The extent and content of outdoor advertisements for sugar-sweetened beverages and fast foods in Soweto
Background: Health experts are calling sugar the new tobacco (Action on Sugar, 2014). The WHO recently revised its recommendations for a maximum daily limit on sugar intake of 25 grams. Yet a 2012 study showed that South African children and adolescents are consuming up to 50 grams and 100 grams per day respectively (Steyn et al., 2003). Sugar is now recognized for its role, not only in promoting caries, obesity and diabetes, but also in the development of cancers. The World Cancer Report 2014, warns of a ‘cancer tidal wave’ over the next 20 years (IARC, 2014) Health promotion alone is insufficient; drawing on the example of tobacco control, such as advertising restrictions, legislation is the key to prevention. The sugar-sweetened beverage (SSB) industry is the leader among all sectors in marketing to young people (Arredondo et al., 2009), thus a similar approach is recommended for restricting SSB advertising to reduce chronic disease risk. There is no data regarding SSB advertising and obesogenic environments in South Africa. This pilot study is the first to describe the location, content and characteristics of outdoor print advertisements for SSBs and fast foods in South Africa. Methodology: This is a secondary analysis of data collected as part of a larger 2013 study investigating the obesogenic environment in Soweto, South Africa. All visible outdoor advertising and branding of SSBs and fast food in a five-square kilometer demarcated area were included. Data on content, quantity, location, size and type of advertisements was collected in the field and a photograph was taken for further analysis. Comparisons were drawn to photographs of alcohol advertising in the same area. Data was captured using a coding sheet and was analysed descriptively and using inferential statistics. The advertisements included billboards, banners, posters, pole advertisements, painted signs, branded school signs, branded shop signs, directional signs and branded umbrellas and fridges. A total of 237 photographs were included in the study. Results: The main findings of this study indicate a significant presence of advertising and branding for sugar-sweetened beverages in Soweto. SSB and fast food advertising and branding accounted for 62.86% of all advertising in the area under study. Of all SSB and fast food brands available in South Africa, Coca-Cola accounted for 86.58% of this advertising and branding. Unlike alcohol advertising, which is restricted to the locations in which alcohol is sold, advertising for SSBs is pervasive throughout the community, seen everywhere from shops and schools to transit stops and on street sides. Most SSB advertising and branding signage is medium or large in size. Images of people were only present in a small number of the adverts. However when people were present, they were consistently young people under the age of 35. The race of people in the adverts consistently represented the black African demographic of Soweto. While the main goal of the adverts appears to be product and brand recognition, there is a trend across the SSB adverts to convey messages of happiness, positivity, friendship, fun and well-being, suggesting that consumption of these products would lend to such outcomes for the consumer. A small percentage also promoted special deals to encourage product purchase. Conclusion: SSB advertising in Soweto is extensive, far surpassing advertising for junk food or alcohol. The government should consider implementing legislation, to restrict SSB advertising. The country should also urgently move to adopt WHO’s new guidelines on the daily upper limit for sugar intake (Mann, 2012), and to limit SSB intake specifically, which should be reflected in revisions to South Africa’s food-based dietary guidelines. Further research should focus on the association between the high rate of exposure to SSB advertising in Soweto and the level of consumption of SSBs and on the understanding of the advertising environment and how this affects the health literacy of South African children and adolescents.
A research report submitted to the School of Public Health, Faculty of Health Sciences, University of Witwatersrand in partial fulfillment of the requirements for the degree of Master of Public Health. 20 October 2014