Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial.

BACKGROUND: Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease. OBJECTIVE: To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households. METHODS: Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10-$30 on three beverages for their child aged 1-5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks). RESULTS: On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (ß = -253.5 g (95% CI: -286.3, -220.6)) and added sugar (ß = -287.8 g (95% CI: -323.1, -252.5)) purchased from sugary drinks. CONCLUSION: Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.

Cancer misinformation on social media.

Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks-such as their extensive use and the relative ease it allows to share information quickly-facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.

Unhealthy Food and Beverage Marketing to Children in the Digital Age: Global Research and Policy Challenges and Priorities.

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.

Menu Labeling and Calories Purchased in Restaurants in a US National Fast Food Chain.

Importance: Menu labeling has been implemented in restaurants in some US jurisdictions as early as 2008, but the extent to which menu labeling is associated with calories purchased is unclear. Objective: To estimate the association of menu labeling with calories and nutrients purchased and assess geographic variation in results. Design, Setting, and Participants: A cohort study was conducted with a quasi-experimental design using actual transaction data from Taco Bell restaurants from calendar years 2007 to 2014 US restaurants with menu labeling matched to comparison restaurants using synthetic control methods. Data were analyzed from May to October 2023. Exposure: Menu labeling policies in 6 US jurisdictions. Main Outcomes and Measures: The primary outcome was calories per transaction. Secondary outcomes included total and saturated fat, carbohydrates, protein, sugar, fiber, and sodium. Results: The final sample included 2329 restaurants, with menu labeling in 474 (31 468 restaurant-month observations). Most restaurants (94.3%) were located in California. Difference-in-differences model results indicated that customers purchased 24.7 (95% CI, 23.6-25.7) fewer calories per transaction from restaurants in the menu labeling group in the 3- to 24-month follow-up period vs the comparison group, including 21.9 (95% CI, 20.9-22.9) fewer calories in the 3- to 12-month follow-up period and 25.0 (95% CI, 24.0-26.1) fewer calories in the 13- to 24-month follow-up period. Changes in the nutrient content of transactions were consistent with calorie estimates. Findings in California were similar to overall estimates in magnitude and direction; yet, among restaurants outside of California, no association was observed in the 3- to 24-month period. The outcome of menu labeling also differed by item category and time of day, with a larger decrease in the number of tacos vs other items purchased and a larger decrease in calories purchased during breakfast vs other times of the day in the 3- to 24-month period. Conclusions and Relevance: In this quasi-experimental cohort study, fewer calories were purchased in restaurants with calorie labels compared with those with no labels, suggesting that consumers are sensitive to calorie information on menu boards, although associations differed by location.

COVID-19-Related Changes to Drug-Selling Networks and Their Effects on People Who Use Illicit Opioids.

OBJECTIVE: The COVID-19 pandemic has significantly affected people's ability to buy, sell, and obtain items that they use in their daily lives. It may have had a particularly negative effect on the ability of people who use illicit opioids to obtain them because the networks they relied on are illicit and not part of the formal economy. Our objective in this research was to examine if, and how, disruptions related to COVID-19 of illicit opioid markets have affected people who use illicit opioids. METHOD: We collected 300 posts--including replies to posts--related to the intersection of COVID-19 and opioid use from Reddit.com, a forum that has several discussion threads (i.e., subreddits) dedicated to opioids. We then coded posts from the two most popular opioid subreddits during the early pandemic period (March 5, 2020-May 13, 2020) using an inductive/deductive approach. RESULTS: We found two themes related to active opioid use during the early pandemic: (a) changes in drug supply and difficulty obtaining opioids, and (b) buying less-trustworthy drugs from lesser-known sources. CONCLUSIONS: Our findings suggest that COVID-19 has created market conditions that place people who use opioids at risk of adverse outcomes, such as fatal overdose.

Contemporary Approaches for Monitoring Food Marketing to Children to Progress Policy Actions.

PURPOSE OF REVIEW: Protecting children from unhealthful food marketing is a global priority policy for improving population diets. Monitoring the nature and extent of children's exposure to this marketing is critical in policy development and implementation. This review summarises contemporary approaches to monitor the nature and extent of food marketing to support policy reform. RECENT FINDINGS: Monitoring approaches vary depending on the stage of progress of related policy implementation, with resource implications and opportunity costs. Considerations include priority media/settings. marketing techniques assessed, approach to classifying foods, study design and if exposure assessments are based on media content analyses or are estimated or observed based on children's media use. Current evidence is largely limited to high-income countries and focuses on content analyses of TV advertising. Ongoing efforts are needed to support monitoring in low-resource settings and to progress monitoring to better capture children's actual exposures across media and settings.

The impact of racially-targeted food marketing and attentional biases on consumption in Black adolescent females with and without obesity: Pilot data from the Black Adolescent & Entertainment (BAE) study.

Unhealthy food advertisements ("advertisements" hereafter referred to as "ads") are linked to poor diet and obesity, and food companies disproportionally target Black youth. Little is known about the mechanisms whereby food ads influence diet. One possibility may be racially-targeted ads that appeal to Black youth. Those with food-related attentional biases may be especially vulnerable. The objective of this project was to assess the feasibility and initial effects of a pilot study testing the influence of racially-targeted food ads and food-related attentional biases on eating behaviors among a sample of Black adolescent females. Feasibility of recruitment, retention, and procedures were examined. Participants (N = 41, 12-17y) were randomized to view a television episode clip of the Big Bang Theory embedded with either four 30-second racially-targeted food ads or neutral ads. A computer dot probe task assessed food-related attentional biases. The primary outcome was caloric consumption from a laboratory test meal. Interactions based on weight and ethnic identity were also examined. Analyses of variance and regressions were used to assess main and interaction effects. Exposure to racially-targeted food ads (versus neutral ads) did not affect energy consumption (p > .99). Although not statistically significant, adolescents with obesity consumed nearly 240 kcal more than non-overweight adolescents (p = 0.10). There were no significant preliminary effects related to food-related attentional biases or ethnic identity (ps = 0.22-0.79). Despite a non-significant interaction, these data provide preliminary support that adolescents with obesity may be particularly vulnerable to racially-targeted food ads. An adequately powered trial is necessary to further elucidate the associations among racially-targeted food ads among Black adolescent girls with obesity.

Comparisons of Culturally Targeted Food and Beverage Advertisements in Caribbean-American Neighborhood and Non-Latinx White Neighborhood in New York City.

Purpose: This descriptive study aimed to (1) compare the number of food and beverage advertisements (ads) located in a Caribbean-American neighborhood and non-Latinx white neighborhood in New York City (NYC), and (2) qualitatively assess and compare the culturally targeted marketing themes of the food and beverage advertisements in both neighborhoods. Methods: Three research assistants photographed all outdoor food and beverage advertisements (n=361) across a 1.6 kilometer distance on a high-retail street in a Caribbean-American neighborhood and a non-Latinx white neighborhood. We used content analysis to evaluate advertising themes, and sorted food into nutritional categories (e.g., fast food and alcohol). We identified two neighborhoods with similar income levels in Queens, NYC, USA-South Ozone Park residents are predominantly non-white Caribbean Americans based on data from the NYC Department of City Planning, whereas residents of Steinway are predominantly non-Latinx white. Results: We identified a significantly higher proportion of fast-food advertisements in the Caribbean-American neighborhood (19.78%, n=36) compared with the non-Latinx white neighborhood (5.03%, n=9; p<0.001). Among beverage advertisements, 30.77% (n=56) featured alcohol brands in the Caribbean-American neighborhood, whereas 22.91% (n=41) featured alcohol brands in the non-Latinx white neighborhood. In the Caribbean-American neighborhood, 24.18% (n=44) of food and beverage advertisements referenced Caribbean culture. Conclusions: The Caribbean-American neighborhood in this study had more fast-food advertisements relative to non-Latinx white neighborhoods. More research is needed to understand the effects of culturally targeted ads on Caribbean-American communities.

Food industry donations to patient advocacy organisations focussed on non-communicable diseases.

OBJECTIVE: This study used publicly available Form 990 tax documents to quantify food industry donations to patient advocacy organisations (PAO) dedicated to supporting patients with non-communicable diseases. DESIGN: Observational, cross-sectional assessment of significant national and international food industry donations to US-based non-communicable disease-focussed PAO between 2000 and 2018. Researchers recorded and categorised the: (1) frequency and value of donations; (2) reason for donation; (3) name and type of PAO recipient and (4) non-communicable disease focus of the PAO. SETTING: Form 990 tax documents. PARTICIPANTS: Nine food and beverage companies that donated to non-communicable disease-focussed PAO. RESULTS: Adjusting for inflation, nine food and beverage companies collectively donated $10 672 093 (n 2709) to the PAO between 2001 and 2018. The largest category of donations was 'matching gifts' (67·9 %, median amount = $115·16), followed by 'general operations support' (25·8 %, median amount = $107·79). Organisations focussing on cancer received the largest number and amount of donations ($6 265 861, n 1968). Eight of the nine companies made their largest monetary value of donation to PAO focussed on cancer. CONCLUSIONS: Publicly available tax data provide robust information on food industry donation practices. Our findings document the food industry's role in supporting patient advocacy organisations and raise questions regarding conflicts of interest. Increased awareness of food industry donation practices involving PAO may generate pressure for policies mandating transparency or encourage donors and recipients to voluntarily disclose donations. If public disclosure becomes widespread, constituents, advocates, researchers and policymakers can better supervise and address potential conflicts of interest.

COVID-Washing in US Food and Beverage Marketing on Twitter: Content Analysis.

BACKGROUND: Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages. OBJECTIVE: We aimed to document the types and frequencies of COVID-19-related themes in US food and beverage companies' Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets. METHODS: Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and "retweets"; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content. RESULTS: Our final sample included 874 COVID-19-themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products. CONCLUSIONS: Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19.

Beverage Availability and Price: Variations by Neighborhood Poverty Level in New York City.

Objective: To describe the variability in the availability and price of sugary drinks, low-calorie drinks, and water/seltzer across high- and low-poverty census tracts in the five boroughs of New York City (NYC). Design: Cross-sectional study. Our primary analysis compared the overall sample of beverages. Secondary analyses included tests for differences in the availability of beverage categories by neighborhood poverty level. Setting: We collected data from 106 stores (31 supermarkets, 29 convenience stores, 29 pharmacies, 9 Targets, and 8 Dollar Trees) in NYC. Fifty-four stores were located in high-poverty census tracts and 52 were located in low-poverty census tracts. Results: The mean Price per 0.03-liter of sugary drinks across the sample was $0.08, which was significantly higher than the price of low-calorie drinks ($0.07, p=0.01) but not different from water/seltzer ($0.08, p=0.65). Sugary drinks and water/seltzer were available in 91% of retailers, and low-calorie drinks were available in 87% of retailers. There was no statistical difference in availability of sugary drinks compared with low-calorie drinks or water/seltzer overall or within high- or low-poverty census tracts. Analyzed by store type, the mean price per ounce of sugary drinks differed significantly from water/seltzer at convenience stores, pharmacies, and Target stores (bodegas: $0.08 vs. $0.09, p=0.03; pharmacies: $0.11 vs. $0.08, p=0.02; Target stores: $0.07 vs. $0.09, p=0.01). Conclusions: Sugary drinks were available in most food retail settings in NYC, with little variation by census tract poverty level. Interventions that raise the price of sugary drinks to make healthier alternatives, such as water, the more affordable option should be considered.

Comparing the Prevalence of Alcohol, Combustible and Electronic Cigarettes, Hookah, and Marijuana, in Music Videos across 6 Genres of Popular Music from 2014-2020.

OBJECTIVES: To determine the frequency of alcohol, marijuana, cigarettes/cigars, e-cigarettes, and hookah portrayals in popular music lyrics and videos on YouTube across 6 genres over 7 years; assess percent change over the years, document brand placement, and determine frequency of promotion of substances/devices by Teen Choice Award celebrities. METHODS: We analyzed 699 songs from the Billboard Hot 100 between 2014 and 2020. Two raters coded 10% of the songs to establish inter-rater reliability and remaining songs were reviewed by one rater. RESULTS: The majority of songs (59.2%) on YouTube included either lyrical or video depictions and 20.6% included both. Songs that featured substances/devices were viewed 148 billion times on YouTube as of February 2021. Nearly 25% of videos depicting substances/devices featured branding. Forty-three (18.22%) of the music celebrities who featured substances/devices in their videos received one or more Teen Choice Awards during the study period. CONCLUSIONS: Popular music celebrities promote substance use in their lyrics and music videos, which are easily accessible to children and adolescents. Some of these celebrities are highly popular and influential among adolescents.Policy Implications. Findings support the need to limit promotion of these substances to youth by influencers to reduce substance use and misuse.

Food and Beverage Product Appearances in Educational, Child-Targeted YouTube Videos.

Background: Food advertisement exposure is associated with children's increased caloric intake, but little is known about food/beverage placements in child-oriented educational YouTube videos. We aimed to quantify the prevalence of food/beverages in these videos and assess their nutritional quality. Methods: Researchers identified child-oriented educational YouTube videos from 2020, using keyword searches. We coded the names of featured food/beverages, coded how the food/beverages were interacted with, quantified the number of minutes the food/beverages appeared, and assessed the nutritional quality of the food/beverages. Results: A sample of 400 videos with the highest number of views was identified, 165 of which featured food/beverages. These 165 videos were collectively viewed over 1.1 billion times. Among these videos, 108 (67.4%) featured unhealthy foods and 86 (52.1%) featured branded products. Most food/beverages were used in experiment/tutorials (n = 143, 86.7%). Of the 165 videos featuring food/beverages, 91 (55.2%) did not depict food/beverages in their video thumbnail. Conclusions: While unhealthy food/beverages appear frequently in child-oriented educational YouTube videos, parents and teachers may not be aware of the presence of branded food/beverage products in these videos that could influence their children's food and brand preferences. The Federal Trade Commission should collect data on food and beverage company sponsorship of educational videos aimed at children and adolescents.

Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums.

BACKGROUND: The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. OBJECTIVE: This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. METHODS: We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. RESULTS: Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. CONCLUSIONS: Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms.

Brands with personalities - good for businesses, but bad for public health? A content analysis of how food and beverage brands personify themselves on Twitter.

OBJECTIVE: To examine the extent to which food and beverage brands exhibit personalities on Twitter, quantify Twitter users' engagement with posts displaying personality features and determine advertising spending across these brands on Twitter. DESIGN: We identified 100 tweets from 10 food and beverage brands that displayed a 'personality', and 100 'control' tweets (i.e. a post by that brand on the same day). Our codebook quantified the following personification strategies: (1) humour; (2) trendy language and (3) absence of food product mentions. We used media articles to quantify other personification strategies: (4) referencing trending topics; (5) referencing current events; (6) referencing internet memes and (7) targeting niche audiences. We calculated brands' number of tweets, re-tweets, 'likes', and comments and report the relationship between advertising spending and retweets per follower. SETTING: Twitter posts. PARTICIPANTS: Ten food and beverage brands that were described in media articles (e.g. Forbes) as having distinct personalities. RESULTS: Personality tweets earned 123 013 retweets, 732 076 'likes' and 14 806 comments, whereas control tweets earned 61 044 retweets, 256 105 'likes' and 14 572 comments. The strategies used most included humour (n 81), trendy language (n 80) and trending topics (n 47). The three brands that spent the most on advertising had similar or fewer retweets per follower than the four that spent relatively little on advertising. CONCLUSIONS: Some food and beverage brands have distinct 'personalities' on Twitter that generate millions of 'likes' and retweets. Some retweets have an inverse relationship with advertising spending, suggesting 'personalities' may be a uniquely powerful advertising tool for targeting young adults.

Associations between State-Level Obesity Rates, Engagement with Food Brands on Social Media, and Hashtag Usage.

Food advertisement exposure is associated with increased caloric intake, but little is known about food/beverage placements in the digital media environment. We aimed to examine the correlation between the number of people who follow food and beverage brand social media accounts (i.e., user engagement) and state-level obesity rates; quantify social media followers' use of "healthy" vs. "unhealthy" hashtags; and analyze the relationship between user engagement and hashtag usage. We identified the 26 fast-food and beverage brands with the highest advertising expenditures and used Demographics Pro to determine the characteristics of social media users amongst the 26 brands. A series of regression analyses were conducted that related the mean percentage of brand followers and state-level obesity rates. We then identified 733 hashtags on Instagram and 703 hashtags on Twitter, coding them as "healthy", "unhealthy", "neutral", or "unrelated to health". Intercoder reliability was established using ReCal2, which indicated a 90% agreement between coders. Finally, we conducted ANCOVA to examine the relationship between the mean percentage of brand followers and their hashtag usage. There was a significant, positive correlation between the state-level obesity rate and the mean percentage of followers of sugary drink or fast-food brands on Instagram and Twitter, but such a correlation between obesity and low-calorie drink brand followers was only found on Twitter. Our findings illustrate the relationship between the social media food environment and obesity rates in the United States. Given the high rates of engagement with food brands on social media, policies should limit digital advertisements featuring fast-food, sugary drink, and low-calorie drink brands.

A Qualitative Analysis of Black and White Adolescents' Perceptions of and Responses to Racially Targeted Food and Drink Commercials on Television.

Food and beverage marketing is a major driver of childhood obesity, and companies target their least nutritious products to Black youth. However, little is known about adolescents' perceptions of and responses to racially targeted food marketing. In this qualitative study, we investigated how Black and White adolescents perceived and responded to racially targeted television commercials for food and beverages. We recruited 39 adolescents aged 12-17 years in New York City to watch a series of commercials and then participate in an in-depth interview using a semi-structured interview guide. The research team recorded, transcribed, and analyzed interviews using ATLAS.ti. Overall, participants responded positively to commercials that featured celebrities. They were also able to recognize the commercials and reported they had been exposed to marketing from these companies on social media and in subways/buses. Many participants considered the advertised brands as healthy or able to enhance athletic performance because of their endorsement by or association with athletes. Participants also understood that marketers were using racial targeting in their ads but that targeting did not translate into improved perceptions or responses towards advertised products. These findings suggest the need to empirically evaluate and further explore Black and White adolescents' responses to racially targeted food marketing.

How Food Marketing on Instagram Shapes Adolescents' Food Preferences: Online Randomized Trial.

BACKGROUND: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children's exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents' preferences. OBJECTIVE: This study examined whether adolescents could identify food companies' Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents' preferences. METHODS: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame-which includes the logo, comments, and "likes." In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. RESULTS: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the "labeled ad condition." In the "unlabeled ad condition," however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). CONCLUSIONS: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features.

Social Media Accounts of Food and Beverage Brands Have Disproportionately More Black and Hispanic Followers than White Followers.

Introduction: On television, food companies promote their least nutritious products to Black and Hispanic youth more than White youth, but little is known about the extent to which Black and Hispanic adolescents may disproportionately engage with unhealthy food and beverage brands on social media relative to White adolescents. Methods: In 2019, we purchased and analyzed demographic data of social media users who followed 27 of the most marketed food/beverage brands on Instagram and Twitter. We used one-sample t-tests to compare percentages of Black, Hispanic, and White followers of the selected brands' accounts versus all social media accounts, and independent samples t-tests to compare followers of sugary versus low-calorie drink brands. We also used linear regression to examine associations between racially targeted marketing practices and the percentages of Black, Hispanic, and White followers on social media. Results: On Instagram, the percentage of Black followers of the selected brands (12.7%) was higher than the percentage of Black followers of any account (7.8%) (p<0.001). On Twitter, findings were similar for Hispanic users but opposite for White users. A higher racially targeted ratio was positively associated with the percentage of Black followers, and negatively associated with the percentage of White followers. Sugary drink brands had more Hispanic followers than low-calorie drink brands (p<0.001). Conclusions: Unhealthy food/beverage brands that target Black adolescents have a disproportionately higher percentage of Black followers on social media relative to White followers. These findings support the 2019 proposal to restrict racially targeted advertising through the Children's Online Privacy and Protection Act.

Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemic.

BACKGROUND: Big events (i.e., unique historical disruptions) like the COVID-19 epidemic and its associated period of social distancing can transform social structures, social interactions, and social norms. Social distancing rules and the fear of infection have greatly reduced face-to-face interactions, increased loneliness, reduced ties to helping institutions, and may also have disrupted the opioid use behaviors of people who use drugs. This research used Reddit to examine the impact of COVID-19 on the social networks and social processes of people who use opioids. METHODS: Data were collected from the social media forum, Reddit.com. At the beginning of the COVID-19 pandemic in the U.S. (March 5, 2020, to May 13, 2020), 2,000 Reddit posts were collected from the two most popular opioid subreddits (r/OpiatesRecovery, r/Opiates). Posts were reviewed for relevance to COVID-19 and opioid use resulting in a final sample of 300. Thematic analysis was guided by the Big Events framework. RESULTS: The COVID-19 pandemic was found to create changes in the social networks and daily lives among persons who use opioids. Adaptions to these changes shifted social networks leading to robust social support and mutual aid on Reddit, including sharing and seeking advice on facing withdrawal, dealing with isolation, managing cravings, and accessing recovery resources. CONCLUSIONS: Reddit provided an important source of social support and mutual aid for persons who use opioids. Findings indicate online social support networks are beneficial to persons who use opioids, particularly during big events where isolation from other social support resources may occur.