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File: Nutrition Pdf 131197 | Bmjnph 2021 Full
open access original research comparing mcdonald s food marketing bmjnph first published as 10 1136 bmjnph 2021 000229 on 21 december 2021 downloaded from practices on official instagram accounts across ...

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                Open access                                                                                                                                  Original research
                                                   Comparing McDonald’s food marketing  BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from 
                                                   practices on official Instagram accounts 
                                                   across 15 countries
                                                                                 1                          2                           2                        2                          2
                                                   Omni Cassidy     ,  Hye Won Shin,  Edmund Song,  Everett Jiang,  Ravindra Harri,  
                                                                              2                                       1                                  1                      1,2
                                                   Catherine Cano,  Rajesh Vedanthan     ,  Gbenga Ogedegbe,  Marie Bragg
              To cite: Cassidy O, Shin HW,         ABSTRACT                                                                  What this paper adds
              Song E, et al.  Comparing            Background  Social media advertising by fast food 
              McDonald’s food marketing            companies continues to increase globally, and exposure 
              practices on official                to food advertising contributes to poor diet and                          ► McDonald’s posts 154% more posts in lower- 
              Instagram accounts across            negative health outcomes (eg, cardiovascular disease).                        middle- income countries compared to higher- 
              15 countries. BMJ Nutrition,         McDonald’s—the largest fast food company in the                               income countries.
              Prevention & Health                  world—operates in 101 countries, but little is known                      ► McDonald’s uses more child- targeted marketing 
              2021;0:e000229. doi:10.1136/                                                                                       themes in lower-middle-        income countries com-
              bmjnph-2021-000229                   about their marketing techniques in various regions. The                      pared to higher- income countries.
                                                   objective of this study was to compare the social media                   ► McDonald’s uses more health promotion themes in 
              ► Additional supplemental            advertising practices of McDonald’s—the largest fast food                     higher- income countries compared to lower- middle- 
              material is published online only.   company in the world—in 15 high- income, upper- middle- 
              To view, please visit the journal    income and lower- middle- income countries.                                   and  upper- middle- income  countries.
              online  (http:// dx. doi. org/ 10.   Methods  We randomly selected official McDonald’s 
              1136/ bmjnph- 2021- 000229).         Instagram accounts for 15 high- income, upper- middle- 
              1Department of Population            income and lower- middle- income countries. We captured                 obesity and non-communicable diseases, such  
              Health, NYU Langone Health,          all the screenshots that McDonald’s posted on those                     as type 2 diabetes, cardiovascular disease and 
              New York, New York, USA              Instagram accounts from September to December 2019.                                             2 3
                                                                                                                           certain cancers.            Although several factors 
              2Department of Public Health         We quantified the number of followers, ‘likes’, ‘comments’              influence diet, fast food has been linked to 
              Nutrition, New York University       and video views associated with each account in April                   poor diet and obesity because of its calori-
              School of Global Public Health,      2020. We used content analysis to examine differences in                                                                               4–6
              New York, New York, USA              the marketing techniques.                                               cally dense, nutritionally poor quality.                            
                                                                                                                           More than 30% of US youth consume fast 
              Correspondence to                    Results  The 15 accounts collectively maintained                        food daily,7 and fast food restaurant chains                               http://nutrition.bmj.com/
              Dr Omni Cassidy, NYU Langone         10 million followers and generated 3.9 million ‘likes’,                 have rapidly increased their global pres-
              Health, New York, New York,          164 816 comments and 38.2 million video views. We                                                                                         8
              USA;                                 identified 849 posts. The three lower- middle- income                   ence, particularly in lower- income countries.  
               omni. cassidy@ nyulangone. org      countries had more posts (n=324; M, SD=108.0, 38.2                      McDonald’s is the largest fast food company 
                                                   posts) than the five upper- middle- income countries                    in the world with more than 14 000 restau-
              Received 29 March 2021               (n=227; M, SD=45.4, 37.5 posts) and seven high- income                  rants in the US and nearly 22 000 restaurants 
                                                   countries (n=298; M, SD=42.6, 28.2 posts). Approximately                in other countries.9 Given fast food’s impact 
              Accepted 29 June 2021                12% of the posts in high- income countries included                                                                                       4
                                                                                                                           on nutrition and negative health outcomes,  
                                                   child- targeted themes compared with 22% in lower-                      the growth of fast food companies’ interna-                                 on January 2, 2023 by guest. Protected by copyright.
                                                   middle- income countries. Fourteen per cent of the posts in             tionally, especially in lower-income countries,  
                                                   high- income countries included price promotions and free               may exacerbate the double healthcare and 
                                                   giveaways compared with 40% in lower- middle- income                    economic burden of communicable and non- 
                                                   countries.                                                              communicable diseases.1 10
                                                   Conclusions  Social media advertising has enabled                          Although the relationship between the 
                                                   McDonald’s to reach millions of consumers in lower- 
                                                   middle- income and upper- middle- income countries with                 growth of fast food companies internationally 
                                                   disproportionately greater child- targeted ads and price                and the individual demand for fast food is 
                                                   promotions in lower- middle- income countries. Such reach               complex, fast food advertisements (‘ads’) play 
                                                   is concerning because of the increased risk of diet- related            an influential role in persuading individuals 
                                                   illnesses, including cardiovascular disease, in these                   to consume fast foods.11 Food and beverage 
                                                   regions.                                                                ads are ubiquitous on television and in 
              © Author(s) (or their                                                                                        outdoor settings, but social media ads are an 
              employer(s)) 2021. Re- use                                                                                                                          12
                                                                                                                           emerging area of concern.  Instagram is one 
              permitted under CC BY- NC. No        INTRODUCTION                                                            of the most popular social media platforms in 
              commercial re- use. See rights       Poor diet is the leading cause of mortality                                            13
              and permissions. Published by                                                                                the world,  and allows fast food companies 
                                                                   1 2
              BMJ.                                 worldwide,  and places individuals at risk for                          to advertise products through posting images 
                                                               Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229                                                      1
                                                                                             BMJ Nutrition, Prevention & Health
          and videos, and engaging with their followers through           METHODS                                                          BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from 
          accompanying captions and comments. Currently, 60%              We identified a sample of 15 countries based on three 
          of the world’s population uses the internet and 50% of          criteria: (1) if McDonald's was sold in the country; (2) 
                                                 14                       if the country had an official McDonald’s Instagram 
          the users are active on social media.  According to one 
          growth projection, nearly 60% of global internet users          page and (3) if the country could be categorised as an 
          were using social media in January 2020, which equates          HIC, UMIC or LMIC based on 2019 World Bank classifi-
                                                 15                               21
          to over 3.8 billion social media users.  In an online study     cations.  We chose McDonald’s because it is the largest 
                                                                                                  13
          surveying over 15 000 adults from the US, the UK, Canada,       global fast food chain,  and selected Instagram because 
          Mexica and Australia, 64% of participants reported expo-        it is one of the most popular social media platforms for 
          sure to sugary drink marketing through online ads or            adolescents and young adults with approximately one 
                        16                                                                                22 23
          social media.  Fast food companies that advertise on            billion active users per month.
          social media, therefore, are capable of increasing their 
          market to people around the world who regularly access          Data collection
          social media.                                                   We collected data from September 2019 to April 2020, 
            Data increasingly show that the majority of food and          and the Instagram posts were gathered from September to 
          beverage ads on social media are for unhealthy foods            December 2019. We used McDonald’s corporate website 
          and beverages.17–19 In one study examining social media         to generate a list of all the countries with McDonald’s fast 
          food and beverage ads in Australia, all of the foods            food chains (see figure 1 for flow chart). We then made a 
          advertised on Facebook pages managed by the food                list of all official McDonald’s Instagram accounts for each 
          and beverage brands were for energy- dense, nutrition-          of the countries. To determine if the Instagram account 
                           17                                             was officially associated with McDonald’s, we confirmed 
          ally poor foods.  Another study showed that 77% of the          the presence of a ‘verification badge’ on the Instagram 
          social media ads Canadian adolescents viewed within a           profile. A verification badge is a blue checkmark logo 
          5- minute period were for unhealthy food and beverage           that appears next to the account’s name that signifies 
          ads, and 97% of these foods were considered high in             that Instagram has confirmed the account is associated 
                              18
          fat, sugar and salt.  Exposure to these types of ads may        with a celebrity, public figure or global brand. McDon-
          contribute to food preferences and consumption that             ald’s only had one official account for most of the coun-
          may precipitate poor diet and adverse health outcomes           tries. If McDonald’s had more than one official account 
          in these communities.11
            One of largest qualitative analyses of fast food ads across   for the country, we used the account with the most 
          different countries examined 16 food and beverage               followers. From this list, we selected a subset of 15 coun-
          company websites in Germany and the US (high- income            tries, ensuring that at least one country was represented 
          countries (HICs)), China and Mexico (upper-middle-              in each of the continents in which McDonald’s operates. 
                                                                          The country remained in the sample pool if it met the 
          income countries (UMICs)) and India and the Phil-               inclusion criteria. If a country did not meet the criteria,      http://nutrition.bmj.com/
                                                                    20
          ippines (lower- middle- income countries (LMICs)).              it was excluded, and another country was randomly 
          Results suggested that fast food companies advertised           selected. This process was repeated until all 15 countries 
          more healthy products in wealthier countries compared           met the criteria. We initially identified and selected coun-
          with lower- income countries, demonstrating segmenta-           tries based on GDP. On further reflection, we determined 
                                                                    20
          tion in their advertising techniques across countries.          that classifications from the 2019 World Bank Database 
          That study also found that food and beverage companies                                    21
          promoted more philanthropic activities in lower-income          were more appropriate.  We then grouped the coun-
                                                                          tries into their respective economic categories based on 
                                                           20                                                                               on January 2, 2023 by guest. Protected by copyright.
          countries compared with wealthier countries.  Another           the three classifications defined by the 2019 World Bank 
          content analysis examining 2 000 social media posts in                                            21
          the US demonstrated that 30% of posts included captions         Database: HIC, UMIC and LMIC.  We screen captured all 
                                                                          posts on the official McDonald’s Instagram accounts from 
          that attempted to interact directly with social media           1 September 2019 to 31 December 2019. In April 2020, 
                19
          users.  Little is known, however, about the marketing           we recorded image type (image or video) and number of 
          techniques of a single food company in countries with           ‘likes’, comments and video views, if applicable.
          varying economic statuses.
            To determine if there are differences in the marketing        Establishing the qualitative codebook
          techniques across multiple countries of varying  To evaluate the posts for their marketing content, we devel-
          economic statuses, the objective of this study was to           oped a qualitative codebook based on similar qualitative 
          compare Instagram posts for McDonald’s, the largest                                      19 24
                                                                          food marketing studies.      The codebook (online supple-
                                      13
          global fast food franchise,  in a subset of 15 countries        mental appendix 1) included the following variables: (1) 
          of varying gross domestic products (GDPs) and: (1)              food and/or beverage shown; (2) celebrity/influencers/
          determine the number of followers, ‘likes’, comments,           sponsorships; (3) healthy habits (eg, exchanging fries 
          posts, video posts and total views of videos and (2) quan-      for apples); (4) child- targeted (eg, showing a picture of 
          tify the frequency with which McDonald’s uses different         a child or adolescent); (5) special price promotions; (6) 
          marketing strategies.                                           promote McDonald’s app, website or McDelivery; (7) free 
          2                                                                   Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229
           BMJ Nutrition, Prevention & Health 
                                                                                                                                    BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from 
                                                                                                                                    http://nutrition.bmj.com/
                                                                                                                                     on January 2, 2023 by guest. Protected by copyright.
          Figure 1  Flow chart of country selection.
          giveaway/voucher; (8) culturally relevant (eg, religious    Pilot coding
          symbols); (9) engagements (eg, encouragements to like,      Pilot coding was conducted to establish interrater reli-
          comment or read the bio); (10) philanthropy/charity;        ability using 10% of the posts. An acceptable level of 
          (11) emotional appeal; (12) new branch (ie, promoting a     reliability was determined by at least a 90.0% agreement 
          newly opened McDonald’s restaurant) and (13) humour                                                           25
                                                                      or Krippendorf alpha coefficient of 0.70 or above.  Five 
          (eg, memes). We discussed the definition of each code-      coders were initially trained on the codebook and partic-
          book category to ensure consistency among coders. The       ipated in the pilot coding. However, only two coders 
          definition of each marketing technique is summarised in     achieved a Krippendorf alpha coefficient of at least 0.70 
          table 1.                                                    or 90.0% agreement for all variables, and they coded the 
          Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229                                            3
                                                                                                    BMJ Nutrition, Prevention & Health
                                                                                                                                                      BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from 
            Table 1  Definition of the marketing techniques
            Marketing technique                   Definition
            Food and/or beverage shown            Any visual food or beverage item. (For food, this does not include packaging. For beverage, this can 
                                                  include beverage cups as long as the post does not clearly show that the cup is empty. Background 
                                                  menu with images of food/beverage does not apply to this category as well as animated food/
                                                  beverage unless it is part of the concept of the post)
            Celebrity/influencer/sponsorships     Includes a reference to the person or organisation (must have over 10K followers) on the post or is 
                                                  partnering with McDonald’s
            Healthy habits                        Promotes healthy diet, exercise, conservation efforts, local farms, education or any other ideas that 
                                                  promote the well- being of the person or environment
            Child- targeted                       Shows a child, cartoons, Happy Meal, toys, characters (eg, from films) or any other child-r elated 
                                                  themes
            Special price promotions              Discount offers, 2- for- 1 deals, buy- one- get- free deals or any other reduced- price promotions
            Promote McDonald’s App, website or    Promotes app, website or McDelivery in any way (eg, app store logo)
            McDelivery
            Free giveaway/voucher                 Includes competitions with free prizes, free food offers and any other free giveaways that do not 
                                                  include purchasing another item
            Culturally relevant                   Includes holidays, famous monuments (has to be relevant to its country), religious symbols or any 
                                                  other reference to the country’s culture
            Engagement                            Encourages to like, comment, read the bio or any other way to interact with the post
            Philanthropy/charity                  Undertakes any charitable work
            Emotional appeal                      Evokes emotional reaction (eg, happiness) or allows to reminiscence
            New branch                            Markets a new regional McDonald’s that has opened
            Humour                                Any post that attempts to use comic marketing (eg, memes, jokes, comic actions)
           remaining 90% of the data. The codes for the remaining               (HICs); Romania, Lebanon, Malaysia, Brazil and South 
           three coders were discarded. Because the two coders rated            Africa (UMICs) and Indonesia, Egypt and India (LMICs). 
           the same sample of data, there were two potential sets of            These countries collectively maintained 10 million 
           data. The final dataset was composed of half of each of              followers, generated 3 883 952 ‘likes’, 164 816 comments, 
           the two coders’ sets of data based on random selection.              and 38 247 012 video views, and posted 849 times during 
           Some of the countries’ Instagram accounts had posts that             the 4- month data collection period (see table 2). The 
           were not in English, so we used Google Translator in the             average numbers of followers were 2.1 million (LMICs;                 http://nutrition.bmj.com/
           Chrome extension to translate these posts into English.              0.9% of Instagram users), 3.5 million (UMICs; 2.0% of 
           Data analytical plan                                                 Instagram users) and 4.4 million (UICs; 1.5% of Insta-
           We used R V.1.2.1578 to conduct descriptive analyses to              gram users; see table 2). The countries with the highest 
           calculate the number of followers, ‘likes’, comments,                number of followers included the US (3.7 million; HIC), 
           posts, video posts and video views associated with each              Brazil (2.6 million; UMIC) and Indonesia (1.1 million; 
           McDonald’s Instagram account. We also calculated the                 LMIC).
                                                                                  We identified 153.7% more posts on average in LMICs 
           frequency that McDonald’s used each marketing tech-                  compared with HICs. That is, we identified an average                  on January 2, 2023 by guest. Protected by copyright.
           nique across the 15 countries.                                       (SD) of 108.0 (38.2) posts in the LMICs as compared 
           Patient and public involvement                                       with 42.6 (28.2) posts in the HICs during the same time 
           The project does not include human subjects and was                  period.
           exempt from human subjects ethics review committee. It               Qualitative analysis of marketing strategies
           was not appropriate or possible to involve patients or the 
           public in the design, or conduct, or reporting, or dissem-           Child- targeted marketing themes appeared more 
           ination plans of our research.                                       frequently in lower- income countries than HICs (see 
                                                                                figure 2). The reverse was true for health promotion 
                                                                                themes. We identified 71 (22.0%, see table 3) child- 
           RESULTS                                                              targeted posts in LMICs, but just 33 child- targeted posts 
           Descriptive characteristics                                          (14.5%) in UMICs and 37 (12.4%) in HICs. The HICs’ 
           We identified McDonald’s franchises in a total of 118 coun-          accounts also portrayed more healthy habits (n=14, 
           tries, and McDonald’s had official Instagram accounts                4.7%) compared with the UMICs’ accounts (n=6, 2.6%) 
           for 62 countries. Our subset of 15 countries (25% of all             and LMICs’ accounts (n=8, 2.5%).
           accounts) included: the US, Australia, Canada, the UK,                 Two forms of price-related themes—free giveaways and  
           United Arab Emirates (UAE), Portugal and Panama                      price promotions—appeared more frequently in LMICs' 
           4                                                                        Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229
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...Open access original research comparing mcdonald s food marketing bmjnph first published as on december downloaded from practices official instagram accounts across countries omni cassidy hye won shin edmund song everett jiang ravindra harri catherine cano rajesh vedanthan gbenga ogedegbe marie bragg to cite o hw abstract what this paper adds e et al background social media advertising by fast companies continues increase globally and exposure contributes poor diet posts more in lower negative health outcomes eg cardiovascular disease middle income compared higher bmj nutrition the largest company prevention world operates but little is known uses child targeted doi themes com about their techniques various regions pared objective of study was compare promotion additional supplemental material online only high upper view please visit journal http dx org methods we randomly selected for department population captured obesity non communicable diseases such nyu langone all screenshots tha...

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