To test whether point-of-sale (POS) information about the nutrition content of sugar-sweetened beverages (SSB) promotes healthier drink choices among teenagers, and explore whether POS intervention effects vary based on prior exposure to a sugary drink public health campaign (13 Cancers).

Between-subjects online experiment with three POS signage conditions: no signage (control); sugar content (SC) and Health Star Rating (HSR). Participants viewed their assigned POS sign alone, then alongside a drinks product display and chose which drink they would buy. Perceptions of various drink products and campaign recall were assessed.

Australia.

Adolescents aged 13–17 years (n 925) recruited via an online panel.

POS signs did not promote a significant reduction in preference for SSB (cf. control condition). Cognitive and emotional responses to POS signs were strongest for the SC sign, which was rated higher than the HSR sign on various perceived effectiveness measures. Participants who saw the SC sign rated SSB as less healthy (cf. control condition) and were more likely to accurately estimate the number of teaspoons of sugar in soft drink (cf. HSR sign and control conditions). There was no significant interaction between prior exposure to the 13 Cancers campaign and POS signage condition regarding preferences for and perceptions of SSB.

SSB POS interventions may not have the desired effect on adolescents’ drink preferences. Testing SSB POS signs in real-world retail settings is needed to determine whether positive educational impacts extend to promoting healthier drink purchases and reduced SSB consumption among teenagers.

There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature.

Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was ‘likelihood of reducing SSB consumption in next 6 months’, and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure.

Australia.

A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18–45 years, 56 % overweight or obese).

Respondents indicated that they were ‘not at all’ (30·1 %), ‘somewhat’ (43·9 %) and ‘very likely’ (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be ‘very much’ at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption.

Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks.

The current study aimed to assess the nutritional quality of Australian secondary school canteen menus.

Stratified national samples of schools provided canteen menus in 2012–2013 and 2018, which were systematically assessed against a ‘traffic light’ classification system according to the National Healthy School Canteen Guidelines. Items were classified as green (healthiest and recommended to dominate canteen menus), amber (select carefully) or red (low nutritional quality, should not appear on canteen menus), and pricing and promotional strategies were recorded.

Australia.

Canteen menus from 244 secondary schools (2012–2013 n 148, 2018 n 96).

A total of 21 501 menu items were classified. Forty-nine percent of canteen menus contained at least 50 % green items; however, nearly all (98·5 %) offered at least one red item and therefore did not comply with national recommendations. Snacks and drinks had the least healthy profile of all product sectors, and a large proportion of schools supplied products typically of poor nutritional quality (meat pies and savoury pastries 91·8 %, sugary drinks 89·5 %, sweet baked goods 71·5 %, ice creams 64·1 % and potato chips 44·0 %). Red items were significantly cheaper than green items on average, and many schools promoted the purchase of red items on canteen menus (52·8 %). There were few differences between survey waves.

There is considerable room for improvement in the nutritional quality of canteen menus in Australian secondary schools, including in the availability, pricing and promotion of healthier options. Additional resources and services to support implementation of national guidelines would be beneficial.

To examine demographic and behavioural correlates of frequent consumption of fast food among Australian secondary school students and explore the associations between fast food consumption and social/environmental factors.

Cross-sectional survey using a web-based self-report questionnaire.

Secondary schools across all Australian states and territories.

Students aged 12–17 years participating in the 2012–2013 National Secondary Students’ Diet and Activity survey (n 8392).

Overall, 38 % of students surveyed reported consuming fast food at least weekly. Being male, residing in lower socio-economic areas and metropolitan locations, having more weekly spending money and working at a fast food outlet were all independently associated with consuming fast food once a week or more, as were several unhealthy eating (low vegetable intake and high sugary drink and snack food intake) and leisure (low physical activity and higher commercial television viewing) behaviours and short sleep duration. Frequent fast food consumption and measured weight status were unrelated. Students who agreed they go to fast food outlets with their family and friends were more likely to report consuming fast food at least weekly, as were those who usually ‘upsize’ their fast food meals and believe fast food is good value for money.

These results suggest that frequent fast food consumption clusters with other unhealthy behaviours. Policy and educational interventions that reach identified at-risk groups are needed to reduce adolescent fast food consumption at the population level. Policies placing restrictions on the portion sizes of fast food may also help adolescents limit their intake.

To explore parents’ responses to sponsorship of children’s sport by unhealthy food brands and two alternative pro-health sponsorship options.

Between-subjects online experiment with four sponsorship conditions: (i) non-food branding (control); (ii) unhealthy food branding; (iii) healthier food branding; (iv) public health nutrition campaign branding. Participants were shown a short video and a promotional flyer for a fictional junior sports programme, with sponsor content representing their assigned brand. Afterwards, participants were asked a series of questions assessing their brand awareness, brand attitudes and preference for food sponsor branded products.

Australia.

Australian parents (n 1331) of children aged 6–9 years.

Compared with the control condition, unhealthy food sponsorship promoted increased awareness, branded product preferences and favourable attitudes towards unhealthy food sponsor brands. Healthier food sponsorship promoted similar effects for healthier food sponsor brands, except there was no significant increase in positive attitudes towards these brands. Sponsorship by public health nutrition campaigns promoted more negative attitudes towards unhealthy food sponsor brands and increased preference for healthier food sponsor branded products. Overall, healthier food sponsors and public health campaign sponsors were perceived to have better programme–sponsor fit and to be more appropriate sponsors of children’s sport than unhealthy food sponsors.

Restrictions on unhealthy food sponsorship of children’s sport are needed to prevent unhealthy food brands from exploiting junior sport sponsorship to enhance their appeal. Sponsorship of children’s sport by healthier food brands or public health nutrition campaigns could help promote healthier food choices among parents.

To explore children’s responses to sponsorship of community junior sport by unhealthy food brands and investigate the utility of alternative, pro-health sponsorship options.

Between-subjects experiment, with four sponsorship conditions: A, non-food branding (control); B, unhealthy food branding; C, healthier food branding; D, obesity prevention campaign branding.

Online experiment conducted in schools. Participants were shown a junior sports pack for their favourite sport that contained merchandise with branding representing their assigned sponsorship condition. Participants viewed and rated the sports pack, completed a distractor task, then completed questions assessing brand awareness, brand attitudes and preference for food sponsors’ products.

Students in grades 1 to 3 (aged 5–10 years; n 1124) from schools in metropolitan Melbourne, Australia.

Compared with the control condition, there were no significant effects of unhealthy food branding on awareness of, attitudes towards or preference for these brands. Exposure to healthier food branding prompted a significant increase in the proportion of children aware of these brands, but did not impact attitudes towards or preference for these brands. Exposure to either healthier food branding or obesity prevention campaign branding prompted a significant reduction in the proportion of children showing a preference for unhealthy food sponsor products.

The sponsorship of children’s sport by healthier food brands may promote awareness of these brands and healthier sponsorship branding may reduce preferences for some unhealthy food products. Establishing and implementing healthy sponsor criteria in sports clubs could forge healthier sponsorship arrangements and help phase out unhealthy food and beverage sponsors.

To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.

Cross-sectional self-completion survey and height and weight measurements.

Australian secondary schools.

Students aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).

Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine.

High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

Cross-sectional survey of students’ eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

Australian secondary schools across all states/territories.

Secondary-school students aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 12 188).

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week (‘frequent snackers’). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m2 were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.

Cross-sectional survey of students’ vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.

Secondary schools across all Australian states and territories.

Secondary-school students (n 12 188; response rate: 54 %) aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey.

Overall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1–2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).

Results suggest that socio-economic disparities in Australian adolescents’ eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

To assess parents’ responses to common, potentially misleading strategies for marketing energy-dense and nutrient-poor (EDNP) child-oriented foods.

Between-subjects online experiment to test whether nutrient claims and sports celebrity endorsements on the front of packs of EDNP products lead parents to prefer and rate these foods more favourably.

Australia.

A total of 1551 parents of children aged 5–12 years, who were the main household grocery buyers.

Inclusion of nutrient claims or sports celebrity endorsements on EDNP products led parents to perceive these products to be more nutritious than if they did not include such promotions. When asked to choose between a pair of different products (EDNP v. healthier), 56 % of parents did not read a nutrition information panel (NIP) before making their choice and this did not differ by promotion condition. These parents were more likely to choose an EDNP product if it included a nutrient claim (OR = 1·83, 95 % CI 1·31, 2·56; P < 0·001) or sports celebrity endorsement (OR = 2·37, 95 % CI 1·70, 3·32; P < 0·001). Sports celebrity endorsements also enhanced parent's perceptions of typical consumers of the product, perceptions of product healthiness and quality, as well as purchase intentions.

Nutrient claims and sports celebrity endorsements tip consumer preferences towards EDNP products bearing such promotions, especially among the majority who do not read the NIP. As parents largely determine what foods are available to children at home, it is critical that initiatives aimed at reducing the persuasive impact of food marketing include this target group.

To examine the association between television advertising exposure and adults’ consumption of fast foods.

Cross-sectional telephone survey. Questions included measures of frequency of fast-food consumption at different meal times and average daily hours spent watching commercial television.

Subjects comprised 1495 adults (41 % response rate) aged ≥18 years from Victoria, Australia.

Twenty-three per cent of respondents usually ate fast food for dinner at least once weekly, while 17 % consumed fast food for lunch on a weekly basis. The majority of respondents reported never eating fast food for breakfast (73 %) or snacks (65 %). Forty-one per cent of respondents estimated watching commercial television for ≤1 h/d (low viewers); 29 % watched for 2 h/d (moderate viewers); 30 % watched for ≥3 h/d (high viewers). After adjusting for demographic variables, high viewers were more likely to eat fast food for dinner at least once weekly compared with low viewers (OR = 1·45; 95 % CI 1·04, 2·03). Both moderate viewers (OR = 1·53; 95 % CI 1·01, 2·31) and high viewers (OR = 1·81; 95 % CI 1·20, 2·72) were more likely to eat fast food for snacks at least once weekly compared with low viewers. Commercial television viewing was not significantly related (P > 0·05) to fast-food consumption at breakfast or lunch.

The results of the present study provide evidence to suggest that cumulative exposure to television food advertising is linked to adults’ fast-food consumption. Additional research that systematically assesses adults’ behavioural responses to fast-food advertisements is needed to gain a greater understanding of the mechanisms driving this association.