Changes in household food and drink purchases following restrictions on the advertisement of high fat,salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis

BackgroundRestricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases.Methods and findingsOver 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks.ConclusionsThis study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.

Amy Yau and co-workers study food and drink purchases after the introduction of advertising restrictions in London, UK.     

Belief in Food Addiction and Obesity-Related Policy Support

Objectives

This study examines whether belief in the food addiction construct is associated with support for obesity-related policies (e.g., restrictions on foods served in schools and workplace cafeterias, subsidies on fruits and vegetables), while simultaneously examining other factors associated with policy support (e.g., political party affiliation).

Design

Cross-sectional.

Setting

Online Community.

Participants

200 individuals were recruited through Amazon Mechanical Turk.

Measurements

Participants (n = 193) responded to three questions about belief in food addiction and a measure evaluating support for 13 obesity-related policy initiatives. Individuals also completed the modified Yale Food Addiction Scale (mYFAS), self-reported height and weight, and provided demographic information (age, gender, race, political party affiliation).

Results

Belief in food addiction was significantly associated with greater support for obesity-related initiatives, even when accounting for the significant associations of age, gender, and political party. Belief in food addiction and political party both had moderate effect sizes for predicting support for obesity-related policy. There was an interaction between age and belief in food addiction, with significant associations with policy support for both younger and older individuals, though the effect was larger for younger participants.

Conclusion

The current study provides evidence that belief in food addiction is associated with increased obesity-related policy support, comparable to the influence of one’s political party. Growing evidence for the role of an addictive process in obesity may have important implications for public support of obesity-related policy initiatives.     

Understanding and addressing waste of food in the Kingdom of Saudi Arabia

IntroductionMultiple estimates suggest the Kingdom of Saudi Arabia (KSA) may have one of the highest rates of wasted food globally. The KSA has limited arable lands and scarce water and thus relies on extensive imports and food subsidies to meet food demand. Accordingly, waste and loss of food are a significant concern for food security.Materials and methodsA narrative literature review was performed to identify the available information relevant to characterizing the context, magnitude of food wasted in the KSA, key contributing factors, and existing interventions and recommendations.ResultsEstimates of annual per capita waste of food ranged from 165 kg to 511 kg. Given the country's relatively limited agricultural production, the consumer and retail levels are primary targets for intervention. Key contributors to waste include culture, food valuation, policy and industry factors, and awareness and concern. The country is at an early stage of developing responses. We build upon existing approaches and recommendations, with particular emphasis on the potential role of agricultural extension staff in addressing the issue, and highlight research needs.ConclusionsGiven the potentially exceptional levels of wasted food in the KSA and the extensive evidence gaps, there is a great need for further research and action. Our review and synthesis presents numerous opportunities to advance innovative waste reduction approaches in the country, with particular relevance for other parts of the Middle East and other areas early in their efforts to address waste of food.     

In the Same Boat? A Comparative Analysis of the Approaches of Russia and Canada in the Negotiation of the IMO’s Mandatory Polar Code

Abstract

In the field of Arctic shipping, Canada and the Russian Federation have enacted extensive unilateral national regulations cognizant of Article 234, UN Convention on the Law of the Sea. On the global level, both states have been important actors in negotiating the International Maritime Organization’s mandatory Polar Code, a legal instrument with implications for regulations at the national level. This article compares and contrasts the approaches, positions, and arguments of Canada and Russia especially regarding national systems to control navigation and vessel-source pollution. The results suggest different emphases stemming from the two states’ political and economic realities and capacities.     

Political rationale,aims, and outcomes of health-related high-level meetings and special sessions at the UN General Assembly: A policy research observational study

BackgroundRecognising the substantial political weight of the United Nations General Assembly (UNGA), a UN General Assembly special session (UNGASS) and high-level meetings (HLMs) have been pursued and held for 5 health-related topics thus far. They have focused on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS, 2001), non-communicable diseases (NCDs, 2011), antimicrobial resistance (AMR, 2016), tuberculosis (TB, 2018), and universal health coverage (UHC, 2019). This observational study presents a comprehensive analysis of the political and policy background that prompted the events, as well as an assessment of aims, approaches, and ultimate outcomes.Methods and findingsWe investigated relevant agencies’ official documents, performed a literature search, and accessed international institutions’ websites for the period 1990–2020. Knowledgeable diplomatic staff and experts provided additional information. Outcomes were evaluated from a United Nations perspective based on national and international commitments, and funding trends. Eliciting an effective governmental response through UNGASSs/HLMs is a challenge. However, increased international commitment was evident after the HIV/AIDS (2001), NCDs (2011), and AMR (2016) meetings. The more recent TB (2018) and UHC (2019) HLMs have received general endorsements internationally, although concrete commitments are not yet documented. Although attribution can only be hypothesized, financial investments for HIV/AIDS following the UNGASS were remarkable, whereas following HLMs for NCDs, AMR, and TB, the financial investments remained insufficient to face the burden of these threats. Thus far, the HIV/AIDS UNGASS was the only one followed by a level of commitment that has likely contributed to the reversal of the previous burden trend. Limitations of this study include its global perspective and aerial view that cannot discern the effects at the country level. Additionally, possible peculiarities that modified the response to the meetings were not looked at in detail. Finally, we assessed a small sample of events; thus, the list of strategic characteristics for success is not exhaustive.ConclusionsOverall, UNGASSs and HLMs have the potential to lay better foundations and boldly address key health challenges. However, to succeed, they need to (i) be backed by large consensus; (ii) engage UN authorities and high-level bodies; (iii) emphasise implications for international security and the world economy; (iv) be supported by the civil society, activists, and champions; and (v) produce a political declaration containing specific, measurable, achievable, relevant, and time-bound (SMART) targets. Therefore, to ensure impact on health challenges, in addition to working with the World Health Assembly and health ministries, engaging the higher political level represented by the UNGA and heads of state and government is critical.

Paolo Rodi and colleagues analyze the political and policy response to UN General Assembly and high-level meetings focused on HIV/AIDS, non-communicable diseases, antimicrobial resistance, tuberculosis and universal health coverage.     

“Like Throwing a Bowling Ball at a Battle Ship” Audience Responses to Australian News Stories about Alcohol Pricing and Promotion Policies: A Qualitative Focus Group Study

Introduction

Policies affecting alcohol’s price and promotion are effective measures to reduce harms. Yet policies targeting populations are unpopular with the public, whose views can be influenced by news framings of policy narratives. In Australia, alcohol taxation receives high news coverage, while advertising restrictions have not until recently, and narratives are highly contested for each. However, research specifically examining how audiences respond to such news stories is scant. We sought to explore audience understanding of news reports about two alcohol policy proposals.

Method

From June to August 2012, 46 participants were recruited for 8 focus groups in age-brackets of young people aged 18–25 years, parents of young people, and adults aged 25 or older. Groups were split by education. Participants were asked their prior knowledge of alcohol policies, before watching and discussing four news stories about alcohol taxation and advertising.

Results

Participants were clear that alcohol poses problems, yet thought policy solutions were ineffective in a drinking culture they viewed as unamenable to change and unaffected by alcohol’s price or promotion. Without knowledge of its actual effect on consumption, they cited the 2008 alcopops tax as a policy failure, blaming cheaper substitution. Participants had low knowledge of advertising restrictions, yet were concerned about underage exposure. They offered conditional support for restrictions, while doubting its effectiveness. There was marked distrust of statistics and news actors in broadcasts, yet discussions matched previous research findings.

Conclusions

News coverage has resulted in strong audience understanding of alcohol related problems but framed solutions have not always provided clear messages, despite audience support for policies. Future advocacy will need to continue recent moves to address the links between alcohol’s price and promotion with the drinking culture, as well as facilitate understandings of how this culture is amenable to change through the use of evidence-based policies.     

Tobacco Industry Manipulation of Tobacco Excise and Tobacco Advertising Policies in the Czech Republic: An Analysis of Tobacco Industry Documents

Background

The Czech Republic has one of the poorest tobacco control records in Europe. This paper examines transnational tobacco companies'' (TTCs'') efforts to influence policy there, paying particular attention to excise policies, as high taxes are one of the most effective means of reducing tobacco consumption, and tax structures are an important aspect of TTC competitiveness.

Methods and Findings

TTC documents dating from 1989 to 2004/5 were retrieved from the Legacy Tobacco Documents Library website, analysed using a socio-historical approach, and triangulated with key informant interviews and secondary data. The documents demonstrate significant industry influence over tobacco control policy. Philip Morris (PM) ignored, overturned, and weakened various attempts to restrict tobacco advertising, promoting voluntary approaches as an alternative to binding legislation. PM and British American Tobacco (BAT) lobbied separately on tobacco tax structures, each seeking to implement the structure that benefitted its own brand portfolio over that of its competitors, and enjoying success in turn. On excise levels, the different companies took a far more collaborative approach, seeking to keep tobacco taxes low and specifically to prevent any large tax increases. Collective lobbying, using a variety of arguments, was successful in delaying the tax increases required via European Union accession. Contrary to industry arguments, data show that cigarettes became more affordable post-accession and that TTCs have taken advantage of low excise duties by raising prices. Interview data suggest that TTCs enjoy high-level political support and continue to actively attempt to influence policy.

Conclusion

There is clear evidence of past and ongoing TTC influence over tobacco advertising and excise policy. We conclude that this helps explain the country''s weak tobacco control record. The findings suggest there is significant scope for tobacco tax increases in the Czech Republic and that large (rather than small, incremental) increases are most effective in reducing smoking. Please see later in the article for the Editors'' Summary     

Global Health Governance and the Commercial Sector: A Documentary Analysis of Tobacco Company Strategies to Influence the WHO Framework Convention on Tobacco Control

Background

In successfully negotiating the Framework Convention on Tobacco Control (FCTC), the World Health Organization (WHO) has led a significant innovation in global health governance, helping to transform international tobacco control. This article provides the first comprehensive review of the diverse campaign initiated by transnational tobacco corporations (TTCs) to try to undermine the proposed convention.

Methods and Findings

The article is primarily based on an analysis of internal tobacco industry documents made public through litigation, triangulated with data from official documentation relating to the FCTC process and websites of relevant organisations. It is also informed by a comprehensive review of previous studies concerning tobacco industry efforts to influence the FCTC. The findings demonstrate that the industry''s strategic response to the proposed WHO convention was two-fold. First, arguments and frames were developed to challenge the FCTC, including: claiming there would be damaging economic consequences; depicting tobacco control as an agenda promoted by high-income countries; alleging the treaty conflicted with trade agreements, “good governance,” and national sovereignty; questioning WHO''s mandate; claiming the FCTC would set a precedent for issues beyond tobacco; and presenting corporate social responsibility (CSR) as an alternative. Second, multiple tactics were employed to promote and increase the impact of these arguments, including: directly targeting FCTC delegations and relevant political actors, enlisting diverse allies (e.g., mass media outlets and scientists), and using stakeholder consultation to delay decisions and secure industry participation.

Conclusions

TTCs'' efforts to undermine the FCTC were comprehensive, demonstrating the global application of tactics that TTCs have previously been found to have employed nationally and further included arguments against the FCTC as a key initiative in global health governance. Awareness of these strategies can help guard against industry efforts to disrupt the implementation of the FCTC and support the development of future, comparable initiatives in global health. Please see later in the article for the Editors'' Summary     

Are life cycle assessments a threat to sound public policy making?

This paper deals with the question of whether Life Cycle Assessments (LCAs), with their focus on objective and quantitative results, are the best way to support public policy processes. The public policy making process is characterized as a continuous discoursive struggle. Criteria are defined to distinguish between good and bad public policy discourses to judge the effects of LCA on the public policy process. Many policy scientists argue that methodologies that emphasize quantification and the use of formal methods are not beneficial for sound public policy making. An empirical report of the role LCAs played in public policy making processes on PVC and chlorine in the Netherlands is made to evaluate the contribution of LCAs to public policy making processes and to identify the main limitations of the current LCA methodologies and practices. It appears that political actors tend to use LCAs in a polarizing way. LCAs are easily misused due to their apparent objectivity, and the quantitative and black box nature of their results. LCAs contain an implicit, normative frame that does not match the environmentalists’ perception on the kind of evidence needed on toxic effects of organochlorines, which reduced the open nature of the Dutch PVC debate. It is recommended to develop a methodology for product evaluation that approaches the issue in a more open and emergent way to prevent “premature closure” of the analysis. It is expected that a focus on the development of balanced, rich arguments on facts and values in the study process will be more fruitful than the calculation of integral, quantitative indicators.     

Conservation Heroes Versus Environmental Villains: Perceiving Elephants in Caprivi,Namibia

This article investigates the impact of transnational environmental organizations on rural people involved in conservation by exploring the impacts of the Convention of International Trade in Endangered Species of Flora and Fauna (CITES) ivory trade ban on Namibia’s elephant conservation policy. This case study examines how rural African people are put into categories of ‘conservation heroes’ or ‘environmental villains’ by local conservation practitioners, government officials in Namibia and transnational conservation actors. Findings indicate that the approach of state officials and conservation organizations (CO) results in incomplete representations of both rural African people and the cultural importance these people attach to elephants. The article concludes that current environmental narratives associated with rural African people have been used as powerful ‘tools of persuasion’ at the state and international level to support and legitimate conservation policy and resource use in relation to the concerns of transnational environmental actors to the exclusion of rural African people.     

Arguing for biodiversity in practice: a case study from the UK

With a web of different local actors, often with different perspectives and interests, turning ideas into practice for biodiversity often involves communicating, negotiating, bargaining and, therefore, argumentation. Within this process arguments are selected by actors, to achieve their goals, with varying levels of effectiveness. We examine the use of arguments in UK national biodiversity policies and at the local level from the perspective of those putting forward and receiving arguments. We assess the positive and negative framings within arguments and the effectiveness of arguments. Using interviews and formal documents as sources of data, we analyse nine argumentative interactions from a case study in the Greater Manchester area in the UK. Our findings highlight differences between arguments in national biodiversity policy and those used at the local level. We also show a link between positive framing and salient arguments that were particularly effective. In more polarised, high conflict situations the credibility of the argument, specifically how well it aligned with policy frameworks, strongly influenced its effectiveness. These findings suggest that selecting arguments that identify common ground at the local level contributes to effective outcomes by highlighting areas of mutual benefit. Where this is not possible, a strong policy framework for the conservation of biodiversity is important. A combination of bottom up and top down approaches is most likely to provide effective arguments for biodiversity.     

住院医师规范化培训中的问题及国际经验启示

目的 梳理我国住院医师规范化培训存在的问题,借鉴国际经验,提出相关政策建议。方法 对现阶段我国住院医师规范化培训存在问题和典型国家住院医师培训开展文献调研和专家咨询。结果 我国 住院医师规范化培训存在管理制度不完善,培训过程和内容不合理,考核制度不健全,动员机制不顺畅等问题。结论 根据 国际经验,提出厘清各部门分工,充分发挥行业组织的桥梁和纽带作用;加强顶层设计和政策配套,保障培训制度的落实;拓宽培养内容,加强学员考核,提高培养质量等政策建议。     

Private Governance, Public Purpose? Assessing Transparency and Accountability in Self-Regulation of Food Advertising to Children

Reducing non-core food advertising to children is an important priority in strategies to address childhood obesity. Public health researchers argue for government intervention on the basis that food industry self-regulation is ineffective; however, the industry contends that the existing voluntary scheme adequately addresses community concerns. This paper examines the operation of two self-regulatory initiatives governing food advertising to children in Australia, in order to determine whether these regulatory processes foster transparent and accountable self-regulation. The paper concludes that while both codes appear to establish transparency and accountability mechanisms, they do not provide for meaningful stakeholder participation in the self-regulatory scheme. Accordingly, food industry self-regulation is unlikely to reflect public health concerns or to be perceived as a legitimate form of governance by external stakeholders. If industry regulation is to remain a feasible alternative to statutory regulation, there is a strong argument for strengthening government oversight and implementing a co-regulatory scheme.     

Fungibility: Florida Seminole Casino Dividends and the Fiscal Politics of Indigeneity

ABSTRACT   In this article, I examine Florida Seminoles' governmental distributions of tribal-gaming revenues that take the form of per capita dividends. Dividends reveal the political and cultural stakes of money's fungibility—its ability to substitute for itself. From tribal policy debates over children's dividends to the legitimization of political leadership through monetary redistribution, Seminoles selectively exploit the fungibility of money to break or make ties with one another and with non-Seminoles. They do so in ways that reinforce indigenous political authority and autonomy, and they thereby challenge structural expectations in U.S. public culture and policy that would oppose indigenous distinctiveness to the embrace of money. [Keywords: money, tribal gaming, American Indians, Florida Seminoles]     

“Efforts to Reprioritise the Agenda” in China: British American Tobacco's Efforts to Influence Public Policy on Secondhand Smoke in China

Background

Each year, 540 million Chinese are exposed to secondhand smoke (SHS), resulting in more than 100,000 deaths. Smoke-free policies have been demonstrated to decrease overall cigarette consumption, encourage smokers to quit, and protect the health of nonsmokers. However, restrictions on smoking in China remain limited and ineffective. Internal tobacco industry documents show that transnational tobacco companies (TTCs) have pursued a multifaceted strategy for undermining the adoption of restrictions on smoking in many countries.

Methods and Findings

To understand company activities in China related to SHS, we analyzed British American Tobacco''s (BAT''s) internal corporate documents produced in response to litigation against the major cigarette manufacturers to understand company activities in China related to SHS. BAT has carried out an extensive strategy to undermine the health policy agenda on SHS in China by attempting to divert public attention from SHS issues towards liver disease prevention, pushing the so-called “resocialisation of smoking” accommodation principles, and providing “training” for industry, public officials, and the media based on BAT''s corporate agenda that SHS is an insignificant contributor to the larger issue of air pollution.

Conclusions

The public health community in China should be aware of the tactics previously used by TTCs, including efforts by the tobacco industry to co-opt prominent Chinese benevolent organizations, when seeking to enact stronger restrictions on smoking in public places.     

Arguments for biodiversity conservation: factors influencing their observed effectiveness in European case studies

Making a strong case for biodiversity protection is central to meeting the biodiversity targets in international agreements such as the CBD and achieving the UN Sustainable Development Goals. Effective arguments are needed to convince diverse actors that protection is worthwhile, and can play a crucial role in closing the implementation gap between biodiversity policy targets and outcomes. Drawing on a database of arguments from 11 European case studies, along with additional interview and case study material from all 13 case studies of the BESAFE project, we analysed relationships between potential and observed effectiveness of arguments. Our results show that strong logic, robustness, and timing of arguments are necessary but not sufficient conditions for arguments to be effective. We find that use of multiple and diverse arguments can enhance effectiveness by broadening the appeal to wider audiences, especially when arguments are repeated and refined through constructive dialogue. We discuss the role of framing, bundling and tailoring arguments to audiences in increasing effectiveness. Our results provide further support for the current shift towards recognition of value pluralism in biodiversity science and decision-making. We hope our results will help to demonstrate more convincingly the value of biodiversity to stakeholders in decision processes and thus build better cases for its conservation.     

Hiding in the Shadows: Philip Morris and the Use of Third Parties to Oppose Ingredient Disclosure Regulations

Background

In 1996 Massachusetts proposed regulations that would require tobacco companies to disclose information about the ingredients in their products on a by-brand basis. This paper examines the strategies employed by Philip Morris to stop these regulations from being implemented.

Methods and Finding

We used previously secret tobacco industry documents and published literature to examine the activities of the tobacco companies after the regulations were proposed. Philip Morris hired a public relations firm to establish a coalition that was instructed to oppose the regulations by linking them to other industrial sectors (the slippery slope) and stating they would damage the state''s economy. Philip Morris also retained a polling firm to test the popularity of specific arguments against ingredient disclosure and developed a strategic plan for opposing similar regulations in Vermont.

Conclusion

Tobacco companies have historically used third parties to form coalitions to oppose ingredient disclosure regulations. These coalitions have had success preventing regulations from being implemented after they are initially proposed by creating the appearance of local opposition. With countries around the world currently implementing ingredient disclosure regulations in the WHO Framework Convention on Tobacco, governments and regulatory agencies should be aware of the political strategies that the tobacco companies have used to create the impression of popular opposition to these measures.     

Distribution and population development of introduced Ring-necked Parakeets Psittacula krameri in Britain between 1983 and 1998

Capsule Of the three subpopulations, only the one west of London was increasing, with little spread.

Aims To investigate the distribution and population dynamics of feral Ring-necked Parakeets in Great Britain.

Methods County bird report records (from 1983–95) were collated and analysed to determine distribution and population trends. Roost counts were undertaken monthly from September 1996 to September 1998 to determine minimum population counts and trends.

Results The parakeets were distributed in three subpopulations: west of London, southeast London and in Thanet, Kent. The total population increased during the period, with little spread, except for a slight westward range expansion. Flock size did not increase, and population growth was only apparent from maximum counts at communal roosts. The roosts were largest in the early autumn when, in each of the three years, minimum total population counts were obtained. The west of London population was large and growing, while the southeast London and Thanet populations were smaller and not increasing. The yearly total population counts were 1508, 1880 and 2060.

Conclusion The population is still relatively small and range expansion is slow, suggesting that agricultural areas are not yet threatened by this potential pest species.     

Submitting articles to the BMJ

ObjectiveTo investigate how doctors engage with patients with psychotic illness in routine consultations.DesignConversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder.SettingTwo psychiatric outpatient clinics in east London and south west London.Participants7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder.ResultsPatients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients'' concerns about their psychotic symptoms.ConclusionsPatients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients'' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.

What is already known on this topic

Patients with psychotic illness are difficult to engage in the health servicesNo research has been published on how doctors engage with these patients in consultations

What this study adds

Patients actively attempt to talk about the content of their psychotic symptomsDoctors'' reluctance and discomfort in engaging with this topic is apparentAddressing patients'' concerns may lead to a more satisfactory outcome of the consultation and improve engagement with services