Young adults: beloved by food and drink marketers and forgotten by public health?

INTRODUCTION

There is little argument that preventing childhood obesity is an important public health priority. Policymakers, parents, communities, civil society, schools, celebrity chefs and—to varying degrees—a limited number of food and beverage companies have all lent support to improving the diets and physical activity levels of children. Most advocacy, policy and research attention have focused on the factors that shape children's food and beverage choices, including emphasizing the impact that marketing has on these choices. Public health experts and international bodies, such as the World Health Organization, agree that reducing children's exposure to unhealthy food and beverage marketing, including by regulating how and where these products are marketed, is an effective strategy for combating the global rise in rates of childhood obesity (World Health Organisation, 2010).

However, a potential drawback of this child-focused approach is that food and beverage marketers may simply shift promotional resources and efforts to other vulnerable targets including adolescents and young adults. Any marketing that is ostensibly aimed at these more mature target populations is also highly likely to spill over and appeal to younger children (Winpenny et al., 2014), who admire and follow the trends of their older peers. Equally, food and beverage marketing directed at young adults has escaped public health scrutiny and is neither well monitored nor assessed for its impact on food consumption patterns or weight status (Nelson et al., 2008).

In this paper, we highlight the potential drawbacks of an overly child-oriented focus in research, advocacy and policy responses aimed at addressing the impact that energy-dense, nutrient-poor (EDNP) food and beverage marketing has on diet and weight. Our goal is to create discussion and debate on how best to ensure this vulnerable population is not missed in future obesity prevention efforts, particularly given that they are a highly favoured target of EDNP food and beverage marketers.

PART 1: YOUNG ADULT OVERWEIGHT AND OBESITY RATES ON THE RISE

One of the most concerning features of the continuing rise in the prevalence of overweight (body mass index ≥25 but <30) and obesity (body mass index ≥30) is that the greatest proportionate rise has occurred in the youngest adult age groups. Young adults experience the fastest rates of weight gain across the life course and the prevalence of overweight and obesity in young adults is growing faster than in older adults (Allman-Farinelli et al., 2007). A high prevalence of overweight and obesity in young adults can be seen across the globe in both low (OECD Directorate for Employment, Labour and Social Affairs, 2014) and high-income (Australian Institute of Health and Welfare [AIHW], 2013; Norman et al., 2003) countries. In the USA, for example, 34.5% of all 12–19 year olds and 60.3% of 20–39 year olds are considered overweight or obese (Ogden et al., 2014). In Australia, 15.1% of young adults age 18–24 are obese (Australian Bureau of Statistics, 2013). By 2020, it has been projected that in Mexico, deemed to be one of the most overweight nations, that obesity rates amongst young adults (age 20–24) will reach 30% for males and 31% for females (Rtveladze et al., 2014).

Weight gain prevention in young adults is essential, as beginning early adulthood with a healthy body weight means it is much more likely that a person will maintain a healthy weight later in life (Votruba et al., 2014). In response to this public health issue, the WHO included a target for halting the rise in adolescent and adult obesity in the global action plan for the prevention and control of non-communicable diseases (World Health Organisation, 2013).

Compared with older adults, young adults have a higher intake of EDNP foods and drinks, including sugar-sweetened beverages (Bleich et al., 2008), deep fried potatoes, savoury pastries, pizza and confectionery (Rangan et al., 2008). Some of these dietary choices, particularly soft drinks and fast food are amongst the most heavily advertised EDNP foods and beverages (Cairns et al., 2013). Correspondingly, young adults are also a major financial contributor to the EDNP food and beverage industry. Australians aged 15–24 years spend an average of AUS$180 per week on food and non-alcoholic beverages, more than any other category outside of housing costs and transport (Australian Bureau of Statistics, 2011). In the UK, students, who account for about half of the young adult population, contribute an estimated £20 billion to the economy every year (Mitchell, 2012).

There is no standard age definition for ‘young adulthood’. Rather than define this group by age, it may be more useful to consider the characteristics and milestones that constitute this period of life. This can be a time of flux and life change that may include attending college or university, moving out of the family home, buying and preparing one's own food for the first time or travelling alone. It can be a period of financial instability, with higher levels of unemployment, lower incomes and little disposal funds. Other factors such as identity development and shifting interpersonal influences differentiate young adulthood from other life stages and are likely to influence the adoption of both healthy and unhealthy behaviours (Nelson et al., 2008). While it is artificial to arbitrarily assign childhood, adolescence and young adulthood as beginning and ending at precise cut-off points, for the purposes of this paper we will consider young adults to be those approximately aged 15–24 years.

PART 2: EDNP FOOD AND BEVERAGE INDUSTRY TARGETING YOUNG ADULTS

Vulnerability to marketing impacts extend to young adults

Youth vulnerability to commercial marketing is often framed according to Piagetian theory, which outlines age-specific stages in the development of cognition that correlates with processing of marketing messages and decreased vulnerability to being influenced by messages with increasing age (Calvert, 2008). Underscored by this theory is the notion that an improved understanding of marketers' selling and persuasive intentions with increasing age confers a resistance against this type of marketing. However, more recently proposed psychological theories suggest that understanding of marketing intent is necessary but not sufficient in decreasing vulnerability to marketing in young people. Other proposed conditions necessary for defence include both the ability to produce counterarguments against advertising and the motivation to do so (Harris et al., 2009). Further, marketing influences can occur even in the absence of cognitive processing and awareness of message exposure (Chartrand, 2005). As such, age, and with it marketing comprehension, is not an adequate defence against potential harms of marketing of risky or unhealthy products.

Relative to older adults, adolescents and young adults are identified as more impulsive and self-conscious, which creates conditions for increased vulnerability to marketing and branding (Pechmann et al., 2005). During this life stage, the developmental challenge of forming a personal identity that is separate from that of their parents’ results in increased peer pressures and self-consciousness, as young people turn to peers to help forge this identity. The social anxiety and desire for the projection of self-identity increases receptivity to marketing, and particularly to marketing that uses emotional appeals. Marketing can contribute to young adult identity formation (Chaplin and John, 2005) and socialization by conferring social norms and expectations (Harris et al., 2009).

Marketing exploits young adults' social pressures

Marketers exploit young adults' susceptibility to social pressures through ‘image marketing’, which refers to the creation of persuasive appeals that project symbolic, idealized person-types who would be consumers of the product (Bishop, 2000). This form of marketing aims to sell not only a tangible product, but also image attributes and symbols of consumption. Image marketing works by associating products with consumption attributes, rather than by emphasizing product physical or sensory superiority, such as better taste compared with a competitor product. Image marketing focuses messages on consumer attributes, suggesting that product consumption will heighten person-appeal and that users will feel and look better, and impress friends (Pechmann et al., 2005). Marketers also intersect with, and potentially distort, projections of social norms that arise from other socialization agents, such as peers, family and social institutions. For example, viral marketing through social networking websites and peer ambassador programmes harnesses the influence of peers to convey a brand as important and normative. Red Bull's Student Brand Manager programme is a typical example of this peer-to-peer influence approach (Red Bull, 2010). Other marketing approaches, including the use of celebrity endorsements and sponsorship of youth events, organizations and institutions all tie marketing messages to other influencers and give the impression of endorsement from these other agents.

Tobacco industry manipulation of young adult susceptibility to social influences has been well documented (Centres for Disease Control and Prevention, 2012). Strategies such as sponsorship of music and sporting events, and promotions at bars and parties have been used to integrate tobacco products into youth social contexts (Ling and Glantz, 2002). In 2001–02, the tobacco brand Camel held ‘Casbah’ themed bar events with Camel costumed staff, flavoured cigarette samples and gifts including branded cigarette holders (Lewis et al., 2004). So, too, have alcohol manufacturers employed marketing strategies that associate their products as an integral part of social engagement for young people (McCreanor et al., 2005). Absolute Vodka, an international spirits brand, sponsors fashion events, dance parties and creative competitions. In 2014, Absolute promoted the campaign ‘Nights by Absolute’, in which the vodka company partnered ‘with four boundary-pushing artists, in four of the world's greatest cities, to reinvent the nature of nightlife’ (Absolut, 2014).

There are also many emerging instances of food and non-alcoholic beverage marketing campaigns similarly using techniques to ‘naturalize’ brands within young adults' social contexts and youth culture. Red Bull has run a promotional initiative since 2012 called ‘Red Bull Sound Select’, which hosts music events across the USA, Canada and New Zealand. Entry tickets are a token amount of US$3.00 and available only to members who register via social media (Figure 1). The low cost of event tickets is countermanded by the collection of personal data during online registration, which can be used as a basis for future targeted marketing.

Fig. 1:

Photo of a Red Bull Sound Select event, taken from the Red Bull Facebook page.

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Source: https://www.facebook.com/RBSoundSelect?fref=ts.

These forms of marketing may be less scrutinized than mass media advertising approaches for products with significant health risks. Equally, this greater emphasis on below-the-line marketing has emerged alongside the introduction of marketing restrictions on more traditional media channels (Lewis et al., 2004).

Young adults are an accessible and valuable market segment

Publicly available and accurate data detailing the total amount spent on marketing EDNP food and beverages is difficult and costly to access. Globally, the total advertising spend on confectionery alone was estimated to be US$2.8 billion for the first 9 months of 2013 (WARC, 2014). In 2013, the top 20 global advertising spenders included well-known food and beverage companies and brands such as Mcdonald's, Nestle, Pepsico, Mars, The Coca Cola Company and Unilever (Nielsen, 2013).

In the USA, total advertising spending by fast food restaurants in traditional media (excluding online) reached US$4.6 billion in 2012 ( Harris et al., 2013). Just 10 fast food restaurants were responsible for 73% of this spending. Eighteen to twenty-four years olds were amongst the highest exposed to the television component of this advertising, viewing nearly 2000 television advertisements for fast food restaurants annually (Harris et al., 2013). Comparably, in Australia, food, beverage and personal/healthcare is the largest segment of the advertising industry, accounting for 32.8% (AUS$606.1 million) of the industry's total value (Marketline, 2015).

According to Euromonitor International's 2011 annual survey of online consumers (which spans eight major markets), students aged 20–34 years were more likely than other respondents to eat meals later and snack more, consume ready meals at home, order takeaway food to eat at home, pay more for convenience products and order groceries/takeaway food online (Euromonitor International, 2013). The survey authors go on to suggest that there are tremendous opportunities for marketers to appeal to the students with ready meals, takeaways, fast food and other items that are quick and easy to prepare, and can be eaten on the go.

While most empirical studies measuring youth exposure to food marketing have focused on children (Cairns et al., 2013), high digital media engagement amongst young adults suggests that marketing exposure in this demographic is large, particularly in the current new media age (Kelly et al., 2015) Almost all (93%) of young adults aged 18–29 years in the USA access the Internet, compared with three-quarters of adults overall (Pew Research Center, 2014), and engagement with online advertising is also high, with young adults internationally reporting that they frequently view, share and comment on online advertising content (Microsoft Advertising and Synovate, 2013).

Corresponding with young adults' expansive digital media use, marketers exploit new technology to reach and engage young adults. Microsoft Advertising outline strategies for reaching young adults on a variety of Microsoft platforms, including Xbox gaming, which is claimed to be an ‘indispensable component’ (Microsoft Advertising, 2014) of young adults' life, Skype, the Bing online search engine and Microsoft Mobile Advertising Mobile advertising have the potential to target messages not only by key demographics but also by location, through location-enabled services on these devices. Young adults are more likely than older adults to use geosocial services, such as ‘Foursquare’, to ‘check-in’ to locations, making them an ideal target for this form of marketing (Pew Research Center, 2011).

PART 3: CURRENT PUBLIC HEALTH APPROACHES TO PROTECT YOUNG ADULTS FROM EDNP FOOD AND BEVERAGE MARKETING

EDNP food and beverage marketing restrictions are currently focused primarily on reducing exposure to television advertisements amongst young children. Unlike the widespread adoption of laws restricting tobacco marketing and promotion, the regulation of EDNP food and beverage marketing is not commonplace. The World Cancer Federation Research Fund International collates examples of policy actions from around the world that attempt to limit exposure to EDNP food and beverage marketing (World Cancer Research Fund International, 2014). Only a handful of countries limit advertising of unhealthy foods during children's television programmes and viewing hours. A systematic review of the effect of such laws and of industry self-regulation policies shows that while government mandated laws could reduce children's total exposure to unhealthy food and drink advertising on television, self-regulation is ineffective (Galbraith-Emami and Lobstein, 2013).

Restrictions on EDNP food and beverage marketing to older ages are limited. In a rare example, South Korea prevents EDNP food and beverage brands using promotional gifts (such as a toy) in any Internet advertising to children under 18 years age (World Cancer Research Fund International, 2014). Little if any existing regulations would limit any of the advertising examples highlighted above. The primary rationale for this regulatory focus has been that young children are unable to distinguish between advertisements and other media content and are thus highly vulnerable to being exploited by advertisers (Calvert, 2008). Additionally, it is politically expedient to highlight advertising aimed at children to assist in gaining public and legislator support for any reforms. The vast majority of public health research attention has also been directed at understanding childhood exposure to, and experience of, EDNP food and beverage marketing and very little is known about the amount, nature and impact of promotions that are targeted at young adults (Larson et al., 2008).

The chiefly voluntary and ad hoc nature of advertising codes meant to limit children's exposure to EDNP food and beverage marketing has had a minimal impact on actual advertising exposure for this population (Obesity Policy Coalition, 2011). Young children do not view media in a sealed vacuum where they exclusively access only programmes and content expressly directed at their age group. Advertising that is ostensibly aimed at older children, adolescents and young adults also appeals, and easily ‘leaks’, to younger audiences. Correspondingly, by only focusing on advertising that is obviously aimed at young children, many opportunities are created for EDNP food and beverage companies to claim to legitimately create promotions aimed at young adults. The tobacco industry realized this some decades ago, and without changing any of its marketing practices, simply began referring to younger smokers with the more acceptable term of ‘young adult’ instead of youth, adolescent or teenager (Freeman, 2012). As such, advertising restrictions that focus solely on children are problematic, as they do not protect children and render advertising to young adult populations as wholly acceptable.

There is insignificant government or industry effort to limit EDNP food and beverage marketing aimed at young adults. However, there have been documented attempts to improve the broader food environments to which young adults are specifically exposed, through local policy implementation on secondary school or university and college campuses (The Greatist Team, 2014). This has included strategies such as menu labelling to identify healthier choices and increased availability of healthy meal options. However, banning EDNP food and beverage advertising on campuses does not appear to be a common approach, and soft drinks (Brooks, 2014) and fast food items (Swinburne Student Diary, 2014) are typically highly accessible and heavily promoted in these settings.

PART 4: RECOMMENDATIONS FOR FUTURE ACTION BY GOVERNMENTS, ACADEMICS AND CIVIL SOCIETY

Reducing young adult exposure to EDNP food and beverage marketing through regulation

Industry self-regulation has not been effective in reducing children's exposure to EDNP food and beverage marketing (Galbraith-Emami and Lobstein, 2013), and it seems unlikely that it has had any impact on the marketing exposures of young adults. Of the 25 food industry pledges on marketing to children listed in the Yale Rudd Centre repository, all but one pledge only encompassed children under 12 years of age (Yale Rudd Center for Food Policy and Obesity, 2014). Comprehensive government regulations to restrict EDNP food and beverage marketing through all media, including social and mobile media, sport and event sponsorship and in secondary schools, are needed to effectively reduce adolescent and young adult exposure. Regulations should include measures that specifically restrict the use of lifestyle and image marketing and ban the use of celebrities or professional athletes. This could be similar in approach to alcohol marketing restrictions in France, where for example, alcohol brands are not permitted to sponsor sports and alcohol advertisement content is strictly limited to product attributes (Craplet, 2005).

Strict regulation of advertising of products with the potential to cause harm is not without precedence. For example, consumer advertising of prescription medicines is banned nearly universally, with the notable exceptions of the USA and New Zealand. Comprehensive bans on tobacco advertising have been adopted in more than 90 countries (World Health Organisation, 2014). Support of the adoption of a Global Convention to Promote and Protect Healthy Diets (World Obesity Federation and Consumers International, 2014), modelled from the successful WHO Framework Convention on Tobacco Control, during the 68th World Health Assembly is essential. As has been done in tobacco control, any policy and media advocacy by academics and civil society should also cover young adults in proposed regulation changes (Hopkinson et al., 2013).

Social media platforms could also be pressured to adopt more health-focused advertising polices. For example, Facebook currently prohibits tobacco and gambling marketing and restricts alcohol marketing (Williams, 2013). This policy could be broadened to include restricting the access of younger Facebook users to EDNP food and beverage promotions. Alternatively, a surcharge could be placed on EDNP food and beverage advertising and these funds used by health groups for counter advertising aimed at young adults. In addition, online privacy protection acts, such as the Children's Online Privacy Protection Act in the USA (Federal Trade Commission, 2013), could extend limiting digital tracking beyond those under age 13 to adolescents and explicitly incorporate EDNP food and beverage marketing.

Countering the impact of EDNP food and beverage marketing to young adults

Counter-marketing efforts, similar to the highly successful US anti-tobacco industry truth^® campaign, could be adopted with the goal of increasing understanding amongst young adults on how they are targeted and manipulated by the EDNP food and beverage industry (Niederdeppe et al., 2004). These campaigns could also assist in increasing the urgency and profile of restricting EDNP food and beverage marketing on the policy agenda. Social media potentially offer an opportunity to keep such campaigns relatively inexpensive. Given the growing interest in delivering preventive healthcare through these platforms, this may be an opportune time to approach social media companies to provide support to organizations that work to reduce obesity (Farr and Oreskovic, 2014).

Utilizing other new media channels popular with young adults may also prove essential to successfully reaching this demographic group. Online game-based viral marketing programmes (Ip et al., 2014) and mobile phone app interventions have shown promise for promoting positive dietary behaviours (Hebden et al., 2013) and smoking cessation (Free et al., 2011). The emergence and increasing popularity of self-tracking devices such as the Fitbit^® health tracker may also be effective in engaging with young adult populations.

Creating a social movement to combat the corporate forces that threaten healthy weight maintenance amongst young adults is also a promising area of public health advocacy and action. NCDFree (non-communicable disease) is an example of an organization that is engaging with young people globally to stimulate local action to take on the leading causes of death and disability globally (NCDFree, 2015). Employing community mobilization models from the environmental and civil rights sector and employing everyday social media tools show promise in transforming NCD prevention from an individual choice to an issue of universal, social concern.

Future research priorities

Initially, improved monitoring will be critical to highlight the extent of young adults' exposure to EDNP food and beverage marketing. Coordinated and consistently collected data, from across countries and over time, will assist in informing policy discussions and increasing pressure for better regulation. This will be particularly challenging across social and other new media platforms that are constantly evolving (Freeman et al., 2014). Young adults and parents of adolescents could potentially be involved in collecting data on outdoor and events-based advertising around schools and universities, sport sponsorship and promotions appearing on social and other online media.

Conducting research with young adults to assess how their opinions, attitudes and behaviours are influenced by exposure to EDNP food and beverage marketing is needed. Young adults could be regularly polled on the acceptability of comprehensive restrictions of EDNP food and beverage marketing. This may assist in giving a stronger voice to young adult concerns about their weight (Walsh et al., 2014) and accelerate the implementation of regulations that support maintaining a healthy weight through increasing public pressure on policymakers.

Young adults must be a priority population in future obesity prevention efforts. While limiting EDNP food and beverage marketing aimed at this group is only one aspect of a comprehensive approach to obesity prevention, any public health efforts directed at this group will be severely hampered if not also accompanied by initiatives that address the abundance of unhealthy marketing. The sheer volume of promotions is likely to drown out even the most well-crafted public health messages and programmes. Policies that protect young adults from EDNP food and beverage marketing may also increase the effectiveness of policies that are meant to protect children.

FUNDING

This work was supported by the Australian National Preventive Health Agency, grant number 64FRE2011.

REFERENCES