Snack food advertising in stores around public schools in Guatemala

This study describes the type of snack foods advertised to children in stores in and around public schools and assesses if there is an association between child-oriented snack food advertising and proximity to schools. The food industry is flooding the market, taking advantage of the lack of strict regulation in Guatemala. Child-oriented advertisements are available in almost all stores within a short walking distance from schools, exposing children to an obesogenic environment.

Snack food advertising in stores around public schools in
Guatemala
Violeta Chacona, Paola Letonaa, Eduardo Villamorb, and Joaquin Barnoyaa,c,*
aDepartment of Research, Cardiovascular Surgery Unit of Guatemala, Guatemala City,
Guatemala.
bDepartment of Epidemiology, University of Michigan School of Public Health, Ann Arbor,
Michigan, USA.
cDivision of Public Health Sciences, Department of Surgery, Washington University in St. Louis,
School of Medicine, St. Louis, Missouri, USA.
Abstract
Obesity in school-age children is emerging as a public heath concern. Food marketing influences
preferences and increases children's requests for food. This study sought to describe the type of
snack foods advertised to children in stores in and around public schools and assess if there is an
association between child-oriented snack food advertising and proximity to schools. All food
stores located inside and within a 200 square meter radius from two preschools and two primary
schools were surveyed. We assessed store type, number and type of snack food advertisements
including those child-oriented inside and outside stores. We surveyed 55 stores and found 321
snack food advertisements. Most were on sweetened beverages (37%) and soft drinks (30%).
Ninety-two (29%) were child-oriented. Atoles (100.0%), cereals (94.1%), and ice cream and
frozen desserts (71.4%) had the greatest proportion of child-oriented advertising. We found more
child-oriented advertisements in stores that were closer (<170 m) to schools compared to those
farther away. In conclusion, the food industry is flooding the market, taking advantage of the lack
of strict regulation in Guatemala. Child-oriented advertisements are available in almost all stores
within a short walking distance from schools, exposing children to an obesogenic environment.
Keywords
children; marketing; food industry
Introduction
Childhood obesity is emerging as a public health concern in Latin America (Rivera et al.
2013). Guatemala is experiencing the double burden of disease that combines a high
prevalence of childhood stunting (54.5%) (World Health Organization 2008) with a rising
childhood overweight prevalence (27.1%) (World Health Organization 2009). Overweight
results from a combination of genetics, psychosocial variables and environmental factors
*Corresponding author. [e-mail] Postal address: 9a avenida 8-00 zona 11, Guatemala City, Guatemala..
HHS Public Access
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Crit Public Health. 2015 ; 25(3): 291–298. doi:10.1080/09581596.2014.953035.
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that affect diet and physical activity (Bouchard 2007; Schwartz and Puhl 2003). Among the
environmental factors, food marketing is key to promote childhood weight gain (Harris et al.
2009).
Child-oriented food marketing influences brand preferences and increases children's requests
for food (Hastings G et al. 2005; Letona et al. 2014). Overweight and obese children have
higher recognition of food advertisements and therefore food consumption, compared to
their non-counterparts (Halford et al. 2004). A direct correlation between television
advertising exposure and childhood obesity has also been documented (Robinson 1999;
Gortmaker et al. 1999). Similarly, food displays and advertisements in school kiosks are
strongly associated with purchase by primary and secondary school children (Mazur et al.
2008). Furthermore, consumer segmentation, a marketing strategy that involves dividing the
market into different groups with similar characteristics (e.g., age) has proven a useful tool
for the food industry to increase sales (McGinnis, Appleton, and Kraak 2006). In addition,
trade liberalization policies promoting worldwide expansion of unhealthy food industry may
also contribute to obesity (De Vogli, Kouvonen, and Gimeno 2011).
In 2007, the United Kingdom was the first country to restrict television child-oriented
advertising of high fat foods on all children's and non-children's channels before 9:00 PM
(Ofcom 2007). Quebec, Norway and Sweden have also implemented bans on television food
advertising and in-school marketing oriented to children (World Health Organization 2007).
Although not yet conclusive (Adams et al. 2012), a combination of interventions, in addition
to restricting television advertising, holds the most promise to decrease children's
advertising exposure (Bogart 2013; McGinnis, Appleton, and Kraak 2006). Examples
include regulation of all marketing types of unhealthy foods and implementation of nutrition
standards for foods and beverages sold in school kiosks (McGinnis, Appleton, and Kraak
2006).
In Guatemala, packaged foods nutrition labeling is regulated by the Food Control and
Regulation Department of the Ministry of Health. According to the Department, nutrition
health claims should be consistent with the nutrition information on the label (Consejo de
Ministros de Integración Económica 2012). However, to the best of our knowledge, there is
no enforcement and no regulation of child-oriented food advertising (Hawkes and Lobstein
2011). Furthermore, the types and quantity of snack foods advertised to children at the point
of sale have not been documented. Moreover, the association between child-oriented snack
food advertising and proximity to schools is yet unknown. Therefore, this study sought to
describe the type of snack foods advertised to children in stores in and around public schools
and assess if there was an association between child-oriented snack food advertising and
proximity to schools.
Methods
Out of 95 public schools, two preschools and two primary schools (students between 4 to 12
years old) located in the Municipality of Mixco were conveniently selected for this study.
Mixco is a city with 483,705 inhabitants (Instituto Nacional de Estadística de Guatemala
2012) in the Department of Guatemala. Since public schools in Mixco have similar
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characteristics, selected schools were not likely to be atypical (Ministerio de Educación
2012). Most children enrolled in public schools are from low socioeconomic status (World
Bank 2009) and enrollment in primary education is 95.8% (60% completion) (Guatemala
Human Rights Commission 2010). We obtained permission from the School District
Supervisor and each school principal to survey kiosks inside the schools for food
advertising.
All food kiosks located inside schools were surveyed. Using Google™ Earth, we identified
all stores located in a 200 meters radius centered on each school's entrance and surveyed the
distance in meters between the school entrance and each store. We arbitrarily categorized
the distance between the school entrance and stores as less than 170 meters and equal or
more than 170 meters as we considered this a reasonable distance for children between 4 to
12 years of age to walk to and from school.
We adapted the tobacco point of sale advertisement checklist by Cohen et al (Cohen et al.
2008), and adapted by Barnoya et al (Barnoya et al. 2010) to assess the store type (i.e., small
store, large store, school kiosk, street vendor, pharmacy, service station), total number of
snack food advertisements and those child-oriented inside and outside stores. We also
assessed the number of stores with snack foods displayed at the counter or snack foods less
than 50 cm from tobacco products, and in-store marketing techniques (display racks,
refrigerators, containers, and shelves). The checklist was pilot tested in seven stores located
in Mixco and found to be appropriate to assess child-oriented snack food advertisements and
in-store marketing techniques. In addition, training was conducted with two research
assistants one week prior to data collection.
Advertisements were defined as any posters, stickers, free-standing signs, banners, painting
on walls, or flags inside or outside stores. They were considered child-oriented if they had
images of promotional characters (i.e., licensed, brand-specific or sports character, cartoon,
animal/creature, or celebrity), premium offers (i.e., collectibles, toys, or raffles), children's
television or movie tie-ins, sports references (e.g., soccer balls, team logo), or the word
“child” or synonym (e.g., junior). To allow for comparisons with previously published data
(Bragg et al. 2013) on packaged snack food marketing, we included sweetened beverages
(i.e., fruit and energy drinks), soft drinks, pastries and cookies, savory snacks, dairy
products, cereals, ice cream and frozen desserts, and bottled water. Considering that atoles
(traditional fortified cereal-based drink) are one of the most frequently consumed beverages
among Guatemalan children (Montenegro-Bethancourt et al. 2010), we also included
packaged atoles as a category.
For data entry we used REDCap™ web-based application. Descriptive statistics were used
to summarize total and child-oriented advertisements. Median (25th – 75th percentiles) was
used to describe the distribution of advertisements (total, child-oriented, interior and
exterior) per store. Analyses were done with Fisher's exact and Chi-square tests for
categorical variables, and Wilcoxon ranksum test for continuous variables, using STATA®
software (version 11.1, 2009).
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Results
We found 64 stores inside (n=2) and around (n=62) two preschools and two primary schools
in Mixco. Nine were closed at the time of the assessment; therefore 55 stores were surveyed.
Among these, 58.2% (n=32) were small stores, 32.7% (n=18) large stores, 5.5% (n=3) street
vendors, and 3.6% (n=2) school kiosks. Thirteen stores (20.3%) had no advertising (6 small,
4 large, and 3 street vendors).
There were 321 snack food advertisements and most were on sweetened beverages (37%)
and soft drinks (30%). Twenty-eight advertisements (8.7%) were on pastries and cookies, 25
(7.8%) on savory snacks, 24 (7.5%) on dairy products, 17 (5.3%) on cereals, and 7 (2.2%)
on ice cream and frozen desserts. Twenty-nine percent (n=92) of all snack food
advertisements found in stores were child-oriented. We found 3 water advertisements (no
child-oriented). Atoles (100.0%), cereals (94.1%), and ice cream and frozen desserts
(71.4%) had the greatest proportion of child-oriented advertising, while 9 (36%) of savory
snacks were child-oriented (p<0.0001).
In stores located closer to schools (<170 m), median interior and exterior child-oriented
advertisements were 1 (1 – 2) and 2 (1 – 2), respectively (Table 1). More stores located
closer to schools had display racks (57.1%) and shelves (100.0%) promoting child-oriented
snack foods (Table 1). In stores located farther from schools (≥170 m) we found more snack
foods displayed at the counter and close (<50 cm) to tobacco products (57.1%) compared
with stores closer to schools.
Discussion
In this study we found that most advertisements in stores around schools were on sweetened
beverages and soft drinks. Atoles and cereals had the greatest proportion of child-oriented
advertising. Our results yield that stores closer to schools had more child-oriented
advertisements compared to those farther away.
Our results are consistent with those of food advertisements around primary schools in
Australia, where advertisements of unhealthy foods were higher in areas closer to schools
(Kelly et al. 2008). The food industry achieves repeated brand exposure by placing
advertisements in stores close to schools (Kelly et al. 2008). This has been associated with
increased food consumption, and therefore higher risk of obesity (Andreyeva, Kelly, and
Harris 2011).
Age-specific market segmentation strategies are used by the food industry to reach children
in schools (aged 4 to 12 years) and increase sales (McGinnis, Appleton, and Kraak 2006).
According to our findings, one third of advertisements in stores around schools were child-
oriented suggesting that the industry is using segmentation strategies to promote snack foods
to children in Guatemala.
Product placement at the point-of-sale influences choice and increases sales (Glanz, Bader,
and Iyer 2012). In our sample, stores located closer to schools had more display racks and
shelves promoting child-oriented snack foods, compared to those farther away. This in-store
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marketing technique is likely to influence children's purchase of unhealthy snacks at the
point of sale. Regarding tobacco products, most stores had tobacco products displayed near
snack foods. Therefore, as tobacco, the food industry is using the point of sale as yet
unregulated marketing strategy in Guatemala. Placing both products is associated with
increased brand recognition and consumption (or initiation in the case of cigarettes) (Hosler
and Kammer 2012; Henriksen et al. 2010; Barnoya et al. 2010).
Snack food advertising has been previously documented near schools and in neighborhoods
of different socioeconomic status in different countries (Maher, Wilson, and Signal 2005;
Batada et al. 2008; Gebauer and Laska 2011). Unhealthy snack food and beverage
advertising has been found to be higher in stores (including near schools) and in low
socioeconomic status neighborhoods (Yancey et al. 2009). However, only one has focused
on child-oriented advertising and distance from school, and included all advertising (Kelly et
al. 2008). Our findings are in agreement with what has been previously published and add
that child-oriented snack food advertising is highly prevalent near schools in Guatemala, a
LMIC.
Even though data on the companies responsible for advertising snack foods in Guatemala is
lacking, multinational companies (e.g., PepsiCo, The Coca-Cola Company) dominate the
beverage market as in the rest of Latin America (Comision Economica para América Latina
y el Caribe 2005). Therefore, globalization is disproportionately benefiting multinational
companies, promoting economic inequality and fueling the obesity epidemic (De Vogli et al.
2013).
Our study should be viewed in light of some limitations. We only described child-oriented
snack food advertisements and not all food advertisements. Similar to the Bragg, et al. study
(Bragg et al. 2013), advertising of confectioneries were not included and therefore our
results cannot be generalized to these snacks also marketed to children. Additionally, even
though our sample was not intended to be representative of the entire country, child-oriented
advertisements are likely to be the same nationwide considering convenience stores are
found in almost every neighborhood nationwide.
In conclusion, child-oriented snack food advertising at the point of sale is a strategy widely
used by the food industry to reach children. Just as the tobacco industry takes advantage of
the unregulated environment in Guatemala, point of sale advertising is only one of several
channels the food industry uses. Any effort to promote healthy eating inside schools would
be ruled out by the heavy exposure to this pervasive form of marketing in stores around
schools. Therefore, any comprehensive population strategy aiming to decrease exposure to
unhealthy snack food advertising should include the point of sale just as other traditional
advertising venues. While the food industry would likely oppose, a ban on snack food
advertisements in stores around schools is possible, similar to tobacco advertising
restrictions.
Supplementary Material
Refer to Web version on PubMed Central for supplementary material.
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Acknowledgements
This work was carried out with the aid of a grant from the International Development Research Centre, Ottawa,
Canada [Project number 106883-001]. Joaquin Barnoya receives additional support from an unrestricted grant from
the American Cancer Society and from Barnes Jewish Hospital Foundation. Additional support was received from
NIH Research Grant # D43 TW009315 funded by the Fogarty International Center.
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Table 1
Child-oriented snack food advertising (ads) in 55 stores around four public schools in Guatemala City
All stores (n=55) <170 m from school (n=28) ≥170 m from school (n=27) p*
Total ads, median (IQR) 5 (1 - 8) 6.5 (0 - 9.5) 4 (1 - 6) 0.26
Child-oriented ads, median (IQR) 1 (0 - 3) 2 (0 - 3) 1 (0 - 2) 0.16
Exterior child-oriented ads, median (IQR) 1 (0 - 2) 2 (1 - 2) 1 (0 - 2) 0.11
Interior child-oriented ads, median (IQR) 1 (0 - 2) 1 (1 - 2) 0.5 (0 - 2) 0.36
Stores with interior ads that can be seen from the street, % (n) 49.1 (27) 59.3 (16) 40.7 (11) 0.10
Stores with child-oriented snack foods displayed at the counter, % (n) 47.3 (26) 42.3 (11) 57.7 (15) 0.89
Stores with child-oriented snack foods <50 cm from tobacco products, % (n) 12.7 (7) 42.9 (3) 57.1 (4) 0.65
Stores with child-oriented in-store marketing techniques, % (n)
Display racks 76.4 (42) 57.1 (24) 42.9 (18) 0.09
Refrigerators/freezers 24.5 (14) 35.7 (5) 64.3 (9) 0.19
Containers 18.2 (10) 50.0 (5) 50.0 (5) 0.95
Shelves 1.8 (1) 100.0 (1) 0.0 (0) 0.32
*Wilcoxon ranksum test for continuous variables and Chi-square test for categorical variables.
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