Saudi Cultural Missions Theses & Dissertations
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Item Restricted TOBACCO, ALCOHOL AND HIGH FAT, SALT AND SUGAR FOOD AUDIO-VISUAL CONTENT IN VIDEO ON DEMAND ORIGINAL FILMS AND POPULAR TELEVISED SPORTING EVENTS: IMPLICATIONS FOR PUBLIC HEALTH(Khaldoon Alfayad, 2023-05-12) Alfayad, Khaldoon; Murray, RachaelBackground: Research on the impact of different media is continually developing within the public health field, and audio-visual content has been identified as having potential negative outcomes on viewers through possible contribution to the prevalence of lifestyle behaviours, such as tobacco smoking, alcohol consumption and high fat, sugar and salt (HFSS) food consumption in adults and children. The UK has developed policies to control the accessibility of tobacco and alcohol products since the 1930s, ranging from increased taxes to more stringent advertising restrictions, smoke-free legislation, reinforced health warnings, managing the drinking environment, reducing drunk-driving, and brief interventions and treatment among others. Efforts continue to be made today to lower the number of individuals who engage in harmful use of tobacco and alcohol, including age and marketing controls to reduce advertising exposure to young people. Following these policy interventions, the UK has seen general decreases in tobacco and alcohol consumption among young people. However, the increasing role of media in alcohol and tobacco content exposure is a cause for concern to regulators and public health supporters. The UK government has, however, proposed fewer policies to address increasing levels of obesity in the UK, apart from the Soft Drink Industry Levy and the recently announced watershed ban prohibiting the advertisement of junk food online and before 9pm on TV. The few policies could be because obesity is a multifaceted health issue with no specific contributing factor. Researchers have outlined potential interventions that could help tackle HFSS food consumption, including restrictions on the number of fast-food outlets, reformulation of foods and drinks, and stricter regulation on the advertising of junk food. Limiting advertising on junk food is more important today than ever as HFSS food promotions become increasingly popular on traditional media, such as television and movies, and non-traditional media channels, including sponsored webpages, third-party sites, and social media among related channels. Research on alcohol, tobacco, and HFSS imagery exposure has been previously undertaken. However, limited studies have compared exposure to alcohol, tobacco, and HFSS imagery within the UK-wide population and there is no contemporary data. The aim of this study was to investigate the extent of broadcast media exposure (specifically television, films, and sports sponsorship) of tobacco, alcohol, and HFSS foods in adults and children. Objectives: Specific objectives of the study were to analyse and evaluate tobacco, alcohol, and HFSS contents, as well as estimating population exposure to this content (where viewing data is available). Three content analyses were completed: (1) Netflix and Amazon Prime Video original films released and viewed in 2017. (2) FIFA 2018 Men’s World Cup broadcast by the British Broadcast Corporation (BBC) and Independent Television Network (ITV). (3) FIFA 2019 Women’ World Cup broadcast by the British Broadcast Corporation (BBC) and the Independent Television Network (ITV). Methods: The study started by sampling films on Netflix and Amazon Prime Video for analysis. The study selected the most popular movies on Netflix and Amazon Prime Video watched by audiences across the UK in 2017, according to IMDb rating statistics. Data collected from Netflix and Amazon Prime Video included instances of tobacco, alcohol, and HFSS imagery appearing in 5-minute intervals. Instance of tobacco use were coded based on imagery, or tobacco appearance in the form of outright use, display of tobacco paraphernalia, inferred tobacco use, or brand appearance. The coding categories for alcohol included actual alcohol use which was defined as on-screen consumption of alcohol products. The type of alcohol product, whether beer, wine, champagne, or spirit was recorded during the coding process. The study was also interested in implied use of alcohol, which was interpreted as visible appearance of alcoholic products without outright consumption. The study also coded implied use of alcohol, which referred to verbal references to alcohol, drunken behaviour, and other appearances depicting alcohol use in the films. The coding process documented the type of HFSS product based on the ‘Big Five’ categories: pre-sugared breakfast cereals, confectionery, savoury snacks, soft drinks, and fast-food outlets. All episodes of tobacco, alcohol or HFSS consumption within the 5-minute period were recorded as one event irrespective of the number of appearances within that interval. However, where one episode appeared over a transition between one 5-minute periods to another 5-minute period, it was counted as two separate episodes. However, multiple branding information appearing within a 5-minute interval were counted separately. Data collected were initially recorded using Microsoft Excel prior to analysis using SPSS or Graph Pad Prism statistical software. Cumulative frequencies were used during statistical analysis. The cumulative frequencies were used to determine the number of observations above or below a certain value in the collected data set. The study calculated cumulative frequencies for visuals occurring in five-minute intervals within the selected Netflix and Amazon Prime Video films. Next, the study selected matches for the FIFA 2018 Men’s World Cup and the 2019 Women’s World Cup. For the FIFA 2018 Men’s World Cup, matches involving England, Saudi Arabia, Russia, and the final match were selected for analysis. The matches involving England and the final game were selected since they had the potential of high viewership and were relevant to the UK. Saudi Arabia and Russia were selected due to the strict alcohol promotion regulations in the countries; Russia was also the host country of the FIFA World Cup 2018. For the 2019 Women’s World Cup, all matches from Group D, which included England and the final match were selected for coding due to the likelihood that they would draw high viewership. Group A matches featuring France, except three that were not available, were also selected for coding. After selecting the men’s and women’s matches, all billboard advertisements which occurred during the two halves as well as during the period between the first and the second halves were coded. After watching the matches and encountering the adverts the data has been collected, including the appearance of logos for the selected brands “McDonald’s”, “Coca-Cola”, “Powerade” and “Budweiser”, which were indications of advertisements for these brands in the men’s and women’s matches. For each appearance, the start and end time (in minutes and seconds i.e., 6:30-6:54) and match period (first half, second half, extra time and penalties) were recorded. Visual occurrences of each brand that appeared in clear, uninterrupted view on the screen received a single count in each instance. The duration of each continuous visual appearance was timed to the nearest second. Population exposure estimates of imagery content in the selected matches were used to approximate gross and per capita impressions. Per capita gross impressions were derived based on the frequency and duration of appearances (to the nearest second) of branding within the selected matches. Appearances overlapping between intervals were coded in the two intervals. To estimate UK population exposure to branding content, this study analysed the distribution of branding appearances and used that distribution to compute cumulative gross and per capita impressions. Gross impressions were determined by multiplying the estimate of the UK population who had watched the men’s and women’s FIFA World Cup matches by the number of branding occurrences in each match. Per capita gross impressions of were obtained by dividing the total number of gross HFSS branding appearances across all the matches in the sample by the total population in the UK. Results: Results of the study provided evidence that original films on VOD services, such as Netflix and Amazon Prime Video, are likely to be a source of potential exposure to alcohol in the UK. Potential harmful exposure refers to the extent to which the target audience in the UK encountered certain alcohol, tobacco, or HFSS imagery in the selected movies, likely to have contributed to increased used of these products. There was no major difference in alcohol, tobacco and HFSS imagery observed in movies selected from Amazon Prime Video and Netflix. The total percentage of alcohol and HFSS intervals were the same on each service, but the proportion of tobacco content on Amazon Prime Video was slightly higher. The most frequently consumed tobacco product were cigarettes (14.8%), represented in most films containing tobacco. Findings on the 2018 FIFA World Cup showed about 3.7 billion gross branded alcohol impressions to UK viewers. The study also revealed that an estimated 354 million alcohol impressions were delivered to children in the UK. Upon analysing the films and sporting events, the findings confirmed the presence of high HFSS content. HFSS brands were also evident in the 2018 FIFA men’s World Cup (1806 brand appearances) with popular advertising brands being Coca Cola (25.7% of the total brand appearances), McDonald’s (33.3% of total brand appearances), Budweiser (30.4% of total brand appearances) and Powerade (10.5% of total brand appearances), as well as in the 2019 women’s FIFA World Cup (1104 brand appearances) with the main advertising brands being Coca Cola (62.04% of the brand appearances) and Powerade (37.95% of brand appearances). The 13 matches analysed in the men’s game delivered an estimated 6.7 billion gross branded HFSS impressions, with the estimated total HFSS food impressions delivered to viewers varying across the selected matches. The highest per capita impressions (1.8 billion) were in the game between Tunisia and England, and the lowest per capita impressions (7.9 million) were in the match between Panama and Tunisia. Gross per capita impressions delivered to children across the entire 13 matches was 852 million. The 10 matches in the women’s game delivered an estimated 2.5 billion gross branded HFSS of total impressions. The highest HFSS food impressions (532.67 million) were in the match between England and Scotland, and the lowest (74.26 million) were in the match between Scotland and Argentina. The total of the branded HFSS child impressions was 164 million over the 10 matches. Study findings show that VOD services and the 2018 Men’s and 2019 Women’s World Cup are a significant source of exposure to alcohol, tobacco, and HFSS imagery to all age groups of individuals in the UK and are likely to aid HFSS consumption. Conclusion: The current study found that instances of alcohol, tobacco, and HFSS imagery were prevalent in original Netflix and Amazon Prime Video films, as well as the 2018 and 2019 FIFA World Cup. Potential regular and prolonged exposure to alcohol, tobacco, and HFSS imagery is a major risk factor likely to influence behaviour towards the consumption of these products among the young people. Specifically, the frequency of display and the proportion of programming time containing such imagery represents a source of exposure to alcohol, tobacco, and HFSS products. The possibility that being exposed can lead to behaviour change is supported by the heuristic model and the social learning theory, which theorize that people learn or acquire new patterns of behaviour by either observing or imitating other people. These findings show that stricter regulations need to be applied to prohibit alcohol, tobacco, and HFSS imagery. In view of the changing viewing habits of adolescents, there is a need for the regulation of tobacco, alcohol and HFSS imagery in original content from VOD services, whether this be updating the European audio-visual media services directive to ensure that regulations specifically include alcohol, tobacco and HFSS content, or ensuring that the current UK regulations which cover Amazon Prime Video are applied across Europe. Given the potential influence of brand appearances in FIFA World Cup events on food choices and alcohol consumption among children and young adults, it is important that the current regulations on alcohol and HFSS advertisement include televised sporting events, which are currently unregulated.33 0