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
Evaluating the influence of racially targeted food and beverage advertisements on Black and White adolescents’ perceptions and preferencesBragg, M., Miller, A. N., Kalkstein, D. A., Elbel, B. D., & Roberto, C. A.
Page(s)41-49Introduction: 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.
Sports sponsorships of food and nonalcoholic beveragesBragg, M., Miller, A. N., Roberto, C. A., Sam, R., Sarda, V., Harris, J. L., & Brownell, K. D.
Issue4BACKGROUND: 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.
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
Issue5Objectives 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.
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., Graham, D. J., Elbel, B. D., & Roberto, C. A.
Journal titlePreventive MedicineIn 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.
Comparison of online marketing techniques on food and beverage companies' websites in six countriesBragg, M., Eby, M., Arshonsky, J., Bragg, A., & Ogedegbe, O.
Journal titleGlobalization and Health
Issue1Food 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., Pageot, Y. K., Hernández-Villarreal, O., Kaplan, S., & Kwon, S. C.
Journal titlePublic Health Nutrition
Page(s)1-7Objectives: 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)1-10The 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.
Marketing Food and Beverages to Youth Through SportsBragg, M., Roberto, C. A., Harris, J. L., Brownell, K. D., & Elbel, B. D.
Journal titleJournal of Adolescent HealthFood 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.
Using behavioral economics to improve dietary intakeBragg, M., & Elbel, B. D.
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)164-173Previous 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., Miller, A. N., Elizee, J., Dighe, S., & Elbel, B. D.
Issue1BACKGROUND: 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.
New York City healthy happy meals bill: Potential impact on fast food purchasesElbel, B. D., Mijanovich, T., Cantor, J., & Bragg, M.
Journal titleAmerican Journal of Preventive Medicine
Impact of a Culturally Sensitive Health Self-Empowerment Workshop Series on Health Behaviors/Lifestyles, Body Mass Index, and Blood Pressure of Culturally Diverse Overweight/Obese AdultsTucker, C. M., Butler, A., Kaye, L. B., Nolan, S. E. M., Flenar, D. J., Marsiske, M., Bragg, M., Hoover, E., & Daly, K.
Journal titleAmerican Journal of Lifestyle Medicine
Page(s)122-132Objective. To examine the impact of the health self-empowerment theory-based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (body mass index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low-income households. Design. A total of 153 overweight/obese adults participated in an immediate treatment (IT) group (n = 100) or a waitlist control (WC) group (n = 53). Results. Post-intervention, the IT group compared with the WC group reported (a) significantly higher engagement in physical activity and healthy eating; (b) significantly less intake of calories, total fat, trans fat, saturated fat, sugar, and added sugar; (c) significantly higher motivators for engaging in 2 of 4 specific health-smart behaviors; (d) significantly lower barriers to engaging in 3 of 4 specific health-smart behaviors; and (e) significantly lower BMI and systolic blood pressure. Conclusion. The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults-individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.
Athlete endorsements in food marketingBragg, M., Yanamadala, S., Roberto, C. A., Harris, J. L., & Brownell, K. D.
Page(s)805-810OBJECTIVE: This study quantified professional athletes' endorsement of food and beverages, evaluated the nutritional quality of endorsed products, and determined the number of television commercial exposures of athlete-endorsement commercials for children, adolescents, and adults. METHODS: One hundred professional athletes were selected on the basis of Bloomberg Businessweek's 2010 Power 100 rankings, which ranks athletes according to their endorsement value and prominence in their sport. Endorsement information was gathered from the Power 100 list and the advertisement database AdScope. Endorsements were sorted into 11 endorsement categories (eg, food/beverages, sports apparel). The nutritional quality of the foods featured in athlete-endorsement advertisements was assessed by using a Nutrient Profiling Index, whereas beverages were evaluated on the basis of the percentage of calories from added sugar. Marketing data were collected from AdScope and Nielsen. RESULTS: Of 512 brands endorsed by 100 different athletes, sporting goods/apparel represented the largest category (28.3%), followed by food/beverages (23.8%) and consumer goods (10.9%). Professional athletes in this sample were associated with 44 different food or beverage brands during 2010. Seventy-nine percent of the 62 food products in athlete-endorsed advertisements were energy-dense and nutrient-poor, and 93.4% of the 46 advertised beverages had 100% of calories from added sugar. Peyton Manning (professional American football player) and LeBron James (professional basketball player) had the most endorsements for energy-dense, nutrient-poor products. Adolescents saw the most television commercials that featured athlete endorsements of food. CONCLUSIONS: Youth are exposed to professional athlete endorsements of food products that are energy-dense and nutrient-poor. Pediatrics 2013;132:805-810.
Examining the relationship between soda consumption and eating disorder pathologyBragg, M., & M., W.
Journal titleAdvances in Eating Disorders: Theory, Research and Practice
The science on front-of-package food labelsHawley, K. L., Roberto, C. A., Bragg, M., Liu, P. J., Schwartz, M. B., & Brownell, K. D.
Journal titlePublic Health Nutrition
Page(s)430-439Objective The US Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research. Design A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011. Results Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation. Conclusions The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems' abilities to influence consumer behaviour is needed.
The use of sports references in marketing of food and beverage products in supermarketsBragg, M., Liu, P. J., Roberto, C. A., Sarda, V., Harris, J. L., & Brownell, K. D.
Journal titlePublic Health Nutrition
Page(s)738-742Objective Food marketing has been identified as a significant driver of the childhood obesity epidemic. The purpose of the present study was to (i) conduct a content analysis of the types of sports references that appear on supermarket food and beverage products and (ii) assess each product's nutritional and marketing profile. Design This was a descriptive study. Every product featuring sports references on the packaging was purchased in two major supermarkets during 2010. A content analysis was conducted and nutritional evaluations were made based on the Nutrient Profile Model, a validated nutrition model. Marketing data were obtained from The Nielsen Company. Setting Two major supermarkets in Connecticut, USA. Subjects Food and beverage products (n 102) were selected from two supermarkets. Results The 102 products (fifty-three foods and forty-nine beverages) had sports references as part of their packaging: 72·5 % featured a character exercising, 42·2 % were endorsed by a professional sports entity and 34·0 % were child-targeted. The median nutrition score for food products was 36 (1 = unhealthiest and 100 = healthiest; scores of ≥63 are considered healthy according to this model). More than two-thirds of beverages (69·4 %) were 100 % sugar-sweetened. Children saw significantly more commercials for these products than adults. Conclusions Companies place sports figures on food and beverage products that are child-targeted and unhealthy.
Choosing front-of-package food labelling nutritional criteria: How smart were 'Smart Choices'?Roberto, C. A., Bragg, M., Livingston, K. A., Harris, J. L., Thompson, J. M., Seamans, M. J., & Brownell, K. D.
Journal titlePublic Health Nutrition
Page(s)262-267Objective The 'Smart Choices' programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as 'Smart Choices' could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry- developed, validated nutritional standard. Design A total of 100 packaged products that qualified for a 'Smart Choices' designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method.Results In all, 64 % of the products deemed 'Smart Choices' did not meet the NPM standard for a healthy product. Within each 'Smart Choices' category, 0 % of condiments, 8•70 % of fats and oils, 15•63 % of cereals and 31•58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed 'Smart Choices' were considered healthy according to the NPM standard. Conclusions The 'Smart Choices' programme is an example of industries' attempts at self-regulation. More than 60 % of foods that received the 'Smart Choices' label did not meet standard nutritional criteria for a 'healthy' food choice, suggesting that industries' involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.
Evaluation of consumer understanding of different front-of-package nutrition labels, 2010-2011Roberto, C. A., Bragg, M., Seamans, M. J., Mechulan, R. L., Novak, N., & Brownell, K. D.
Journal titlePreventing chronic disease
Issue9Introduction: Governments throughout the world are using or considering various front-of-package (FOP) food labeling systems to provide nutrition information to consumers. Our web-based study tested consumer understanding of different FOP labeling systems. Methods: Adult participants (N = 480) were randomized to 1 of 5 groups to evaluate FOP labels: 1) no label; 2) multiple traffic light (MTL); 3) MTL plus daily caloric requirement icon (MTL+caloric intake); 4) traffic light with specific nutrients to limit based on food category (TL+SNL); or 5) the Choices logo. Total percentage correct quiz scores were created reflecting participants' ability to select the healthier of 2 foods and estimate amounts of saturated fat, sugar, and sodium in foods. Participants also rated products on taste, healthfulness, and how likely they were to purchase the product. Quiz scores and product perceptions were compared with 1-way analysis of variance followed by post-hoc Tukey tests. Results: The MTL+caloric intake group (mean [standard deviation], 73.3% [6.9%]) and Choices group (72.5% [13.2%]) significantly outperformed the no label group (67.8% [10.3%]) and the TL+SNL group (65.8% [7.3%]) in selecting the more healthful product on the healthier product quiz. The MTL and MTL+caloric intake groups achieved average scores of more than 90% on the saturated fat, sugar, and sodium quizzes, which were significantly better than the no label and Choices group average scores, which were between 34% and 47%. Conclusion: An MTL+caloric intake label and the Choices symbol hold promise as FOP labeling systems and require further testing in different environments and population subgroups.
Facts up front versus traffic light food labels: A randomized controlled trialRoberto, C. A., Bragg, M., Schwartz, M. B., Seamans, M. J., Musicus, A., Novak, N., & Brownell, K. D.
Journal titleAmerican Journal of Preventive Medicine
Page(s)134-141Background: The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thousands of food products. Purpose: To test consumer understanding of the Facts Up Front system (Facts Up Front) compared to the Multiple Traffic Light system (Traffic Light). Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients; Traffic Light uses an interpretive color-coded scheme to alert consumers to low, medium, and high levels of certain nutrients. Design: Participants in an Internet-based study were randomized to one of five front-of-package label conditions: (1) no label; (2) Traffic Light; (3) Traffic Light plus information about protein and fiber (Traffic Light+); (4) Facts Up Front; or (5) Facts Up Front plus information about "nutrients to encourage" (Facts Up Front+). Setting/ participants: A total of 703 adults recruited through an online database in May 2011 participated in this study, and data were analyzed in June 2011. Main outcome measures: Total percentage correct quiz scores were generated reflecting participants' ability to compare two foods on nutrient levels, based on their labels, and to estimate amounts of saturated fat, sugar, sodium, fiber and protein in the foods. Results: The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes (p80% on all quizzes). Conclusions: Overall, those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions. Trial registration: This study is registered at clinicaltrials.gov NCT01626729.
Food industry front groups and conflicts of interest: The case of Americans against food taxesYanamadala, S., Bragg, M., Roberto, C. A., & Brownell, K. D.
Journal titlePublic Health Nutrition
Obesity and public policyGearhardt, A. N., Bragg, M., Pearl, R. L., Schvey, N. A., Roberto, C. A., & Brownell, K. D.
Journal titleAnnual Review of Clinical Psychology
Page(s)405-430There is a pressing need to reduce both the prevalence and impact of obesity. This review begins with a discussion of the roles of treatment and prevention. Two overriding issues, weight bias and the addictive nature of food, are covered because of their importance not only to the individuals affected but also to public policy. We then cover promising policy areas in which changes can be implemented to support healthy behaviors: school policy, food marketing, food labeling and packaging, and taxes on unhealthy foods. The roles of the food industry and federal, state, and local governments are also discussed. ©
Low-income children's reported motivators of and barriers to healthy eating behaviors: A focus group studyKaye, L. B., Tucker, C. M., Bragg, M., & Estampador, A. C.
Journal titleJournal of the National Medical Association
Page(s)941-951Background: Despite national attention to the childhood obesity epidemic, there are few US-based studies that directly ask children - especially children from low-income families and from multiple racial/ethnic groups - why they do or do not engage in healthy eating behaviors. Objective: The purpose of this study was to identify motivators of and barriers to healthy eating behaviors, as reported by black, Hispanic, and white children from low-income families. Method: Six gender- and race/ethnicity-concordant focus groups were conducted with 37 children who were aged 9 to 12 years and from families with an annual household income of $40 000 or less. Multiple strategies were used to employ a culturally sensitive approach to both data collection and data analysis (eg, a team of culturally diverse researchers utilized inductive qualitative analysis to analyze focus group transcripts). Results: The motivators of and barriers to healthy eating behaviors most commonly reported across the 6 focus groups included social influence, taste, issues of availability, weight concerns, and the desire to be healthy. A variety of less commonly reported motivators and barriers were also discussed. Findings were generally similar across gender and race/ethnicity. Conclusions: Children in this age range can indeed identify a variety of motivators and barriers that influence their engagement in healthy eating behaviors. Interventions targeting obesity and eating behaviors should include an assessment of children's own perceived motivators of and barriers to healthy eating.
An observational study of consumer use of fast-food restaurant drive-through lanes: Implications for menu labelling policyRoberto, C. A., Hoffnagle, E., Bragg, M., & Brownell, K. D.
Journal titlePublic Health Nutrition
Page(s)1826-1828Objective Some versions of restaurant menu labelling legislation do not require energy information to be posted on menus for drive-through lanes. The present study was designed to quantify the number of customers who purchase fast food through drive-in windows as a means of informing legislative labelling efforts.Design This was an observational study.Setting The study took place at two McDonalds and Burger King restaurants, and single Dairy Queen, Kentucky Fried Chicken, Taco Bell and Wendys restaurants.Subjects The number of customers entering the chain restaurants and purchasing food via the drive-through lane were recorded. A total of 3549 patrons were observed.Results The percentage of customers who made their purchases at drive-throughs was fifty-seven. The overall average (57 %) is likely a conservative estimate because some fast-food restaurants have late-night hours when only the drive-throughs are open.Conclusions Since nearly six in ten customers purchase food via the drive-through lanes, menu labelling legislation should mandate the inclusion of menu labels on drive-through menu boards to maximise the impact of this public health intervention.
Motivators of and barriers to engaging in physical activity: Perspectives of low-income culturally diverse adolescents and adultsBragg, M., Tucker, C. M., Kaye, L. B., & Desmond, F.
Journal titleAmerican Journal of Health Education
Page(s)146-154Background: Obesity rates are rising in the United States, especially among low-income and racial/ethnic minority individuals. Exploring motivators and barriers relative to engaging in physical activity is imperative. Purpose: The purpose of this study was to identify motivators and barriers relative to engagement in physical activity as reported by culturally diverse low-income adolescents and adults. Methods: A total of 91 adolescent (11 to 15 years of age) and adult (18 years of age or older) participants who self-identified as African American, Hispanic, or non-Hispanic White engaged in age group-, race/ethnicity-, and gender-concordant focus groups. Results: Qualitative data analysis indicated that the motivators and barriers most commonly identified among the adolescent and adult focus groups were: social influence; time and priorities; physical environment; fun and enjoyment; inherently physical activities; weight concerns; fatigue, physical discomfort and current fitness level; and immediate positive feelings. Discussion: Findings were generally similar across age group, gender and race/ethnicity. Age group-specific, gender-specific and race/ethnicity-specific motivators and barriers were related to how commonly the motivators and barriers were identified among each group. Translation to Health Education Practice: Implications for increasing physical activity among low-income culturally diverse adolescents and adults are discussed.