Background Emerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and “comfort eating” as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how “Big Food” and “Big Alcohol” are capitalizing on the COVID-19 pandemic to market their products and brands. Objective We aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia. Methods We conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia. Results Nearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice. Conclusions This is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. “COVID-washing” by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to “build back better” in a post-COVID-19 world.

Objective: The present study assessed the impact of the retailer-led removal of unhealthy beverages from display at a self-service café within a major health service. While unhealthy beverages remained available from behind the counter upon request, this was not communicated directly to customers. Design: Drinks were categorised based on the state government nutrient profiling system, classifying drinks as 'green' (best choices), 'amber' (choose carefully) and 'red' (limit). Total drink sales (as number of items sold per week) in the café were measured for five weeks. All unhealthy 'red' beverages were removed from display (but were still available for purchase) and the sales of all beverages were measured for another six weeks. Results: We found that, in response to this strategy, the proportion of 'red' drinks sold decreased from 33 % to 10 % of total drink sales. As 'amber' and 'green' drink sales increased in response to this strategy, total retailer sales remained steady. Most consumers appeared to switch to purchasing 'amber' drinks rather than the healthiest option, 'green' drinks. Conclusions: The removal of unhealthy beverages from display can result in consumers making healthier purchases, while not significantly affecting retailers' sales. Keywords Public health policy Nutrition Community RetailCompelling evidence suggests that consumption of unhealthy drinks is associated with weight gain and increased risk of a number of adverse health outcomes (1,2) . Therefore governing bodies and health departments around the world have made a number of recommendations to decrease their consumption (3,4) . Community retail settings represent an important avenue of unhealthy drink purchase and consumption. As such, many strategies have been considered that attempt to influence consumer choices at the point of purchase, including standardised portion sizes and warning labels (5) .In Victoria, Australia, one health service is working with its food retailers to trial and implement a range of different strategies to improve the healthfulness of foods and drinks purchased throughout the service (6) . The present study assessed the impact of one of these novel strategies, removing unhealthy drinks from display in a self-service café, on total drink sales and on sales of healthy and unhealthy drinks. These drinks were kept behind the counter and were still available on request by the customer. MethodsThe present study was a non-controlled before-and-after evaluation of a natural experiment at a café located in a major Victorian hospital. This location leads to high numbers of both sales and customers, including hospital employees and hospital patients and their families. At the café, customers make their drink selection via a self-service fridge and then take their choice to the counter to pay. These self-service fridges are displayed in conjunction with food displays.

Objective: To compare the cost and affordability of two fortnightly diets (representing the national guidelines and current consumption) across areas containing Australia’s major supermarkets. Design: The Healthy Diets Australian Standardised Affordability and Pricing protocol was used. Setting: Price data were collected online and via phone calls in 51 urban and inner regional locations across Australia. Participants: N/A. Results: Healthy diets were consistently less expensive than current (unhealthy) diets. Nonetheless, healthy diets would cost 25-26% of the disposable income for low-income households and 30-31% of the poverty line. Differences in gross incomes (the most available income metric which overrepresents disposable income) drove national variations in diet affordability (from 14% of the median gross household incomes in the Australian Capital Territory and Northern Territory, to 25% of the median gross household income in Tasmania). Conclusions: In Australian cities and regional areas with major supermarkets, access to affordable diets remain problematic for families receiving low incomes. These findings are likely to be exacerbated in outer regional and remote areas (not included in this study). To make healthy diets economically appealing, policies that reduce the (absolute and relative) costs of healthy diets and increase the incomes of Australians living in poverty are required.

Objective: To describe the use of artificial intelligence (AI)-enabled dark nudges by leading global food and beverage companies to influence consumer behaviour. Design: The five most recent annual reports (ranging from 2014–2018 or 2015–2019, depending on the company) and websites from 12 of the leading companies in the global food and beverage industry were reviewed to identify uses of AI and emerging technologies to influence consumer behaviour. Uses of AI and emerging technologies were categorised according to the Typology of Interventions in Proximal Physical Micro-Environments (TIPPME) framework, a tool for categorising and describing nudge-type behaviour change interventions (which has also previously been used to describe dark nudge-type approaches used by the alcohol industry). Setting: Not applicable. Participants: 12 leading companies in the global food and beverage industry. Results: Text was extracted from 56 documents from 11 companies. AI-enabled dark nudges used by food and beverage companies included those that altered products and objects’ availability (e.g., social listening to inform product development), position (e.g., decision technology and facial recognition to manipulate the position of products on menu boards), functionality (e.g., decision technology to prompt further purchases based on current selections) and presentation (e.g., augmented or virtual reality to deliver engaging and immersive marketing). Conclusions: Public health practitioners and policymakers must understand and engage with these technologies and tactics if they are to counter industry promotion of products harmful to health, particularly as investment by the industry in AI and other emerging technologies suggests their use will continue to grow.

IntroductionTikTok has over one billion monthly users and is particularly popular among children. We examined the (1) use of owned media by major unhealthy food and non-alcoholic beverage brands on TikTok and (2) nature of branded hashtag challenges instigated by such brands and the user-generated content created in response.MethodsWe assessed the (1) content of all videos posted on the accounts of 16 top food and non-alcoholic beverage brands (based on global brand share) as at 30 June 2021, and (2) content and sentiment of a sample of brand-relevant user-generated content created in response to branded hashtag challenges instigated by these brands.ResultsOf 539 videos posted by brands, 60% were posted in the first half of 2021. The most common marketing strategies were branding (87% of videos), product images (85%), engagement (31%) and celebrities/influencers (25%). Engagement included instigation of branded hashtag challenges that encouraged creation of user-generated content featuring brands’ products, brands’ videos and/or branded effects. The total collective views of user-generated content from single challenges ranged from 12.7 million to 107.9 billion. Of a sample of 626 brand-relevant videos generated in response to these challenges, 96% featured branding, 68% product images and 41% branded effects. Most portrayed a positive (73%) or neutral/unclear (25%) sentiment, with few negative (3%).ConclusionUnhealthy food and non-alcoholic beverage brands are using TikTok to market brands and products via their own accounts and to encourage users to create and share their own content that features branding and product images. Given TikTok’s popularity among children, this study supports the need for policies that protect children from the harmful impact of food marketing on social networking platforms.