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Purpose: Awareness and literacy regarding nutritional facts, as well as behaviour in reading front-of-pack labelling, are still lacking in Indonesia. This study aims to increase awareness and knowledge towards food labelling and ultra-processed food (UPF) in the community. Design/methodology/approach: This was a community service activity involving 33 adults aged 14–45 years. The activity was conducted through a sequence of pre-test, nutrition education focusing on food labelling (first session) and UPF (second session), and post-test. A set of 15 questions consisting of 13 multiple-choices and 2 exploratory questions was used to collect information from respondents. Data was analysed using a paired t-test, whereas qualitative data was analysed using a thematic approach. Findings: After receiving the two sessions of education, participants' knowledge increased 11.55 points (pre-test vs post-test mean ± SE 76.90 ± 0.28 vs 88.45 ± 0.19; p < 0.001). The top five UPF products frequently consumed by participants were snacks (both sweets and savoury), instant noodles, canned food, beverages, mainly sugar-sweetened beverages (SSB) and bread and frozen foods. From the participants' perspective, instead of prohibiting UPF advertisement, conducting food and nutrition sustainable education is more important to control UPF intake. Research limitations/implications: This study has both strengths and limitations. The findings of this activity represent the real evidence of food and nutrition-related phenomena in the community. Equally important, nutrition education topics were comprehensive and based on recent evidence. Nevertheless, as a community service activity, the findings were more straightforward and did not involve as many participants. Additionally, the post-education assessment took place immediately after the session, but there was no follow-up evaluation to determine whether participants retained the knowledge or had changed their behaviours. Practical implications: Therefore, advanced research is highly encouraged to explore the impact of UPF advertising on food choice preferences and consumption. Additionally, there is also a need to develop an ideal nutrition education kit that focuses on reading food labels and understanding UPF. Evaluating social-behavioural changes related to UPF following a comprehensive nutrition training programme is another crucial issue for research. Furthermore, assessing the initiation and implications of implementing SSB taxes in Indonesia is essential for understanding their potential effects. Originality/value: Nutrition education significantly enhances adults' knowledge of food labelling and UPF. Instead of banning UPF marketing, most participants favoured a sustainable approach involving continuous education to reduce UPF consumption. [ABSTRACT FROM AUTHOR]

Objectives: To identify and evaluate the difference between voluntary and mandatory food marketing policies and regulations targeting childhood obesity and to study the role of media, the food industry, and private associations in implementing such policies. Methods: A review of policies and legislation about unhealthy food marketing was conducted by searching and extracting relevant grey literature from the websites of international health agencies, food marketing pledge databases, GINA, and NOURISHING policy databases. Statutory laws and self-regulations of high-income countries were compared with each other and with the WHO recommendations. Results: Regulations differ regarding target audience, nutrient profiling, communication media, and marketing techniques. To date, no country has implemented comprehensive regulations restricting all forms of unhealthy food marketing. Statutory laws are more meticulous and rigorous than self-regulatory policies. Conclusion: The goal of reducing childhood obesity through restrictions on unhealthy food advertising has not been met. While not welcomed by all actors, mandatory regulations may be more effective than voluntary measures in reaching this goal. A system for monitoring adherence to regulations and providing both incentives and penalties for violations is warranted. [ABSTRACT FROM AUTHOR]

Background/Objectives: Childhood obesity is a multifactorial chronic disease that represents one of the main preventable causes of morbidity and mortality. This study analyzes how nutritional beliefs influence eating habits and the prevalence of overweight and obesity in Spanish children and adolescents. Methods: A cross-sectional study was conducted in 35 educational centers in 12 Spanish provinces, with a sample of 1131 children and adolescents aged 6 to 14 years. Anthropometric and sociodemographic data were collected, and dietary habits were assessed by means of questionnaires. Statistical analyses were used to identify associations between dietary beliefs and body mass index. Results: In total, 29.5% of participants were overweight or obese. Two groups of beliefs were identified: healthier beliefs and less healthy beliefs. Children with less healthy dietary beliefs had a significantly higher BMI (22.16 kg/m2) compared to those with healthier beliefs (17.2 kg/m2). False nutritional beliefs, influenced by advertising and the family environment, contribute to overweight and obesity. Discussion: Dietary beliefs play a crucial role in determining eating habits and, therefore, the health of children. Nutrition education and public policies that promote healthy eating habits are essential to prevent childhood obesity. It is important to involve the family, the school, and the media in these efforts. Conclusions: Despite efforts, many children continue to hold erroneous nutritional beliefs that contribute to the rise in overweight and obesity. This study highlights the importance of addressing dietary beliefs and promoting appropriate nutrition education to prevent childhood obesity. It is recommended to implement educational strategies and public policies that regulate the advertising of unhealthy foods and promote healthy eating habits. [ABSTRACT FROM AUTHOR]

Copyright of Jurnal Pendidikan Indonesia is the property of Publikasi Indonesia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There are several laws, policies, and recommendations providing protection to children from environmental harm. Lack of clean food can be one of such harms. Clean food is not just about food availability or accessibility but also about food safety. This means that food must be free of adverse substances—in other words, it must be healthy food. For decades, there have been discussions and attempts to find solutions on how to reduce the marketing of unhealthy food to children to prevent overweight, obesity, and diseases. It has also been proved that unhealthy food too often reaches children through digital marketing. This article discusses whether the existing legal grounds and policies provide sufficient protection to children from unhealthy food advertised on digital media. It also explores how technology impacts children's right to clean food and what could be the solutions for managing this issue. [ABSTRACT FROM AUTHOR]

Adolescent obesity continues to be a public health challenge with poor quality diets contributing to its etiology. As part of the process to plan health promotion and policy interventions, understanding adolescents perceived facilitators and barriers to healthful eating is important. An integrative convergent mixed‐methods systematic review was used to synthesize qualitative and quantitative evidence from studies among adolescents aged 10–19 years in high‐income countries. Medline, Embase, PsycInfo, and Scopus were searched for peer‐reviewed articles published between 2010 and 2023 and exploring adolescents' perspectives on healthful eating and contemporary contextual factors. Transformed quantitative data were integrated with qualitative data. Text was coded into subthemes and themes using an inductive approach. Key facilitators included health and physical appearance; motivation; taste; nutrition knowledge, awareness, and skills; nutrition education access; availability and accessibility of healthful foods; family; and social influences and digital media. Key barriers included taste and cravings for unhealthful foods; mood; lack of motivation, awareness, knowledge, and skills; high availability and low cost of unhealthful foods; peers and social influences; ineffective school policies; high density of fast‐food outlets; unhealthful food advertising; digital influences; and time constraints. Social, behavioral, digital, and food environmental factors should be considered from an adolescent perspective in the design of education, health promotion, and policy interventions. [ABSTRACT FROM AUTHOR]

Assertive advertising messages, such as "You must try our taco!" are ubiquitous in the hospitality industry. However, the effectiveness of assertive language as a food advertising strategy is not well understood. Drawing on language expectancy theory, this research examines how language assertiveness shapes consumers' responses to food advertisements featuring organic versus conventional food. Findings reveal that assertive (vs. nonassertive) language boosts consumers' intentions to purchase organic food, whereas nonassertive (vs. assertive) language increases consumers' intentions to purchase conventional food. Furthermore, our mediation analysis reveals that brand competence inference serves as the psychological mechanism underlying the impact of language assertiveness and food type on purchase intention. [ABSTRACT FROM AUTHOR]

Food labeling significantly helps consumers to make informed food choices. Considering the importance of nutrition knowledge for using food labels and making dietary decisions, the opinion of consumers on the usage of nutritional information as part of food advertising was investigated. Based on information collected via an online survey of 183 participants in the Republic of North Macedonia, this study provided consumers' perceptions and attitudes regarding food safety, brand influence, health claims, and label comprehensibility. Results of the survey indicated that while a significant percentage of respondents (48.9%) understood health claims, only 26.8% were familiar with the Nutri-Score labeling system. Brand recognition was high (96.1%), with 68.3% associating brand with product quality. Also, concerns about food safety were prevalent, with 64.8% expressing doubts about the safety of food products available at the national market. Another worrying outcome is understanding food labels, since more than half of respondents (58.8%) stated that the labels are not entirely comprehended. This study demonstrated the need for improvement of the public education on labeling systems, enhanced food safety measures, and stated apparent and more readable food labels, ultimately promoting appropriate food choices and ensuring consumer protection in the Republic of North Macedonia.

Background: The use of dietary supplements (DS) has risen over the past decade, supported by the growth of e-marketplace (EM) platforms as a primary source of product information and purchases. However, these platforms have experienced a surge in health and nutritional misinformation, leading to negative health effects. Objectives: This study explored the characteristics and estimated the prevalence of misinformation on web pages selling DSs on popular Thai EM platforms. Materials and Methods: The prevalence of misinformation was assessed based on Thai regulatory criteria by analyzing DS web pages from two popular Thai EM platforms. In December 2022, 332 web pages were systematically selected for cross-sectional content analysis by identifying the general characteristics of these web pages as viewed by consumers. Misinformation prevalence was estimated by the number of web pages with each type of inappropriate information, using 10 Thai food advertising regulatory criteria. Results: The DS web pages on Thai popular EM platforms exhibited similar content structure, including product navigating function, product description, seller information, past consumer reviews and ratings, and online cart and purchase system functions. Of the 332 web pages, 85% contained at least one misinformation statement. The most common misinformation was unapproved claims on food benefits (82%). 48% contained overclaims of skin or beauty nourishment and weight-loss effects. Moreover, 42% overclaimed misinformation products' influence on body structure or functions. Misinformation was mostly found in text-based content (63%), image-based content (61%), and video clips (6%). Conclusion: There is a high prevalence of misinformation on DS web pages on two popular Thai EM platforms. The findings underscore the importance and urgency of online misinformation surveillance and the need for Thai regulatory authorities to accelerate the development of monitoring and control mechanisms of online DS marketing on online platforms. [ABSTRACT FROM AUTHOR]

Although insect-based food is considered a potential solution to global food security issues, its acceptance remains low. This study explores effective advertising strategies to enhance consumers' willingness to consume (WTC) insect-based food by analyzing the interplay of anthropomorphic language (used/not used), message framing (loss frame/gain frame), and spatial distance (online shopping/offline shopping). A total of 745 participants were recruited via "Wenjuanxing," with 458 valid responses obtained after screening. Participants were randomly assigned to view one of eight ads and complete a questionnaire. Three-way ANOVA and post hoc t-tests revealed that anthropomorphic language significantly increases WTC. Additionally, gain-framed (loss-framed) messages are more effective in online advertisements (offline advertisements). This matching effect is amplified by the use of anthropomorphic language in the advertisements. The findings provide marketing insights for promoting insect-based and other unconventional foods, contributing to the advancement of a sustainable global food system to address future food and environmental challenges. [ABSTRACT FROM AUTHOR]

Issue Addressed: The pervasive promotion of energy‐dense, nutrient‐poor food and drinks undermines efforts by adolescents and their parent/carers to maintain a nutritious diet during a crucial developmental period. This study examined the association between awareness of food and drink advertisements and adolescents' dietary behaviours and intake. Methods: A sample of Australian secondary students aged 12–17 years (N = 8763) self‐reported their awareness of food and drink advertisements across seven settings, whether they had tried a new product or asked a parent/carer to purchase a product they had seen advertised, and their consumption of various unhealthy food and drink types. Analyses used multilevel mixed‐effects generalised linear models adjusted for school‐level clustering, socio‐demographic factors and television viewing. Results: Students with higher advertising awareness were more likely to have tried a new product they had seen advertised (adjusted prevalence ratio [APR] = 1.62, 95% CI = 1.51–1.73, p <.001) and asked their parent/carer to buy an advertised product (APR = 1.62, 95% CI = 1.51–1.73, p <.001) at least once in the past month. As advertising awareness increased, so too did students' likelihood of reporting these dietary behaviours. A high unhealthy food intake was more commonly reported among students with higher advertising awareness (APR = 1.45, 95% CI = 1.32–1.58, p <.001), as was a high unhealthy drink intake (APR = 1.29, 95% CI = 1.18–1.42, p <.001). Conclusions: Australian adolescents are vulnerable to the persuasive effects of food and drink marketing. So What?: Greater restrictions on the way the food and drink industry can market their products to adolescents are needed to better support them in developing and maintaining positive dietary behaviours. [ABSTRACT FROM AUTHOR]

Issue Addressed: Little is known about the executional techniques that are most likely to make healthy eating messages memorable over the longer term. The aim of this exploratory study was to identify factors contributing to the ongoing salience of the Go for 2&5 social marketing campaign among older audience members. Methods: Interviews were conducted with 75 Western Australians aged 60+ years. A peer‐interviewing method was used whereby eight older people recruited and interviewed members of their extended peer groups. The interview guide included questions about interviewees' recollections of healthy eating messages across their lifespans. Results: Around one in five interviewees discussed the Go for 2&5 campaign that was on air in Western Australia between 2002 and 2011. These discussions focused on either specific advertisement features that were considered to be especially memorable (in particular, humour and the use of anthropomorphised depictions of produce) and/or their recollection of the number of daily servings of fruits and vegetables recommended in the campaign. Few were able to recall other healthy eating campaigns, and in some cases it was assumed that advertisements for specific food stores or products constituted health advice. Conclusions: Different campaign attributes may influence shorter‐term attitudinal and behavioural responses versus longer‐term recall. The characteristics of the Go for 2&5 campaign appear to have enabled it to achieve relatively high levels of recall among older people. So What?: The study results suggest that some advertising approaches that activate the peripheral route to persuasion may achieve recall over a longer period of time. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement. Design: A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received. Results: The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, 'teen language' and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content. Conclusion: Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents' exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements. [ABSTRACT FROM AUTHOR]

Introduction: Television food advertisements targeting children are recognised as a significant health risk, influencing their dietary choices and contributing to the increasing prevalence of Non Communicable Diseases (NCDs) among children in Low and Middle-income Countries (LMICs). Understanding maternal perceptions and attitudes towards these advertisements is crucial for designing effective public health interventions. Aim: To evaluate maternal perceptions and attitudes toward television food advertisements targeting children, specifically among mothers of children aged 4-11 years. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatric and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India, from My 2023 to November 2023. A total of 332 mothers of children aged 4-11 years were divided into two groups: Group 1 (mothers of children aged 4-7 years) with 159 participants, and group 2 (mothers of children aged 8-11 years) with 173 participants. A prevalidated, closed-ended questionnaire consisting of 24 questions was administered to the mothers. The reliability of the questionnaire was ensured through the preliminary exploratory study and expert reviews, achieving a Cronbach's Alpha value of 0.84. Data analysis was performed using descriptive statistics and Chi-square tests to compare perceptions of mothers in both groups. Results: The study received 332 responses from mothers with children aged 4-11 years. Significant differences between the two age groups were observed. In group 1, 64 (52%) mothers mothers agreed, while 41 (57.7%) mothers in group 2 strongly agreed that their children show a keen interest in watching food advertisements. Additionally, 80 (55.9%) mothers in group 1 agreed, while 39 (44.8%) mothers in group 2 strongly agreed that their children do not understand the persuasive intent of food advertisements, with statistical significance (p-value=0.001). Most mothers, 75 (52.4%) in group 1 and 68 (47.6%) in group 2, agreed that reducing exposure to food advertisements would improve children's eating behaviour (p-value=0.01). Moreover, 61 (64.9%) mothers in group 1 strongly agreed, and 77 (58.3%) mothers in group 2 agreed that seeing advertisements persuaded children to want unhealthy foods, highlighting significant differences between the age groups (p-value=0.004). Conclusion: Mothers recognise the negative impact of TV food advertisements on their children's eating habits, particularly noting the use of cartoons and celebrities to promote unhealthy snacks and low-nutrition food that their children struggle to understand. The present study emphasises the urgent need for regulatory measures to protect young viewers and promote healthier dietary choices across different age groups. [ABSTRACT FROM AUTHOR]

Summary Objective Methods Results Conclusion The objective of this study is to evaluate obesity‐related genetic factors in relation to excess consumption and assess if food cues modify associations.Children (9–12 years) completed a randomized crossover experiment. During two visits, children ate a preload and then snacks ad libitum while watching television, embedded with food or non‐food advertisements to assess eating in the absence of hunger (EAH). Primary exposures were obesity‐associated genotypes, FTO rs9939609 and MC4R rs571312, and a paediatric‐specific polygenic risk score (PRS). Outcomes included consumption of all snacks (total EAH) and gummy candy only (gummy candy EAH). Linear mixed‐effects models tested whether genetic exposures related to EAH outcomes. We tested for effect modification by food cues using multiplicative interaction terms.Among 177 children, each FTO risk allele was associated with a 30% increase in gummy candy EAH (p = 0.025) in adjusted models. Food cue exposure exacerbated associations between the FTO variant with gummy candy EAH (p = 0.046). No statistically significant associations were found between MC4R and EAH.The results suggest children with the FTO rs9939609 risk allele may be predisposed to excess consumption of candy and that this association may be exacerbated by food cues. [ABSTRACT FROM AUTHOR]

Humorous messages (not derogatory jokes) related to obesity seem to be retweeted frequently. Potentially, such humor could be included in viral public health campaigns to combat obesity, but would jokes actually increase the likelihood of purchasing healthy foods advertised on social media? 411 participants were asked to test two soon-to-be-introduced features (e.g., repost button) in Instagram on their phones. Participants scrolled through a series of posts about various topics ranging from architecture to beauty products. A healthy food post, preceded by one of four joke types (two containing the word "fat"), was embedded at the top, middle or bottom position of the Instagram page. After participants scrolled through the page, perhaps reposting some posts, they were presented with the healthy food product featured in the post and were asked to indicate a purchase probability (0-100), as well as whether they recognized the food product from the post (yes/no). At the end of the study, the individual jokes were rated as "funny/not funny" and "positive/ negative". If the food product was recognized, the joke type played a role. In particular, jokes containing the word "fat" had a negative effect on the purchase probability. However, if the food product was not recognized, only its position on the page mattered. The purchase probability was highest if the product was placed at the top. Social media, criticized for promoting unhealthy food consumption, especially among children, can therefore also be used to address issues such as the global obesity epidemic. [ABSTRACT FROM AUTHOR]

This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations. [ABSTRACT FROM AUTHOR]

Copyright of Challenges of the Future / Izzivi Prihodnosti is the property of Fakulteta za Organizacijske Studije v Novem mestu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article deals with the most important food advertisements in which black bodies were used to support Italian colonial propaganda. The aim of the article is to show the role of race, gender, and sexuality in the dissemination of various racial stereotypes and colonial imaginaries in the public sphere. Using the SALCE ad collection, quantitative and qualitative analyses of the visual sources considered are combined. In the conclusion, some new possible historical trajectories are identified to explore the role of advertising in shaping a racialized and sexist public imagination view of overseas in terms of visuality and taste.

There is currently a growing interest in the study of the consumption of carbonated beverages and their harmful effects on health. The highest consumption of soft drinks occurs in the adolescent population belonging to educational institutions, which has made university students the main focus of the study, due to the nutritional vulnerability of this population during their academic training. Therefore, the objective of this study was to analyze the consumption of soft drinks by students of the School of Nutrition and Dietetics of the Universidad del Sinú. To collect the information, a sociodemographic characterization questionnaire was implemented, and variables such as gender, age, socioeconomic stratum, level of knowledge about soft drinks, attitude towards soft drink consumption, preferred soft drink brand, and anthropometric characteristics (weight and height) were studied, based on this last information the Body Mass Index (BMI) was determined, additionally, the frequency of consumption was studied and related to each of the above factors. The data obtained were analyzed using ANOVA analysis and the HSD Tukey test. The results showed that the greater the frequency of consumption, the greater the increase in weight, and that gender, class, level of knowledge, attitude, and brand affected the frequency of consumption of soft drinks, leading to the conclusion that these factors influence the frequency of consumption of soft drinks. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? Physically locating liquor stores near schools can strongly influence the chances of youth accessing and consuming alcohol, and may also increase children's exposure to alcohol advertising. Investigating the association between the presence of a liquor store near a school and the prevalence of outdoor alcohol advertising is crucial from a policy perspective, as it can inform future regulations on the placement of liquor stores and outdoor advertising near educational institutions.All outdoor alcohol advertising within a 500 m radius (audit zone) of 64 randomly selected schools from local government areas across metropolitan Perth was identified by direct observation; recording the size, setting, location and content of each advertisement. Results were compared based on whether the school audit zone contained a liquor store or not.Over half (n = 36, 56%) of all school audit zones had at least one alcohol advertisement, with an average number of 5.9 alcohol advertisements per zone (SD = 10.2). The majority (97.9%) of advertisements were in the 38 audit zones containing a liquor store (average = 9.7, SD = 11.9 per zone), compared to zones without a liquor store (average = .3, SD = .7 per zone).Perth school zones containing a liquor store in their 500 m radius had, on average, 30 times more outdoor alcohol advertising, compared with school zones without a nearby liquor store.The siting of liquor stores and the display of alcohol advertisements around educational settings require combined policy, planning and public health approaches to mitigate children's exposure to alcohol marketing, especially during school transit. [ABSTRACT FROM AUTHOR]

Copyright of Sakarya Communication Journal / Sakarya İletişim is the property of Sakarya Iletisim and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES. Methods: Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower). Results: Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17–69), vs Medianhigh = 10.5 (IQR 4–17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16–99) vs Medianhigh = 13.5 (IQR 6–25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8–19) vs Medianhigh = 6 (IQR 2–8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13–65) vs Medianhigh = 14 (IQR 4–29), p = 0.045).There were no significant differences by school type. Conclusion: This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status. [ABSTRACT FROM AUTHOR]

Amidst global health concerns such as COVID-19 and rising obesity rates, the connection between food choices, societal well-being, and cultural shifts has gained attention. In China, the rise of "light food" consumption on platforms like Taobao reflects a growing trend towards health-conscious dietary preferences. With a dataset comprising 633 images and 45,817 words, condensed into 50 images for analysis, this research aims to understand how these advertisements influence perceptions of healthiness and desirability, and whether there is a discrepancy between advertised health benefits and actual nutritional content. This study delves into the advertising strategies employed for light food products on the Taobao platform in China, utilizing a Textual–Visual Thematic Analysis (TVTA) framework. Noteworthy findings include: (1) Internet-based light food advertising adopts a dual textual and visual approach. (2) Identification of prevalent multimodal devices, such as medium shots, varied camera angles, vibrant colors, and large size. (3) Uncovering inconsistencies in presentation that may pose potential consumer misperceptions. These discoveries underscore the nuanced landscape of light food advertising, offering valuable insights for both academia and industry. [ABSTRACT FROM AUTHOR]

This paper examines how injunctive, descriptive, and benefit appeals encourage consumers to engage in unfamiliar 'sustainable behaviours' – specifically, the consumption of surplus food, defined as edible foods that are never sold to or consumed by targeted customers. Three experiments involving 815 participants were run to assess reference group and message framing types as moderators of advertising appeal influence. Results indicate a significant interactive effect between reference group and advertising appeal on sustainable food consumption practices. For descriptive appeals, membership groups were the most effective for promoting sustainable food consumption; for injunctive and benefit appeals, aspirational groups were the most effective. Interaction between advertising appeal and message framing also exerted a significant effect on sustainable food consumption behaviours, with descriptive and benefit appeals the most effective when used with positive message framing, and injunctive appeals the most effective when used with negative message framing. [ABSTRACT FROM AUTHOR]

Abstract Background The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. Methods Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. Results The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). Conclusion Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television.

Abstract Background With the COVID-19 pandemic and the restrictions imposed to contain the spread of SARS-CoV-2, the Brazilian population has increased the time spent at home and watching television (TV). Since food advertising exposure is a key driver of food choices, this study described the content of food advertisements (ads) on Brazilian TV during the COVID-19 pandemic. Methods This is an exploratory study. A total of 684 h of TV programming comprised of three free-to-air channels and two pay-per-view channels was recorded from 06 a.m. to 12 a.m. for eight non-consecutive days in June 2020. A content analysis of all the food-related ads was carried out. The data collection process followed INFORMAS Protocol for TV food advertising monitoring. Results The sample was composed of 7,083 ads, 752 (10.6%) of which were food-related and 487 (6.9%) were promoting ultra-processed foods. The content analysis indicated seven thematic categories, all of them with reference to the COVID-19 pandemic: brand and product differentials (79.8%); visual and sound effects (70.2%); thematic campaigns (56.0%); digitization (22.9%); convenience (16.5%); economic benefits (11.9%); and commensality and social interaction (6.1%). Ads content varied according to the day of the week, the time of the day, the length of the ad, and the channel type. Conclusions The thematic of food advertising on Brazilian TV during the COVID-19 pandemic is aligned with the country’s health crisis context and varied during the programming.

Background/Objectives: Childhood obesity is a multifactorial chronic disease that represents one of the main preventable causes of morbidity and mortality. This study analyzes how nutritional beliefs influence eating habits and the prevalence of overweight and obesity in Spanish children and adolescents. Methods: A cross-sectional study was conducted in 35 educational centers in 12 Spanish provinces, with a sample of 1131 children and adolescents aged 6 to 14 years. Anthropometric and sociodemographic data were collected, and dietary habits were assessed by means of questionnaires. Statistical analyses were used to identify associations between dietary beliefs and body mass index. Results: In total, 29.5% of participants were overweight or obese. Two groups of beliefs were identified: healthier beliefs and less healthy beliefs. Children with less healthy dietary beliefs had a significantly higher BMI (22.16 kg/m2) compared to those with healthier beliefs (17.2 kg/m2). False nutritional beliefs, influenced by advertising and the family environment, contribute to overweight and obesity. Discussion: Dietary beliefs play a crucial role in determining eating habits and, therefore, the health of children. Nutrition education and public policies that promote healthy eating habits are essential to prevent childhood obesity. It is important to involve the family, the school, and the media in these efforts. Conclusions: Despite efforts, many children continue to hold erroneous nutritional beliefs that contribute to the rise in overweight and obesity. This study highlights the importance of addressing dietary beliefs and promoting appropriate nutrition education to prevent childhood obesity. It is recommended to implement educational strategies and public policies that regulate the advertising of unhealthy foods and promote healthy eating habits.

The fast pace of our daily lives often prompts consumers to seek convenient and ready-to-eat snacks, such as cereal bars. This work aims to characterize the cereal bars available in the Portuguese market (Study 1), as well as consumers' perceptions of different types of these products (Study 2). First, we collected data (e.g. nutritional information, price) on 277 cereal bars from two major Portuguese retailers. The results indicated that most of these products do not comply with the current guidelines for key nutrients like sugar, fat, and salt. Second, using an online survey, we asked participants (N = 373) to evaluate cereal bars from different categories (e.g. "energy/protein") across eleven dimensions. Overall, the bars were rated as tasty but also unhealthy, highly caloric, processed, and unsuitable for athletes, children, and weight loss. Interestingly, participants overestimated the content of most nutrients contained in cereal bars. A content analysis revealed that participants indicated more reasons for not consuming (e.g. excessive sugar content) than consuming (e.g. convenience) these products. Given the increasing popularity of cereal bars, our findings call for action from multiple stakeholders toward improving cereal bars' nutritional profile and advancing our understanding of consumers' perceptions of these products to facilitate healthier choices. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Estudios de la Administración Local y Autonómica is the property of Instituto Nacional de Administracion Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Our special issue on young consumers introduces readers to a research area that has been part of the consumer behavior field for over 50 years. We provide an overview of topics and findings from past to present that have appeared in marketing and consumer journals. We also identify current research issues and gaps and invite readers to contribute to the field. Throughout our discussion, we introduce the 10 articles in this special issue, whose topics include neuroscience insights into youth risk behaviors, the effects of social media on youth, social activism among young people, strategies for encouraging them to eat healthier food, parenting strategies and youth smoking, how gambling advertising affects youth, their need for marketplace literacy, and the importance of studying the lived experiences of youth in poverty. These articles include empirical findings and identify opportunities for future research that can positively impact the lives of children and adolescents. [ABSTRACT FROM AUTHOR]

Copyright of Global Journal of Economics & Business is the property of Refaad for Studies, Research & Development and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. Methods: Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. Results: The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). Conclusion: Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television. [ABSTRACT FROM AUTHOR]

Introduction: Social media has become a ubiquitous part of daily life. However, little is known about the influence of food-related social media content (FRSMC) on the eating habits of Malaysian undergraduates. This study explored FRSMC usage of undergraduates enrolled in a non-health program, its influence on eating habits, and how such social media content influences dietary behaviours. Method: This qualitative semi-structured interview study involved chemical engineering (CE) undergraduates at a university in Penang, Malaysia. The study was carried out from April 2021 to March 2022 during which ten participants were purposively selected. Based on precedent qualitative research sampling rule of thumb, this sample size of ten participants provided sufficient data saturation for an initial exploratory study. The interview sessions were recorded, transcribed, and thematically analyzed. Results: According to study findings, in terms of usage, food advertising and promotions; cooking tutorials and food and nutrition information are the most appealing types of FRSMC. With regards to eating habits, FRSMC can lead to healthy and unhealthy food choices. The study identified several perceived challenges, namely unrealistic and untrustworthy content, difficult and repetitive content, and algorithm-driven deviations from healthy diets. The effectiveness of FRSMC can be enhanced by creating trustworthy and engaging content. Conclusion: The study highlights that social media engagement can have both positive and negative impact on food choices among undergraduates. Some FRSMC are perceived to encourage and motivate undergraduates to adopt healthier dietary habits. Future research could involve a larger sample, representative of diverse socio-demographic groups in Malaysia. [ABSTRACT FROM AUTHOR]

With the explosive growth of the mobile application (app) market, food delivery apps have become an indispensable functional element in the foodservice industry especially in the midst of the coronavirus pandemic. However, research about food delivery apps and its advertisement (ad) has hardly been carried out in the hospitality context. This study filled this gap and explored how ad attributes of the food delivery app influence consumer post-purchase behavior. Our results demonstrated these attributes significantly affect attitude toward ads. In addition, this attitude along with satisfaction maximized the influence of the contribution of the attributes to inducing approach decisions. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period for future health outcomes. Food habits and cognitive development are underway, and it is a period of heightened sensitivity to external influences and emotional shifts. We experimentally test the individual and combined influence of food advertisements and emotional primes (i.e., positive, negative, neutral) on adolescent food choices. Participants completed a food choice task selecting five snacks out of twenty healthy and unhealthy options in an online experiment. Prior to the food choice, we randomized whether adolescents were exposed to unhealthy food or non‐food online advertisements. To induce experimental variation in adolescents' emotions, they were assigned to watch two, two‐minute film clips validated to elicit the targeted emotion. The online food advertisement did not significantly impact food choices, except that Black and Hispanic groups selected a higher share of calories from unhealthy foods. Participants in a negative emotional state selected more unhealthy sweet snacks. Finally, we find only weak evidence that a positive emotional state amplified the impact of food advertisements on the nutritional quality of food selection. Together, results suggest that while a negative emotional state drives food choices, this pattern occurs independently from food advertisement exposure. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine adolescents' social media environment connected to unhealthy food marketing. As social media have become a ubiquitous part of young people's everyday lives, marketers have also shifted their focus to these channels. Literature on this phenomenon is still scarce and often takes a quite narrow view of the role of marketing in social media. Furthermore, the experiences of the adolescents are seldom considered. Design/methodology/approach: Using a sociocultural approach and netnographic methodology, this study presents findings from a research project conducted in Finland. The data consist of both social media material and focus group interviews with adolescents. Findings: The findings elaborate on unhealthy food marketing to adolescents in social media from two perspectives: sociocultural representations of unhealthy foods in social media marketing and social media influencers connecting with adolescents. Originality/value: The study broadens and deepens the current understanding of unhealthy food marketing to adolescents taking place in social media. The study introduces a novel perspective to the topic by looking at it as a sociocultural phenomenon. [ABSTRACT FROM AUTHOR]

Background: With the COVID-19 pandemic and the restrictions imposed to contain the spread of SARS-CoV-2, the Brazilian population has increased the time spent at home and watching television (TV). Since food advertising exposure is a key driver of food choices, this study described the content of food advertisements (ads) on Brazilian TV during the COVID-19 pandemic. Methods: This is an exploratory study. A total of 684 h of TV programming comprised of three free-to-air channels and two pay-per-view channels was recorded from 06 a.m. to 12 a.m. for eight non-consecutive days in June 2020. A content analysis of all the food-related ads was carried out. The data collection process followed INFORMAS Protocol for TV food advertising monitoring. Results: The sample was composed of 7,083 ads, 752 (10.6%) of which were food-related and 487 (6.9%) were promoting ultra-processed foods. The content analysis indicated seven thematic categories, all of them with reference to the COVID-19 pandemic: brand and product differentials (79.8%); visual and sound effects (70.2%); thematic campaigns (56.0%); digitization (22.9%); convenience (16.5%); economic benefits (11.9%); and commensality and social interaction (6.1%). Ads content varied according to the day of the week, the time of the day, the length of the ad, and the channel type. Conclusions: The thematic of food advertising on Brazilian TV during the COVID-19 pandemic is aligned with the country's health crisis context and varied during the programming. [ABSTRACT FROM AUTHOR]

With the popularity and success of food-related social media content, food marketers have begun utilizing social media influencers to promote their food brands. In particular, mukbang—video broadcasts of individuals eating copious amounts of food—is a prominent genre of public social media food exhibition that can provide opportunities for food-related social media influencer marketing. The present study examines how parasocial interaction (i.e. nonreciprocal interpersonal relationships formed with media personalities) with a mukbang social media influencer impacts advertising effectiveness and information credibility. A total of 404 U.S. participants completed an online survey. Structural equation modeling found that participants' parasocial interactions with mukbang social media influencers predicted perceived source trustworthiness, perceived source expertise, and credibility of the information regarding the food content posted. Furthermore, influencer source credibility and information credibility positively impacted consumer brand and video attitudes, as well as behavioral intentions to consume the foods featured in the social media content. Study results provide evidence-based implications for food-related social media influencer marketing strategies and insight into the important role of information credibility on eating behaviors of social media consumers. [ABSTRACT FROM AUTHOR]

Purpose: The current research aimed to examine the prevalence of Instagram posts featuring ultra-processed products targeted at adolescents in Uruguay and hence investigate the frequency of such posts among a vulnerable consumer segment in a country that cannot be classified as WEIRD (i.e. Western, educated, industrialized, rich and democratic). Design/methodology/approach: The study relied on a cross-sectional content analysis. A total of 2,014 Instagram posts promoting ultraprocessed products or brands commercializing such products, generated by 118 Instagram accounts between August 15th, 2020, and February 15th, 2021, were analyzed. Nine indicators of food marketing targeted at adolescents were selected to identify posts targeted at this age segment. Inductive coding was used to describe the content of the posts. Descriptive statistics and generalized linear models were used to analyze the data. Findings: In total, 17.6% of the posts were identified as targeted at adolescents. Graphic design and adolescent language were the most prevalent indicators of marketing targeted at adolescents, followed by explicit references to adolescents or young adults and memes. Posts identified as targeted at adolescents mainly promoted snacks and discretionary foods. Differences in the content of posts identified as targeted and not targeted at adolescents were observed. Research limitations/implications: The analysis was restricted to one social media platform in one country during a limited period of time, which limits the generalizability of the findings to other media platforms, samples and settings. Social implications: Results stress the need to implement digital food marketing regulations to reduce exposure of adolescents to the deleterious effects of stemming from marketing of unhealthy foods and provide empirical evidence to inform their development. Originality/value: The study breaks new ground by analyzing the prevalence and exploring the characteristics and content of Instagram posts promoting ultra-processed products to adolescents in an under-researched geographic area of the world. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to food marketing increases the risk of poor diet. Children's perception and interpretation of food marketing across digital media platforms is understudied. Children aged 9–11 years are uniquely susceptible to food marketing because children may watch content alone, and it is unclear whether embedded ads are decipherable by children (e.g., social media influencers) and if children are receptive to advertisements. Methods: The authors collected data from 21 child–parent dyads in 2022 to fill this gap. Children were interviewed about their food marketing exposure and media use and were asked to share their perspectives on food advertisements. Parents completed a survey for household digital devices, demographics, and perception of their child's food advertising knowledge. Results: This study found that all children generally recognized direct food advertisements, could describe them with varying levels of confidence, and shared examples. Despite self-identifying ads and understanding the intent of advertising, many children are still receptive to advertisements on the basis of engaging content (e.g., liking the ads as entertainment, watching ads even when given the chance to skip the ad) and the food items marketed (e.g., liking the taste of foods). Conclusions: These findings suggest that knowledge of advertisement exposure and intent of advertising are not sufficient to reduce receptiveness of unhealthy food ad exposure. Additional research on the potential impacts of embedded ads, such as through social media influencers, is needed to understand children's interaction with the current digital media landscape.

Abstract Objective: Food advertising is an important determinant of unhealthy eating. However, analysing a large number of advertisements (ads) to distinguish between food and non-food content is a challenging task. This study aims to develop a machine learning-based method to automatically identify and classify food and non-food ad videos. Design: Methodological study to develop an algorithm model that prioritises both accuracy and efficiency in monitoring and classifying advertising videos. Setting: From a collection of Brazilian television (TV) ads data, we created a database and split it into three sub-databases (i.e. training, validation and test) by extracting frames from ads. Subsequently, the training database was classified using the EfficientNet neural network. The best models and data-balancing strategies were investigated using the validation database. Finally, the test database was used to apply the best model and strategy, and results were verified with field experts. Participants: The study used 2124 recorded Brazilian TV programming hours from 2018 to 2020. It included 703 food ads and over 20 000 non-food ads, following the protocol developed by the INFORMAS network for monitoring food marketing on TV. Results: The results showed that the EfficientNet neural network associated with the balanced batches strategy achieved an overall accuracy of 90·5 % on the test database, which represents a reduction of 99·9 % of the time spent on identifying and classifying ads. Conclusions: The method studied represents a promising approach for differentiating food and non-food-related video within monitoring food marketing, which has significant practical implications for researchers, public health policymakers, and regulatory bodies.

Abstract Objective: To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES). Design: A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years. Setting: All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017. Participants: N/A. Results: Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients. Conclusion: The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

The purpose of this study was to ascertain how to advertise healthy eating to adolescents in a bid to respond to global childhood obesity. Using an interpretivist research design, a three-year, bi-national study was conducted with English and Swedish participants aged 12–14. Creative research methods explored their relationship to food advertising, consumer self-perception and their own creative recommendations. By taking the adolescents' perspective, the paper reports on creative strategies likely to increase their receptiveness to healthy food advertising, e.g. use of visual statistics, branding and a departure from the healthy-versus-unhealthy dichotomy. The paper recommends additions to social cognitive theory, an underutilised theory within marketing, by infusing the model with a social marketing orientation intent upon increasing its utility when advertising healthy eating to adolescents. [ABSTRACT FROM AUTHOR]

Given the obesity epidemic and regulatory responses to this public health crisis in the United States and the European Union, it is especially important that we understand how consumers evaluate health and nutrition information presented on food labels and in food advertisements. A single study has explored consumer scepticism of food labelling versus that of food advertising. We replicate the results of this initial work, ask additional questions that extend our understanding of consumer scepticism, and replicate our own findings. Respondents are consistently uncertain about food science, distrustful of regulatory efficacy, suspicious of commercial speech, and sceptical of health claims and the Nutrition Facts Panel. Taken together, these stable results suggest possible manufacturer and regulatory responses and future research directions. [ABSTRACT FROM AUTHOR]