Faculty Bibliography

BACKGROUND:The school environment plays a vital role in shaping children's health and well-being. Nutrition education supports health promotion and disease prevention; however, it is unclear how comprehensive curricula are in the content they cover. This study explored the content of K-12 nutrition curricula in US public schools. METHODS:We analyzed nutrition education curricula from the 2023-2024 school year across a target sample of 50 states. Materials were collected through online searches and phone calls to districts and schools. We employed content analysis to assess nutrition concepts and modes of curriculum delivery, using a codebook to systematically code the curricula. RESULTS:We obtained 110 curricula across 38 states. Common concepts included macronutrients (54.5%), micronutrients (55.4%), food groups (58%), and the benefits of good nutrition (69%). Fewer curricula addressed consequences of poor nutrition (44.5%) or behavioral changes like portion size (38.1%). Most curricula (87.2%) used didactic methods, with only 19.5% incorporating hands-on activities. Broader topics such as environmental impacts of food choices (17.2%) were less common. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY/UNASSIGNED:Nutrition education plays a critical role in shaping children's long-term health outcomes; however, challenges remain in ensuring consistent and high-quality instruction. CONCLUSIONS:Nutrition education in the US focuses on core nutrition concepts and often relies on didactic methods, with limited hands-on activities. This highlights the need for more engaging, standardized programs.

INTRODUCTION/UNASSIGNED:This study leverages advertising industry data to quantify social media advertising expenditures and advertising impressions of the food and beverage industry on Facebook, Twitter/X, and Instagram from January 2019 to August 2021. METHODS/UNASSIGNED:=18 months). Primary outcomes were monthly trends expenditures of food/beverage advertising and the number of views and expenditures of food/beverage advertising by platform (e.g., TV, online, mobile, print). Primary outcomes was measured by monthly expenditures by (1) social media company, (2) brand, and (3) before COVID-19 versus the first year of the pandemic. RESULTS/UNASSIGNED:for interaction<0.001). CONCLUSIONS/UNASSIGNED:These data reveal that the food/beverage industry spends at least $2.8 billion on social media advertising, which generate billions of views for their products online. Determining adults' exposure to social media food advertising is critical for understanding the upstream factors that shape the risk for diet-related diseases.

OBJECTIVE:To evaluate the healthfulness of the food/beverage products featured by TikTok influencers whose audiences include millions of adolescents. DESIGN/METHODS:In a cross-sectional study, we collected the maximum available up to 100 videos from the top 100 TikTok influencers in the US-based on views, likes, comments, and shares-in July 2022. For each video, we identified the most prominent food/beverage product featured. We used the Nutrient Profile Index (NPI) to classify food products as healthy/unhealthy. We grouped beverages by category. SETTING/METHODS:TikTok. PARTICIPANTS/METHODS:n/a. RESULTS:Our sample included 8,871 videos, 1,360 (15.3%) of which featured at least one food (n=755, 55.5%), beverage (n=580, 42.6%), or dietary supplement (n=25, 1.8%). Mean NPI score for foods was 54.73 (SD 19.95). Most foods (58%) were considered unhealthy, with a 20-percentage-point difference between branded (70.8%) and unbranded (50.8%) foods. Alcoholic (n=154, 26.6%) and energy (n=149, 25.7%) drinks were the most featured overall. Among branded beverages, energy drinks were the largest category (n=148, 38.9%). Among unbranded beverages, alcoholic drinks were the largest category (n=73, 36.5%). CONCLUSIONS:More than half of the foods promoted by TikTok influencers were considered unhealthy and most beverages featured were alcoholic and energy drinks. Many foods and a large share of alcoholic beverages were unbranded, either reflecting genuine influencer preferences or potentially masking the true extent of commercial marketing. Given the reach of influencers, including millions of adolescents, stronger regulations are needed for social media platforms, influencers, and brands to protect consumers from undue harm from food/beverage marketing.

INTRODUCTION/BACKGROUND:Menu labels were federally mandated in May 2018, but the authors are not aware of any work that has evaluated the impact of the national rollout of this legislation in restaurants using a comparison group to account for potential bias. METHODS:Using synthetic control methods, Taco Bell restaurants that implemented menu labels after nationwide labeling (n=5,060 restaurants) were matched to restaurants that added calorie labels to menus after local labeling legislation (and prior to nationwide labeling). The effect of menu labeling on calories purchased per transaction after nationwide labeling between groups (i.e., "later-treated" and "early-treated" restaurants) was estimated using a two-way fixed effects regression model, with time modeled as relative month from implementation and fixed effects for calendar month and restaurant. RESULTS:In the baseline period, average calories per transaction was 1,242 (SD=178) in the national menu labeling group and 1,245 (SD=183.9) in the comparison group, with parallel trends between groups. Difference-in-differences model results indicated that transactions from restaurants in the national menu labeling group included 7.4 (95% CI: 7.3, 7.5) more calories than was predicted based on the trend in the comparison group. Average number of total transactions per month decreased ∼2% more in the national menu labeling group relative to the comparison group. CONCLUSIONS:Negligible changes were observed in calories purchased and number of transactions in restaurants that added calorie labels due to national legislation, above and beyond secular changes. Other strategies may be necessary to promote meaningful decreases in daily calories purchased in restaurants going forward.

BACKGROUND:Glucagon-like peptide-1 (GLP-1) medications, recently introduced in the United States for treating type 2 diabetes and obesity, have sparked interest and discussion on social media. Social media has emerged as a prominent platform for the distribution of health information; its vast user base and accessibility make it a popular resource for individuals seeking medical advice. This study characterized GLP-1 medication-related content on Instagram about 3 critical areas of public health: women's health, access from nontraditional settings, and barriers to access. OBJECTIVE:This study aimed to perform passive content analysis in which information patterns would be observed from Instagram posts. METHODS:We examined 40 GLP-1 medication-related Instagram posts to develop a list of the most frequently used hashtags. In total, 10 "top posts" were collected for 7 days (July 11-17, 2023) for 11 study hashtags (eg, #Ozempic). Duplicates, deleted posts or accounts, non-English content, and unrelated posts were removed. Each post was reviewed by at least 2 coders. Coding discrepancies were resolved through discussion. RESULTS:The final sample included 239 posts. More than half of the posts (130/239, 54%) were from GLP-1 medication users. Raters perceived most users to be female (90/97, 92.8%); inferred that most used medications for weight loss (69/130, 53.1%); determined the most frequently noted health condition was polycystic ovarian syndrome (25/130, 19.2%); and judged posts to have positive sentiments about well-being (64/130, 49.2%) and toward the medications (100/130, 76.9%). About a quarter of the posts (55/239, 23%) offered services for obtaining GLP-1 medications; GLP-1 medications were perceived to be accessible via nontraditional health care settings (eg, medical spas) versus traditional settings (39/239,16.3% vs 12/239, 5%). Most users (78/97, 80.4%) were perceived to be White; barriers to access (ie, shortages, insurance, and cost) were infrequently mentioned (6/239, 2.5%; 3/239, 1.3%; and 1/239, 0.4%, respectively). CONCLUSIONS:Our findings highlight the perceived benefits of GLP-1 medications for women's health, the need to increase health literacy about where to safely access medications, and how additional attention is needed for equitable access to GLP-1 medications. The onus is on social media companies to promote content that is safe and for the health care system and its payers to address health care inequities for historically marginalized communities.

INTRODUCTION/BACKGROUND:Social media is the most prominent source of online food and beverage advertisements (ads) seen by adolescents. Companies target adolescent social media users with ads that feature calorie-dense, nutrient-poor products, and exposure to ads drives poor diet and risk for future diet-related diseases. Black, Hispanic and lower socio-economic status youth are exposed to significantly more ads than White peers. Several state-level policies in the USA have passed restricting youth from accessing social media without parental approval, and some policies have banned advertising to youth. This protocol paper describes a current study that aims to understand the impact of such policies in two states, Louisiana and Texas, as they were among the first to be implemented with racially/ethnically diverse populations. METHODS AND ANALYSIS/METHODS:This study employs a repeated cross-sectional difference-in-difference design in which 700 youth ages 13-17 years are being recruited each year for 5 years (Louisiana n=175, Texas n=175, matched comparisons from other states n=350). Youth screen record their mobile devices for 60 minutes while they browse social media platforms (eg, TikTok, Instagram) or use the internet. They also complete a brief survey about a variety of topics (eg, health behaviours, mental health). Adolescents are compensated for screen recording ($75) and the survey ($25). Study team members are coding recordings for several characteristics, including media platforms used, appearances of food or beverages, and food or beverage type. We will estimate the impact of policies on food and beverage ads seen per hour using Ordinary Least Squares regression models and heterogeneity-robust standard errors clustered at the state level (by year and cumulatively). We will run additional models with interaction terms with income and race/ethnicity, separately, to test the role of the policies on health disparities. ETHICS AND DISSEMINATION/BACKGROUND:Study procedures have been approved by the Institutional Review Board of the NYU Grossman School of Medicine. We will distribute findings in peer-reviewed journals and at local and national conferences. To complement traditional dissemination pathways, we will create infographics to share with relevant community stakeholders. We will also share findings with policymakers in states that have passed or considered similar policies.

The concept of 'food justice' recognizes the systemic injustices embedded in the U.S. food system and the urgent need for transformative policies to ensure equitable access to affordable, nutritious, and culturally relevant food. Limited access to these foods drives food insecurity and increases the prevalence of diet-related diseases in low-income and minority communities. Dominant narratives that individualize hunger and food insecurity often blame the individual and overlook the underlying structural factors that sustain these issues. These narratives have considerable influence. They shape public opinion and can also guide policy decisions. This commentary explores the goals of the food justice movement in the U.S., describes how the food and racial justice movements intersect, and examines the role of commercial marketing and public policy in shaping the food justice discourse. We also reflect on the efforts that should be made to reframe these dominant narratives and facilitate meaningful change in the food environment.

BACKGROUND:Food and beverage marketing is an important influence on the health and diets of adolescents. Food and beverage companies spend billions of dollars annually on advertisements to promote their products and are increasingly focusing on social media influencers. Influencer product endorsements blur the line between entertainment and marketing. OBJECTIVE:This study aimed to quantify how often TikTok influencers promote products from food and beverage brands and document the range of ways they disclose brand relationships in their content. METHODS:We collected up to 100 videos posted on or before July 1, 2022, from each of the top 100 influencers on TikTok in the United States and recorded information about the influencer (eg, number of followers) and video (eg, number of views and likes). For each video that contained food or beverage products, we identified the main product featured. A team of research assistants then coded each video for how the product was featured (ie, in the video, audio, or caption) and, for branded products, whether the video was accompanied by any disclosures of brand relationships. Average pairwise percentage agreement among coders was 92%, and average pairwise Cohen κ was 0.82. RESULTS:Among the 8871 videos from 97 influencers that made up the final analytical sample, we identified 1360 videos (15.3%) that featured at least one food or beverage product. These 1360 videos were viewed >9 million times and received >1 million likes each. Nearly half (n=648, 47.6%) of the videos featured a branded product. Most videos featuring a branded product did not contain a brand relationship disclosure (n=449, 69.3%). Among videos that disclosed a brand relationship, influencers used 10 different types of disclosures. Tagging a brand in the video's caption was the most common disclosure method (n=182, 28.1%). Six types of caption hashtags were used to disclose brand relationships, including #[brandname] (n=63, 9.7%) and #ad (n=30, 4.6%). Only 1 video (0.2%) made use of TikTok's official disclosure label and only 1 video (0.2%) verbally mentioned a contractual agreement with a brand. CONCLUSIONS:Among the food and beverage videos with disclosures we identified, the most frequently used mechanism-tagging the brand-did not clearly differentiate between sponsored content and the influencer trying to attract a brand or followers who may like that brand. Social media users, particularly adolescents, need clearer, more robust disclosures from influencers to protect against the undue influence of food marketing. These findings may also inform calls for the Children's Food and Beverage Advertising Initiative-the largest self-regulatory pledge to reduce unhealthy food marketing-to include older adolescents, who are heavily targeted by food and beverage companies on social media.

OBJECTIVE:The objective of this study was to evaluate potential sources of heterogeneity in the effect of calorie labeling on fast-food purchases among restaurants located in areas with different neighborhood characteristics. METHODS:In a quasi-experimental design, using transaction data from 2329 Taco Bell restaurants across the United States between 2008 and 2014, we estimated the relationships of census tract-level income, racial and ethnic composition, and urbanicity with the impacts of calorie labeling on calories purchased per transaction. RESULTS:Calorie labeling led to small, absolute reductions in calories purchased across all population subgroups, ranging between -9.3 calories (95% CI: -18.7 to 0.0) and -37.6 calories (95% CI: -41.6 to -33.7) 2 years after labeling implementation. We observed the largest difference in the effect of calorie labeling between restaurants located in rural compared with those located in high-density urban census tracts 2 years after implementation, with the effect of calorie labeling being three times larger in urban areas. CONCLUSIONS:Fast-food calorie labeling led to small reductions in calories purchased across all population subgroups except for rural census tracts, with some subgroups experiencing a greater benefit.

BACKGROUND:Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. OBJECTIVE:This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents' preferences for the advertisements and featured products. METHODS:Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants' ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement-"liking;" following; commenting; tagging a friend). RESULTS:Latinx (n=436; 48.3%) and White (n=467; 51.7%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps≤.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of "liking" advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). CONCLUSIONS:This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products.