Unhealthful Food-and-Beverage Advertising in Subway Stations: Targeted Marketing, Vulnerable Groups, Dietary Intake, and Poor Health.

Unhealthful food-and-beverage advertising often targets vulnerable groups. The extent of such advertising in subway stations has not been reported and it is not clear how ad placement may relate to subway ridership or community demographics, or what the implications might be for diets and diet-related health in surrounding communities. Riding all subway lines (n = 7) in the Bronx, NY, USA, investigators systematically assessed all print ads (n = 1586) in all stations (n = 68) in 2012. Data about subway ridership came from the Metropolitan Transportation Authority. Demographic data on surrounding residential areas came from the U.S. Census Bureau. Data on dietary intake and diet-related conditions came from a city health-department survey. There were no ads promoting "more-healthful" food-or-beverage items (i.e., fruits, vegetables, whole grains, nuts, water or milk). There were many ads for "less-healthful" items (e.g., candies, chips, sugary cereals, frozen pizzas, "energy" drinks, coffee confections, hard alcohol, and beer). Ad placement did not relate to the number of riders entering at stations. Instead, exposure to food-or-beverage ads generally, and to "less-healthful" ads particularly (specifically ads in Spanish, directed at youth, and/or featuring minorities), was directly correlated with poverty, lower high-school graduation rates, higher percentages of Hispanics, and/or higher percentages of children in surrounding residential areas. Correlations were robust to sensitivity analyses. Additional analyses suggested correlations between ad exposures and sugary-drink consumption, fruit-and-vegetable intake, and diabetes, hypertension, and high-cholesterol rates. Subway-station ads for "less-healthful" items were located disproportionately in areas home to vulnerable populations facing diet and diet-related-health challenges. The fact that uneven ad placement did not relate to total rider counts suggests ads were not directed at the largest possible audiences but rather targeted to specific groups.