Chocolate unicorns and smiling teddy biscuits: analysis of the use of child-directed marketing on the packages of Australian foods.

OBJECTIVE: The use of food packaging as a vehicle for marketing to children is under investigated. Our objective was to determine the prevalence and types of child-directed promotional techniques used on food packaging in Australia. DESIGN: Based on existing literature and regulations, we developed a framework to classify on-pack child-directed promotional techniques involving the use of characters and other elements that appeal to children. We analysed the packaging of all products in eight food categories available for sale from supermarkets in 2019 and recorded the use of child-directed promotions on pack. We assessed the number and proportion of products displaying child-directed promotional techniques overall and assessed the healthiness of products using child-directed promotions against four indicators of healthiness to provide summary data overall and for the manufacturers who most frequently employed child-targeted strategies. SETTING: Data were collected from the FoodSwitch database in Sydney, Australia. RESULTS: 901/8006 (11·3 %) products displayed one or more child-directed on-pack element. Most frequent was on foods for infants and young children (n 315), confectionery (n 283), snack foods (n 172) and dairy (n 168). Personified characters were the most commonly used element (n 512). Products using child-directed promotional techniques scored poorly on all four indicators of healthiness: mean health star rating 2·34 (out of 5); 81 % ultra-processed and 6·1 % and 4·5 % products eligible to market to children under Western Pacific and Mexican nutrient profiling schemes, respectively. CONCLUSIONS: Australian children are targeted by promotional techniques on the packaging of unhealthy food products. Stronger regulation of these techniques is warranted to protect children's health.

Association of lactation with maternal risk of type 2 diabetes: A systematic review and meta-analysis of observational studies.

AIM: To investigate the association between lactation and maternal risk of type 2 diabetes, including a potential graded association according to lactation duration. METHODS: A systematic review and meta-analysis of observational studies that investigated the reported association between lactation (irrespective of duration, intensity or mode) and maternal risk of type 2 diabetes was conducted. RESULTS: A total of 22 studies (17 cohort studies and five cross-sectional studies) were included in this systematic review, and 16 contributed to the meta-analysis. Studies that investigated the association of lactation with risk of type 2 diabetes in the first months after birth in women with gestational diabetes reported conflicting results. Studies with a longer follow-up showed a graded protective association for lactation and the risk of type 2 diabetes, with a potentially larger risk reduction in women with gestational diabetes than in those without gestational diabetes. Overall, ever versus never lactation was associated with a 27% lower risk of type 2 diabetes (RR 0.73, 95% CI [0.65, 0.83]). Each additional month of lactation was associated with a 1% lower risk of type 2 diabetes (RR 0.99, 95% CI [0.98, 0.99]). However, the overall quality of the studies was modest. CONCLUSIONS: Lactation is associated with a significantly reduced risk of maternal type 2 diabetes over the life course, particularly in women with gestational diabetes. The protective effect seems to increase with longer duration of lactation. Further research is warranted to understand whether this association is modified by exposure to other risk factors.

E-cigarettes: A continuing public health challenge in India despite comprehensive bans.

India has introduced comprehensive e-cigarette bans focused on protecting youth from vaping-related harm. Despite these bans, educated young people appear to be a relatively high user group, although little is known about their usage patterns. The aims of the present study were to examine educated young adults' e-cigarette-related attitudes and behaviors and their support for various e-cigarette control policies. In total, 840 tertiary-educated young adults completed an online survey. Demographic characteristics, e-cigarette and tobacco use, beliefs about e-cigarettes, exposure to e-cigarette advertising, sources of access to e-cigarettes, numbers of family members and peers who vape, and support for a range of e-cigarette policies were assessed. One-third (33%) reported never having heard of e-cigarettes/vapes, 23% reported ever using e-cigarettes, 70% reported ever using tobacco, and 8% were dual users of both e-cigarettes and tobacco. Only 8% of e-cigarette users reported daily use. Vapers sourced e-cigarettes from retail outlets (vape shops, tobacconists) and their social networks (friends, siblings). Just under two-thirds of those who were aware of e-cigarettes believed them to be harmful and to contain chemicals. Among non-users, 31% were curious about using e-cigarettes and 23% intended to use in the following year, indicating high levels of susceptibility. The results suggest that despite a complete ban, young people are still able to access e-cigarettes in India. Greater education about harms associated with vaping and more intensive monitoring and enforcement could assist in reducing uptake in relatively high-prevalence groups such as educated young adults.

Digital Marketing of Breast-Milk Substitutes: a Systematic Scoping Review.

PURPOSE OF REVIEW: Globally, too few children are breastfed as recommended. Commercial promotion of breast-milk substitutes (BMS) is one factor undermining breastfeeding globally. Although the International Code of Marketing of BMS prohibits all forms of marketing, promotion has been observed in digital environments. We aimed to understand the scope and impact of digital marketing for the promotion of BMS. RECENT FINDINGS: BMS are promoted strategically and in an integrated fashion across multiple digital channels (social media, manufacturer websites, online retailers, blogs, mobile apps and digital streaming services). Traditional marketing strategies like gifts, discounts and coupons are also disseminated digitally. Data mining, real-time direct-to-consumer advertising and partnering with peer-group social media influencers are additional avenues. Exposure to digital marketing is common. Research on the impact of digital marketing is scarce, but its negative impact on breastfeeding intention and initiation has been documented. Case reports from marketing industry press corroborate academic evidence by highlighting the benefits of digital marketing to BMS companies in recruiting new users and increasing sales. To protect and promote breastfeeding, coordinated global action and strengthened national measures will be needed to implement, monitor and enforce the International Code in a digital context. Further action could include voluntary restrictions on BMS marketing by social media platforms and greater use of government-led data and health privacy regulation.

Young people's support for various forms of e-cigarette regulation in Australia and the UK.

BACKGROUND: The aim of this study was to examine young people's support for e-cigarette policies in two countries with very different e-cigarette regulatory environments - Australia and the UK. METHODS: An online survey was administered to 1,185 15-24 year olds (590 from Australia, 595 from the UK). Survey items assessed demographics, use of vaping and tobacco products, exposure to others' vaping behaviours, exposure to e-cigarette advertising, perceptions of harms associated with e-cigarettes, and support for 14 e-cigarette policies. Frequencies for support were calculated for each policy by country and overall, and a mixed effects negative binomial regression was performed to identify factors associated with support. RESULTS: Majority support was expressed for 10 of the 14 policies in the Australian sample and six in the UK sample. Significantly higher levels support were found among Australian respondents compared to UK respondents for all policies except one where the difference failed to reach statistical significance. Support was strongest for policies relating to preventing access by minors, including warnings on packages, and prohibiting misleading advertising. Support was weakest for policies restricting access to e-cigarettes and flavours. Factors associated with higher levels of support were harm perceptions, never having used e-cigarettes, and older age. CONCLUSIONS: The results suggest general support for a broad range of e-cigarette control policies among young people in Australia and the UK, despite very different e-cigarette regulatory environments in these countries. Enhancing awareness of the potential harms associated with e-cigarette use appears to be key to optimising support for the assessed policies among members of this age group.