Bridget Kelly's research while affiliated with University of Wollongong and other places

BACKGROUND Prevailing childhood obesity in Asia adds risk for future adult burden of obesity and non-communicable diseases. Weak policies across most Asian countries enables unrestricted marketing of obesogenic foods and beverages directly to children. Television is the common medium for food marketing to reach this audience. OBJECTIVE This study aimed to assess the extent and nature of television food and non-alcoholic beverage marketing in nine Asian countries (Bangladesh, China, India, Malaysia, Mongolia, Nepal, Philippines, Sri Lanka and Vietnam) with capacity building from the International Network for Food and Obesity/NCD Research, Monitoring and Action Support who enabled harmonization of data collection method and content analyses. METHODS Advertised foods were categorized as permitted (P) or not permitted (NP) based on the nutrient profile models (NPM) established by the WHO regional offices for South-East Asia (SEARO) and the Western Pacific (WPRO). Data were reported as rate of food advertisements (ads/h/channel) overall and persuasive strategy usage during children’s peak (PVT) and non-peak (non-PVT) viewing times. RESULTS Cross-country comparisons, irrespective of country income level, indicated NP food advertising dominated children’s popular television channels especially during PVT with rates as per WPRO/ SEARO criteria ranging from 2.40/ 2.29 ads/h/channel (Malaysia) to 9.70/ 9.41 ads/h/channel (Philippines). Persuasive strategy rates were also higher during PVT compared to non-PVT. Sugar-sweetened beverages, sugar-containing solid foods, and high salt and fat-containing snacks and fast foods were frequently advertised. Evaluation of the application of WPRO and SEARO NPMs identified inconsistencies due to regional taste and cuisine variations across Asia. CONCLUSIONS Our study clearly showed unhealthy food marketing through popular children’s television channels is widely occurring in Asia and is a clear breach of child rights. Evidence outcomes will be used to advocate for stronger policy regulations to control unhealthy food marketing and strengthen strategies to promote a healthier food environment for the Asian people. CLINICALTRIAL Not relevant to this study as this is not a clinical trial.

Introduction The Government of Thailand has drafted legislation to protect children from the harmful impact of unhealthy food (including beverages) marketing. Local evidence on Thai children’s exposure to, and the impact of, this marketing is necessary to, first, support the adoption of this Law and, second, to contribute to assessing policy implementation and effectiveness. This study aimed to develop and validate a questionnaire for examining Thai children’s exposure to unhealthy food marketing and its impact on diet-related outcomes. Materials and methods To design the questionnaire, we first conceptualised the range of impacts of unhealthy food marketing on children’s diet-related outcomes based on published frameworks. These outcomes related to food brand loyalty, preference, purchase and consumption. We conducted a literature review to gather related questions used in earlier surveys to assess these outcomes. Using these questions, we assessed content validity with five experts. Face validity and reliability were assessed for 32 children. Validity was assessed using Content Validity Index (CVI) and Kappa statistics. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC). Results We identified 15 survey questions that had been used to assess the outcomes of interest. The CVI of all questions was 1.0, indicating perfect agreement with each question’s relevance by the experts. Most questions were perceived to be easy to read and comprehend, suggesting face validity. Cronbach’s alpha and ICC of all questions were both 0.75, demonstrating internal consistency across responses to questions about, separately, brand loyalty, preferences, purchase and consumption. Conclusion The final 15-item questionnaire provides a valid and reliable survey instrument for measuring the impact of unhealthy food marketing on children’s diet-related outcomes. This instrument will be useful for gathering local evidence on the need for policy reform to protect children from unhealthy food marketing in Thailand. The instrument also provides a cost-effective approach for generating evidence in other jurisdictions to propel policy actions. This is a pilot study and the validity and reliability needs further testing after a larger-scale roll-out.

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Background Food marketing is a key factor that influences children’s dietary behaviors. This study assessed the nature and extent of food and beverage advertising on television (TV) in 2014 and 2022 in Thailand. Methods TV was recorded for one week in March 2014 and in May 2022 from 7-9am and 3-7 pm on weekends, and 3-7 pm on weekdays across two channels (64 h recorded each year). The nutrient profile model from Bureau of Nutrition, Ministry of Public Health Thailand was used to classify food and non-alcoholic beverages as: Group A (‘healthy’), Group B (‘less unhealthy’) or Group C (‘unhealthy’). Results In 2014, 475 food advertisements were identified, with on average of 6.3 unhealthy food advertisements per hour. In 2022, 659 food advertisements were identified, with an average of 9.2 unhealthy food advertisement per hour. In both time periods, the most frequently advertised food products were non-alcoholic beverages. The rate of unhealthy food advertising per hour of broadcast was significantly higher than for other moderately unhealthy and healthy foods, and was also significantly higher in 2022 than in 2014. Conclusions Food and beverage advertising on Thai television is predominantly promotes unhealthy foods and, in particular, sugar-sweetened beverages. Therefore, Thai Government should enact new legislation to protect children from food TV ads in order to control both the frequency and nature of unhealthy TV food marketing to protect the health of Thai children.

Objective: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. Design:Children responded to a cross-sectional online survey about their attitudes towards, and purchase and consumption behaviours of, 10 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. Participants:10-16 year old children (n400) Setting:Australia Results: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. Conclusions: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.

Background This systematic review examined the effectiveness of experiential learning interventions for improving children’s physical activity knowledge, attitudes, and behaviours. It also aimed to identify intervention characteristics that resulted in the greatest impact. Methods Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to January 2023. Eligible studies: (1) included children 0–12 years; (2) assessed the effect of physical activity outcomes on children’s physical activity knowledge, attitudes or behaviour and (3) were randomised controlled trials conducted in any setting. Study risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool. Intervention approaches were categorised, and effect sizes were compared across studies for each outcome. Results Twelve studies were included in the review: ten in school age and two in below five years. For behavioural outcomes, six of eight studies showed medium to large effects (effects size (ES) range: 0.3–0.9), two of the three studies that assessed attitudinal outcomes displayed medium effects (ES range: 0.4–0.5) and both studies that assessed knowledge outcomes displayed medium to large effects (ES range: 0.4–1.3). The two experiential learning interventions among children < 5 years demonstrated small to medium effects on behaviour change (ES range: 0.2–0.5). Effective interventions combined enjoyable practical activities (fitness activities, games and challenges), with behaviour change techniques (goal setting, and self-monitoring), were underpinned by a behaviour change theory, and were often of short duration (< 4 months) but intense (several sessions/week). Moderate to high statistical heterogeneity was observed for behaviour outcomes and risk of bias across studies was generally high. Conclusions This review provides some evidence supporting the effectiveness of experiential learning interventions in improving physical activity outcomes in school-aged children. Additional evidence is needed in children <5 years old. Future experiential learning interventions need to strengthen the evidence with rigorous methodological quality and clear reporting of the experiential learning components.