Assistant Professor of Public Health Nutrition
Dr. Marie Bragg’s work focuses on identifying and affecting environmental and social factors associated with obesity, food marketing, and health disparities.
Trained as a Clinical Psychologist, Dr. Bragg utilizes psychology and public health research methods to study food policy and obesity, and her research advocates for changes in US food policy and population-level solutions - not only individual behavior change. Her research has examined the impact of racially targeted food and beverage marketing on adolescents; catalogued the food and beverage industry’s use of music celebrity and professional athlete endorsements in promoting unhealthy products; evaluated various marketing techniques used on packaged foods in supermarkets and outdoor advertisements; and assessed how labeling and intrapersonal and social factors influence food and beverage preferences. Her research has been funded by the National Institutes of Health (NIH) and the NYC Department of Health, and has resulted in numerous peer-reviewed articles.
At the SeedProgram, Dr. Bragg conducts research on obesity, health disparities, and international and domestic food policy, in order to provide policymakers and organizations with evidence-based guidance on improving the world’s diet and health outcomes. Her research program allows students to collect data, conduct qualitative coding analyses, assist with manuscript development and grant submissions, and draft IRB applications. Additionally, her students have published papers and posters, and received funding for their own projects.
BS, Psychology and BA, English, University of Florida, Gainesville, FLMS, Clinical Psychology, Yale University, New Haven, CTMPhil, Clinical Psychology, Yale University, New Haven, CTClinical Internship, Montefiore Medical Center, Bronx, NYPhD, Clinical Psychology, Yale University, New Haven, CT
Jane Olejarczyk Award, Yale University (2012)Yale Graduate Teaching Center Fellowship, Yale University (2012)Yale University Dissertation Fellowship, Yale University (2012)William Kessen Teaching Award, Yale University (2011)
FoodNutritionObesityPublic Health NutritionPublic Health Policy
Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemicBunting, A. M., Frank, D., Arshonsky, J., Bragg, M. A., Friedman, S. R., & Krawczyk, N.
Journal titleDrug and alcohol dependence
Volume222AbstractBackground: Big events (i.e., unique historical disruptions) like the COVID-19 epidemic and its associated period of social distancing can transform social structures, social interactions, and social norms. Social distancing rules and the fear of infection have greatly reduced face-to-face interactions, increased loneliness, reduced ties to helping institutions, and may also have disrupted the opioid use behaviors of people who use drugs. This research used Reddit to examine the impact of COVID-19 on the social networks and social processes of people who use opioids. Methods: Data were collected from the social media forum, Reddit.com. At the beginning of the COVID-19 pandemic in the U.S. (March 5, 2020, to May 13, 2020), 2,000 Reddit posts were collected from the two most popular opioid subreddits (r/OpiatesRecovery, r/Opiates). Posts were reviewed for relevance to COVID-19 and opioid use resulting in a final sample of 300. Thematic analysis was guided by the Big Events framework. Results: The COVID-19 pandemic was found to create changes in the social networks and daily lives among persons who use opioids. Adaptions to these changes shifted social networks leading to robust social support and mutual aid on Reddit, including sharing and seeking advice on facing withdrawal, dealing with isolation, managing cravings, and accessing recovery resources. Conclusions: Reddit provided an important source of social support and mutual aid for persons who use opioids. Findings indicate online social support networks are beneficial to persons who use opioids, particularly during big events where isolation from other social support resources may occur.
Student-led research team-building program may help junior faculty increase productivity in competitive biomedical research environmentBragg, M., Arshonsky, J., Pageot, Y., Eby, M., Tucker, C. M., Yin, S., Goldmann, E., & Jay, M.
Journal titleBMC Medical Education
Issue1AbstractBackground: Interdisciplinary research teams can increase productivity among academic researchers, yet many junior investigators do not have the training or financial resources to build productive teams. We developed and tested the acceptability and feasibility of three low-cost services to help junior faculty build and maintain their own research teams. Methods: At an urban academic medical centre, we implemented three types of consultation services: 1) giving talks on evidence-based best practices for building teams; 2) providing easy-to-use team building resources via email; and 3) offering a year-long consultation service—co-led by students—that taught faculty to build and maintain research teams. Our primary outcome was the number of faculty who used each service. For the yearlong consultation service, we asked faculty participants to complete three online self-assessments to rate their leadership confidence, the team’s performance, and which of the consultation components were most helpful. We used descriptive statistics to evaluate faculty assessment scores at three timepoints by comparing median scores and interquartile ranges. Results: We gave 31 talks on team building to 328 faculty and postdoctoral fellows from 2014 to 2020. Separately, 26 faculty heard about our research team building expertise and requested materials via email. For the consultation service, we helped build or enhance 45 research teams from 2014 to 2020. By the end of the consultation, 100% of the faculty reported they were still maintaining their team. In the initial survey, the majority of participants (95.7%, n = 22) reported having no or few experiences in building teams. Further, when asked to rate their team’s performance at 12-months, faculty highly rated many elements of both teamwork and taskwork, specifically their team’s productivity (6/7 points), morale (6/7 points), and motivation (6/7 points). By the end of the program, faculty participants also highly rated two components of the consultation program: recruitment assistance (7/10 points) and provision of team management tools (7/10 points). Conclusions: For participating faculty, our program provided valued guidance on recruitment assistance and team management tools. The high demand for team-building resources suggests that junior faculty urgently need better training on how to develop and manage their own team.
Waste generation and carbon emissions of a hospital kitchen in the US: Potential for waste diversion and carbon reductionsThiel, C. L., Park, S. W., Musicus, A. A., Agins, J., Gan, J., Held, J., Horrocks, A., & Bragg, M. A.
Journal titlePloS one
Issue3AbstractThis study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitchen generated 1515.15 kg (1.7 US tons) of solid waste daily or 0.23 kg of total waste per meal served. Extrapolating to all meals served in 2019, the hospital kitchen generates over 442,067 kg (487 US tons) of waste and emits approximately 294,466 kg of CO2e annually from waste disposal. Most of this waste (85%, 376,247 kg or 415 US tons annually) is currently sent to landfill. With feasible changes, including increased recycling and moderate composting, this hospital could reduce landfilled waste by 205,245 kg (226 US tons, or 55% reduction) and reduce GHG emissions by 189,025 kg CO2e (64% reduction). Given NYC's ambitious waste and GHG emission reduction targets outlined in its OneNYC strategic plan, studies analyzing composition, emissions, and waste diversion potential of large institutions can be valuable in achieving city sustainability goals.
“How will I get my next week's script?” Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemicKrawczyk, N., Bunting, A. M., Frank, D., Arshonsky, J., Gu, Y., Friedman, S. R., & Bragg, M. A.
Journal titleInternational Journal of Drug PolicyAbstractBackground: The COVID-19 pandemic poses significant challenges to people with opioid use disorder (OUD). As localities enforce lockdowns and pass emergency OUD treatment regulations, questions arise about how these changes will affect access and retention in care. In this study, we explore the influence of COVID-19 on access to, experiences with, and motivations for OUD treatment through a qualitative analysis of public discussion forums on Reddit. Methods: We collected data from Reddit, a free and international online platform dedicated to public discussions and user-generated content. We extracted 1000 of the most recent posts uploaded between March 5th and May 13th, 2020 from each of the two most popular opioid subreddits “r/Opiates” and “r/OpiatesRecovery” (total 2000). We reviewed posts for relevance to COVID-19 and opioid use and coded content using a hybrid inductive-deductive approach. Thematic analysis identified common themes related to study questions of interest. Results: Of 2000 posts reviewed, 300 (15%) discussed topics related to the intersection of opioid use and COVID-19. Five major themes related to OUD treatment were identified: Concern about closure of OUD treatment services; transition to telehealth and virtual care; methadone treatment requirements and increased exposure to COVID-19; reactions to changing regulations on medications for OUD; and influences of the pandemic on treatment motivation and progress. Conclusion: In the face of unprecedented challenges due to COVID-19, reactions of Reddit opioid forum users ranged from increased distress in accessing and sustaining treatment, to encouragement surrounding new modes of treatment and opportunities to engage in care. New and less restrictive avenues for treatment were welcomed by many, but questions remain about how new norms and policy changes will be sustained beyond this pandemic and impact OUD treatment access and outcomes long-term.
An online randomized trial of healthy default beverages and unhealthy beverage restrictions on children's menusRummo, P. E., Moran, A. J., Musicus, A. A., Roberto, C. A., & Bragg, M. A.
Journal titlePreventive Medicine Reports
Volume20AbstractSeveral U.S. jurisdictions have adopted policies requiring healthy beverage defaults on children's menus, but it is unknown whether such policies or restrictions leads to fewer calories ordered. We recruited 479 caregivers of children for an online choice experiment and instructed participants to order dinner for their youngest child (2–6 years) from two restaurant menus. Participants were randomly assigned to one type of menu: 1) standard beverages on children's menus (Control; n = 155); 2) healthy beverages on children's menus (water, milk, or 100% juice), with unhealthy beverages available as substitutions (Default; n = 162); or 3) healthy beverages on children's menus, with no unhealthy beverage substitutions (Restriction; n = 162). We used linear regression with bootstrapping to examine differences between conditions in calories ordered from beverages. Secondary outcomes included percent of participants ordering unhealthy beverages (full-calorie soda, diet soda, and/or sugar-sweetened fruit drinks) and calories from unhealthy beverages. Calories ordered from beverages did not differ across conditions at Chili's [Default: 97.6 (SD = 69.8); p = 0.82; Restriction: 102.7 (SD = 71.5); p = 0.99; Control: 99.4 (SD = 72.7)] or McDonald's [Default: 90.2 (SD = 89.1); p = 0.55; Restriction: 89.0 (SD = 81.0); p = 0.94; Control: 96.5 (SD = 95.2)]. There were no differences in the percent of orders or calories ordered from unhealthy beverages. Though Restriction participants ordered fewer calories from full-calorie soda [(3.0 (SD = 21.6)] relative to Control participants [13.4 (SD = 52.1); p = 0.04)] at Chili's, we observed no such difference between Default and Control participants, or across McDonald's conditions. Overall, there was no effect of healthy default beverages or restrictions in reducing total calories ordered from unhealthy beverages for children in our experiment.
Brands with personalities – good for businesses, but bad for public health? A content analysis of how food and beverage brands personify themselves on TwitterGreene, T., Seet, C., Barrio, A. R., McIntyre, D., Kelly, B., & Bragg, M. A.
Journal titlePublic Health Nutrition
Page(s)1-23AbstractObjective: To examine the extent to which food and beverage brands exhibit personalities on Twitter, quantify Twitter users’ engagement with posts displaying personality features, and quantify advertising spending across these brands on Twitter. Design: We identified 100 tweets from 10 food and beverage brands that displayed “personality,” and 100 “control” tweets (i.e., a post by that brand on the same day). Our codebook quantified the following personification strategies: 1) humor; 2) trendy language; and 3) absence of food product mentions. We used media articles to quantify other personification strategies: 4) referencing trending topics; 5) referencing current events; 6) referencing internet memes; and 7) targeting niche audiences. We calculated the brands’ number of tweets, re-tweets, “likes,” and comments and report the relationship between advertising spending and retweets per follower. Setting: Twitter posts. Participants: 10 food and beverage brands that were described in media articles (e.g., Forbes) as having distinct personalities. Results: Personality tweets earned 123,013 retweets, 732,076 “likes,” and 14,806 comments whereas control tweets earned 61,044 retweets, 256,105 “likes,” and 14,572 comments. The strategies used most included: humor (n=81), trendy language (n=80), and trending topics (n=47). The three brands that spent the most on advertising had similar or fewer retweets per follower than the four that spent relatively little on advertising. Conclusions: Some food and beverage brands have distinct “personalities” on Twitter that generate millions of “likes” and retweets. Some retweets have an inverse relationship with advertising spending, suggesting “personalities” may be a uniquely powerful advertising tool for targeting young adults.
Child Social Media Influencers and Unhealthy Food Product PlacementAlruwaily, A., Mangold, C., Greene, T., Arshonsky, J., Cassidy, O., Pomeranz, J. L., & Bragg, M.
Issue5AbstractOBJECTIVES: We aimed to determine the frequency with which kid influencers promote branded and unbranded food and drinks during their YouTube videos and assess the nutritional quality of food and drinks shown. METHODS: Researchers used Socialbakers data to identify the 5 most-watched kid influencers (ages 3 to 14 years) on YouTube in 2019. We searched for 50 of their most-watched videos and 50 of their videos that featured food and/or drinks on the thumbnail image of the video. We coded whether kid influencers consumed or played with food or toys, quantified the number of minutes food and/or drinks appeared, and recorded names of branded food and/or drinks. We assessed the nutritional quality of foods using the Nutrient Profile Model and identified the number of drinks with added sugar. RESULTS: A sample of 418 YouTube videos met the search criteria, and 179 of those videos featured food and/or drinks. Food and/or drinks were featured in those videos 291 times. Kid influencers’ YouTube videos were collectively viewed .48 billion times, and videos featuring food and/or drinks were viewed 1 billion times. Most food and/or drinks were unhealthy branded items (n = 263; 90.34%; eg, McDonald’s), followed by unhealthy unbranded items (n = 12; 4.1%; eg, hot dogs), healthy unbranded items (n = 9; 3.1%; eg, fruit), and healthy branded items (n = 7; 2.4%; eg, Yoplait yogurt). CONCLUSIONS: Kid influencers generate millions of impressions for unhealthy food and drink brands through product placement. The Federal Trade Commission should strengthen regulations regarding product placement on YouTube videos featuring young children.
Examining the relationship between youth-targeted food marketing expenditures and the demographics of social media followersRummo, P. E., Cassidy, O., Wells, I., Coffino, J. A., & Bragg, M. A.
Journal titleInternational journal of environmental research and public health
Issue5AbstractBackground: To determine how many adolescents follow food/beverage brands on Instagram and Twitter, and examine associations between brands’ youth-targeted marketing practices and percentages of adolescent followers. Methods: We purchased data from Demographics Pro to characterize the demographics of Twitter and Instagram users who followed 27 of the most highly advertised fast food, snack, and drink brands in 2019. We used one-sample t-tests to compare percentages of adolescent followers of the selected brands’ accounts versus all social media accounts, independent samples t-tests to compare followers of sugary versus low-calorie drink brands, and linear regression to examine associations between youth-targeted marketing practices and the percentages of adolescent followers. Results: An estimated 6.2 million adolescents followed the selected brands. A higher percentage of adolescents followed the selected brands’ accounts (9.2%) compared to any account on Twitter (1.2%) (p < 0.001), but not Instagram. A higher percentage of adolescents followed sugary (7.9%) versus low-calorie drink brands (4.3%) on Instagram (p = 0.02), but we observed the opposite pattern for adults on Twitter and Instagram. Television advertising expenditures were positively associated with percentages of adolescent followers of the selected brands on Twitter (p = 0.03), but not Instagram. Conclusions: Food and sugary drink brands maintain millions of adolescent followers on social media.
Fast food, beverage, and snack brands on social media in the United States: An examination of marketing techniques utilized in 2000 brand postsBragg, M. A., Pageot, Y. K., Amico, A., Miller, A. N., Gasbarre, A., Rummo, P. E., & Elbel, B.
Journal titlePediatric Obesity
Issue5AbstractBackground: Exposure to food advertisements is associated with poor diet among youth, and food and beverage companies are increasingly advertising on social media sites that are popular among youth. Objective: To identify the prevalence of social media advertising among fast food, beverage, and snack companies and examine advertising techniques they use on Instagram, Facebook, Twitter, Tumblr, and Vine. Methods: We quantified the increase in the creation of social media accounts from 2007 to 2016 among 200 fast food, beverage, and snack brands from the United States. We conducted content analyses to examine the marketing themes and healthfulness of products featured in 2000 posts from a subset of 20 brands and used multilevel regression to assess associations between marketing themes (eg, adolescents socializing) and interactive tools (eg, hashtags). Results: Two hundred brands collectively managed 568 accounts in 2016. Content analyses revealed that unique social media features (eg, geo-tags) appeared in 74.5% (n = 1489) of posts, and 31.5% (n = 630) were interactive. Posts featuring adolescents were more likely to be interactive than posts featuring adults (P < 0.001). Two-thirds (67.9%; n = 362) of foods shown were unhealthy, and 61.2% (n = 435) of beverages were sugar sweetened. Conclusions: Social media food advertising is pervasive and uses interactive tools to engage with users.
Food industry donations to academic programs: A cross-sectional examination of the extent of publicly available dataBragg, M. A., Elbel, B., & Nestle, M.
Journal titleInternational journal of environmental research and public health
Issue5AbstractNo studies have documented the prevalence of the food industry’s funding of academic programs, which is problematic because such funding can create conflicts of interest in research and clinical practice. We aimed to quantify the publicly available information on the food industry’s donations to academic programs by documenting the amount of donations given over time, categorizing the types of academic programs that receive food industry donations, cataloguing the source of the donation information, and identifying any stated reasons for donations. Researchers cataloged online data from publicly available sources (e.g., official press releases, news articles, tax documents) on the food industry’s donations to academic programs from 2000 to 2016. Companies included 26 food and beverage corporations from the 2016 Fortune 500 list in the United States. Researchers recorded the: (1) monetary value of the donations; (2) years the donations were distributed; (3) the name and type of recipient; (4) source of donation information; and (5) reasons for donations. Adjusting for inflation, we identified $366 million in food industry donations (N = 3274) to academic programs. Universities received 45.2% (n = 1480) of donations but accounted for 67.9% of total dollars given in the sample. Community colleges, schools (i.e., preschool, elementary, middle, and high schools), and academic nonprofits, institutes, foundations, and research hospitals collectively received 54.8% of the donations, but made up less than one-third of the monetary value of donations. Half of the donations (49.0%) did not include a stated reason for the donation. In our sample, donations grew from $3 million in 2000 to $24 million in 2016. Food companies in our sample donated millions of dollars to universities and other academic programs but disclosed little information on the purpose of the donations. Achieving transparency in donation practices may only be possible if federal policies begin to require disclosures or if companies voluntarily disclose information.
Trends in Store-Level Sales of Sugary Beverages and Water in the U.S., 2006–2015Rummo, P. E., Pho, N., Bragg, M. A., Roberto, C. A., & Elbel, B.
Journal titleAmerican journal of preventive medicine
Page(s)522-529AbstractIntroduction: Previous research on sugar-sweetened beverage trends has focused on self-reported consumption from surveys. Few studies used objective store sales or explored differences by area-level demographics and store type. Methods: The average volume of beverages sold per store per 3-digit zoning improvement plan code from 2006 to 2015 was calculated using national Nielsen Retail Scanner point-of-sale data from 24,240 stores. A multilevel regression model analyzed annual trends, with random intercepts for state and separate models for beverage type (regular soda, no/low-calorie soda, other sugary drinks, 100% fruit juice, bottled water). Differences by store type (convenience, supermarkets, drug stores, mass merchandisers) and area-level demographics (categorized as tertiles) were examined. Data were analyzed in 2019. Results: The model-based estimates indicated that sales of regular soda (−11.8%), no/low-calorie soda (−19.8%), and 100% fruit juice (−31.9%) decreased over time, whereas sales of bottled water (+34.4%) increased and sales of other sugary drinks remained stable (+2.4%). Decreases in sugar-sweetened beverage sales were largely concentrated in supermarkets and larger in areas with high income and education levels and a high percentage of black and Hispanic people. There were also relatively larger increases in bottled water sales in states located in the South and Midwest. Conclusions: The finding that sales of sugar-sweetened beverages decreased over time, whereas sales of bottled water increased is encouraging because sugar-sweetened beverage consumption is linked to obesity and other chronic conditions. This study provides a novel, rigorous assessment of U.S. beverage sales trends and differences by community and store characteristics.
Ubiquity of Sugary Drinks and Processed Food Throughout Food and Non-Food Retail Settings in NYCMezzacca, T. A., Anekwe, A. V., Farley, S. M., Kessler, K. A., Rosa, M. Q., Bragg, M. A., & Rummo, P. E.
Journal titleJournal of Community Health
Page(s)973-978AbstractSugary drinks and processed foods are associated with negative health outcomes in adults, including weight gain, and their consumption should be limited. However, they may be difficult to avoid if they are ubiquitously available in the retail environment. This study aimed to quantify the availability of such products for sale throughout New York City (NYC) at both food and non-food retailers. In 2018, ten one-mile retail-dense NYC street segments were selected for the sample. Data collectors canvassed each segment and visited all retailers, recording the type (food/non-food) and presence of processed food and beverages for sale. Descriptive statistics were analyzed for availability of products sold in retailers overall and by retailer type. In total, 491 retailers were identified (191 food, 300 non-food). Sugary drinks were available at 83% of food retailers and 19% of non-food retailers, while processed foods were available at 61% of food retailers and 16% of non-food retailers. Eighty-five percent of food retailers and 21% of non-food retailers sold sugary drinks and/or processed foods. This study supports and builds on results of previous research examining the availability of food and beverages in the retail environment. Sugary drinks and processed foods are ubiquitous at food and non-food retailers, providing pervasive cues to consume energy-dense, nutrient-poor products. Restrictions on where such products can be sold merit consideration.
Understanding the extent of adolescents’ willingness to engage with food and beverage companies’ instagram accounts: Experimental survey studyLutfeali, S., Ward, T., Greene, T., Arshonsky, J., Seixas, A., Dalton, M., & Bragg, M. A.
Journal titleJMIR Public Health and Surveillance
Issue4AbstractBackground: Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents’ online relationships with unhealthy food brands. Objective: We aimed to understand the extent to which adolescents’ preferences for Instagram food ads are shaped by the presence of comments and varying numbers of “likes.” We hypothesized that adolescents would show the highest preferences for ads with more “likes” and comments. We predicted that these differences would be greater among adolescents who were “heavy social media users” (ie, >3 hours daily) vs “light social media users” (ie, <3 hours daily). Methods: We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of “likes.” Adolescents reported ad preferences and willingness to engage with the brand. Results: Adolescents rated ads with medium or high numbers of “likes” higher than ads with few “likes” (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001). Conclusions: Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many “likes,” demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children’s Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years.
Evaluating the influence of racially targeted food and beverage advertisements on Black and White adolescents’ perceptions and preferencesBragg, M. A., Miller, A. N., Kalkstein, D. A., Elbel, B., & Roberto, C. A.
Page(s)41-49AbstractIntroduction: The present study measures how racially-targeted food and beverage ads affect adolescents’ attitudes toward ads and brands, purchase intentions for advertised products, and willingness to engage with brands on social media. Methods: Black and White adolescents were recruited through Survey Sampling International in 2016. Participants completed an online survey in which they were randomized to view either four food and beverage ads (e.g., soda, candy commercials)featuring Black actors or four food and beverage ads featuring White actors. Results: For the two components of the attitudinal outcome, Black participants were more likely to report a positive affective response toward racially-similar ads compared to Whites. However, White participants were more likely to like ads that were racially-dissimilar compared to Black participants. Data were analyzed in 2016–2017, and we used an alpha level of 0.05 to denote statistical significance. Conclusions: Both Black and White adolescents reported more positive affective responses to ads that featured Blacks compared to ads that featured Whites. Because there were no differences on two outcomes, future research should examine the influence of racially-targeted marketing in real-world contexts (e.g., social media)and longitudinal exposure to targeted advertising on dietary behavior.
Comparing five front-of-pack nutrition labels’ influence on consumers’ perceptions and purchase intentionsGorski Findling, M. T., Werth, P. M., Musicus, A. A., Bragg, M. A., Graham, D. J., Elbel, B., & Roberto, C. A.
Journal titlePreventive Medicine
Page(s)114-121AbstractIn 2011, a National Academy of Medicine report recommended that packaged food in the U.S. display a uniform front-of-package nutrition label, using a system such as a 0–3 star ranking. Few studies have directly compared this to other labels to determine which best informs consumers and encourages healthier purchases. In 2013, we randomized adult participants (N = 1247) in an Internet-based survey to one of six conditions: no label control; single traffic light; multiple traffic light; Facts Up Front; NuVal; or 0–3 star ranking. We compared groups on purchase intentions and accuracy of participants’ interpretation of food labels. There were no differences in the nutritional quality of hypothetical shopping baskets across conditions (p = 0.845). All labels improved consumers’ abilities to judge the nutritional quality of foods relative to no label, but the best designs varied by outcomes. NuVal and multiple traffic light labels led to the greatest accuracy identifying the healthier of two products (p < 0.001), while the multiple traffic light also led to the most accurate estimates of saturated fat, sugar, and sodium (p < 0.001). The single traffic light outperformed other labels when participants compared nutrient levels between similar products (p < 0.03). Single/multiple traffic light and Facts Up Front labels led to the most accurate calories per serving estimations (p < 0.001). Although front-of-package labels helped participants more accurately assess products’ nutrition information relative to no label, no conditions shifted adults’ purchase intentions. Results did not point to a clearly superior label design, but they suggest that a 3-star label might not be best for educating consumers.
Marketing Food and Beverages to Youth Through SportsBragg, M. A., Roberto, C. A., Harris, J. L., Brownell, K. D., & Elbel, B.
Journal titleJournal of Adolescent Health
Page(s)5-13AbstractFood and beverage marketing has been identified as a major driver of obesity yet sports sponsorship remains common practice and represents millions of dollars in advertising expenditures. Research shows that food and beverage products associated with sports (e.g., M&M's with National Association for Stock Car Auto Racing logo) generate positive feelings, excitement, and a positive self-image among adults and children. Despite this, self-regulatory pledges made by food companies to limit exposure of unhealthy products to children have not improved the nutritional quality of foods marketed to children. We reviewed the literature about sports-related food marketing, including food and beverage companies’ use of sports sponsorships, athlete endorsements, and sports video games. This review demonstrates that sports sponsorships with food and beverage companies often promote energy-dense, nutrient-poor products and while many of these promotions do not explicitly target youth, sports-related marketing affects food perceptions and preferences among youth. Furthermore, endorsement of unhealthy products by professional athletes sends mixed messages; although athletes may promote physical activity, they simultaneously encourage consumption of unhealthy products that can lead to negative health outcomes. We argue that more athletes and sports organizations should stop promoting unhealthy foods and beverages and work with health experts to encourage healthy eating habits among youth.
Sports sponsorships of food and nonalcoholic beveragesBragg, M. A., Miller, A. N., Roberto, C. A., Sam, R., Sarda, V., Harris, J. L., & Brownell, K. D.
Issue4AbstractBACKGROUND: Food and nonalcoholic beverage companies spend millions of dollars on professional sports sponsorships, yet this form of marketing is understudied. These sponsorships are valuable marketing tools but prompt concerns when unhealthy products are associated with popular sports organizations, especially those viewed by youth. METHODS: This descriptive study used Nielsen audience data to select 10 sports organizations with the most 2-17 year old viewers of 2015 televised events. Sponsors of these organizations were identified and assigned to product categories. We identified advertisements promoting food and/or nonalcoholic beverage sponsorships on television, YouTube, and sports organization Web sites from 2006 to 2016, and the number of YouTube advertisement views. The nutritional quality of advertised products was assessed. RESULTS: Youth watched telecasts associated with these sports organizations over 412 million times. These organizations had 44 food and/or nonalcoholic beverage sponsors (18.8% of sponsors), second to automotive sponsors (n = 46). The National Football League had the most food and/or nonalcoholic beverage sponsors (n = 10), followed by the National Hockey League (n = 7) and Little League (n = 7). We identified 273 advertisements that featured food and/or nonalcoholic beverage products 328 times and product logos 83 times (some advertisements showed multiple products). Seventy-six percent (n = 132) of foods had unhealthy nutrition scores, and 52.4% (n = 111) of nonalcoholic beverages were sugarsweetened. YouTube sponsorship advertisements totaled 195.6 million views. CONCLUSIONS: Sports sponsorships are commonly used to market unhealthy food and nonalcoholic beverages, exposing millions of consumers to these advertisements.
Supermarket retailers' perspectives on healthy food retail strategies: In-depth interviewsMartinez, O., Rodriguez, N., Mercurio, A., Bragg, M., & Elbel, B.
Journal titleBMC public health
Issue1AbstractBackground: Excess calorie consumption and poor diet are major contributors to the obesity epidemic. Food retailers, in particular at supermarkets, are key shapers of the food environment which influences consumers' diets. This study seeks to understand the decision-making processes of supermarket retailers - including motivators for and barriers to promoting more healthy products - and to catalogue elements of the complex relationships between customers, suppliers, and, supermarket retailers. Methods: We recruited 20 supermarket retailers from a convenience sample of full service supermarkets and national supermarket chain headquarters serving low- and high-income consumers in urban and non-urban areas of New York. Individuals responsible for making in-store decisions about retail practices engaged in online surveys and semi-structured interviews. We employed thematic analysis to analyze the transcripts. Results: Supermarket retailers, mostly representing independent stores, perceived customer demand and suppliers' product availability and deals as key factors influencing their in-store practices around product selection, placement, pricing, and promotion. Unexpectedly, retailers expressed a high level of autonomy when making decisions about food retail strategies. Overall, retailers described a willingness to engage in healthy food retail and a desire for greater support from healthy food retail initiatives. Conclusions: Understanding retailers' in-store decision making will allow development of targeted healthy food retail policy approaches and interventions, and provide important insights into how to improve the food environment.
A content analysis of outdoor non-alcoholic beverage advertisements in GhanaBragg, M. A., Hardoby, T., Pandit, N. G., Raji, Y. R., & Ogedegbe, G.
Journal titleBMJ open
Issue5AbstractObjectives This was a two-part descriptive study designed to (1) assess the marketing themes and sugar content of beverages promoted in outdoor advertisements (ads) within a portion of Accra, Ghana and (2) quantify the types of ads that appeared along the Accra-Cape Coast Highway. Setting A 4.7 km 2 area of Accra, Ghana and a 151 km region along the highway represented the target areas for collecting photos of outdoor beverage ads. Primary and secondary outcome measures Number and types of beverage ads, sugar content of beverage products featured in ads and marketing themes used in ads. Design Two researchers photographed outdoor beverage ads in a 4.7 km 2 area of Accra and used content analysis to assess marketing themes of ads, including the portrayal of children, local culture, music, sports and health. Researchers also recorded the number and type of ads along a 151 km stretch of the Accra-Cape Coast Highway. Researchers assessed the added sugar content to determine which beverages were sugar-sweetened beverages (SSBs). Results Seventy-seven photographed ads were analysed. Seventy-three per cent (72.7%) of ads featured SSBs, and Coca-Cola accounted for 59.7% of ads. Sixty-five per cent (64.9%) of all ads featured sodas, while 35.1% advertised energy drinks, bottled or canned juice drinks and coffee-based, milk-based and water-based beverages. Thirteen per cent (13%) of ads featured children and 5.2% were located near schools or playgrounds. Nine per cent (9.1%) of ads contained a reference to health and 7.8% contained a reference to fitness/strength/sport. Along the Accra-Cape Coast Highway, Coca-Cola accounted for 60% of branded ads. Conclusion This study demonstrates the frequency of outdoor SSB ads within a 4.7 km 2 area of Accra, Ghana. Coca-Cola was featured in the majority of ads, and the child-targeted nature of some ads indicates a need to expand the Children's Food and Beverage Advertising Initiative pledge to reduce child-targeted marketing on a global scale.
Comparison of online marketing techniques on food and beverage companies' websites in six countriesBragg, M. A., Eby, M., Arshonsky, J., Bragg, A., & Ogedegbe, G.
Journal titleGlobalization and Health
Issue1AbstractFood and beverage marketing contributes to poor dietary choices among adults and children. As consumers spend more time on the Internet, food and beverage companies have increased their online marketing efforts. Studies have shown food companies' online promotions use a variety of marketing techniques to promote mostly energy-dense, nutrient-poor products, but no studies have compared the online marketing techniques and nutritional quality of products promoted on food companies' international websites. For this descriptive study, we developed a qualitative codebook to catalogue the marketing themes used on 18 international corporate websites associated with the world's three largest fast food and beverage companies (i.e. Coca-Cola, McDonald's, Kentucky Fried Chicken). Nutritional quality of foods featured on those websites was evaluated based on quantitative Nutrient Profile Index scores and food category (e.g. fried, fresh). Beverages were sorted into categories based on added sugar content. We report descriptive statistics to compare the marketing techniques and nutritional quality of products featured on the company websites for the food and beverage company websites in two high-income countries (HICs), Germany and the United States, two upper-middle-income countries (UMICs), China and Mexico, and two lower-middle-income countries (LMICs), India and the Philippines. Of the 406 screenshots captured from company websites, 678% depicted a food or beverage product. HICs' websites promoted diet food or beverage products/healthier alternatives (e.g. baked chicken sandwich) significantly more often on their pages (25%), compared to LMICs (145%). Coca-Cola featured diet products significantly more frequently on HIC websites compared to LMIC websites. Charities were featured more often on webpages in LMICs (154%) compared to UMICs (26%) and HICs (23%). This study demonstrates that companies showcase healthier products in wealthier countries and advertise their philanthropic activities in lower income countries, which is concerning given the negative effect of nutrition transition (double burden of overnutrition and undernutrition) on burden of non-communicable diseases and obesity in lower income countries.
Content analysis of targeted food and beverage advertisements in a Chinese-American neighbourhoodBragg, M. A., Pageot, Y. K., Hernández-Villarreal, O., Kaplan, S. A., & Kwon, S. C.
Journal titlePublic Health Nutrition
Page(s)2208-2214AbstractObjectives The current descriptive study aimed to: (i) quantify the number and type of advertisements (ads) located in a Chinese-American neighbourhood in a large, urban city; and (ii) catalogue the targeted marketing themes used in the food/beverage ads. Design Ten pairs of trained research assistants photographed all outdoor ads in a 0·6 mile2 (1·6 km2) area where more than 60·0 % of residents identify as Chinese American. We used content analysis to assess the marketing themes of ads, including references to: Asian cultures; health; various languages; children; food or beverage type (e.g. sugar-sweetened soda). Setting Lower East Side, a neighbourhood located in the borough of Manhattan in New York City, USA. Subjects Ads (n 1366) in the designated neighbourhood. Results Food/beverage ads were the largest ad category (29·7 %, n 407), followed by services (e.g. mobile phone services; 21·0 %, n 288). Sixty-seven per cent (66·9 %) of beverages featured were sugar-sweetened, and 50·8 % of food ads promoted fast food. Fifty-five per cent (54·9 %) of food/beverage ads targeted Asian Americans through language, ethnicity of person(s) in the ad or inclusion of culturally relevant images. Fifty per cent (50·2 %) of ads were associated with local/small brands. Conclusions Food/beverage marketing practices are known to promote unhealthy food and beverage products. Research shows that increased exposure leads to excessive short-term consumption among consumers and influences children's food preferences and purchase requests. Given the frequency of racially targeted ads for unhealthy products in the current study and increasing rates of obesity-related diseases among Asian Americans, research and policies should address the implications of food and beverage ads on health.
Geospatial clustering in sugar-sweetened beverage consumption among Boston youthTamura, K., Duncan, D. T., Athens, J. K., Bragg, M. A., Rienti, M., Aldstadt, J., Scott, M. A., & Elbel, B.
Journal titleInternational Journal of Food Sciences and Nutrition
Page(s)719-725AbstractThe objective was to detect geospatial clustering of sugar-sweetened beverage (SSB) intake in Boston adolescents (age = 16.3 ± 1.3 years [range: 13–19]; female = 56.1%; White = 10.4%, Black = 42.6%, Hispanics = 32.4%, and others = 14.6%) using spatial scan statistics. We used data on self-reported SSB intake from the 2008 Boston Youth Survey Geospatial Dataset (n = 1292). Two binary variables were created: consumption of SSB (never versus any) on (1) soda and (2) other sugary drinks (e.g., lemonade). A Bernoulli spatial scan statistic was used to identify geospatial clusters of soda and other sugary drinks in unadjusted models and models adjusted for age, gender, and race/ethnicity. There was no statistically significant clustering of soda consumption in the unadjusted model. In contrast, a cluster of non-soda SSB consumption emerged in the middle of Boston (relative risk = 1.20, p =.005), indicating that adolescents within the cluster had a 20% higher probability of reporting non-soda SSB intake than outside the cluster. The cluster was no longer significant in the adjusted model, suggesting spatial variation in non-soda SSB drink intake correlates with the geographic distribution of students by race/ethnicity, age, and gender.
Using behavioral economics to improve dietary intakeBragg, M. A., & Elbel, B. In Behavioral Economics and Healthy Behaviors: Alternatives to regulation, bans, and taxation.
Perceived spatial stigma, body mass index and blood pressure: A global positioning system study among low-income housing residents in New York CityDuncan, D. T., Ruff, R. R., Chaix, B., Regan, S. D., Williams, J. H., Ravenell, J., Bragg, M. A., Ogedegbe, G., & Elbel, B.
Journal titleGeospatial Health
Page(s)164-173AbstractPrevious research has highlighted the salience of spatial stigma on the lives of low-income residents, but has been theoretical in nature and/or has predominantly utilised qualitative methods with limited generalisability and ability to draw associations between spatial stigma and measured cardiovascular health outcomes. The primary objective of this study was to evaluate relationships between perceived spatial stigma, body mass index (BMI), and blood pressure among a sample of low-income housing residents in New York City (NYC). Data come from the community-based NYC Low-income Housing, Neighborhoods and Health Study. We completed a crosssectional analysis with survey data, which included the four items on spatial stigma, as well objectively measured BMI and blood pressure data (analytic n=116; 96.7% of the total sample). Global positioning systems (GPS) tracking of the sample was conducted for a week. In multivariable models (controlling for individual-level age, gender, race/ethnicity, education level, employment status, total household income, neighborhood percent non-Hispanic Black and neighborhood median household income) we found that participants who reported living in an area with a bad neighborhood reputation had higher BMI (B=4.2, 95%CI: -0.01, 8.3, P=0.051), as well as higher systolic blood pressure (B=13.2, 95%CI: 3.2, 23.1, P=0.01) and diastolic blood pressure (B=8.5, 95%CI: 2.8, 14.3, P=0.004). In addition, participants who reported living in an area with a bad neighborhood reputation had increased risk of obesity/overweight [relative risk (RR)=1.32, 95%CI: 1.1, 1.4, P=0.02) and hypertension/pre-hypertension (RR=1.66, 95%CI: 1.2, 2.4, P=0.007). However, we found no differences in spatial mobility (based GPS data) among participants who reported living in neighborhoods with and without spatial stigma (P>0.05). Further research is needed to investigate how placebased stigma may be associated with impaired cardiovascular health among individuals in stigmatised neighborhoods to inform effective cardiovascular risk reduction interventions.
Popular music celebrity endorsements in food and nonalcoholic beverage marketingBragg, M. A., Miller, A. N., Elizee, J., Dighe, S., & Elbel, B. D.
Issue1AbstractBACKGROUND: Food and beverage marketing has been associated with childhood obesity. We quantified the number and type of food or beverage brands promoted by music celebrities, assessed the nutritional quality of the products, and examined Teen Choice Award data to assess the celebrities' popularity among adolescents. METHODS: This was a descriptive study. A list of music celebrities associated with the 2013 and 2014 Billboard Hot 100 Chart, which ranks songs according to sales and radio impressions, was compiled. Data on celebrity endorsements were gathered from official company Web sites, YouTube commercials, an advertising database, and media reports. Nutritional quality of foods was assessed according to the Nutrient Profile Index, whereas nonalcoholic beverages were evaluated based on calories from added sugar. Teen Choice Award nominations were used to measure the celebrities' popularity among adolescents. RESULTS: Of the 590 endorsements made by the 163 celebrities in the sample, consumer goods (eg, fragrances, makeup) represented the largest endorsement category (26%), followed by food and beverage (18%) and retail (11%). Sixty-five celebrities were collectively associated with 57 different food and beverage brands owned by 38 parent companies. Of these 65 celebrities, 53 (81.5%) had ≥1 Teen Choice Award nomination. Forty-nine (71%) of the 69 nonalcoholic beverage references promoted sugar-sweetened beverages. Twenty-one (80.8%) of the 26 endorsed foods were energy dense and nutrient poor. Baauer, will.i.am, Justin Timberlake, Maroon 5, and Britney Spears had the most food and beverage endorsements. CONCLUSIONS: This study demonstrates that music celebrities who are popular among adolescents endorse energy-dense, nutrient-poor products.