Épidémiologie et santé publique // Epidemiology and Public Health

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Adherence barriers and interventions to improve ART adherence in Sub-Saharan African countries: A systematic review protocol
(2022) Buh, Amos; Deonandan, Raywat; Gomes, James; Krentel, Alison; Oladimeji, Olanrewaju; Yaya, Sanni
The HIV/AIDS pandemic continues to be a major public health concern, particularly in Sub-Saharan Africa (SSA). Despite efforts to reduce new infections and deaths with the use of antiretroviral therapy (ART), SSA countries continue to bear the heaviest burden of HIV/AIDS globally, accounting for two-thirds of global new infections. The goal of this review is to identify common barriers to ART adherence as well as common effective interventions that can be implemented across SSA countries to improve ART adherence.
The healthfulness and prominence of sugar in child-targeted breakfast cereals in Canada
(2017) Potvin Kent, Monique; Cameron, Cher; Philippe, Sarah
Introduction: The objective of this study was to compare the nutritional content and healthfulness of child-targeted and “not child-targeted” breakfast cereals and to assess the predominance of added sugar in these products. Methods: We collected data on the nutritional content of 262 unique breakfast cereals found in the five largest grocery store chains in Ottawa (Ontario) and Gatineau (Quebec). We noted the first five ingredients and the number of added sugars present in each cereal from the ingredients list. The various cereal brands were then classified as either “healthier” or “less healthy” using the UK Nutrient Profile Model. We assessed each cereal to determine if it was child-targeted or not, based on set criteria. Statistical comparisons were made between child and not child-targeted cereals. Results: 19.8% of all breakfast cereals were child-targeted, and these were significantly lower in total and saturated fat. Child-targeted cereals were significantly higher in sodium and sugar and lower in fibre and protein, and were three times more likely to be classified as “less healthy” compared to not child-targeted cereals. No child-targeted cereals were sugar-free, and sugar was the second most common ingredient in 75% of cereals. Six breakfast cereal companies had child-targeted product lines that consisted entirely of “less healthy” cereals. Conclusion: There is a need for regulations that restrict food marketing to children and youth under the age of 17 on packaging to reduce their appeal to this age group. Children’s breakfast cereals also need to be reformulated through government-set targets, or through regulation should compliance be deemed unacceptable.
Benchmarking unhealthy food marketing to children and adolescents in Canada: a scoping review
(2022) Potvin Kent, Monique; Hatoum, Farah; Wu, David; Remedios, Lauren; Bagnato, Mariangela
Introduction: Unhealthy food and beverage marketing in various media and settings contributes to children’s poor dietary intake. In 2019, the Canadian federal government recommended the introduction of new restrictions on food marketing to children. This scoping review aimed to provide an up-to-date assessment of the frequency of food marketing to children and youth in Canada as well as children’s exposure to this marketing in various media and settings in order to determine where gaps exist in the research. Methods: For this scoping review, detailed search strategies were used to identify relevant peer-reviewed and grey literature published between October 2016 and November 2021. Two reviewers screened all results. Results: A total of 32 relevant and unique articles were identified; 28 were peer reviewed and 4 were from the grey literature. The majority of the studies (n = 26) examined the frequency of food marketing while 6 examined actual exposure to food marketing. Most research focussed on children from Ontario and Quebec and television and digital media. There was little research exploring food marketing to children by age, geographical location, sex/gender, race/ethnicity and/or socioeconomic status. Conclusion: Our synthesis suggests that unhealthy food marketing to children and adolescents is extensive and that current self-regulatory policies are insufficient at reducing the presence of such marketing. Research assessing the frequency of food marketing and preschooler, child and adolescent exposure to this marketing is needed across a variety of media and settings to inform future government policies.
Sex differences in youth’s exposure to food and beverage advertisements on broadcast television in four cities in Canada
(2023) Potvin Kent, Monique; Soares Guimarães, Julia; Amson, Ashley; Pauzé, Elise; Remedios, Lauren; Bagnato, Mariangela; Pritchard, Meghan; Onwo, Ajiri; Wu, David; L’Abbé, Mary; Mulligan, Christine; Vergeer, Laura; Weippert, Madyson
Introduction: Sex differences exist in children’s obesity rates, dietary patterns and television viewing. Television continues to be a source of unhealthy food advertising exposure to children in Canada. Our objective was to examine sex differences in food advertising exposure in children aged 2 to 17 years across four Canadian English-language markets. Methods: We licensed 24-hour television advertising data from the company Numerator for January through December 2019, in four cities (Vancouver, Calgary, Montréal and Toronto) across Canada. Child food advertising exposure overall, by food category, television station, Health Canada’s proposed nutrient profiling model, and marketing techniques were examined on the 10 most popular television stations among children and compared by sex. Advertising exposure was estimated using gross rating points, and sex differences were described using relative and absolute differences. Results: Both male and female children were exposed to an elevated level of unhealthy food advertising and a plethora of marketing techniques across all four cities. Differences between sexes were evident between and within cities. Compared to females, males in Vancouver and Montréal viewed respectively 24.7% and 24.0% more unhealthy food ads/person/year and were exposed to 90.2 and 133.4 more calls to action, 93.3 and 97.8 more health appeals, and 88.4 and 81.0 more products that appeal to children. Conclusion: Television is a significant source of children’s exposure to food advertising, with clear sex differences. Policy makers need to consider sex when developing food advertising restrictions and monitoring efforts.
Treatment completion and outcome in a partial hospitalization program: interactions among patient variables
(1999) Tasca, Giorgio; Balfour, Louise; Bissada, Hany; Busby, Keith; Conrad, Gretchen; Cameron, Paul; Colletta, Salvatore; Potvin Kent, Monique; Turpin, Pierre
Reviews of treatment completion suggest using psychological variables and more complex designs to help predict completion status and understand the relationships among variables. 102 patients (mean age 37.9 yrs) with serious emotional, coping, and interpersonal problems were admitted to a partial hospitalization program. 58 completed the program and 44 terminated prematurely. Psychological mindedness (PM), interpersonal problems, and chronicity of psychiatric problems were used as predictors. A hierarchical logistic regression was conducted. PM and chronicity emerged as statistically significant individual predictors of completion status. Only chronicity increased the odds of classifying completers, while noncompleters were not classified above chance. The interaction between PM and chronicity was statistically significant, but did not increase accurate classification over and above chronicity alone. Completers with more chronic problems had higher levels of PM. PM may act as a buffer against the negative impact of chronicity. It was found that those who completed treatment tended to benefit from treatment.
Breakfast skipping is associated with differences in meal patterns, macronutrient intakes and overweight among pre-school children
(2009) Dubois, Lise; Girard, Manon; Potvin Kent, Monique; Farmer, Anna; Tatone-Tokuda, Fabiola
Objectives: To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children. Design: A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires. Setting: Data obtained from a representative sample (n 2103) of children born in Quebec (Canada) in 1998. Subjects: One thousand five hundred and forty-nine children, with a mean age of 49 (SD 3·12) months. Results: Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products. Conclusions: Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.
Internet marketing directed at children on food and restaurant websites in two policy environments
(2013) Potvin Kent, M; Dubois, L; Kent, E A; Wanless, A J
Objective: Food and beverage marketing has been associated with childhood obesity yet little research has examined the influence of advertising policy on children's exposure to food/beverage marketing on the Internet. The purpose of this study was to assess the influence of Quebec's Consumer Protection Act and the self-regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) on food manufacturer and restaurant websites in Canada. Design and Methods: A content analysis of 147 French and English language food and restaurant websites was undertaken. The presence of child-directed content was assessed and an analysis of marketing features, games and activities, child protection features, and the promotion of healthy lifestyle messages was then examined on those sites with child-directed content. Results: There were statistically no fewer French language websites (n = 22) with child-directed content compared to English language websites (n = 27). There were no statistically significant differences in the number of the various marketing features, or in the average number of marketing features between the English and French websites. There were no fewer CAI websites (n = 14) with child-directed content compared to non-CAI websites (n = 13). The CAI sites had more healthy lifestyle messages and child protection features compared to the non-CAI sites. Conclusion: Systematic surveillance of the Consumer Protection Act in Quebec is recommended. In the rest of Canada, the CAI needs to be significantly expanded or replaced by regulatory measures to adequately protect children from the marketing of foods/beverages high in fat, sugar, and sodium on the Internet.
Applying a Consumer Behavior Lens to Salt Reduction Initiatives
(2017) Regan, Áine; Potvin Kent, Monique; Raats, Monique; McConnon, Áine; Wall, Patrick; Dubois, Lise
Reformulation of food products to reduce salt content has been a central strategy for achieving population level salt reduction. In this paper, we reflect on current reformulation strategies and consider how consumer behavior determines the ultimate success of these strategies. We consider the merits of adopting a 'health by stealth', silent approach to reformulation compared to implementing a communications strategy which draws on labeling initiatives in tandem with reformulation efforts. We end this paper by calling for a multi-actor approach which utilizes co-design, participatory tools to facilitate the involvement of all stakeholders, including, and especially, consumers, in making decisions around how best to achieve population-level salt reduction.
Food and Beverage Marketing in Schools: A Review of the Evidence
(2017) Velazquez, Cayley E; Black, Jennifer L; Potvin Kent, Monique
Despite growing interest from government agencies, non-governmental organizations and school boards in restricting or regulating unhealthy food and beverage marketing to children, limited research has examined the emerging knowledge base regarding school-based food and beverage marketing in high-income countries. This review examined current approaches for measuring school food and beverage marketing practices, and evidence regarding the extent of exposure and hypothesized associations with children's diet-related outcomes. Five databases (MEDLINE, Web of Science, CINAHL, Embase, and PsycINFO) and six grey literature sources were searched for papers that explicitly examined school-based food and beverage marketing policies or practices. Twenty-seven papers, across four high-income countries including Canada (n = 2), Ireland (n = 1), Poland (n = 1) and United States (n = 23) were identified and reviewed. Results showed that three main methodological approaches have been used: direct observation, self-report surveys, and in-person/telephone interviews, but few studies reported on the validity or reliability of measures. Findings suggest that students in the U.S. are commonly exposed to a broad array of food and beverage marketing approaches including direct and indirect advertising, although the extent of exposure varies widely across studies. More pervasive marketing exposure was found among secondary or high schools compared with elementary/middle schools and among schools with lower compared with higher socio-economic status. Three of five studies examining diet-related outcomes found that exposure to school-based food and beverage marketing was associated with food purchasing or consumption, particularly for minimally nutritious items. There remains a need for a core set of standard and universal measures that are sufficiently rigorous and comprehensive to assess the totality of school food and beverage marketing practices that can be used to compare exposure between study contexts and over time. Future research should examine the validity of school food and beverage marketing assessments and the impacts of exposure (and emerging policies that reduce exposure) on children's purchasing and diet-related knowledge, attitudes and behaviors in school settings.
Physical distancing messages targeting youth on the social media accounts of Canadian public health entities and the use of behavioral change techniques
(2021) Dimanlig-Cruz, Sheryll; Han, Arum; Lancione, Samantha; Dewidar, Omar; Podinic, Irina; Kent, Monique Potvin; Brouwers, Melissa
Introduction: Physical distancing (PD) is an important public health strategy to reduce the transmission of COVID-19 and has been promoted by public health authorities through social media. Although youth have a tendency to engage in high-risk behaviors that could facilitate COVID-19 transmission, there is limited research on the characteristics of PD messaging targeting this population on social media platforms with which youth frequently engage. This study examined social media posts created by Canadian public health entities (PHEs) with PD messaging aimed at youth and young adults aged 16–29 years and reported behavioral change techniques (BCTs) used in these posts. Methods: A content analysis of all social media posts of Canadian PHEs from Facebook, Twitter, Instagram and YouTube were conducted from April 1st to May 31st, 2020. Posts were classified as either implicitly or explicitly targeting youth and young adults. BCTs in social media posts were identified and classified based on Behavior Change Technique Taxonomy version 1 (BCTTv1). Frequency counts and proportions were used to describe the data. Results: In total, 319 youth-targeted PD posts were identified. Over 43% of the posts originated from Ontario Regional public health units, and 36.4 and 32.6% of them were extracted from Twitter and Facebook, respectively. Only 5.3% of the total posts explicitly targeted youth. Explicit posts were most frequent from federal PHEs and posted on YouTube. Implicit posts elicited more interactions than explicit posts regardless of jurisdiction level or social media format. Three-quarters of the posts contained at least one BCT, with a greater portion of BCTs found within implicit posts (75%) than explicit posts (52.9%). The most common BCTs from explicit posts were instructions on how to perform a behavior (25.0%) and restructuring the social environment (18.8%). Conclusions: There is a need for more PD messaging that explicitly targets youth. BCTs should be used when designing posts to deliver public health messages and social media platforms should be selected depending on the target population.
The Frequency and Healthfulness of Food and Beverages Advertised on Adolescents' Preferred Web Sites in Canada
(2018) Potvin Kent, Monique; Pauzé, Elise
Purpose: The purpose of this study was to document the frequency and healthfulness of pop-up and banner food advertisements displayed on third-party Web sites preferred by adolescents in Canada. Methods: Syndicated Internet advertising exposure data licensed from comScore was used to identify adolescents' (ages 12–17) 10 most popular Web sites and determine the frequency of food and beverage display advertisements on these Web sites from June 2015 to May 2016. The nutrition information for all advertised products was collected, and the healthfulness of all food and beverage ads was assessed using the Pan-American Health Organization (PAHO) and the U.K. Nutrient Profile Models (NPM). Results: In total, there were 14.4 million food advertisements on all 10 Web sites from June 2015 to May 2016. The most frequently advertised food categories were cakes, cookies, and ice cream (32.5%); cold cereal (20.5%); restaurants (18.0%); and sugar-sweetened beverages (12.0%). Most advertised products (93.3%) were categorized as excessive in either fat, sodium, or free sugars according to the PAHO NPM, and 83.5% of ads were categorized as “less healthy” according to the U.K. NPM. Specifically, 81.3% of ads were excessive in free sugars, 22.1% were excessive in sodium, 14.1% were excessive in saturated fat, and 11.8% were excessive in total fat according to the PAHO NPM. Conclusions: Canadian adolescents are potentially exposed to a high frequency of unhealthy food and beverage display advertisements on their preferred Web sites. Regulations restricting food and beverage marketing to children need to include digital media and should consider protecting adolescents up to the age of 17.
Less healthy breakfast cereals are promoted more frequently in large supermarket chains in Canada
(2017) Potvin Kent, Monique; Rudnicki, Erika; Usher, Crystal
Background: The majority of food expenditures are made in supermarkets and this environment influences our purchasing and food intake. Breakfast cereals are frequently marketed as healthy food choices. The objective of this study was to examine the frequency of in–store promotions for cold breakfast cereals in Canadian supermarkets and to determine whether healthier or less healthy breakfast cereals are promoted more frequently. Methods: Data was collected once per week over a four-week period from a convenience sample of the five largest Canadian supermarkets in the Ottawa/Gatineau area. Data collection included the number of shelf facings, promotional displays, and the cost of cereals/100 g. The UK Nutrient Profiling Model was used to determine the healthfulness of each breakfast cereal. Results: 29.8% (n = 67) of the 225 unique cereals were classified as healthier and 70.2% (n = 158) were classified as less healthy. Less healthy cereals were displayed at eye level, in the profitable middle shelves, 2.9 times more frequently than healthier cereals. There were 5.3 times more breakfast cereal shelf facings, 4.2 more end cap displays, 1.7 more mid-aisle displays and 3.3 more special pricing signage for less healthy cereals compared to healthier cereals. Less healthy cereals had a significantly higher average total number of shelf facings compared to healthier cereals (t = −4.28 (280.8), p < .001). Conclusions: Breakfast cereal manufacturers need to consider reformulation of their breakfast cereals to improve their healthfulness and supermarkets need to increase the marketing of healthy breakfast cereals within their stores.
The effectiveness of self-regulation in limiting the advertising of unhealthy foods and beverages on children’s preferred websites in Canada
(2018) Potvin Kent, Monique; Pauzé, Elise
Objective: To assess the effectiveness of the self-regulatory Canadian Children’s Food and Beverage Advertising Initiative (CAI) in limiting advertising of unhealthy foods and beverages on children’s preferred websites in Canada. Design/Setting/Subjects: Syndicated Internet advertising exposure data were used to identify the ten most popular websites for children (aged 2–11 years) and determine the frequency of food/beverage banner and pop-up ads on these websites from June 2015 to May 2016. Nutrition information for advertised products was collected and their nutrient content per 100 g was calculated. Nutritional quality of all food/beverage ads was assessed using the Pan American Health Organization (PAHO) and UK Nutrient Profile Models (NPM). Nutritional quality of CAI and non-CAI company ads was compared using χ2 analyses and independent t tests. Results: About 54 million food/beverage ads were viewed on children’s preferred websites from June 2015 to May 2016. Most (93·4 %) product ads were categorized as excessive in fat, Na or free sugars as per the PAHO NPM and 73·8 % were deemed less healthy according to the UK NPM. CAI-company ads were 2·2 times more likely (OR; 99 % CI) to be excessive in at least one nutrient (2·2; 2·1, 2·2, P<0·001) and 2·5 times more likely to be deemed less healthy (2·5; 2·5, 2·5, P<0·001) than non-CAI ads. On average, CAI-company product ads also contained (mean difference; 99 % CI) more energy (141; 141·1, 141·4 kcal, P<0·001, r=0·55), sugar (18·2; 18·2, 18·2 g, P<0·001, r=0·68) and Na (70·0; 69·7, 70·0 mg, P<0·001, r=0·23) per 100 g serving than non-CAI ads. Conclusions: The CAI is not limiting unhealthy food and beverage advertising on children’s preferred websites in Canada. Mandatory regulations are needed.
The effectiveness of the food and beverage industry's self-established uniform nutrition criteria at improving the healthfulness of food advertising viewed by Canadian children on television
(2018) Potvin Kent, Monique; Smith, Jennifer R; Pauzé, Elise; L'Abbé, Mary
Background: Food and beverage marketing has been identified as an environmental determinant of childhood obesity. The purpose of this study is to assess whether the Uniform Nutrition Criteria established and implemented by companies participating in the self-regulatory Canadian Children’s Food and Beverage Advertising Initiative (CAI) had an impact on the healthfulness of food and beverage advertising during television programming with a high share of children in the viewing audience. Methods: Data on food advertising were licensed from Numeris for 27 television stations for Toronto for May 2013 and May 2016 (i.e. before and after the implementation of the nutrition criteria). First, television programs that had a child audience share of ≥35% (when the nutrition criteria applied) were identified. Ten percent of these programs were randomly selected and included in the study. After identifying the food and beverage ads that aired during these programs, the nutritional information of advertised products was collected and their healthfulness was assessed using the Pan-American Health Organization (PAHO) and UK Nutrient Profile Models (NPM). The healthfulness of CAI products advertised in May 2013 and 2016 was compared using Chi-square tests. Results: Although in May 2016, products advertised by CAI companies were more likely to be categorized as healthier by the UK NPM (21.5% versus 6.7%, χ2(1) = 12.1,p = 000) compared to those advertised in May 2013, the frequency of advertised products considered less healthy in May 2016 remained very high (78.5%) and comparable to that of products advertised by companies not participating in the CAI (80.0% categorized as less healthy). Furthermore, in both May 2013 and May 2016, 99–100% of CAI advertisements featured products deemed excessive in either fat (total, saturated, trans), sodium or free sugars according to the PAHO NPM. Conclusions: Despite modest improvements noted after the implementation of the CAI’s Uniform Nutrition Criteria, the healthfulness of most products advertised during programs with a high share of children in the viewing audience remains poor. Mandatory regulations are needed.
The effectiveness of voluntary policies and commitments in restricting unhealthy food marketing to Canadian children on food company websites
(2019) Vergeer, Laura; Vanderlee, Lana; Potvin Kent, Monique; Mulligan, Christine; L'Abbé, Mary R
Marketing unhealthy foods and beverages to children (M2K) fosters poor dietary patterns, increasing obesity and noncommunicable disease risk. Federal restrictions on M2K have been under development in Canada since 2016; however, at present, M2K is mostly self-regulated by food companies. This study aimed to compare M2K on Canadian websites of food companies with and without voluntary policies or commitments in this area. A systematic content analysis of company websites was conducted in spring/summer 2017 for major packaged food (n = 16), beverage (n = 12), and restaurant chain (n = 13) companies in Canada. M2K policies were sourced from company websites and published corporate documents. Sixteen companies (43%) reported national and/or global M2K policies, while 21 companies (57%) had no published policies. The websites of Canadian companies (n = 154) were scanned for child-directed products and marketing; type and frequency of marketing techniques were recorded. Child-directed marketing appeared on 19 websites of 12 companies (32%), including 9 companies with M2K policies. Websites featured products with unconventional flavours, colours, shapes, or child-oriented packaging, and used promotional characters, contests, games, activities, or lettering and graphics appealing to children. The nutritional quality of products marketed to children was evaluated using a nutrient profile model developed by Health Canada for proposed M2K regulations. Of the 217 products marketed to children, 97% exceeded Health Canada's proposed ∼5% Daily Value threshold for saturated fat, sodium, and/or sugars, 73% of which were products from 9 companies with policies. These findings highlight the limitations of self-regulation in restricting M2K on food company websites, reinforcing the need for government regulations.
Children and adolescents' exposure to food and beverage marketing in social media apps
(2019) Potvin Kent, Monique; Pauzé, Elise; Roy, Elisabeth-Anne; de Billy, Nicholas; Czoli, Christine
Background: Unhealthy food marketing is a powerful determinant of unhealthy diets and obesity among children. Although it is known that food marketers target young people on social media, no study has yet quantified children's exposure on these platforms. Objectives: To compare the frequency and healthfulness of food marketing seen by children and adolescents on social media apps as well as estimate their weekly exposure. Methods: 101 children and adolescents (ages 7-16 years) completed a survey on their media use and were recorded using their two favourite social media apps for 5 minutes each on the mobile device they usually use. Recordings of app use were reviewed to identify food marketing exposures. Results: Overall, 72% of participants were exposed to food marketing. Of the 215 food marketing exposures identified, most promoted unhealthy products such as fast food (44%) and sugar-sweetened beverages (9%). Adolescents viewed more instances of food marketing, on average, per 10-minute period compared with children (Mean [SD] = 2.6 [2.7] versus 1.4 [2.1], U = 1606, z = 2.94, P = 0.003). It was also estimated that children and adolescents see food marketing 30 and 189 times on average per week on social media apps, respectively. Conclusions: Statutory regulations restricting unhealthy food marketing to adolescents and children on social media should be considered.
Food and beverage marketing in primary and secondary schools in Canada
(2019) Potvin Kent, Monique; Velazquez, Cayley E; Pauzé, Elise; Cheng-Boivin, Olivia; Berfeld, Noami
Background: Unhealthy food marketing is considered a contributor to childhood obesity. In Canada, food marketing in schools is mostly self-regulated by industry though it is sometimes restricted through provincial school policies. The purpose of this study was to document the type of food marketing activities occurring in Canadian schools and examine differences by school characteristics. Methods: An online survey was sent to public primary and secondary schools from 27 school boards in Ontario, British Columbia, and Nova Scotia and was completed by 154 Principals in spring 2016. This survey queried the type of food marketing occurring in schools including advertisements, food product displays, fundraising, exclusive marketing agreements, and incentive programs, among others. The occurrence of food marketing was described using frequencies, medians, and ranges. Chi-square and Fisher Exact tests were conducted to assess school-level differences in the frequency of marketing activities by school type (primary versus secondary), province (Ontario versus British Columbia), and the socio-economic status of most students (low versus middle/high income). The significance level was set at α < 0.05 for all tests. Results: Overall, 84% of schools reported at least one type of food marketing and the median number of distinct types of marketing per school was 1 (range 0–6). The most frequently reported forms of marketing were the sale of branded food, particularly chocolate, pizza, and other fast food, for fundraising (64% of schools); food advertisements on school property (26%), and participation in incentive programs (18%). Primary schools (n = 108) were more likely to report participating in incentive programs (25%) and selling branded food items (72%) compared to secondary schools (n = 46; 2 and 43% respectively; p < 0.01). Conversely, secondary schools were more likely to report food advertising on school property (56%), exclusive marketing arrangements with food companies (43%), and food product displays (19%) than primary schools (13, 5 and 2%, respectively; p < 0.01). Conclusion: The presence of food marketing in most participating schools suggests that the current patchwork of policies that restrict food marketing in Canadian schools is inadequate. Comprehensive restrictions should be mandated by government in both primary and secondary schools to protect children and youth from this marketing.
Strategies used by the Canadian food and beverage industry to influence food and nutrition policies
(2020) Vandenbrink, D; Pauzé, E; Potvin Kent, M
Background: Unhealthy food environments contribute to the rising rates of obesity and diet-related diseases. To improve the Canadian nutritional landscape, Health Canada launched the Healthy Eating Strategy in October 2016 which involved several initiatives including the restriction of unhealthy food marketing to children, the reduction of sodium in the food supply and the introduction of front-of-package labelling. Subsequently, various stakeholders engaged in discussions with Health Canada. This study sought to describe the interactions between Health Canada and industry and non-industry stakeholders and to identify the strategies used by industry to influence food and nutrition policy in Canada. Methods: Documents such as correspondences and presentations exchanged in interactions between Health Canada and stakeholders regarding the Healthy Eating Strategy were obtained from Health Canada’s Openness and Transparency website. The participating stakeholders of each interaction and the topics discussed were determined and described quantitatively. A directed content analysis was then conducted to identify the strategies employed by industry to influence policy. This was guided by a previously developed coding framework that was adapted during analysis. Results: A total of 208 interactions concerning the Healthy Eating Strategy occurred between October 2016 and June 2018. Of the interactions for which documents were received (n = 202), 56% involved industry stakeholders, 42% involved non-industry stakeholders and 2% involved both. Industry stakeholders were more likely to initiate interactions with Health Canada (94% of their interactions) than non-industry stakeholders (49%). Front-of-package labelling was the most frequently discussed topic by industry stakeholders (discussed in 49% interactions involving industry) while non-industry stakeholders most frequently discussed the Healthy Eating Strategy as a whole (discussed in 37% of interactions involving non-industry). A wide variety of strategies were used by industry in their attempts to influence policy. Those most frequently identified included: “framing the debate on diet- and public health-related issues”, “promoting deregulation”, “shaping the evidence base”, “stressing the economic importance of industry”, and “developing and promoting alternatives to proposed policies”. Conclusion: Industry stakeholders are highly active in their attempts to influence Canadian nutritional policies. Policymakers and public health advocates should be aware of these strategies so that balanced and effective food and nutrition policies can be developed.
Exposure to Food and Beverage Advertising on Television among Canadian Adolescents, 2011 to 2016
(2020) Czoli, Christine D; Pauzé, Elise; Potvin Kent, Monique
Adolescents represent a key audience for food advertisers, however there is little evidence of adolescent exposure to food marketing in Canada. This study examined trends in Canadian adolescents' exposure to food advertising on television. To do so, data on 19 food categories were licensed from Nielsen Media Research for May 2011, 2013, and 2016 for the broadcasting market of Toronto, Canada. The average number of advertisements viewed by adolescents aged 12-17 years on 31 television stations during the month of May each year was estimated using television ratings data. Findings revealed that between May 2011 and May 2016, the total number of food advertisements aired on all television stations increased by 4%, while adolescents' average exposure to food advertising decreased by 31%, going from 221 ads in May 2011 to 154 in May 2016. In May 2016, the advertising of fast food and sugary drinks dominated, relative to other categories, accounting for 42% and 11% of all exposures, respectively. The findings demonstrate a declining trend in exposure to television food advertising among Canadian adolescents, which may be due to shifts in media consumption. These data may serve as a benchmark for monitoring and evaluating future food marketing policies in Canada.
Food and Beverage Advertising to Children and Adolescents on Television: A Baseline Study
(2020) Pinto, Adena; Pauzé, Elise; Mutata, Rachel; Roy-Gagnon, Marie-Hélène; Potvin Kent, Monique
The progressive rise in Canadian child obesity has paralleled trends in unhealthy food consumption. Industry has contributed to these trends through aggressive food and beverage marketing in various media and child settings. This study aimed to assess the extent of food and beverage advertising on television in Canada and compare the frequency of food advertising broadcasted during programs targeted to preschoolers, children, adolescents and adults. Annual advertising from 2018 was drawn from publicly available television program logs. Food and beverage advertisement rates and frequencies were compared by, target age group, television station, month and food category, using linear regression modelling and chi-square tests, in SAS version 9.4. Rates of food and beverage advertising differed significantly between the four target age groups, and varied significantly by television station and time of the year, in 2018. The proportion of advertisements for food and beverage products was significantly greater during preschooler-, child-, and adult-programming [5432 (54%), 142,451 (74%) and 2,886,628 (48%), respectively; p < 0.0001] compared to adolescent-programming [27,268 (42%)]. The proportion of advertisements promoting fast food was significantly greater among adolescent-programming [33,475 (51%), p < 0.0001] compared to other age groups. Legislation restricting food and beverage advertising is needed in Canada as current self-regulatory practices are failing to protect young people from unhealthy food advertising and its potential negative health effects.

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