Marie Bragg

Marie Bragg
Marie Bragg

Assistant Professor of Public Health Nutrition

Professional overview

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.

Education

BS, Psychology and BA, English, University of Florida, Gainesville, FL
MS, Clinical Psychology, Yale University, New Haven, CT
MPhil, Clinical Psychology, Yale University, New Haven, CT
Clinical Internship, Montefiore Medical Center, Bronx, NY
PhD, Clinical Psychology, Yale University, New Haven, CT

Honors and awards

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)

Areas of research and study

Food
Nutrition
Obesity
Public Health Nutrition
Public Health Policy

Publications

Publications

Beverage Availability and Price: Variations by Neighborhood Poverty Level in New York City

Bragg, M. A., Rummo, P. E., Greene, T., Arshonsky, J., Anekwe, A. V., Mezzacca, T. A., & Farley, S. M. (n.d.).

Publication year

2022

Journal title

Health Equity

Volume

6

Issue

1

Page(s)

322-329
Abstract
Abstract
Objective: To describe the variability in the availability and price of sugary drinks, low-calorie drinks, and water/seltzer across high- and low-poverty census tracts in the five boroughs of New York City (NYC). Design: Cross-sectional study. Our primary analysis compared the overall sample of beverages. Secondary analyses included tests for differences in the availability of beverage categories by neighborhood poverty level. Setting: We collected data from 106 stores (31 supermarkets, 29 convenience stores, 29 pharmacies, 9 Targets, and 8 Dollar Trees) in NYC. Fifty-four stores were located in high-poverty census tracts and 52 were located in low-poverty census tracts. Results: The mean Price per 0.03-liter of sugary drinks across the sample was $0.08, which was significantly higher than the price of low-calorie drinks ($0.07, p=0.01) but not different from water/seltzer ($0.08, p=0.65). Sugary drinks and water/seltzer were available in 91% of retailers, and low-calorie drinks were available in 87% of retailers. There was no statistical difference in availability of sugary drinks compared with low-calorie drinks or water/seltzer overall or within high- or low-poverty census tracts. Analyzed by store type, the mean price per ounce of sugary drinks differed significantly from water/seltzer at convenience stores, pharmacies, and Target stores (bodegas: $0.08 vs. $0.09, p=0.03; pharmacies: $0.11 vs. $0.08, p=0.02; Target stores: $0.07 vs. $0.09, p=0.01). Conclusions: Sugary drinks were available in most food retail settings in NYC, with little variation by census tract poverty level. Interventions that raise the price of sugary drinks to make healthier alternatives, such as water, the more affordable option should be considered.

Brands with personalities - Good for businesses, but bad for public health? A content analysis of how food and beverage brands personify themselves on Twitter

Greene, T., Seet, C., Rodríguez Barrio, A., McIntyre, D., Kelly, B., & Bragg, M. A. (n.d.).

Publication year

2022

Journal title

Public Health Nutrition

Volume

25

Issue

1

Page(s)

51-60
Abstract
Abstract
Abstract Objective: To examine the extent to which food and beverage brands exhibit personalities on Twitter, quantify Twitter users' engagement with posts displaying personality features and determine advertising spending across these brands on Twitter. Design: We identified 100 tweets from 10 food and beverage brands that displayed a 'personality', and 100 'control' tweets (i.e. a post by that brand on the same day). Our codebook quantified the following personification strategies: (1) humour; (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 brands' number of tweets, re-tweets, 'likes', and comments and report the relationship between advertising spending and retweets per follower. Setting: Twitter posts. Participants: Ten 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 humour (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.

Comparing the Prevalence of Alcohol, Combustible and Electronic Cigarettes, Hookah, and Marijuana, in Music Videos across 6 Genres of Popular Music from 2014–2020

Albert, S. L., Rogers, E., Hall, Z., Zuardo, G., & Bragg, M. A. (n.d.).

Publication year

2022

Journal title

Substance Use and Misuse

Volume

57

Issue

6

Page(s)

967-974
Abstract
Abstract
Objectives: To determine the frequency of alcohol, marijuana, cigarettes/cigars, e-cigarettes, and hookah portrayals in popular music lyrics and videos on YouTube across 6 genres over 7 years; assess percent change over the years, document brand placement, and determine frequency of promotion of substances/devices by Teen Choice Award celebrities. Methods: We analyzed 699 songs from the Billboard Hot 100 between 2014 and 2020. Two raters coded 10% of the songs to establish inter-rater reliability and remaining songs were reviewed by one rater. Results: The majority of songs (59.2%) on YouTube included either lyrical or video depictions and 20.6% included both. Songs that featured substances/devices were viewed 148 billion times on YouTube as of February 2021. Nearly 25% of videos depicting substances/devices featured branding. Forty-three (18.22%) of the music celebrities who featured substances/devices in their videos received one or more Teen Choice Awards during the study period. Conclusions: Popular music celebrities promote substance use in their lyrics and music videos, which are easily accessible to children and adolescents. Some of these celebrities are highly popular and influential among adolescents. Policy Implications. Findings support the need to limit promotion of these substances to youth by influencers to reduce substance use and misuse.

Comparisons of Culturally Targeted Food and Beverage Advertisements in Caribbean-American Neighborhood and Non-Latinx White Neighborhood in New York City

Milan, C. C., Singh, K. R., Burac, A., Janak, A. P., Gu, Y., & Bragg, M. A. (n.d.).

Publication year

2022

Journal title

Health Equity

Volume

6

Issue

1

Page(s)

72-80
Abstract
Abstract
Purpose: This descriptive study aimed to (1) compare the number of food and beverage advertisements (ads) located in a Caribbean-American neighborhood and non-Latinx white neighborhood in New York City (NYC), and (2) qualitatively assess and compare the culturally targeted marketing themes of the food and beverage advertisements in both neighborhoods. Methods: Three research assistants photographed all outdoor food and beverage advertisements (n=361) across a 1.6 kilometer distance on a high-retail street in a Caribbean-American neighborhood and a non-Latinx white neighborhood. We used content analysis to evaluate advertising themes, and sorted food into nutritional categories (e.g., fast food and alcohol). We identified two neighborhoods with similar income levels in Queens, NYC, USA - South Ozone Park residents are predominantly non-white Caribbean Americans based on data from the NYC Department of City Planning, whereas residents of Steinway are predominantly non-Latinx white. Results: We identified a significantly higher proportion of fast-food advertisements in the Caribbean-American neighborhood (19.78%, n=36) compared with the non-Latinx white neighborhood (5.03%, n=9; p<0.001). Among beverage advertisements, 30.77% (n=56) featured alcohol brands in the Caribbean-American neighborhood, whereas 22.91% (n=41) featured alcohol brands in the non-Latinx white neighborhood. In the Caribbean-American neighborhood, 24.18% (n=44) of food and beverage advertisements referenced Caribbean culture. Conclusions: The Caribbean-American neighborhood in this study had more fast-food advertisements relative to non-Latinx white neighborhoods. More research is needed to understand the effects of culturally targeted ads on Caribbean-American communities.

Food industry donations to patient-advocacy organizations focused on non-communicable diseases

Del Giudice, I. M., Tsai, K. A., Arshonsky, J., Bond, S., & Bragg, M. A. (n.d.).

Publication year

2022

Journal title

Public Health Nutrition
Abstract
Abstract
Objective: This study used publicly available Form 990 tax documents to quantify food industry donations to patient-advocacy organizations (PAOs) dedicated to supporting patients with non-communicable diseases. Design: Observational, cross-sectional assessment of significant national and international food industry donations to U.S.-based non-communicable disease-focused PAOs between 2000 and 2018. Researchers recorded and categorized the: (1) frequency and value of donations, (2) reason for donation, (3) name and type of PAO recipient, and (4) non-communicable disease focus of the PAO. Setting: Form 990 tax documents. Participants: Nine food and beverage companies that donated to non-communicable disease-focused PAOs. Results: Adjusting for inflation, nine food and beverage companies collectively donated $10,672,093 (n=2709) to the PAOs between 2001-2018. The largest category of donations was "matching gifts"(67.9%, median amount=$115.16), followed by "general operations support"(25.8%, median amount=$107.79). Organizations focusing on cancer received the largest number and amount of donations ($6,265,861, n=1,968). Eight of the nine companies made their largest monetary value of donation to PAOs focused on cancer. Conclusions: Publicly available tax data provide robust information on food industry donation practices. Our findings document the food industry's role in supporting patient advocacy organizations and raise questions regarding conflicts of interest. Increased awareness of food industry donation practices involving PAOs may generate pressure for policies mandating transparency or encourage donors and recipients to voluntarily disclose donations. If public disclosure becomes widespread, constituents, advocates, researchers, and policymakers can better supervise and address potential conflicts of interest.

Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums

Arshonsky, J., Krawczyk, N., Bunting, A. M., Frank, D., Friedman, S. R., & Bragg, M. A. (n.d.).

Publication year

2022

Journal title

JMIR Formative Research

Volume

6

Issue

3
Abstract
Abstract
Background: The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. Objective: This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. Methods: We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. Results: Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. Conclusions: Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms.

A qualitative analysis of black and white adolescents’ perceptions of and responses to racially targeted food and drink commercials on television

Miller, A., Cassidy, O., Greene, T., Arshonsky, J., Albert, S. L., & Bragg, M. A. (n.d.).

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

21
Abstract
Abstract
Food and beverage marketing is a major driver of childhood obesity, and companies target their least nutritious products to Black youth. However, little is known about adolescents’ perceptions of and responses to racially targeted food marketing. In this qualitative study, we investigated how Black and White adolescents perceived and responded to racially targeted television commercials for food and beverages. We recruited 39 adolescents aged 12–17 years in New York City to watch a series of commercials and then participate in an in-depth interview using a semi-structured interview guide. The research team recorded, transcribed, and analyzed interviews using ATLAS.ti. Overall, participants responded positively to commercials that featured celebrities. They were also able to recognize the commercials and reported they had been exposed to marketing from these companies on social media and in subways/buses. Many participants considered the advertised brands as healthy or able to enhance athletic performance because of their endorsement by or association with athletes. Participants also understood that marketers were using racial targeting in their ads but that targeting did not translate into improved perceptions or responses towards advertised products. These findings suggest the need to empirically evaluate and further explore Black and White adolescents’ responses to racially targeted food marketing.

Associations between state-level obesity rates, engagement with food brands on social media, and hashtag usage

Gu, Y., Coffino, J., Boswell, R., Hall, Z., & Bragg, M. A. (n.d.).

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

23
Abstract
Abstract
Food advertisement exposure is associated with increased caloric intake, but little is known about food/beverage placements in the digital media environment. We aimed to examine the correlation between the number of people who follow food and beverage brand social media accounts (i.e., user engagement) and state-level obesity rates; quantify social media followers’ use of “healthy” vs. “unhealthy” hashtags; and analyze the relationship between user engagement and hashtag usage. We identified the 26 fast-food and beverage brands with the highest advertising expenditures and used Demographics Pro to determine the characteristics of social media users amongst the 26 brands. A series of regression analyses were conducted that related the mean percentage of brand followers and state-level obesity rates. We then identified 733 hashtags on Insta-gram and 703 hashtags on Twitter, coding them as “healthy”, “unhealthy”, “neutral”, or “unrelated to health”. Intercoder reliability was established using ReCal2, which indicated a 90% agreement between coders. Finally, we conducted ANCOVA to examine the relationship between the mean percentage of brand followers and their hashtag usage. There was a significant, positive correlation between the state-level obesity rate and the mean percentage of followers of sugary drink or fast-food brands on Instagram and Twitter, but such a correlation between obesity and low-calorie drink brand followers was only found on Twitter. Our findings illustrate the relationship between the social media food environment and obesity rates in the United States. Given the high rates of engagement with food brands on social media, policies should limit digital advertisements featuring fast-food, sugary drink, and low-calorie drink brands.

How food marketing on instagram shapes adolescents' food preferences: Online randomized trial

Bragg, M., Lutfeali, S., Greene, T., Osterman, J., & Dalton, M. (n.d.).

Publication year

2021

Journal title

Journal of medical Internet research

Volume

23

Issue

10
Abstract
Abstract
Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children's exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents' preferences. Objective: This study examined whether adolescents could identify food companies' Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents' preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame-which includes the logo, comments, and "likes." In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the "labeled ad condition." In the "unlabeled ad condition," however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features.

Social media accounts of food and beverage brands have disproportionately more black and hispanic followers than white followers

Rummo, P. E., Arshonsky, J. H., Sharkey, A. L., Cassidy, O. L., & Bragg, M. A. (n.d.).

Publication year

2021

Journal title

Health Equity

Volume

5

Issue

1

Page(s)

414-423
Abstract
Abstract
Introduction: On television, food companies promote their least nutritious products to Black and Hispanic youth more than White youth, but little is known about the extent to which Black and Hispanic adolescents may disproportionately engage with unhealthy food and beverage brands on social media relative to White adolescents. Methods: In 2019, we purchased and analyzed demographic data of social media users who followed 27 of the most marketed food/beverage brands on Instagram and Twitter. We used one-sample t-tests to compare percentages of Black, Hispanic, and White followers of the selected brands' accounts versus all social media accounts, and independent samples t-tests to compare followers of sugary versus low-calorie drink brands. We also used linear regression to examine associations between racially targeted marketing practices and the percentages of Black, Hispanic, and White followers on social media. Results: On Instagram, the percentage of Black followers of the selected brands (12.7%) was higher than the percentage of Black followers of any account (7.8%) (p<0.001). On Twitter, findings were similar for Hispanic users but opposite for White users. A higher racially targeted ratio was positively associated with the percentage of Black followers, and negatively associated with the percentage of White followers. Sugary drink brands had more Hispanic followers than low-calorie drink brands (p<0.001). Conclusions: Unhealthy food/beverage brands that target Black adolescents have a disproportionately higher percentage of Black followers on social media relative to White followers. These findings support the 2019 proposal to restrict racially targeted advertising through the Children's Online Privacy and Protection Act.

Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemic

Bunting, A. M., Frank, D., Arshonsky, J., Bragg, M. A., Friedman, S. R., & Krawczyk, N. (n.d.).

Publication year

2021

Journal title

Drug and alcohol dependence

Volume

222
Abstract
Abstract
Background: 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 environment

Bragg, M., Arshonsky, J., Pageot, Y., Eby, M., Tucker, C. M., Yin, S., Goldmann, E., & Jay, M. (n.d.).

Publication year

2021

Journal title

BMC Medical Education

Volume

21

Issue

1
Abstract
Abstract
Background: 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 reductions

Thiel, C. L., Park, S. W., Musicus, A. A., Agins, J., Gan, J., Held, J., Horrocks, A., & Bragg, M. A. (n.d.).

Publication year

2021

Journal title

PloS one

Volume

16

Issue

3
Abstract
Abstract
This 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 pandemic

Krawczyk, N., Bunting, A. M., Frank, D., Arshonsky, J., Gu, Y., Friedman, S. R., & Bragg, M. A. (n.d.).

Publication year

2021

Journal title

International Journal of Drug Policy

Volume

92
Abstract
Abstract
Background: 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 menus

Rummo, P. E., Moran, A. J., Musicus, A. A., Roberto, C. A., & Bragg, M. A. (n.d.).

Publication year

2020

Journal title

Preventive Medicine Reports

Volume

20
Abstract
Abstract
Several 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.

Child Social Media Influencers and Unhealthy Food Product Placement

Alruwaily, A., Mangold, C., Greene, T., Arshonsky, J., Cassidy, O., Pomeranz, J. L., & Bragg, M. (n.d.).

Publication year

2020

Journal title

Pediatrics

Volume

146

Issue

5
Abstract
Abstract
OBJECTIVES: 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 followers

Fast food, beverage, and snack brands on social media in the United States: An examination of marketing techniques utilized in 2000 brand posts

Bragg, M. A., Pageot, Y. K., Amico, A., Miller, A. N., Gasbarre, A., Rummo, P. E., & Elbel, B. (n.d.).

Publication year

2020

Journal title

Pediatric Obesity

Volume

15

Issue

5
Abstract
Abstract
BACKGROUND: 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 data

Bragg, M. A., Elbel, B., & Nestle, M. (n.d.).

Publication year

2020

Journal title

International journal of environmental research and public health

Volume

17

Issue

5
Abstract
Abstract
No 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., 2006–2015

Rummo, P. E., Pho, N., Bragg, M. A., Roberto, C. A., & Elbel, B. (n.d.).

Publication year

2020

Journal title

American journal of preventive medicine

Volume

59

Issue

4

Page(s)

522-529
Abstract
Abstract
Introduction: 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 NYC

Mezzacca, T. A., Anekwe, A. V., Farley, S. M., Kessler, K. A., Rosa, M. Q., Bragg, M. A., & Rummo, P. E. (n.d.).

Publication year

2020

Journal title

Journal of Community Health

Volume

45

Issue

5

Page(s)

973-978
Abstract
Abstract
Sugary 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 study

Lutfeali, S., Ward, T., Greene, T., Arshonsky, J., Seixas, A., Dalton, M., & Bragg, M. A. (n.d.).

Publication year

2020

Journal title

JMIR Public Health and Surveillance

Volume

6

Issue

4
Abstract
Abstract
Background: 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 preferences

Bragg, M. A., Miller, A. N., Kalkstein, D. A., Elbel, B., & Roberto, C. A. (n.d.).

Publication year

2019

Journal title

Appetite

Volume

140

Page(s)

41-49
Abstract
Abstract
Introduction: 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 intentions

Gorski Findling, M. T., Werth, P. M., Musicus, A. A., Bragg, M. A., Graham, D. J., Elbel, B., & Roberto, C. A. (n.d.).

Publication year

2018

Journal title

Preventive Medicine

Volume

106

Page(s)

114-121
Abstract
Abstract
In 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 Sports

Bragg, M. A., Roberto, C. A., Harris, J. L., Brownell, K. D., & Elbel, B. (n.d.).

Publication year

2018

Journal title

Journal of Adolescent Health

Volume

62

Issue

1

Page(s)

5-13
Abstract
Abstract
Food 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.

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