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Objectives This was a two-part descriptive study designed to 1 assess the marketing themes and sugar content of beverages promoted in outdoor advertisements ads within a portion of Accra, Ghana and 2 quantify the types of ads that appeared along the Accra-Cape Coast Highway. Setting A 4. Primary and secondary outcome measures Number and types of beverage ads, sugar content of beverage products featured in ads and marketing themes used in ads. Design Two researchers photographed outdoor beverage ads in a 4. Researchers also recorded the number and type of ads along a km stretch of the Accra-Cape Coast Highway. Researchers assessed the added sugar content to determine which beverages were sugar-sweetened beverages SSBs. Results Seventy-seven photographed ads were analysed. Seventy-three per cent Sixty-five per cent Nine per cent 9. Conclusion This study demonstrates the frequency of outdoor SSB ads within a 4. You will be able to get a quick price and instant permission to reuse the content in many different ways. This is the first study, to our knowledge, to use nutritional analyses and qualitative coding to examine the types of beverage ads that appear in a 4. The study applied the methodology of other research that has assessed outdoor ads eg, capturing ads visible from the street, using similar definitions for ad sizes in other regions, which strengthens the ability to compare findings across studies. Sub-Saharan Africa has experienced increasing rates of diet-related diseases such as obesity, hypertension, heart disease and stroke in recent years. Specifically, researchers have reported increased obesity prevalence in West Africans living in urban compared with rural areas, suggesting a need for public health interventions and public policies to address these largely preventable health risks. One effort towards preventing NCDs examines how food and beverage marketing contributes to poor diet. Food and beverage marketing in the USA is ubiquitous, with ads appearing on billboards, television, the internet, social media sites, in movies and in schools. To understand the developing presence and extent of beverage advertising in Accra, the capital city of Ghana, this descriptive study aimed to 1 assess the marketing themes used in outdoor beverage ads in a 4. For the first stage of the study, three researchers developed a qualitative codebook based on common marketing themes that have been reported in the previous research. We defined billboards as large signs with dimensions greater than 0. These dimensions reflect measurements used in other outdoor ad studies. After developing the codebook, two researchers divided Accra into 5 km 2 regions and chose one site at random to capture a snapshot of urban marketing practices. Larger areas were not feasible for the two researchers to capture given the time-intensive nature of the task. After selecting the data collection site, the researchers took photographs of any non-alcoholic beverage ads that appeared alongside two-lane roads in that region. The exact area was ultimately 4. The rationale for capturing ads that were visible from the street was that such ads would be likely to allow for maximal consumer exposure, in sight of both pedestrians and drivers in the area. Thus, these ads were situated in a way that would have been likely to have a greater impact on potential consumers than more discreet ads. Accra is 65 total square miles km 2 , 23 but the random sample of photographs was captured in East Legon between the University of Ghana and the Kotoka International Airport. Any reference to multinational or local non-alcoholic beverage companies was photographed, including signs and items that featured products or brand logos eg, panels on the exteriors of small stores. The items of particular focus included classification as an SSB or non-SSB and the presence of child-targeted marketing, cultural relevance and health or fitness references, featuring three major food and beverage companies—Coca-Cola, Pepsi and Nestle—and all other brands. These classifications were not assigned as mutually exclusive, such that one ad could be applicable to more than one classification eg, an ad could demonstrate cultural relevance and also contain a health reference. Adequate nutritional information was not available for the following brands featured in the data set: Nido, Vaettel, Nestle Ideal, American Cola, Bel-Aqua, Kalyppo, Fandango and an additional unidentified brand. A second stage of the study involved tracking the number and type of all beverage ads present on the Accra-Cape Coast Highway, the km highway that serves as the primary road for commuters travelling to and from Accra to the coast of Ghana. The highway was selected as an area of study because it is the longest stretch of highway leading into Accra ie, a prime location to target consumers with ads. Of the 77 photos of outdoor non-alcoholic beverage ads that were captured, Coca-Cola brands eg, Fanta, Sprite were featured in None of the Nestle brands promoted infant formula, and none of the Coca-Cola or Pepsi ads promoted a low-calorie or no-calorie beverage. Forty-seven per cent Nearly half Almost half of all ads In Nine percent 9. Five percent 5. Finally, Thirty per cent In ads where an actual beverage was shown, the majority were local fruit and vegetable drink ads Results demonstrate the use of a variety of beverage marketing techniques in a 4. The majority of SSB ads captured in the study were associated with Coca-Cola, followed distantly by Nestle and Pepsi, which is consistent with reports of Coca-Cola increasing their investment in sales in Africa. While culturally targeted advertising can be considered a public health asset if it promotes healthy behaviours eg, encouraging healthcare screenings , previous research shows that culturally targeted ads heavily promote unhealthy products eg, unhealthy foods and beverages, alcohol and tobacco to Black and Latino communities in the USA, which is especially problematic given the disproportionately high rates of chronic diseases in those populations. The WHO recommends comprehensive policies aimed to prevent chronic diseases including national policies that restrict marketing of foods and beverages high in saturated fat, trans fat, sugar and salt imported and exported to other countries. None of the child-targeted ads were associated with Pepsi or Coca-Cola, with the exception of the Coca-Cola school sign. Further, child-targeted ads were used most frequently in fast food restaurants chain located in neighbourhoods where the majority of residents were black. Finally, 9. One positive finding included the lack of ads for infant formula, which has been shown to impede exclusive breastfeeding, the optimal nutrition source for infants and young children. This two-part study has several limitations. The data collection region was a small, 4. Additionally, although the data collection region was selected randomly, it was not selected based on residents' demographic characteristics, which limits our ability to draw conclusions about how ads might appear in different neighbourhoods. Similarly, beverage ads were photographed along roadways, meaning the researchers missed ads that appeared farther from the road. However, the use of ads that were visible from the street reflects previously published methods on outdoor advertising. Finally, because this was a descriptive study that makes no causal assumptions, its impact on policy choice and implementation is likely very limited. Rather, the findings contribute to the literature on outdoor advertising because this is the first study, to our knowledge, to assess outdoor beverage ads in an area of Accra, Ghana. The findings suggest a need for further monitoring of outdoor advertising in these areas. Overall, these findings suggest that SSBs are the primary beverage product promoted in a 4. The limited promotion of low-calorie or no-calorie beverages suggests that sales of soda in Accra may rely on sugary beverages, which are associated with obesity, diabetes and tooth decay. Though some ads appeared next to schools, it was a small percentage, and we were not able to determine whether the company placed the ads there intentionally or by chance. Coca-Cola was featured in the majority of ads, and the child-targeted nature and placement of some Nestle ads suggests they should extend their child-targeted marketing pledges to include reducing ads outside of the USA. The findings point to the need for further monitoring of outdoor advertising in Ghana and suggest that initiating similar data collection in other regions of West Africa could be important, particularly if these advertising patterns are consistent across the region. Brice and Maimuna Marenah. Contributor MAB originated the idea for the manuscript and reviewed relevant literature on the topic. TH assisted with data collection and analysis and helped with the development of the manuscript. YRR provided critical feedback on drafts of the manuscript and assisted in framing the issues. GO provided critical feedback on drafts of the manuscript and assisted in framing the issues. Provenance and peer review Not commissioned; externally peer reviewed. Skip to main content. Log In More Log in via Institution. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Advanced search. Latest content Archive For authors About Browse by collection. Log in via Institution. You are here Home Archive Volume 7, Issue 5 A content analysis of outdoor non-alcoholic beverage advertisements in Ghana. Email alerts. Article Text. Article menu. Global health. A content analysis of outdoor non-alcoholic beverage advertisements in Ghana. Abstract Objectives This was a two-part descriptive study designed to 1 assess the marketing themes and sugar content of beverages promoted in outdoor advertisements ads within a portion of Accra, Ghana and 2 quantify the types of ads that appeared along the Accra-Cape Coast Highway. Statistics from Altmetric. Obesity Food marketing Ghana Strengths and limitations of this study This is the first study, to our knowledge, to use nutritional analyses and qualitative coding to examine the types of beverage ads that appear in a 4. Beverage ads that were not visible to researchers were not included in the study. Methods For the first stage of the study, three researchers developed a qualitative codebook based on common marketing themes that have been reported in the previous research. Sugar content of products featured in outdoor beverage ads Of the 77 photos of outdoor non-alcoholic beverage ads that were captured, View this table: View inline View popup. Marketing themes associated with outdoor beverage ads Nearly half Discussion Results demonstrate the use of a variety of beverage marketing techniques in a 4. References 1. Strom S. Ferdman RA. Stynes T. Gulati N , Ahmed R. India has 1. Non-communicable diseases in sub-Saharan Africa: the case for cohort studies. PLoS Med ; 7 : e Obesity and the nutrition transition in Sub-Saharan Africa. Ann N Y Acad Sci ; : 88 — Prevalence and time trends in obesity among adult West African populations: a meta-analysis. Obes Rev ; 9 : — Pan Afr Med J ; Food marketing to children and youth: threat or opportunity. Priming effects of television food advertising on eating behavior. Health Psychol ; 28 : — Influence of tobacco marketing and exposure to smokers on adolescent susceptibility to smoking. J Natl Cancer Inst ; 87 : — Ewert D , Alleyne D. Risk of exposure to outdoor advertising of cigarettes and alcohol. Am J Public Health ; 82 : — 6. Department of Health and Human Services. Tobacco use among U. Buxton C , Hagan JE. A survey of energy drinks consumption practices among student -athletes in Ghana: lessons for developing health education intervention programmes. J Int Soc Sports Nutr ; 9 : 9. OpenUrl PubMed. The use of sports references in marketing of food and beverage products in supermarkets. Public Health Nutr ; 16 : — Obesogenic environments: access to and advertising of sugar-sweetened beverages in Soweto, South Africa, Prev Chronic Dis ; 12 : E Storefront cigarette advertising differs by community demographic profile. Am J Health Promot ; 24 : e26 — e A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising. Milbank Q ; 87 : — The commercial food landscape: outdoor food advertising around primary schools in Australia. Socio-economic differences in outdoor food advertising in a city in Northern England. Public Health Nutr ; 14 : — New World Encyclopedia. Grier SA , Kumanyika S. Targeted marketing and public health. Annu Rev Public Health ; 31 : — Associations between retail food store exterior advertisements and community demographic and socioeconomic composition. Health Place ; 39 : 43 — World Health Organization. BMJ Publishing Group. BMJ Publishing Group , On the nutrient composition of food and its advertising. European Parliament Web. Child-directed marketing inside and on the exterior of fast food restaurants. Trends in the nutritional content of television food advertisements seen by children in the United States: analyses by age, food categories, and companies. Arch Pediatr Adolesc Med ; : — Exposure to food advertising on television: associations with children's fast food and soft drink consumption and obesity. Econ Hum Biol ; 9 : — Federal Trade Commission. A review of food marketing to children and adolescents: a follow-up report. How television fast food marketing aimed at children compares with adult advertisements. PLoS One ; 8 : e Food and beverage advertising on children's web sites. Pediatr Obes ; 9 : — Marketing sugary cereals to children in the digital age: a content analysis of 17 child-targeted websites. J Health Commun ; 18 : — Examining the interaction between food outlets and outdoor food advertisements with primary school food environments. Health Place ; 15 : — 8. Advertising and availability of 'obesogenic' foods around New Zealand secondary schools: a pilot study. N Z Med J ; : U Outdoor advertising, obesity, and soda consumption: a cross-sectional study. BMC Public Health ; 13 : Children's Food and Beverage Advertising Initiative: program and core principles: at a glance. Point-of-sale promotion of breastmilk substitutes and commercially produced complementary foods in Cambodia, Nepal, Senegal and Tanzania. Matern Child Nutr ; 12 : — Footnotes Contributor MAB originated the idea for the manuscript and reviewed relevant literature on the topic. NGP assisted with data analysis and development of the manuscript. Competing interests None declared. Data sharing statement No additional data available. Read the full text or download the PDF:. Log in.

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