Faculty Bibliography

IMPORTANCE/UNASSIGNED:Menu labeling has been implemented in restaurants in some US jurisdictions as early as 2008, but the extent to which menu labeling is associated with calories purchased is unclear. OBJECTIVE/UNASSIGNED:To estimate the association of menu labeling with calories and nutrients purchased and assess geographic variation in results. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:A cohort study was conducted with a quasi-experimental design using actual transaction data from Taco Bell restaurants from calendar years 2007 to 2014 US restaurants with menu labeling matched to comparison restaurants using synthetic control methods. Data were analyzed from May to October 2023. EXPOSURE/UNASSIGNED:Menu labeling policies in 6 US jurisdictions. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was calories per transaction. Secondary outcomes included total and saturated fat, carbohydrates, protein, sugar, fiber, and sodium. RESULTS/UNASSIGNED:The final sample included 2329 restaurants, with menu labeling in 474 (31 468 restaurant-month observations). Most restaurants (94.3%) were located in California. Difference-in-differences model results indicated that customers purchased 24.7 (95% CI, 23.6-25.7) fewer calories per transaction from restaurants in the menu labeling group in the 3- to 24-month follow-up period vs the comparison group, including 21.9 (95% CI, 20.9-22.9) fewer calories in the 3- to 12-month follow-up period and 25.0 (95% CI, 24.0-26.1) fewer calories in the 13- to 24-month follow-up period. Changes in the nutrient content of transactions were consistent with calorie estimates. Findings in California were similar to overall estimates in magnitude and direction; yet, among restaurants outside of California, no association was observed in the 3- to 24-month period. The outcome of menu labeling also differed by item category and time of day, with a larger decrease in the number of tacos vs other items purchased and a larger decrease in calories purchased during breakfast vs other times of the day in the 3- to 24-month period. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this quasi-experimental cohort study, fewer calories were purchased in restaurants with calorie labels compared with those with no labels, suggesting that consumers are sensitive to calorie information on menu boards, although associations differed by location.

PURPOSE OF REVIEW/OBJECTIVE:Protecting children from unhealthful food marketing is a global priority policy for improving population diets. Monitoring the nature and extent of children's exposure to this marketing is critical in policy development and implementation. This review summarises contemporary approaches to monitor the nature and extent of food marketing to support policy reform. RECENT FINDINGS/RESULTS:Monitoring approaches vary depending on the stage of progress of related policy implementation, with resource implications and opportunity costs. Considerations include priority media/settings. marketing techniques assessed, approach to classifying foods, study design and if exposure assessments are based on media content analyses or are estimated or observed based on children's media use. Current evidence is largely limited to high-income countries and focuses on content analyses of TV advertising. Ongoing efforts are needed to support monitoring in low-resource settings and to progress monitoring to better capture children's actual exposures across media and settings.

OBJECTIVE:The COVID-19 pandemic has significantly affected people's ability to buy, sell, and obtain items that they use in their daily lives. It may have had a particularly negative effect on the ability of people who use illicit opioids to obtain them because the networks they relied on are illicit and not part of the formal economy. Our objective in this research was to examine if, and how, disruptions related to COVID-19 of illicit opioid markets have affected people who use illicit opioids. METHOD:We collected 300 posts--including replies to posts--related to the intersection of COVID-19 and opioid use from Reddit.com, a forum that has several discussion threads (i.e., subreddits) dedicated to opioids. We then coded posts from the two most popular opioid subreddits during the early pandemic period (March 5, 2020-May 13, 2020) using an inductive/deductive approach. RESULTS:We found two themes related to active opioid use during the early pandemic: (a) changes in drug supply and difficulty obtaining opioids, and (b) buying less-trustworthy drugs from lesser-known sources. CONCLUSIONS:Our findings suggest that COVID-19 has created market conditions that place people who use opioids at risk of adverse outcomes, such as fatal overdose.

Unhealthy food advertisements ("advertisements" hereafter referred to as "ads") are linked to poor diet and obesity, and food companies disproportionally target Black youth. Little is known about the mechanisms whereby food ads influence diet. One possibility may be racially-targeted ads that appeal to Black youth. Those with food-related attentional biases may be especially vulnerable. The objective of this project was to assess the feasibility and initial effects of a pilot study testing the influence of racially-targeted food ads and food-related attentional biases on eating behaviors among a sample of Black adolescent females. Feasibility of recruitment, retention, and procedures were examined. Participants (N = 41, 12-17y) were randomized to view a television episode clip of the Big Bang Theory embedded with either four 30-second racially-targeted food ads or neutral ads. A computer dot probe task assessed food-related attentional biases. The primary outcome was caloric consumption from a laboratory test meal. Interactions based on weight and ethnic identity were also examined. Analyses of variance and regressions were used to assess main and interaction effects. Exposure to racially-targeted food ads (versus neutral ads) did not affect energy consumption (p > .99). Although not statistically significant, adolescents with obesity consumed nearly 240 kcal more than non-overweight adolescents (p = 0.10). There were no significant preliminary effects related to food-related attentional biases or ethnic identity (ps = 0.22-0.79). Despite a non-significant interaction, these data provide preliminary support that adolescents with obesity may be particularly vulnerable to racially-targeted food ads. An adequately powered trial is necessary to further elucidate the associations among racially-targeted food ads among Black adolescent girls with obesity.

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/METHODS: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/METHODS:Form 990 tax documents. PARTICIPANTS/METHODS: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.

BACKGROUND:Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media usage during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the U.S. or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages. OBJECTIVE:We aimed to (1) document the types and frequencies of COVID-19-related themes in U.S. food and beverage companies' Twitter posts during the first wave of the pandemic in the U.S., and (2) assess the nutritional quality of food and beverage products featured in these tweets. METHODS:Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 - May 31, 2020. Researchers documented the date of the tweet, number of likes, views, comments, and "retweets", and type of food and beverage products. We coded tweets for the following ten COVID-19 themes: (1) social distancing/staying home/working remotely; (2) contactless delivery/pick-up; (3) hand-washing/sanitizing; (4) masks; (5) safety/protection; (6) staying connected with others; (7) staying active; (8) frontline/essential workers; (9) monetary relief/donations/unemployment; (10) pandemic/unprecedented/difficult times. Researchers calculated the Nutrient Profile Index scores for featured foods and sorted beverages into categories based on sugar content. RESULTS:Our final sample included 874 COVID-19-themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (42.0%), followed by pandemic/unprecedented/difficult times (28.2%), and contactless delivery (27.1%). The majority of tweets (77.6%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% promoted unhealthy products, whereas 17.2% promoted healthy products. CONCLUSIONS:Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19. CLINICALTRIAL/BACKGROUND/:

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 aimed 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 two major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5, 2020 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 discussed at least one type of informal coping strategy. Those strategies included: psychological and behavioral coping skills, adopting healthy habits, and using substances to manage withdrawal symptoms. Twelve subreddit posts explicitly mentioned using social distancing as an opportunity for cessation or reduction of opioid use. CONCLUSIONS:Reddit discussion forums 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.

PURPOSE/UNASSIGNED: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/UNASSIGNED:=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/UNASSIGNED:=44) of food and beverage advertisements referenced Caribbean culture. CONCLUSIONS/UNASSIGNED: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.

OBJECTIVES/UNASSIGNED: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/UNASSIGNED: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/UNASSIGNED: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/UNASSIGNED:Findings support the need to limit promotion of these substances to youth by influencers to reduce substance use and misuse.