Disparities in Sugary Drink Advertising on New York City Streets

Abstract

Introduction: Studies show that outdoor advertisements for unhealthy, consumable products are associated with increased intake and often target youth, low-income neighborhoods, and neighborhoods of color. Despite evidence that overconsumption of sugary drinks contributes to obesity and other chronic conditions, little is known specifically regarding the patterns of outdoor sugary drink advertising. Methods: The number of outdoor, street-level advertisements featuring sugary drinks was assessed in a random sample of retail-dense street segments (N=953) in low, medium, and high-poverty neighborhoods in each of New York City's 5 boroughs in 2015. Negative binomial regression was used to determine associations between sugary drink ad density, poverty level, and other census tract-level demographics (2009−2013 estimates) in each borough and New York City overall. Data were analyzed in 2017−2019. Results: In New York City and in 3 of 5 boroughs, sugary drink ad density was positively associated with increased percentages of black, non-Latino residents (New York City: incidence rate ratio=1.20, p<0.001; Bronx: incidence rate ratio=1.30, p=0.005; Brooklyn: incidence rate ratio=1.18, p<0.001; Manhattan: incidence rate ratio=1.20, p<0.05). Positive associations were also observed with poverty level in Brooklyn (low versus medium poverty: incidence rate ratio=2.16, p=0.09; low versus high poverty: incidence rate ratio=2.17, p=0.02) and Staten Island (low versus medium poverty: incidence rate ratio=3.27, p=0.03). Conclusions: This study found a consistent positive association between the density of outdoor sugary drink advertisements and the presence of non-Latino black residents in New York City and, in some boroughs, evidence of a positive association with neighborhood poverty. These findings highlight the inequities where sugary drinks are advertised in New York City.

A rapid review of stocking and marketing practices used to sell sugar‐sweetened beverages in U.S. food stores

“…64 Additionally, findings regarding the use of SSB advertisements mirror results about the use of pricing strategies, which seem targeted to at-risk consumer groups. 63,69,70 These findings align with reports of targeted strategies used per population, 16,31,32 and results of this research suggest coordinated use of several MMCA strategies to push SSB sales among at-risk U.S. consumer groups who experience health disparities. [7][8][9] More research is required, as few included studies were designed to capture disparities of in-store MCCA strategy use by community factors such as income, location, race/ethnicity, obesity, or consumer consumption.…”

“…Taxation could prompt SSB manufacturers and retailers to use comprehensive marketing‐mix and choice architecture strategies to improve sales 22 . U.S. beverage manufacturers and food retailers cater to consumer demand to maximize business profit, 25 although evidence suggests the prominence of energy‐dense and nutrient‐poor products within retail spaces drives the selection of affordable, palatable, and unhealthy choices beyond consumers' immediate awareness, 24,26–28 especially among at‐risk populations with fewer resources 29,30 who may be disproportionally targeted 16,31,32 …”

“…22 U.S. beverage manufacturers and food retailers cater to consumer demand to maximize business profit, 25 although evidence suggests the prominence of energy-dense and nutrient-poor products within retail spaces drives the selection of affordable, palatable, and unhealthy choices beyond consumers' immediate awareness, 24,[26][27][28] especially among at-risk populations with fewer resources 29,30 who may be disproportionally targeted. 16,31,32 In the United States, consumers purchase the majority of SSB products from convenience, mass merchandizer, dollar, and drug stores, in addition to using traditional supermarkets or grocers. 33 These retailers are often authorized to accept federal nutrition assistance benefits, including the U.S. Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), providing a viable entry point for policy change 34 due to retailer stocking requirements for SNAP and/or WIC authorization.…”

The impact of change in neighborhood poverty on BMI trajectory of 37,544 New York City youth: a longitudinal study

“…Local government and health department action has the ability to directly impact neighborhood environment through actions related to zoning, parks, and provision of services [79][80][81]. Further, a larger local government like New York City -the setting for this study -represents a population with tremendous diversity in characteristics (neighborhoods differ) and outcomes (neighborhoods demonstrate disparities) [29,[82][83][84][85]. Thus, understanding the link between neighborhood and health is critically important to understanding and addressing local health outcomes, such as obesity.…”

The ethics of excise taxes on sugar-sweetened beverages

“…This greater reduction is SSB purchases among low-income households in Mexico provides direct evidence that SSB taxes have progressive impacts on health behaviors. [15] Compared to other groups, lower-income and racial/ethnic minority populations are exposed to more advertising for SSBs, [66][67][68] consume more SSBs, [44] and suffer disproportionately from diet-related chronic disease. [69,70] Thus, most modeling studies of SSB taxes in Western and Latin American countries predict that low-income and/or racial/ethnic minority households would experience the largest reduction in SSB consumption; largest gain in health-or disability-adjusted life year; and greatest reduction in obesity, chronic disease, and/or health care costs.…”