JMIR Publications

ABSTRACT

Background:

Childhood obesity is a public health concern associated with serious health issues. The food environment, which in recent year undergone widespread changes leading to an increase access to ultra-processed foods (UPFs), has been given attention in relation to development of childhood obesity. One part of the food environment is food marketing. Studies from around the world, including Sweden, show that the food marketing landscape is dominated by foods associated with negative health outcomes. However, in previous studies the investigated areas have been determined by researchers.

Objective:

The aim of this study was to test a new child centric methodology to further advance the understanding of the outdoor food advertisement landscape in Sweden.

Methods:

A cross sectional study was performed in two Swedish counties (Stockholm and Gävleborg). Initially, 45 students from four schools in areas with varying SES used a smartphone application (app) to take pictures of food advertisements that they encountered in their everyday lives. The app also recorded the GPS location of where the pictures were taken. Pictures with associated GPS-data were automatically uploaded and visualised in a secure cloud-based dashboard allowing for identification of areas where children see many food advertisements, so called “hotspot areas”. The identified hotspot areas were subsequently visited by two researchers who systematically mapped all the food advertisements in the areas using cameras. All pictures of food advertisements taken by the researchers in the hotspot areas were later analysed based on their content of UPFs, health promoting foods such as fruit, berries, vegetables and seafood (FBVS) as well as price promotions.

Results:

Based on 1310 pictures of food advertisements taken by the students, 34 hotspot areas were identified. A total of 2955 pictures of food advertisements were taken by the researchers in the hotspot areas during the mapping activity. The results of the picture analysis showed that 78 % of the advertisements contained UPFs and 21 % contained FBVS. Out of all food advertisement in all areas combined, 24% contained a price promotion. Out of all price promotions, 74 % advertised UPFs and 20 % advertised FBVS.

Conclusions:

This study showed that the vast majority of outdoor food advertisements in areas where children spend time advertise UPFs and only a 21 % advertise health promoting food such as FBVS. The findings continues to highlight that the food advertised in the Swedish outdoor environment is not in line with dietary guidelines and that it might be time to consider regulatory measures.