horizonte were different in both study periods, particularly in high socially vulnerable neighborhoods.