StanMark. Prevalence of overweight and obesity in adults. Either overweight or obese BMI 25 or more

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1 Prevalence of overweight and obesity in adults Either overweight or obese BMI 25 or more Women ages 20 years and older Obese BMI 30 or more Very obese BMI 40 or more Non Hispanic black women Non Hispanic white women Hispanic women Men ages 20 years and older Non Hispanic black men Non Hispanic white men Hispanic men BMI=body mass index, calculated as weight in kilograms over the square of height in meters

2 Prevalence of overweight and obesity in children Girls ages 6 to 19 years and older Either overweight or obese 85 th percentile or more Obese 95 th percentile or more Very obese 97 th percentile or more Non Hispanic black girls Non Hispanic white girls Hispanic girls Boys ages 6 to 19 years and older Non Hispanic black boys Non Hispanic white boys Hispanic boys U.S.: Trends in younger boys 6 to 11 % obese White Black Mex Am Obesity = at or above the 95 th percentile of the sex and age specific BMI charts of the CDC Growth Charts Source Health United States, 2008, Table 76

3 U.S.: Trends in older girls, ages 12 to 19 years % obese White Black Mex Am Obesity = at or above the 95 th percentile of the sex and age specific BMI charts of the CDC Growth Charts Source Health United States, 2008, Table 76 Does food marketing contribute to health disparities? American Journal of Public Health 2008; 98:

4 Does food marketing contribute to obesity and diet related health disparities? Systematic review of literature published through 2006 Ethnic targeting Disproportionate unfavorable exposure or access of blacks vs. whites, adjusted for socioeconomic status TV ads; magazine ads Food store types and locations (maps; postal codes; census areas; in store promotions) Not child specific Precedent for alcohol and tobacco targeting Product and Promotion (n = 9 studies) Promotion to African Americans relative to whites more focused on low cost, low nutrition, high energy dense foods. Candy, soda, fast food and convenience foods. In store promotions more frequent and less likely to be for healthy items Positive nutritional messages and healthier foods less prevalent relative to white targeted promotion. American Journal of Public Health 2008; 98:

5 Place (n = 11 studies) Black consumers have less access to supermarkets, and higher access to fast food outlets than white consumers. Stores and restaurants were less likely to offer healthier options, to be full service, or to have clean, convenient and secure facilities in areas with more African American residents. Produce quality lower in Black communities American Journal of Public Health 2008; 98:

6 Findings of studies reporting frequency of sugar sweetened beverage advertising to African Americans vs general audiences TV ads TV ads Content analysis of 4 comedy shows watched most often by general audiences and the 4 most watched by African American audiences in the Fall of 1999 according to Nielsen data 38 Content analysis of 553 food advertisements on popular prime time TV programs in the general and African American markets during October and November Black prime time shows had more food commercials per 30 minute program there were 4.8 food commercials compared to 2.9 on general prime time. Soda commercials comprised 13% of the commercials on black prime time shows, compared with 2% of commercials on general prime time shows Food advertisements were 24.3% of ads aired on shows in the African American market compared with 14.9% of ads on shows in the general market. Soft drink advertisements were 10.6% of packaged food advertisements in the African American markets, compared to 2% in of those in the general market. Findings of studies reporting frequency of SSB advertising to African Americans vs general audiences TV ads Differences in types of Soft drinks were 13.5% of products advertised in primetime commercials with white vs. ethnic minority actors for 31 TV shows aired in Spring commercials with non whites (almost exclusively African Americans) appeared compared with 6.2% of commercials with whites. 1999, including 11 shows with primarily African American casts 40 Magazine Content analysis of 500 food Sweetened beverages were the most ads advertisements in 3 well established black oriented magazines over the period from ; ads sampled were all those published during February, May, and November of each year 41 frequent category of food related advertisements in three blackoriented magazines: Ebony (13% of ads), Essence (14% of ads, and Jet (18% of ads). Diet beverages were 8% and 12% of ads in Ebony and Essence respectively, and 5% of ads in Jet.

7 Findings of studies reporting frequency of SSB advertising to African Americans vs general audiences Outdoor ads Content analysis of outdoor African American neighborhoods had the advertisements identified through most ads for sugary beverages 36 field surveys of low and highincome African American, Latino, and white neighborhoods in Austin Texas, Los Angeles CA, and Philadelphia, PA 36 Ethnic Targeting Approaches Psychographics Community relations Sponsorship Scholarships Outdoor advertising Product placements in movies, songs Street teams Giveaways From Grier and Kumanyika, Ann Rev Public Health 2010 Ethnic media Social networking sites Word of mouth Cultural symbols Employment opportunities Advertising revenue Special products (including sweetness and flavors)

8 Advertising spending on media outlets that reach African-American consumers totaled $2.3 billion for the period October 1, 2006 through September 30, 2007 Medium Oct 06 Sep 07 Distribution ($ in millions) Local Radio $ % National Magazine $ % National Cable TV $ % Network TV $ % Syndication TV $ % Total $2, % Source: The Nielsen Company Why are ethnic groups attractive target markets? Distinctive ethno cultural characteristics as a potential basis for segmentation Separate marketing channels Size, growth, and purchasing power Hispanic/Latinos are fastest growing ethnic youth segment in the United States Marketplace behaviors (market research findings) Shopping patterns Parenting patterns Media use patterns (TV; movies)

9 Why are ethnic groups attractive target markets? Civil rights and demands for inclusion Willingness to target Provide advertising revenues Diversity and multicultural marketing globally Trend setters (e.g., hip hop culture) Response patterns homophily From Grier and Kumanyika, Ann Rev Public Health forthcoming Felt targetedness Consumers respond more favorably to targeted advertisements when see themselves in some characteristic of the advertisement (ethnicity; gender; sexual preference; age) Respect in the marketplace salience/brand loyalty Grier, S. A. and A. M. Brumbaugh (1999). "Noticing Cultural Differences: Ad Meanings Created By Target and Non-Target Markets." Journal of Advertising 28(1): 79. Grier, S. A. and A. M. Brumbaugh (2003). Consumer Distinctiveness and Advertising Persuasion. Diversity in Advertising. J. D. Williams, W.-N. Lee and C. P. Haugtvedt. Hillsdale, Lawrence Erlbaum Associates. Grier, S. A. and R. Deshpande (2001). "Social dimensions of consumer distinctiveness: The influence of social status on group identity and advertising persuasion." JMR, Journal of Marketing Research 38(2):

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11 PANAMA Chicky Club on the web

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13 Global Issues Health inequalities by ethnicity? Multicultural marketing country level Positives, re dietary diversity Negatives, re cultural exploitation Ethnic marketing within country Default targeting of low income, less educated, upwardly mobile, less powerful Ethnic Group Differences in Overweight and Obesity, ages 2 to 20 years, England % overweigh or obese General Population Afro Caribbean Males (n=2853) * * * * Indian Pakistani Females (n=2836) Bangladeshi Chinese IOTF definition of overweight and obesity Saxena S et al. Arch Dis Child 2004;89:30 36 Irish No social class differences were identified

14 England Lobstein T. International moves to strengthen food policies. Proceedings of the Nutrition Society, 2009 Netherlands: Overweight and obesity by ethnic group, : 3 17 year olds in the Hague: Boys Boys DeWilde JA et al. Arch Dis Child : originally published online June 24, 2009

15 Netherlands: Overweight and obesity by ethnic group, : 3 17 year olds in the Hague: Girls Girls DeWilde JA et al. Arch Dis Child : originally published online June 24, 2009 Special vulnerability of African American and Latino (or other minority or ethnic youth*) Developmental vulnerability (all youth) Additional ethnic identity formation Higher media use (hours of TV ad exposure) Digital targeting More responsive to marketing Type of ad exposure (more food; more unhealthy food) Broader community targeting *eg, indigenous populations; Pacific Islanders; non-white immigrants

16 Regulatory Precedents Entertainment violence Tobacco Alcohol None of these has been entirely successful in reducing youth exposure to promotion Also, bottle feeding promotion patterns may be of interest See Grier and Kumanyika, Ann Rev Public Health, forthcoming Regulatory issues for adults Competent consumer argument Ability to make rational choices in best self interest vulnerability or incompetent stereotype, particularly sensitive for disadvantaged populations Counter is non rationality of marketing approaches Food availability/access Legal approaches (eg, fast food bans) Community action Fairness in pricing; discounts Market incentives