A critical review of evidence on the sociocultural impacts of food marketing and policy implications.

Historically, responsible marketing policy development has drawn on a substantive research agenda regarding the micro level effects of marketing on food choice. In contrast there has been almost no research on macro level effects. To date public health has been the main disciplinary source of evidence. As a first step towards exploring the significance of this evidence gap, a critically interpretive review of evidence on the effects of food marketing on the sociocultural food environment was conducted. A review of reviews approach was used to search for evidence across a broad multi-disciplinary range of evidence sources. This was supplemented with snowball searches of the reference lists of the identified reviews and included studies. Ten reviews and 31 individual studies met review inclusion criteria. Evidence of impacts on dietary norms, population level shifts in food and drink category preferences and in the cultural values underpinning food behaviours were identified. The review also identified evidence for two mechanisms of effect. The findings represent preliminary evidence in support of the case for the responsible marketing policy research agenda to be expanded from its historical focus on micro level impacts to include research directly focused on its macro level impacts. Expanding research scope to include a much stronger focus on evidence regarding the impacts of for-profit food marketing on the sociocultural food environment would provide direct research support to the strategic policy aim of creating a food environment that encourages healthy food behaviours.

Evolutions in food marketing, quantifying the impact, and policy implications.

A case study on interactive digital marketing examined the adequacy of extant policy controls and their underpinning paradigms to constrain the effects of this rapidly emerging practice. Findings were interactive digital marketing is expanding the strategies available to promote products, brands and consumer behaviours. It facilitates relational marketing; the collection of personal data for marketing; integration of the marketing mix, and provides a platform for consumers to engage in the co-creation of marketing communications. The paradigmatic logic of current policies to constrain youth-oriented food marketing does not address the interactive nature of digital marketing. The evidence base on the effects of HFSS marketing and policy interventions is based on conceptualizations of marketing as a force promoting transactions rather than interactions. Digital technologies are generating rich consumer data. Interactive digital technologies increase the complexity of the task of quantifying the impact of marketing. The rapidity of its uptake also increases urgency of need to identify appropriate effects measures. Independent analysis of commercial consumer data (appropriately transformed to protect commercial confidentiality and personal privacy) would provide evidence sources for policy on the impacts of commercial food and beverage marketing and policy controls.

Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary.

A 2009 systematic review of the international evidence on food and beverage marketing to children is the most recent internationally comprehensive review of the evidence base. Its findings are consistent with other independent, rigorous reviews conducted during the period 2003-2012. Food promotions have a direct effect on children's nutrition knowledge, preferences, purchase behaviour, consumption patterns and diet-related health. Current marketing practice predominantly promotes low nutrition foods and beverages. Rebalancing the food marketing landscape' is a recurring policy aim of interventions aimed at constraining food and beverage promotions to children. The collective review evidence on marketing practice indicates little progress towards policy aims has been achieved during the period 2003-2012. There is a gap in the evidence base on how substantive policy implementation can be achieved. We recommend a priority for future policy relevant research is a greater emphasis on translational research. A global framework for co-ordinated intervention to constrain unhealthy food marketing which has received high level support provides valuable insight on some aspects of immediate implementation research priorities.

Promotional communications for influenza vaccination: a systematic review.

The authors conducted a systematic review that aimed to map current practice and identify effective practice in promotional communications for seasonal influenza vaccination in Europe. They identified 22 studies from 7 European countries. Included studies were primarily outcome evaluations of communications promoting vaccination to health care workers and elderly adults. Evidence on communications to improve public acceptance was sparse. A range of communication approaches, methods, materials, and channels were used, frequently in combination. All forms of promotional communications have the potential to increase uptake in health care workers and can also improve uptake among patients. There was promising evidence that mass communication methods, delivered as standalone activities or as one component of a communication mix, can improve uptake in target populations. Education for health care workers and improved service delivery are common adjuncts to promotional communications that were associated with effectiveness. The evidence suggests that personalized communications, combined with improved service delivery, might boost rates of uptake among elderly adults. Future development of good practice could be enhanced by more systematic, theory-based intervention design and more detailed reporting of process and outcome evaluations. Vaccine hesitancy is increasingly prevalent; more policy and research to improve public acceptance should therefore be considered.

Reputation, relationships, risk communication, and the role of trust in the prevention and control of communicable disease: a review.

Population-level compliance with health protective behavioral advice to prevent and control communicable disease is essential to optimal effectiveness. Multiple factors affect perceptions of trustworthiness, and trust in advice providers is a significant predeterminant of compliance. While competency in assessment and management of communicable disease risks is critical, communications competency may be equally important. Organizational reputation, quality of stakeholder relationships and risk information provision strategies are trust moderating factors, whose impact is strongly influenced by the content, timing and coordination of communications. This article synthesizes the findings of 2 literature reviews on trust moderating communications and communicable disease prevention and control. We find a substantial evidence base on risk communication, but limited research on other trust building communications. We note that awareness of good practice historically has been limited although interest and the availability of supporting resources is growing. Good practice and policy elements are identified: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources. Priority areas for future research include process and cost-effectiveness evaluation and the development of frameworks that integrate communication and biomedical disease control and prevention functions, conceptually and at scale.

Stakeholder insights on the planning and development of an independent benchmark standard for responsible food marketing.

A mixed methods qualitative survey investigated stakeholder responses to the proposal to develop an independently defined, audited and certifiable set of benchmark standards for responsible food marketing. Its purpose was to inform the policy planning and development process. A majority of respondents were supportive of the proposal. A majority also viewed the engagement and collaboration of a broad base of stakeholders in its planning and development as potentially beneficial. Positive responses were associated with views that policy controls can and should be extended to include all form of marketing, that obesity and non-communicable diseases prevention and control was a shared responsibility and an urgent policy priority and prior experience of independent standardisation as a policy lever for good practice. Strong policy leadership, demonstrable utilisation of the evidence base in its development and deployment and a conceptually clear communications plan were identified as priority targets for future policy planning. Future research priorities include generating more evidence on the feasibility of developing an effective community of practice and theory of change, the strengths and limitations of these and developing an evidence-based step-wise communications strategy.

Symposium on "The challenge of translating nutrition research into public health nutrition". Session 5: Nutrition communication. Obesity and social marketing: works in progress.

Internationally, socio-economic trends reinforce the complex physiological mechanisms that favour positive energy balance, leading to an accumulation of excess body weight and associated metabolic disorders. This so-called 'obesogenic environment' is characterised by increasing accessibility and affordability of energy-dense foods and declining levels of physical activity. In the face of such rapidly-rising obesity rates there is general consensus that strategies to address trends in weight gain must go forwards in the absence of complete evidence of cause or effective prevention strategy. Thus, strategy implementation and evaluation must contribute to, as well as be informed by, the evidence base. Social marketing research and practice has a track record that strongly indicates that it can contribute to both the evolving knowledge base on obesity and overweight control policy and the development of effective intervention strategies. Social marketing draws pragmatically on many disciplines to bring about voluntary behaviour change as well as requisite supporting policy and environmental change. Key objectives include: generating insights into the drivers of current behaviour patterns; important barriers to change; client-oriented approaches to new desirable diet and lifestyle choices. Social marketing recognises that target clients have the power to ensure success or failure of obesity control policies. Social marketing seeks to identify genuine exchange of benefits for target adopters of behaviour change and the advocates of change, and how they may be developed and offered within an appropriate relevant context. Social marketing adopts a cyclical approach of learning, strategic development and evaluation, and therefore is well placed to integrate with the multi-disciplinary demands of obesity prevention strategies.

Exploring global consumer attitudes toward nutrition information on food labels.

In many parts of the world, food companies, consumers, and governments are re-examining the provision of nutrition information on food labels. It is important that the nutrition information provided be appropriate and understandable to the consumer and that it impact food-choice behaviors. Potentially, food labeling represents a valuable tool to help consumers make informed decisions about their diet and lifestyle. Food information organizations worldwide have been following consumer trends in the use of this information as well as consumer attitudes about food, nutrition, and health. This paper summarizes a workshop that examined consumer attitudes gathered regionally with the aim of establishing commonalities and differences.