Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study

Abstract

Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment. Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge. Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted. Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45-63%) of schools with tuck shops and advertised in 31% (CI: 25-39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs. Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.

School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

“…As with other legislative measures like taxation, marketing regulations have been contested in favor of self-regulation by industry, which studies have shown to be ineffective [ 80 , 81 ]. In South Africa for instance, SSB advertisements were still present in most primary schools despite the voluntary pledge made by industry not to advertise their products in schools [ 82 ]. Zambia could draw an implementation lesson from the restriction of marketing of breast milk substitutes, which has been in place for over a decade [ 83 ], to strengthen the design of marketing restriction of unhealthy food and beverages.…”

Characteristics of the School Food Environment Affect the Consumption of Sugar-Sweetened Beverages Among Adolescents

“…The school environment has been extensively researched as a place where adolescents are present for a large part of their day and is considered an important determinant for food choices, contributing to the consumption of unhealthy foods (18,(27)(28)(29)(30)(31)(32). International studies have found that SSB availability in the school food environment is associated with the purchase and consumption of these beverages by children and adolescents (27,(33)(34)(35)(36).…”

Diet Therapy and Public Health

“…These factors influence people’s food choices and nutritional status. There is substantial evidence suggesting that the community-level physical food environment contributes to the high levels of obesity and diet-related disease [ 60 , 61 , 62 , 63 , 64 , 65 ]. Few articles published in LMICs on the topic include studies where it is shown that most of the foods sold in the community convenience stores and by street vendors do not foster good health [ 57 , 59 ].…”

“…However, we must be cognizant that the demand by consumers is a key determinant of the food offered by these informal food outlets [ 58 , 66 ]. This is also the case in terms of the type of food sold in schools, as evidence [ 67 , 68 ] has shown that the reason why this food is mostly unhealthy [ 69 ] is because children demand unhealthy food [ 70 ], and their preference for this food is fueled by food marketing [ 61 ]. This has a strong policy implication; hence, policy reforms are required to increase access to affordable healthy food options in communities and schools, so as to curb the indiscriminate sale and marketing of unhealthy food.…”