Abusive advertising of food and drink products on Brazilian television.

In Brazil, any advertising strategies that take advantage of the child's judgment or induce consumers to make harmful health choices are considered abusive. However, the efficacy of restrictions on their use on television (TV) food advertising remains poorly understood. This study analysed the extent and nature of abusive techniques according to national regulations and patterns in their use in food-related ads. Cross-sectional studyrecorded the programming of the three most popular TV channels (6 am-12 am), during eight non-consecutive days, in April 2018. Data collection was based on the INFORMAS protocol and two national regulations. Descriptive analyses were used to describe the types of food ads and abusive techniques used in ultra-processed products (UPP) ads. Principal component analysis was applied to identify patterns of abusive marketing techniques and to relate them to specific food groups. More than 90% of food ads included at least one UPP. Overall, 10.1% of UPP ads targeted children and 57.7% used some kind of abusive technique directed to children and adolescents. Most ads contained messages inducing harmful health choices did not present adequate and clear information about the product and contained more than one type of abusive technique. Four out of five patterns in the use of abusive techniques in UPP ads were specifically directed to children, and fast-food meals were associated with three out of five patterns. The high abusiveness of food advertising in UPP ads should be considered a public health concern given their impact on children's food choices and health.

Consumption of carbonated soft drinks, fruits and vegetables and association with macroeconomic indicators: the analysis of students from seventy-four countries (2003-2015).

This study aimed to compare fruits and vegetables (FV), and carbonated soft drink (CSD) consumption among adolescents from seventy-four countries, according to macroeconomic indicators. This is an ecological study, developed with countries evaluated through the Global School-based Student Health Survey (2003-2014) and the National School Health Survey (PeNSE-Brazil, 2015). The percentages of students in each country who consumed CSD and FV daily and their association with the Human Development Index (HDI) and the Gross National Income per capita (GNIpc) were assessed. Scatter plots were constructed for each marker, and a multilevel model was tested to consider the effects of region in the associations. The overall prevalence of daily CSD consumption was 54·1 %. CSD consumption was positively associated with HDI and GNIpc through multilevel models, and Central and South America showed a considerable higher consumption compared with other regions. Overall, FV daily consumption was 67·9 % and 74·6 %, respectively, and no associations with macroeconomic indicators were found. The study shows concerning rates of CSD consumption among adolescents, and a trend of increased consumption with the improvement of the country's development and GNIpc. This points for the importance of public policies that regulate food and beverage industries to reduce CSD consumption and related co-morbidities among adolescents.

Socioeconomic inequalities in physical activity in Brazil: a pooled cross-sectional analysis from 2013 to 2019.

BACKGROUND: Information on socioeconomic inequalities in physical activity over time is sparse in low- to middle-income countries. In this study, we examined trends in physical activity educational inequalities in adults from Brazil between 2013 and 2019. METHODS: We analyzed data from seven cross-sectional studies including 359,038 adults (≥ 18 years) from the VIGITEL study conducted annually from 2013 to 2019. Participants responded to a questionnaire about physical activity (total, leisure, and commuting). Educational inequalities by sex and skin color were assessed through absolute (slope index of inequality - SII) and relative measures of inequality (concentration index - CIX). RESULTS: We found large absolute and relative inequalities for leisure-time physical activity, favoring those with higher educational attainment (SII2019 = 35.4; CIX2019 = 11.82). Active commuting was more prevalent in intermediate education groups, with a slight inequality toward the less educated group (SII2019 = -2.8; CIX2019 = -0.4). From 2013 to 2019, the absolute educational inequality in physical activity (total, leisure, and commuting) remained unchanged; however, the relative inequality gap narrowed for total physical activity (CIX: 8.4 in 2013 to 5.5 in 2019) and leisure-time physical activity (CIX: 18.3 in 2013 to 11.8 in 2019). Educational inequality increased in leisure-time physical activity among women and non-white individuals, while it reduced among men and white individuals; for active commuting, inequality decreased among women, and increased among men and white individuals. CONCLUSIONS: Inequality in total physical activity and leisure-time physical activity favors the most educated groups in Brazil. Over time, relative educational inequality decreased for total and leisure-time physical activity, while no progress was found for absolute inequality.

Trends in access to female cancer screening in Brazil, 2007-16.

BACKGROUND: This study aims to analyse changes in the prevalence of cervical cancer (CCa) and breast cancer (BCa) screening among women in the Brazilian capitals and Federal District in the last decade (2007-16). METHODS: Data from the surveillance system of risk and protective factors for chronic diseases through telephone interviews (n = 267 949) were used. Adequate screening consisted of, at least, one Pap test triennially, for women aged between 25 and 64 years, and mammography exam biannually, for women aged between 50 and 69 years. The prevalence of adequate screening was investigated for each type of cancer isolated and combined (women aged between 50 and 64 years). The prevalence of adequate screening was estimated for the total population and according to socioeconomic variables. Linear regression models were used. RESULTS: The prevalence of adequate screening test for CCa remained stable, around 82%, while the screening test for BCa increased from 71 to 78% between 2007 and 2016. Higher increases were observed among women with low schooling and from less developed regions. The percentage of adequate screening (considering both types), for women aged between 25 and 69 years, remained stable, close to 78%. CONCLUSIONS: Screening for BCa increased significantly. Smaller coverage rates are verified among women with low schooling and from less developed regions.

Reduction of traditional food consumption in Brazilian diet: trends and forecasting of bean consumption (2007-2030).

OBJECTIVE: To identify changes in traditional dietary behaviour through the evaluation of trends in bean consumption among adults in Brazil between 2007 and 2017 and to estimate its projections up to 2030. DESIGN: Time-series analysis conducted with data from the Surveillance System for Protective and Risk Factors for Chronic Diseases by Telephone Survey (Vigitel) between 2007 and 2017. Weekly consumption of beans was analysed. Prais-Winsten regression evaluated trends for the entire period of study (2007-2017) and in two periods of analyses (2007-2011 and 2012-2017) for the complete set of the population and stratified by socio-demographic characteristics. Estimated prevalence projections were calculated up to the year 2030 using its tendency from 2012 to 2017. SETTING: Brazil. PARTICIPANTS: A probabilistic sample of 572 675 Brazilian adults aged ≥ 18 years. RESULTS: Changes in traditional dietary pattern were identified. Regular consumption of beans (≥ 5 d/week) presented a stable prevalence trend for the total population in the complete and the first analysed period, but a significant decrease in the second half (67·5 % to 59·5 %) among both genders, all age groups and educational levels (except for ≥12 years). The higher magnitude of regular consumption of beans will occur up to the year of 2025 for the total population (46·9 %), when it will be less frequent in the week. CONCLUSION: Reductions in the weekly consumption of beans may represent the weakness of a traditional food culture in a globalised food system. By 2025, regular consumption of beans will cease to be the predominant habit in the country.

Analysing persuasive marketing of ultra-processed foods on Brazilian television.

OBJECTIVES: This study investigated the use of persuasive advertising strategies in ultra-processed food (UPF) advertisements broadcast on the three most popular free-to-air television channels in Brazil. METHODS: The programming of the selected channels was recorded on eight non-consecutive days from April 2018 (6:00 am-12:00 am). Information from each advertising piece was collected through an electronic questionnaire based on the INFORMAS protocol. Food products were classified according to the NOVA classification system. Marketing strategies were investigated in UPF advertisements and stratified into three groups. Principal component analysis was used to identify patterns of strategies. Linear regression models were employed to investigate the association between the patterns and food groups. RESULTS: In total, 90.77% of the food-related advertisements contained at least one UPF, and 96% of them included one or more persuasive advertising strategies. Five advertising patterns were identified and associated with the UPF food groups. CONCLUSIONS: The results showed that food advertising on Brazilian free television is marked by UPF, with the predominant use of persuasive advertising strategies, demonstrating a lack of enforcement of the current regulatory legislation in the country.

Food purchasing sites. Repercussions for healthy eating.

Changes in the food system are associated with the increase in consumption of foods with low nutritional value in recent decades. Data on food purchasing for household consumption, collected from the Instituto Brasileiro de Geografia e Estatística (IBGE--Brazilian Institute of Geography and Statistics) Household Budget Survey (HBS) in 2002-3, were used to describe the contribution of food purchasing sites (FPS) to the diet of Brazilian families. All the 241 distinct FPS mentioned in the HBS were grouped into ten categories, according to the nature of the products available. Food acquisitions were organized into seven groups. Supermarkets and hypermarkets accounted for 49% of the acquisitions and were the main source of six out of the seven food groups. Street markets and greengroceries stood out in the acquisitions of fruits and vegetables, accounting for 39% of this market. The large contribution of supermarkets and hypermarkets to the diet shows the need for healthy eating promotion policies aiming at these locations. Street markets and greengroceries represent important allies for healthy eating.

Sugar-sweetened beverage taxes in Brazil.

OBJECTIVES: We investigated whether taxing sugar-sweetened beverages (SSBs) would improve the diets of households in Brazil. METHODS: We used household food consumption data that the Brazilian Institute of Geography and Statistics collected in 2002-2003 from a nationally representative sample of 48,470 Brazilian households. The consumption of SSBs is expressed as the total SSB calories consumed and as the SSB percentage of the total calories purchased. We investigated price elasticity with regression models, controlling for demographic variables, income, and prices of all other foods and drinks. RESULTS: Increases in the price of SSBs led to reductions in consumption. A 1.00% increase in the price of SSBs led to a 0.85% reduction of SSB calories consumed (1.03% reduction for the poor and 0.63% for the nonpoor). Increased income had a positive effect on SSB consumption, but the effect was less than half the size of the price elasticity (0.41% increase in SSB calories consumed for every 1.00% increase in income). CONCLUSIONS: High SSB price elasticity in Brazil indicates that a tax on purchased weight or volume would lead to reductions in SSB consumption.

Patterns of food acquisition in Brazilian households and associated factors: a population-based survey.

OBJECTIVE: To identify food acquisition patterns in Brazil and relate them to the sociodemographic characteristics of the household. DESIGN: A cross-sectional national Household Budget Survey (HBS). Principal component factor analysis was used to derive food patterns (factors) on the basis of the acquisition of food classified into thirty-two food groups. SETTING: The source of data originates from the 2002-2003 HBS carried out by the Brazilian Institute of Geography and Statistics between June 2002 and July 2003 using a representative sample of all Brazilian households. SUBJECT: A total of 48 470 households allocated into 443 strata of households that were geographically and socio-economically homogeneous as a study unit. RESULTS: We identified two patterns of food acquisition. The first, named 'dual', was characterized by dairy, fruit, fruit juice, vegetables, processed meat, soft drinks, sweets, bread and margarine, and by inverse correlations with Brazilian staple foods. In contrast, the second pattern, named 'traditional', was characterized by rice, beans, manioc, flour, milk and sugar. The 'dual' pattern was associated with higher household educational level, income and the average age of adults on the strata, whereas the 'traditional' presented higher loadings in less-educated households and in the rural setting. CONCLUSIONS: Dietary patterns described here suggest that policies and programmes to promote healthy eating need to consider that healthy and non-healthy foods may be integrated within [corrected] the same pattern.