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Health Promotion International - current issue



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Health literacy in Mainland China: Validation of a functional health literacy test in simplified Chinese

2016-12-07T00:52:49-08:00

Health literacy tests in the Chinese-speaking parts of the world have been mainly developed in traditional Chinese to be used in Hong Kong or Taiwan. So far no validated tool in simplified Chinese to assess functional health literacy in Mainland China has been developed. The aim of the study was to validate the simplified Chinese version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The traditional Chinese version was translated into simplified Chinese and 150 interviews in an outpatient department of a public hospital in Mainland China were conducted. Predictive validity was assessed by known predictors for health literacy and convergent validity by three health literacy screening questions. The Cronbach's α for the reading comprehension part was 0.94 and 0.90 for the numeracy items. Participants with lower education and men had significantly lower levels of health literacy. The reading comprehension part was significantly correlated with two of the health literacy screening questions. Our results indicate that the simplified Chinese version of the S-TOFHLA is a reliable measure of health literacy to be used in Mainland China.




The DECIDE evidence to recommendation framework adapted to the public health field in Sweden

2016-12-07T00:52:49-08:00

Organizations worldwide compile results from scientific studies, and grade the evidence of interventions, in order to assist policy makers. However, quality of evidence alone is seldom sufficient to make a recommendation. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) framework aims to facilitate decision making and to improve dissemination and implementation of recommendations in the healthcare and public health sector. The aim of this study was to investigate whether the DECIDE framework is applicable in the public health field in Sweden. The DECIDE framework was presented and discussed in interviews with stakeholders and governmental organizations and tested in panels. Content analyses were performed. In general, the informants were positive to the DECIDE framework. However, two questions, the first regarding individual autonomy and the second regarding method sustainability, were by the stakeholders felt to be missing in the framework. The importance of the composition of the DECIDE stakeholder panel was lifted by the informants, as was the significant role of the chair. Further, the informants raised concerns about the general lack of research evidence based on RCT design regarding universal methods in the public health sector. Finally, the local, regional and national levels’ responsibility for dissemination and implementation of recommendations were lifted by the informants. The DECIDE framework might be useful as a tool for dissemination and implementation of recommendations in the public health field in Sweden. Important questions for further research are whether these findings are suitable for other public health topics and in other public health settings.




Corporate responsibility for childhood physical activity promotion in the UK

2016-12-07T00:52:49-08:00

The alarming epidemic of obesity and physical inactivity at paediatric age urges societies to rise to the challenge of ensuring an active lifestyle. As one response to this, business enterprises are increasingly engaged in promoting sport and physical activity (PA) initiatives within the frame of corporate social responsibility (CSR). However, comparative analyses among industry sectors of CSR strategies for PA promotion with a particular focus on children are still lacking. This study aimed to explore (i) what are the CSR strategies for PA promotion adopted in different industry sectors and (ii) whether corporate engagement in promoting PA for children is supportive of children's rights to play and be physically active. Corporate pledges pertaining to CSR initiatives to promote PA were analysed. The hypothesis was that companies from different sectors employ different CSR strategies and that companies with a higher profile as regard to public health concerns for children tend to legitimate their action by adopting a compensatory strategy. Results show that the issue of PA promotion is largely represented within CSR commitments. CSR strategies for PA promotion vary across industry sectors and the adoption of a compensatory strategy for rising childhood obesity allows only a limited exploitation of the potential of CSR commitments for the provision of children's rights to play and be physically active. Actors within the fields of public health ethics, human rights and CSR should be considered complementary to develop mainstreaming strategies and improve monitoring systems of PA promotion in children.




How Health in All Policies are developed and implemented in a developing country? A case study of a HiAP initiative in Iran

2016-12-07T00:52:49-08:00

Population health is influenced by many factors beyond the control of health system which should be addressed by other sectors through inter-sectoral collaboration (ISC). Countries have adopted diverse initiatives to operationalize ISC for health such as establishment of Councils of Health and Food Security (CHFSs) and development of provincial Health Master Plans (HMPs) in Iran. The literature, however, provides meager information on how these initiatives have been moved into the top policy agenda, how and by whom they have been formulated and what factors enable or inhibit their implementation. In addressing these knowledge gaps, we employed a qualitative case study approach, incorporating mixed methods: in-depth interviews and a textual analysis of policy documents. Iran founded the Supreme Council of Health and Food Security (SCHFS) at national level in 2006 followed by provincial and district CHFSs to ensure political commitment to ISC for health and Health in All Policies (HiAPs). In 2009, the SCHFS mandated all provincial CHFSs across the country to develop provincial HMP to operationalize the HiAP approach and Kerman was among the first provinces which responded to this call. We selected Kerman province HMP as a case study to investigate the research questions raised in this study. The study revealed two types of leverage, which played crucial role in agenda setting, policy formulation and implementation of HMP including politics (political commitment) and policy entrepreneurs. The multiple streams model was found to be informative for thinking about different stages of a policy cycle including agenda setting, policy formulation and policy implementation. It was also found to be a useful framework in analyzing HiAP initiatives as these policies do not smoothly and readily reach the policy agenda.




Development of a theory-guided pan-European computer-assisted safer sex intervention

2016-12-07T00:52:49-08:00

HIV is a growing public health problem in Europe, with men-having-sex-with-men and migrants from endemic regions as the most affected key populations. More evidence on effective behavioral interventions to reduce sexual risk is needed. This article describes the systematic development of a theory-guided computer-assisted safer sex intervention, aiming at supporting people living with HIV in sexual risk reduction. We applied the Intervention Mapping (IM) protocol to develop this counseling intervention in the framework of a European multicenter study. We conducted a needs assessment guided by the information–motivation–behavioral (IMB) skills model, formulated change objectives and selected theory-based methods and practical strategies, i.e. interactive computer-assisted modules as supporting tools for provider-delivered counseling. Theoretical foundations were the IMB skills model, social cognitive theory and the transtheoretical model, complemented by dual process models of affective decision making to account for the specifics of sexual behavior. The counseling approach for delivering three individual sessions was tailored to participants' needs and contexts, adopting elements of motivational interviewing and cognitive-behavioral therapy. We implemented and evaluated the intervention using a randomized controlled trial combined with a process evaluation. IM provided a useful framework for developing a coherent intervention for heterogeneous target groups, which was feasible and effective across the culturally diverse settings. This article responds to the need for transparent descriptions of the development and content of evidence-based behavior change interventions as potential pillars of effective combination prevention strategies.




A 2-year young adult obesity prevention trial in the US: Process evaluation results

2016-12-07T00:52:50-08:00

Our objective was to conduct a process evaluation of the CHOICES (Choosing Healthy Options in College Environments and Settings) study, a large, randomized, controlled trial designed to prevent unhealthy weight gain in young adults (aged 18–35) attending 2-year community colleges in the USA. The 24-month intervention consisted of participation in an academic course and a social networking and support website. Among intervention participants, completion rates for most course activities were >80%, reflecting a high level of dose received. Course retention and participant satisfaction were also high. Engagement results, however, were mixed with less than half of participants in the online and hybrid sections of the course reporting that they interacted with course materials ≥3 h/week, but 50–75% reporting that they completed required lessons ‘all/very thoroughly’. Engagement in the website activities was also mixed with more than half of intervention participants logging onto the website during the first month, but then declining to 25–40% during the following 23 months of the intervention. Intervention engagement is a challenge of online interventions and a challenge of working with the young adult age group in general. Additional research is needed to explore strategies to support engagement among this population, particularly for relatively long intervention durations.




A content analysis of food advertising on Turkish television

2016-12-07T00:52:50-08:00

The aim of this study was to conduct a comprehensive content analysis of Television (TV) food advertising and compare various food advertisements on free-to-air Turkish national TV channels by broadcast time (duration) and frequency over the period of a week (19–25 April 2012). TV food advertisements were the unit of content analysis in this study. Each advertisement identified as promoting a food product was analysed for content; non-food advertisements were not analysed, although they were counted as a proportion of the advertisements aired. We recorded all programmes for 4 h each per day (7 p.m.–11 p.m.), totalling 84 h. Five types of food-related advertisements were identified (basic foods, junk foods, meat products, beverages and fast food), and six types of non-food advertisements. The Student t-test and ANOVA were used to compare the mean broadcast time of all prime time advertising for the two groups. The mean broadcast times for prime time, non-food advertisements showed a statistically significant difference (p < 0.05). This difference is related to the prime time period 7 p.m.–8 p.m. being considered dinner time for most Turkish families. Additionally, the number and broadcast times of beverage advertisements increased during this time period, while the broadcast time per beverage advertisement decreased (ratio = 20.8 s per ads). As a result, TV food advertising increased not only during dinner time but also in overall broadcast time (per advertisement). These findings may be useful for explaining how advertising can negatively influence food choices, thereby increasing public awareness of the need for health messages targeting obesity.




Systematic review of empowerment measures in health promotion

2016-12-07T00:52:50-08:00

Empowerment, a multi-level construct comprising individual, community and organizational domains, is a fundamental value and goal in health promotion. While a range of scales have been developed for the measurement of empowerment, the qualities of these have not been rigorously assessed. The aim of this study was to evaluate the measurement properties of quantitative empowerment scales and their applicability in health promotion programs. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was done to evaluate empowerment scales across three dimensions: item development, reliability and validity. This was followed by assessment of measurement properties using a ratings scale with criteria addressing an a priori explicit theoretical framework, assessment of content validity, internal consistency and factor analysis to test structural validity. Of the 20 studies included in this review, only 8 (40%) used literature reviews, expert panels and empirical studies to develop scale items and 9 (45%) of studies fulfilled ≥5 criteria on the ratings scale. Two studies (10%) measured community empowerment and one study measured organizational empowerment, the rest (85%) measured individual empowerment. This review highlights important gaps in the measurement of community and organizational domains of empowerment using quantitative scales. A priority for future empowerment research is to investigate and explore approaches such as mixed methods to enable adequate measurement of empowerment across all three domains. This would help health promotion practitioners to effectively measure empowerment as a driver of change and an outcome in health promotion programs.




Readiness for health behavior changes among low fitness men in a Finnish health promotion campaign

2016-12-07T00:52:50-08:00

Men have been a hard-to-reach population in health behavior programs and it has been claimed that they are less interested in health issues than women. However, less is known about that how ready men are to adopt new health behaviors. This study examined readiness for change in physical activity (PA) and eating behavior (EB) among low fitness and overweight working-aged Finnish men who participated in a PA campaign. Associations among perceived health knowledge, health behaviors, psychosocial factors and readiness for change were studied. Data comprised 362 men aged 18–64. Physical fitness was assessed with a body fitness index constructed on the basis of the Polar OwnIndex Test, a hand grip test and an Inbody 720 body composition analysis. Health behavior information was gathered by questionnaire. Descriptive and comparative analyses were conducted by 2 test and Kruskall–Wallis and Mann–Whitney U tests. Associations between health knowledge and health behaviors were explored with logistic regression analyses. Readiness to increase PA and change EB was positively related to higher scores in psychosocial factors, PA and healthy eating habits. Self-rated knowledge on health issues was not related to PA or readiness to change health behaviors; however, it was positively associated with healthy eating and greater perceived promoters of PA. Participants' self-rated knowledge reflected not only an interest in health but also the differences in age and education. Health programs are needed that target both PA and healthy eating in low-fit men at different ages and motivational stages.




A cultural analysis of New Zealand palliative care brochures

2016-12-07T00:52:50-08:00

Low utilization of palliative care services by Māori remains despite increases in services designed to meet Māori needs. The purpose of this study is to explore palliative care information brochures in the context of Māori principles of well-being and communication protocols, and health literacy. We examined 99 brochures from palliative care services in New Zealand and held two focus groups with 12 Māori elders (kaumātua) and extended family (whanau) members. Taking a cultural-discursive approach incorporating Māori worldviews, we analysed textual and conceptual features of the brochures. The findings centred on cultural connection and disconnection within the brochures and serve as a critique of the prominent messages currently presented in these brochures. The findings raise questions about the capacity of agencies to convey culturally resonant messages to kaumātua and their whānau. We identify implications of palliative care brochures for health literacy of provider organizations as well as kaumātua and whanau.




Audit of workplace walkability in an Irish healthcare setting

2016-12-07T00:52:50-08:00

Recent studies suggest that time spent sitting is associated with greater risks of all causes of mortality and cardiovascular disease even for those who live a healthy lifestyle. As part of a healthier worksite initiative, we conducted a worksite walkability audit and staff survey of a large hospital-based administrative campus with a high proportion of health staff working in largely office-based roles. The US Centre for Disease Control (CDC) Healthier Worksite Initiative Walkability Audit Tool was used to audit 20 walking segments. The audit further examined the walkability of segments most likely to be used by outpatients and the families of residents visiting and attending the campus. The second phase of this research involved an employee electronic survey to understand staff requirements from a workplace physical activity initiative. Overall, the campus scored a medium risk to walkability on the CDC audit tool. This means that with some key minor alterations the walking route could be made safe and attractive for walking. There was a 20% (n = 151) response rate to the staff survey with 66% of respondents sitting at their desk for most of the day with the majority spending 5–7 h a day sitting at work. Evidence suggests that reducing sedentary time may be important to public health. The worksite is an ideal location for targeting a large number of individuals. Key public health messages that promote daily recommended physical activity targets should also carry additional messages about reducing occupational sitting time.




Childhood nutrition in the Mississippi Delta: challenges and opportunities

2016-12-07T00:52:50-08:00

Childhood obesity in the USA has more than tripled in the last three decades, and the prevalence is higher in the Mississippi Delta. Insight into the social, cultural and environmental factors that influence inequity can inform efforts to mediate health disparities. Focus groups (n = 12) among parents/guardians of elementary school children (n = 44) and teachers (n = 59) in the Mississippi Delta were used to investigate barriers and facilitators of healthy eating. Transcriptions were analyzed for themes. A strong preference for junk food among children and the pervasiveness of junk foods in schools and communities were cited as barriers to healthy eating. Potential facilitators of healthy eating included desire to avoid chronic disease, effort to limit junk food consumption and school support. Despite support for efforts to improve nutrition in the Delta, participants voiced a sense of inevitability related to children's consumption of unhealthy foods. This study suggests that parents and teachers express concern related to eating habits of children, yet they experience barriers to healthy eating which contribute to a sense of disempowerment. Improving health in the Mississippi Delta requires comprehensive strategies that offer its citizens a sense of agency.




Strengthening sense of coherence: opportunities for theory building in health promotion

2016-12-07T00:52:50-08:00

Sense of coherence (SOC) reflects a coping capacity of people to deal with everyday life stressors and consists of three elements: comprehensibility, manageability and meaningfulness. SOC is often considered to be a stable entity that is developed in young adulthood and stabilizes around the age of 30. Recent studies have questioned this stability of SOC and some studies report on interventions that have been successful in strengthening SOC in adult populations. Currently, however, there is no clear understanding of the mechanisms underlying SOC. As a consequence, it is a challenge to determine what is needed in health promotion activities to strengthen SOC. This article aims to explore the mechanisms underlying SOC as these insights may underpin future health promotion efforts. An exploration of the salutogenic model suggests two important mechanisms: the behavioural and the perceptual. The behavioural mechanism highlights the possibility to empower people to use their resources in stressful situations. The perceptual mechanism suggests that, in order for people to deal with life stressors, it is essential that they are able to reflect on their understanding of the stressful situation and the resources that are available. Based on these mechanisms, we suggest that both empowerment and reflection processes, which are interdependent, may be relevant for health promotion activities that aim to strengthen SOC. The successful application of resources to deal with stressors is not only likely to have a positive influence on health, but also creates consistent and meaningful life experiences that can positively reinforce SOC levels.




Food capacities and satisfaction in participants in food security community interventions in Montreal, Canada

2016-12-07T00:52:50-08:00

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research.




Health in All Policies in South Australia: what has supported early implementation?

2016-12-07T00:52:50-08:00

Health in All Policies (HiAP) is a policy development approach that facilitates intersectoral responses to addressing the social determinants of health and health equity whilst, at the same time, contributing to policy priorities across the various sectors of government. Given that different models of HiAP have been implemented in at least 16 countries, there is increasing interest in how its effectiveness can be optimized. Much of the existing literature on HiAP remains descriptive, however, and lacks critical, empirically informed analyses of the elements that support implementation. Furthermore, literature on HiAP, and intersectoral action more generally, provides little detail on the practical workings of policy collaborations. This paper contributes empirical findings from a multi-method study of HiAP implementation in South Australia (SA) between 2007 and 2013. It considers the views of public servants and presents analysis of elements that have supported, and impeded, implementation of HiAP in SA. We found that HiAP has been implemented in SA using a combination of interrelated elements. The operation of these elements has provided a strong foundation, which suggests the potential for HiAP to extend beyond being an isolated strategy, to form a more integrated and systemic mechanism of policy-making. We conclude with learnings from the SA experience of HiAP implementation to inform the ongoing development and implementation of HiAP in SA and internationally.




With or without the group: Swedish midwives' and child healthcare nurses' experiences in leading parent education groups

2016-12-07T00:52:50-08:00

The aim of the study was to describe and to understand midwives' and child healthcare nurses' experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: ‘How do you refer to your role when working in parent education?’, ‘What is the biggest challenge or difficulty for you when working in parent education?’ and ‘What is most rewarding when working in parent education?’ The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child healthcare nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child healthcare to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups.




Targets to promote swimming between the flags among Australian beachgoers

2016-12-07T00:52:50-08:00

Visiting the beach is a popular activity, but the risk of drowning is real. Drownings are preventable, and swimming between the patrol flags can save lives. The aim of this study is to understand the beliefs people hold in relation to this important water safety behaviour. Participants (N= 514; females = 58%) who were residents of/visitors to coastal areas in South-East Queensland, Australia, completed a theory of planned behaviour belief-based questionnaire. The survey was designed to measure behavioural, normative and control beliefs guiding beachgoers' intentions to swim between the patrol flags. Controlling for age, gender and swimming ability, four critical beliefs (along with self-reported swimming ability) were identified as independently predicting intention. Specifically, the benefits of feeling safe and the cost of feeling limited in choice of where to swim, the social approval from partners and the inhibitor belief about better waves being outside the flags predicted intentions to swim between the flags. This study provides an understanding of the beliefs underlying Australian beachgoers' intentions to swim between the patrol flags. Attention to these targeted beliefs may assist in promoting more regular performance of this beach safety behaviour, thereby combating the increasing rates of drownings and surf rescues.




Implementing Comprehensive School Health in Alberta, Canada: the principal's role

2016-12-07T00:52:50-08:00

Comprehensive School Health (CSH) is an internationally recognized framework that moves beyond the individual to holistically address school health, leading to the development of health-enhancing behaviors while also improving educational outcomes. Previous research has suggested that principal support for CSH implementation is essential, but this role has yet to be explored. Therefore, the purpose of this research was to examine the role of the principal in the implementation of a CSH project aimed at creating a healthy school culture. This research was guided by the grounded ethnography method. Semi-structured interviews were conducted with APPLE School principals (n = 29) to qualitatively explore their role in creating a healthy school culture. A model consisting of five major themes emerged, suggesting that the principal played a fluid role throughout the CSH implementation process. Principals (i) primed the cultural change; (ii) communicated the project's importance to others; (iii) negotiated concerns and collaboratively planned; (iv) held others accountable to the change, while enabling them to take ownership and (v) played an underlying supportive role, providing positive recognition and establishing ongoing commitment. This research provides recommendations to help establish effective leadership practices in schools, conducive to creating a healthy school culture.




Does school health and home economics education influence adults' food knowledge?

2016-12-07T00:52:50-08:00

Home economics and health teachers are to be found in many parts of the world. They teach students about food in relation to its nutritional, safety and environmental properties. The effects of such teaching might be expected to be reflected in the food knowledge of adults who have undertaken school education in these areas. This study examined the food knowledge associations of school home economics and health education among Australian adults. Two separate online surveys were conducted nationwide among 2022 (November 2011) and 2146 Australian adults (November–December 2012). True/false and multiple choice questions in both surveys were used to assess nutrition, food safety and environmental knowledge. Knowledge scores were constructed and compared against respondents' experience of school health or home economics education via multiple regression analyses. The results from both studies showed that home economics (and similar) education was associated with higher levels of food knowledge among several age groups. The associations of home economics education with food knowledge differed across several Australian states and recall of home economics themes differed across the age groups. These findings suggest that home economics education may bring about long-lasting learning of food knowledge. Further research is required, however, to confirm the findings and to test the causal influence of home economics education on adults' food knowledge.




Health promoting leadership practices in four Norwegian industries

2016-12-07T00:52:50-08:00

The aim of this article is to address health promoting leadership; what do leaders actually do to promote health at work? Leadership practice plays a crucial role in the workplace and greatly affects the working environment and working conditions. Through a theoretical and empirical approach, we seek to find characteristics/patterns of health promoting leadership. The definition of health promoting leadership is a democratic and supportive leadership style, where leaders seek to motivate and inspire their employees. The study in this article is based on qualitative research methods. We have investigated and compared leadership practice in four different organizations/industries in Norway: construction, oil and gas, health care and cleaning. These organizations and professions are quite different, and thus leadership must be understood and developed within its context. However, we found some generic characteristics of health promoting leadership: hands-on, accessible, supportive, inclusive and democratic. Current literature only rarely addresses how leadership affects health promotion at work. Consequently, more knowledge is needed about how leaders really succeed in creating healthy workplaces and healthy employees.




Problematics of empowerment: sex worker HIV prevention in the Pacific

2016-12-07T00:52:50-08:00

A recent overview of HIV/STI prevention programmes for sex workers in the Pacific region indicates that, despite a regional policy shift from universal to targeted interventions, Pacific Island countries currently lack core HIV/STI prevention services for sex workers. Across the region, condom distribution, peer outreach and support services for sex workers have ceased even in countries where such programmes had previously existed. This article cautions that the endorsement of empowerment projects does not negate the important role of condom access in HIV and STI prevention efforts for Pacific sex workers. While community empowerment underpins, and is essential to the sustainability of, effective interventions, it does not constitute an adequate form of HIV and STI prevention in and of itself. We contend that in the context of the Pacific Islands, timely and effective HIV prevention measures must specifically attend to the implementation of, and sustained support for, behavioural interventions such as sex-worker-specific peer education, condom and lubricant distribution, and access to appropriate sexual health services. Further, the responsibility for delivery of these should not be borne solely by fledgling sex worker organizations and communities. The evolution of targeted interventions in the Pacific and the current lack of funded condom distribution programmes highlight a more generalizable imperative within HIV prevention to ensure that behaviour change efforts are not considered to be extraneous to, or rendered redundant by, empowerment-based interventions.




Young adults: beloved by food and drink marketers and forgotten by public health?

2016-12-07T00:52:50-08:00

Young adults are a highly desirable target population for energy-dense, nutrient-poor (EDNP) food and beverage marketing. But little research, resources, advocacy and policy action have been directed at this age group, despite the fact that young adults are gaining weight faster than previous generations and other population groups. Factors such as identity development and shifting interpersonal influences differentiate young adulthood from other life stages and influence the adoption of both healthy and unhealthy eating behaviours. EDNP food and beverage marketing campaigns use techniques to normalize brands within young adult culture, in particular through online social media. Young adults must be a priority population in future obesity prevention efforts. Stronger policies to protect young adults from EDNP food and beverage marketing may also increase the effectiveness of policies that are meant to protect younger children. Restrictions on EDNP food and beverage marketing should be extended to include Internet-based advertising and also aim to protect vulnerable young adults.