Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom.
Soc Sci Med. 2022 Jan;292:114548. doi: 10.1016/j.socscimed.2021.114548. Epub 2021 Nov 10.
One in five UK children aged 10-11 years live with obesity. They are more likely to continue living with obesity into adulthood and to develop obesity-related chronic health conditions at a younger age. Regulating the marketing of high fat, salt and sugar (HFSS) foods and beverages has been highlighted as a promising approach to obesity prevention. In 2019, Transport for London implemented restrictions on the advertisement of HFSS products across its network. This paper reports on a process evaluation of the design and implementation of this intervention.
In 2019-2020, we conducted semi-structured interviews with 23 stakeholders. Interviews with those responsible for implementation (n = 13) explored stakeholder roles, barriers and facilitators to policy development/implementation and unintended consequences. Interviews with food industry stakeholders (n = 10) explored perceptions and acceptability of the policy, changes to business practice and impact on business. Data were analysed using a general inductive approach.
Practical challenges included limited time between policy announcement and implementation, translating the concept of 'junk food' into operational policy, the legal landscape, and reported uneven impacts across industry stakeholders. Political challenges included designing a policy the public views as appropriate, balancing health and financial impacts, and the perceived influence of political motivations. Consultation during policy development and close communication with industry reportedly facilitated implementation, as did the development of an exceptions process that provided a review pathway for HFSS products that might not contribute to children's HFSS consumption.
Findings suggest that restricting the outdoor advertisement of HFSS foods and beverages at scale is feasible within a complex policy and business landscape. We outline practical steps that may further facilitate the development and implementation of similar policies and we report on the importance of ensuring such policies are applied in a way that is perceived as reasonable by industry and the public.
在英国，10-11 岁的儿童中有五分之一患有肥胖症。他们更有可能在成年后继续肥胖，并在更年轻时患上与肥胖相关的慢性健康问题。限制高脂肪、高盐和高糖（HFSS）食品和饮料的营销已被强调为预防肥胖的一种有前途的方法。2019 年，伦敦交通局对其网络内的 HFSS 产品广告实施了限制。本文报告了对这一干预措施的设计和实施进行的过程评估。
在 2019-2020 年，我们对 23 名利益相关者进行了半结构化访谈。对负责实施的利益相关者（n=13）的访谈探讨了政策制定/实施的利益相关者角色、障碍和促进因素以及意外后果。对食品行业利益相关者（n=10）的访谈探讨了他们对政策的看法和接受程度、商业实践的变化以及对业务的影响。使用一般归纳方法对数据进行分析。
实际挑战包括政策宣布和实施之间的时间有限、将“垃圾食品”的概念转化为可操作的政策、法律环境以及整个行业利益相关者报告的影响不均等。政治挑战包括设计一项公众认为适当的政策、平衡健康和财务影响，以及认为政治动机的影响。在政策制定过程中进行协商并与行业保持密切沟通据报道有助于实施，此外，制定一个例外程序也有助于为可能不会导致儿童 HFSS 消费的 HFSS 产品提供审查途径。
研究结果表明，在复杂的政策和商业环境下，大规模限制 HFSS 食品和饮料的户外广告是可行的。我们概述了可能进一步促进类似政策的制定和实施的实际步骤，并报告了确保此类政策以行业和公众认为合理的方式实施的重要性。
