Impact of Food Advertising Restrictions in Portugal on Children’s Exposure to Unhealthy Foods and Beverages: A Before-and-After Study

Impact of Food Advertising Restrictions in Portugal on Children’s Exposure to Unhealthy Foods and Beverages: A Before-and-After Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Food Advertising Restrictions in Portugal on Children’s Exposure to Unhealthy Foods and Beverages: A Before-and-After Study Miguel Ángel Royo-Bordonada, Cristina Cavero-Esponera, María Mar Romero-Fernández This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6013827/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Portugal has one of the highest prevalences of childhood obesity in the world. Food advertising, which largely affects the most vulnerable children, contributes to childhood obesity by fostering the consumption of ultra-processed foods and beverages. To prevent this pernicious influence, Portugal passed Act 30/2019 which introduces food advertising restrictions targeted at children and adolescents under 16 years of age. The aim of this study was to assess the Act’s effectiveness in reducing the exposure of children and adolescents under14 years of age to television advertising of unhealthy foods and beverages. Methods We conducted a before-and-after study by measuring the impact of food sector television advertising over the course of two, week-long periods, the first in February 2019 and the second in February 2022. The respective samples included 1121 and 983 children and adolescents aged 4 to 14 years, representative of the Portuguese population in this age range. The nutritional quality of the products advertised was analysed using the nutritional profile issued by the Directorate-General of Health. Before-and-after mean impacts and coverages were compared, using the Chi-squared test to analyse differences in the latter. Results The weekly mean impacts of unhealthy food and beverage advertisements remained stable from 2019 to 2022 (18.9 vs. 18.7). Even so, impacts decreased in the case of low-class children and increased in the case of middle and high-class children. While overall coverage did not vary, it decreased in the morning and afternoon time slots, and increased across the night time slot. As compared to 2019, the weekly number of unhealthy food and beverage commercials increased by 25% in 2022. Conclusions Act 30/2019 did not reduce Portuguese children’s overall exposure to advertisements for unhealthy foods and beverages. In order to be effective, restrictions would, at minimum, have to cover television advertising during the 7 am-12 pm time band, regardless of the intended recipients of the messages, target public or percentage of children’s audience. Childhood obesity food advertising nutritional marketing socio-economic inequalities television BACKGROUND Childhood obesity is a public health problem of global scope, 1 which gives rise to osteomuscular problems, arterial hypertension, dyslipidaemia, diabetes mellitus, asthma, sleep disorders, low self-esteem, depression, and a higher risk of suffering from obesity and related complications at adult age. 2 The overall prevalence of obesity among school-aged children is 8.5%, with higher figures in high-income countries and children from families of lower socio-economic status. 4 Portugal, along with Spain, Italy and Greece, heads the rankings of European countries in the prevalence of obesity and severe obesity, with figures of around 10% and 4% respectively. 5,6 In the last three decades, the prevalence of obesity among school-aged children has risen in most countries around the world. 7 As compared to the period 2000–2011, there was a 1.5-fold increase in the overall prevalence of obesity among children and adolescents from 2012 to 2023. 3 Ultra-processed, high-energy, nutrient-poor foods and beverages increase the risk of obesity from the earliest stages of life. 8 Indeed, as early on as 5 years of age, ultra-processed products account for 29% of Portuguese children’s total caloric intake. 9 The consumption of ultra-processed products, and sugar-sweetened beverages in particular -an independent risk factor for obesity- is highest among children from families of lower socio-economic status. 10 This consumption is fostered and boosted by unhealthy food advertising, which uses persuasive marketing techniques targeted at children, influencing their preferences for, choices, request to parents, and consumption of unhealthy foods, 11 with children from socio-economically disadvantaged backgrounds being disproportionately exposed to such advertising. 12 Television (TV) food advertising, one of the main commercial channels for children, is frequent and persuasive, and the majority of the products advertised are ultra-processed, even on children’s channels or programmes, during protected time slots and at peak viewing times for children. 13 Under experimental conditions, children exposed to TV food advertising consume 60 kcal more per day than do unexposed children, due to a higher intake of ultra-processed products. 14 In 2010, 192 Member States, including Portugal, endorsed Resolution WHA63.14 to restrict unhealthy food marketing to children and adolescents globally. 15 In 2015, the World Health Organisation (WHO) Regional Office for Europe released a nutrient profile model specifically designed for the purpose of restricting the marketing of foods to children, in order to help governments reduce children’s exposure to unhealthy food advertising. 16 In 2018, policies to restrict unhealthy food marketing to children were reported by 54% of European countries, though most countries applied voluntary measures 17 whose effectiveness has been widely questioned. 18 On 23 April 2019, Portugal passed Act 30/2019, which applies restrictions, based on the WHO nutrient profile as adapted by the Directorate-General of Health ( Direção-Geral da Saúde/DGS ), to food advertising from 30 minutes before to 30 minutes after programmes which are targeted at children aged under 16 years or in which children represent at least 25% of the audience. 19 The first impact evaluation envisaged under the Portuguese Act, 5 years after it had been enacted, showed that there was 96% compliance with the advertising content analysed, with television accounting for only 9% of the breaches detected. 20 Furthermore, between 2019 and 2022, there was an increase in the percentage of food products advertised that met the nutrient profile criteria defined by the DGS . That said, however, more than two thirds of products advertised on TV were unhealthy and 20% had content appealing to children. While the WHO and European Union urge Member States to implement regulations aimed at effectively reducing children’s exposure to audiovisual commercial communications for unhealthy foods and beverages, 1 , 21 Portuguese children could continue to be exposed to a considerable amount of unhealthy food commercials on TV. Hence, the aim of this study was to assess the effectiveness of Act 30/2019 in terms of reducing Portuguese children’s exposure to TV advertising of unhealthy foods and beverages. METHODS Study design and subjects We conducted a before-and-after study, using continuous measurement of TV advertising impacts over the course of a full two weeks of broadcasting ─the first week, four months before the entry into force of the Act (18 to 24 February 2019) and the second week, almost three years after the Act’s implementation (21 to 27 February 2022)─ in respective samples of 1121 and 983 children and adolescents aged 4 to 14 years, representative of the Portuguese population in this age group. Advertising impact is the measure of a given commercial’s viewing. The sample was drawn from a consumer panel made up of 1100 households which uses audiometers to record TV viewing by all the members The sample was obtained through stratified random sampling by region (North, Centre, Lisbon and South). Sampling points were selected on the basis of the census sections used by Statistics Portugal ( Instituto Nacional de Estatística ). Sample sections were chosen with a probability proportional to their size, so that all households would be equiprobable. To obtain the greatest sample dispersion possible in each census section, we allowed for no more than 1 panellist household. Households in each section were selected randomly, with quotas being set to ensure proportions similar to those of the target population, in terms of sex, age, social class, professional occupation, and access to pay television. Similarly, provided that there was a sufficient number of towns for the intersections targeted for the setting of sample quotas, there was no more than 1 panellist household per town Data-collection and study variables To measure the number and profile of the viewers who were watching TV during the course of any given day, the households belonging to the consumer panel used an audiometer. This is a remote-control device, similar in appearance to a TV remote, which registers the TV programme being watched at any given time and the person or persons in the household who are watching it, by means of a pre-coded key for each household member present in front of the TV set. The consumer panel provided aggregate information on the number of total advertising impacts received from the food sector, and from each food or drink advertised on the 9 TV channels having the highest audience shares of the target population (children and adolescents aged 4 to 14 years) in three categories of socio-economic level. The panel also furnished data on total insertions (advertisements broadcast) and impacts, by time slot (02:30 − 07:00, 07:00–14:00, 14:00–17:00, 17:00–20:30, 20:30 − 24:00 and 24:00–02:30). Nutritional information about advertised products The nutritional composition of the food and beverages advertised was obtained from the websites of the manufacturing companies or from the online platforms of product retail chains. Where a product’s nutritional information could not be located on the Internet, its label was consulted after the item had been purchased at a food store or supermarket. The nutritional quality of the foods and beverages advertised was analysed using the nutrient profile drawn up by the DGS to implement the statutory restrictions. The DGS profile is based on the profile used by the WHO Regional Office for Europe, which classifies products into 16 food categories (OMS 2015), in which some adaptations were made in order to bring the nutrient thresholds for some food categories into line with the values defined by EU legislation. 22 Other adaptations also reflect Portuguese food reformulation agreements, an analysis of the nutrition composition of Portuguese foods, and adjustment of the model to the limits imposed by the wording of Act 30/2019l. According to the category to which the product belongs and its nutritional composition, the system ascertains whether it is considered healthy or unhealthy and, by extension, whether it may or may not be advertised. Individual restaurant advertising that makes no mention of a specific product or menu does not correspond to any category of the nutritional profile model, and thus renders it inapplicable. Statistical analysis To assess the effect of Act 30/2019, we calculated the difference in the weekly mean impacts of unhealthy food and beverage (UF&B) advertisements from 2019 to 2022, overall and by social class, and the difference in coverages (percentage of the target population exposed to food sector advertisements), overall and by time slot. Before-and-after differences in coverage were compared using the Chi-squared test. Similarly, before-and-after differences in the percentages of food sector advertisements, food sector UF&B advertisements, and total UF&B advertisements were analysed by time slot. RESULTS Table 1 shows the socio-economic characteristics of the samples. Girls represented 48.9% of the sample in 2019 and again in 2022. In both years, most of the participants were of a low social class (56.7% in 2019 and 55.6% in 2022). The socio-demographic distribution of the samples was similar to that of Portuguese population aged 4 to 14 years in both years, with a slight under-representation of the high-class population (22.5% vs. 25.3% in 2019, and 23.3% vs. 25.7% in 2022). Table 1 Socio-demographic characteristics of the study samples, representative of the Portuguese population aged 4 to 14 years, in 2019 and 2022. 2019 2022 n % % population n % % population Sex Male 573 51.1 51.1 502 51.1 51.0 Female 548 48.9 48.9 481 48.9 49.0 Social class High 252 22.5 25.3 229 23.3 25.7 Middle 233 20.8 19.6 206 21.0 25.6 Low 636 56.7 55.1 547 55.6 48.7 Total 1121 100 100 983 100 100 Table 2 shows the total number and weekly mean impacts of UF&B advertising before and after implementation of Act 30/2019. The overall mean number of weekly impacts remained stable, with 18.9 impacts in 2019 and 18.7 in 2022. When the data were analysed by social class, however, in 2022 there was a mean reduction of 3 weekly impacts in low-class participants and an increase of 5.9 and 1.7 weekly impacts in middle and high-class participants respectively. Table 2 Weekly impacts of unhealthy food and beverage advertising on children aged 4 to 14 years, before and after implementation of the Act. Year Total Social class High Middle Low N Mean n Mean n Mean n Mean 2019 21232 18.9 1889 7.5 2659 11.4 16685 26.2 2022 18413 18.7 2110 9.2 3576 17.4 12726 23.3 Difference -0.2 1.7 6.0 -2.9 Table 3 shows food sector coverage before and after the implementation of Act 30/2019. No differences were observed in overall coverage (79.9% vs. 77.3%; p = 0.15). Even so, coverage fell in the morning (41.6% vs. 34%; p < 0.01) and afternoon time slots (28.7% vs. 17.9%; p < 0.01), and rose in the night time slot (62.5% vs. 66.6%; p = 0.05). Table 3 Coverage of food sector advertisements among children aged 4 to 14 years, by time slot, before and after implementation of the Act. Time slot 2019 2022 p 02:30 − 07:00 2.7 0.4 < 0.01 07:00–14:00 41.6 34 < 0.01 14:00–17:00 28.7 17.9 < 0.01 17:00–20:30 49.5 49.1 0.85 20:30 − 24:00 62.5 66.6 0.05 24:00–02:30 14.4 13.4 0.51 Total 79.9 77.3 0.15 As compared to 2019, the percentage of food sector advertisements in 2022 increased (8% vs. 6.7%; p < 0.01) and the percentage of those that were for UF&B decreased slightly (88.8% vs. 91.9%; p < 0.01), resulting in a 25.5% increase in the weekly number of UF&B advertisements, which went from 1325 to 1659 (Table 4 ). Table 4 Insertions and impacts of food sector and unhealthy food and beverage advertisements on children aged 4 to 14 years, before and after implementation of the Act. All sectors Food sector Unhealthy food and beverages Year n n % p n % p 2019 21586 1442 6.7 < 0.01 1325 91.9 < 0.01 2022 23257 1869 8.0 1659 88.8 By time slot, the frequency of UF&B advertisements rose in the afternoon (16.8% vs. 22.1%; p < 0.01) and night time slots (20.9% vs. 23%; p < 0.01), hardly changed in the morning time slot, and fell in the remaining time slots (Table 5 ). Weekly mean impacts increased in the morning (3 vs. 2.8) and night time slots (9.8 vs. 9.2), showed almost no change in the evening time slot, and decreased in the afternoon time slot (1.4 vs. 2.4). Table 5 Insertions and impacts of unhealthy food and beverage advertisements, by time slot, on children aged 4 to 14 years, before and after implementation of the Act. Insertions Impacts Time slot 2019 % 2022 % p 2019 Mean 2022 Mean Difference 02:30 − 07:00 42 3.2 17 1.0 0.2 0.11 0.01 -0.1 07:00–14:00 405 30.6 499 30.1 < 0.01 2.77 2.98 0.2 14:00–17:00 202 15.2 221 13.3 < 0.01 2.38 1.44 -0.9 17:00–20:30 223 16.8 366 22.1 < 0.01 3.24 3.38 0.1 20:30 − 24:00 277 20.9 382 23.0 < 0.01 9.19 9.78 0.6 24:00–02:30 176 13.3 174 10.5 < 0.01 1.29 1.16 -0.1 Total 1325 100 1659 100 < 0.01 18.9 18.7 -0.2 DISCUSSION Three years after implementation of Act 30/2019, which introduced restrictions on UF&B advertising in Portugal, children’s coverage and exposure to this type of TV advertising were similar to those before the Act’s entry into force. There was, however, a slight reduction in the exposure of low-class children, and an increase in that of middle and high-class children. Food sector coverage fell in the morning and afternoon time slots, and rose during peak audience time slots, with similar trends in the mean impacts of UF&B commercials. As compared to 2019, the absolute weekly number of UF&B advertisements increased by 25% in 2022. Most countries with mandatory food marketing policies apply restrictions to UF&B advertising directed at children, i.e., commercials broadcast during children’s viewing time, either in programmes targeted at children or in those in which children exceed a given audience percentage (around 25%), as in Portugal. 23 In South Korea, with a law that restricted advertising during children’s viewing time (5 to 7 pm) and in children’s programmes outside this time slot, there was a reduction in total exposure to unhealthy food advertising, which was of greatest intensity during the scheduled time slot. 24 In Quebec, where advertising targeted at children has been banned since 2018, the frequency of food sector advertisements increased by 11% from 2011 to 2019, including on children’s channels, and though children’s exposure fell, this was due to a reduction in the time that they spent watching TV. 25 In the United Kingdom (UK), in contrast, with almost universal adhesion to the ban and the ensuing reduction in children’s exposure in terms of statutorily regulated channels and time slots, 26 total exposure, taking into account all time slots and commercial channels, did not fall post-regulation, 27 a phenomenon similar to what we observed in Portugal, where there was also evidence of a high degree of adherence to the regulations. 20 Another study undertaken in the UK, on commercial channels popular among children, found that TV advertising of unhealthy foods remained more or less stable after restrictions, with a slight reduction in total frequency and a 5% increase during peak children viewing times. 28 The official report of the UK Advertising Standards Authority noted an increase in advertisements on unscheduled channels and time bands, which would account for the restrictions’ lack of effectiveness. 26 In Chile, the restrictions were applied in two stages. In the first stage, implemented in 2016, unhealthy food advertisements were banned in programmes targeted at children or in those where children represented at least 20% of the audience, which translated as a fall in the percentage of unhealthy food advertisements in children’s programmes and, to a lesser extent, in those intended for generalist audiences. 29 In the second stage, implemented in 2018, the ban was extended to all TV channels and programmes during the 6 am-8 pm time slot. As a result of the restrictions, children’s exposure decreased by 57% after stage 1 and by 73% after stage 2. 30 Along similar lines to what happened in the UK, our results indicate that the Portuguese Act’s lack of effectiveness in reducing children’s exposure to unhealthy food advertising can be assumed to be due to the increase in the frequency of UF&B commercials, and their being redirected to peak children’s audience viewing times. The effectiveness of the Chilean legislation after implementation of the first stage, with provisions of a type similar to the restrictions contained in the Portuguese law, could be due to the fact that Chilean corporate advertisers, aware of the fact that advertising restrictions were going to be extended after just one year to all channels during the 6 am − 8 pm time slot, started preparing for what was about to happen, and instead of redirecting their advertising to generalist programmes or channels, reduced it on these as well. 29 In the UK, in view of the lack of effectiveness of advertising restrictions exclusively targeted at children, the 2022 Health Care Act, which is scheduled to come into force on 1 October 2025, bans TV advertising of unhealthy foods and beverages between 5:30 am and 9 pm, regardless of the intended recipients of the messages or the target public. 31 Moreover, the House of Lords Food, Diet and Obesity Committee has gone on to call for a total ban on the advertising of unhealthy foods across all physical and digital media. 32 To our knowledge, this is the first study to assess the effect of Act 30/2019 on exposure to TV advertising of UF&B in samples representative of the Portuguese population aged 4 to 14 years. Our study has several limitations, however. Firstly, the audience panels only provided us with aggregate data, so that statistical tests could not be applied to check the main hypothesis. Nevertheless, the weekly mean impact was practically identical in 2019 and 2022, and even in a case where it would be most unlikely for the minimal difference observed to be attributable to random chance (18.9 vs. 18.7), this would be of no public health relevance whatsoever. Secondly, the distribution of the sample by social class displayed differences with respect to the population of origin. This could affect the results, since exposure to advertising was far higher among children of low social class, both in 2019 and in 2022, in much the same way as is observed in other countries in the region, such as Spain. 33 Yet this bias in distribution was similar before and after the implementation of Act 30/2019, with an over-representation in both years of low-class participants, the only group in whom a possible positive effect of the regulation was observed, with the result that this may not account for the law’s overall lack of effect. Lastly, this study solely considered exposure to TV advertising. To assess the Act’s global effectiveness, it would be necessary to measure exposure to all media, and to the Internet in particular, because TV advertising could be redirected to unregulated media or to media whose monitoring and control are more complicated. Conclusions In conclusion, Act 30/2019, which bans television advertising of UF&B targeted at children in Portugal, has not been effective in reducing Portuguese children’s overall exposure to this type of TV advertising. Portugal’s experience, along with previous experiences of the UK and Chile, may be of help to other countries willing to implement effective policies for reducing children’s exposure to UF&B advertising. To achieve this would require a total ban on advertising to which children are exposed, regardless of the intended recipients of the messages, target public or percentage of children’s audience. In the case of television, this ban would, at minimum, have to cover the time band from 7 am to 12 pm. Abbreviations UF&B unhealthy foods and beverages TV television Declarations Ethics approval and consent to participate Ethical approval was obtained from our resident Ethics Research Committee (Carlos III Institute of Health). All procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its subsequent amendments or comparable ethical standards. Participants’ informed consent was obtained through Statistics Portugal ( Instituto Nacional de Estatística ). Consent for publication Not applicable. Availability of data and materials The datasets used and analysed in the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was funded by a grant from the Spanish Health Research Fund, Carlos III Institute of Health (Project ENPY 337/22). Authors' contributions MAR conceived the study and wrote the first draft of the manuscript. CCE participated in the data management, analysis of nutritional profile, statistical analysis, and presentation of the results, with the supervision of MAR. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6013827","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":415395887,"identity":"08437840-9044-4f15-91d6-d29a6a4e0131","order_by":0,"name":"Miguel Ángel Royo-Bordonada","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAo0lEQVRIiWNgGAWjYNCCCgkGBmbGhgMkaDlDshbGNlKcpDv78DGJj/Ms7PnbmRsPMFTUEdZidi4tTXLmNonEGYdBDjtzmAgtZ3jMpHm3SSQYgPzC2HaAWC1zJOwhWv4R4zCwlgYJxg1gLQ3MxGhhS7accQzql4RjRPmF+eCNDzV19vz9xx9/ADIIawECFgk4M4EoDcBo/0CkwlEwCkbBKBipAADlXzYZ34djCAAAAABJRU5ErkJggg==","orcid":"","institution":"National School of Public Health, Institute of Health Carlos III","correspondingAuthor":true,"prefix":"","firstName":"Miguel","middleName":"Ángel","lastName":"Royo-Bordonada","suffix":""},{"id":415395889,"identity":"298cfb64-fe60-4129-949b-24d38c258029","order_by":1,"name":"Cristina Cavero-Esponera","email":"","orcid":"","institution":"San José \u0026 Santa Adela Central Red Cross Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Cavero-Esponera","suffix":""},{"id":415395890,"identity":"e1306466-ce09-45d6-a1dc-a35193a5e6d9","order_by":2,"name":"María Mar Romero-Fernández","email":"","orcid":"","institution":"Santa Bárbara Hospital","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Mar","lastName":"Romero-Fernández","suffix":""}],"badges":[],"createdAt":"2025-02-12 09:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6013827/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6013827/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78867718,"identity":"d8165819-cfa1-4cc9-86da-7b9c4ad2c2e7","added_by":"auto","created_at":"2025-03-20 04:46:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":608081,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6013827/v1/50776887-78f5-4242-bcc1-53d3098d6ce8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Food Advertising Restrictions in Portugal on Children’s Exposure to Unhealthy Foods and Beverages: A Before-and-After Study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eChildhood obesity is a public health problem of global scope,\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e which gives rise to osteomuscular problems, arterial hypertension, dyslipidaemia, diabetes mellitus, asthma, sleep disorders, low self-esteem, depression, and a higher risk of suffering from obesity and related complications at adult age.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The overall prevalence of obesity among school-aged children is 8.5%, with higher figures in high-income countries and children from families of lower socio-economic status.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Portugal, along with Spain, Italy and Greece, heads the rankings of European countries in the prevalence of obesity and severe obesity, with figures of around 10% and 4% respectively.\u003csup\u003e5,6\u003c/sup\u003e In the last three decades, the prevalence of obesity among school-aged children has risen in most countries around the world.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e As compared to the period 2000\u0026ndash;2011, there was a 1.5-fold increase in the overall prevalence of obesity among children and adolescents from 2012 to 2023.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUltra-processed, high-energy, nutrient-poor foods and beverages increase the risk of obesity from the earliest stages of life.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Indeed, as early on as 5 years of age, ultra-processed products account for 29% of Portuguese children\u0026rsquo;s total caloric intake.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The consumption of ultra-processed products, and sugar-sweetened beverages in particular -an independent risk factor for obesity- is highest among children from families of lower socio-economic status.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This consumption is fostered and boosted by unhealthy food advertising, which uses persuasive marketing techniques targeted at children, influencing their preferences for, choices, request to parents, and consumption of unhealthy foods,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e with children from socio-economically disadvantaged backgrounds being disproportionately exposed to such advertising.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Television (TV) food advertising, one of the main commercial channels for children, is frequent and persuasive, and the majority of the products advertised are ultra-processed, even on children\u0026rsquo;s channels or programmes, during protected time slots and at peak viewing times for children.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Under experimental conditions, children exposed to TV food advertising consume 60 kcal more per day than do unexposed children, due to a higher intake of ultra-processed products.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn 2010, 192 Member States, including Portugal, endorsed Resolution WHA63.14 to restrict unhealthy food marketing to children and adolescents globally.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In 2015, the World Health Organisation (WHO) Regional Office for Europe released a nutrient profile model specifically designed for the purpose of restricting the marketing of foods to children, in order to help governments reduce children\u0026rsquo;s exposure to unhealthy food advertising.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In 2018, policies to restrict unhealthy food marketing to children were reported by 54% of European countries, though most countries applied voluntary measures\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e whose effectiveness has been widely questioned.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e On 23 April 2019, Portugal passed Act 30/2019, which applies restrictions, based on the WHO nutrient profile as adapted by the Directorate-General of Health (\u003cem\u003eDire\u0026ccedil;\u0026atilde;o-Geral da Sa\u0026uacute;de/DGS\u003c/em\u003e), to food advertising from 30 minutes before to 30 minutes after programmes which are targeted at children aged under 16 years or in which children represent at least 25% of the audience.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe first impact evaluation envisaged under the Portuguese Act, 5 years after it had been enacted, showed that there was 96% compliance with the advertising content analysed, with television accounting for only 9% of the breaches detected.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Furthermore, between 2019 and 2022, there was an increase in the percentage of food products advertised that met the nutrient profile criteria defined by the \u003cem\u003eDGS\u003c/em\u003e. That said, however, more than two thirds of products advertised on TV were unhealthy and 20% had content appealing to children. While the WHO and European Union urge Member States to implement regulations aimed at effectively reducing children\u0026rsquo;s exposure to audiovisual commercial communications for unhealthy foods and beverages,\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Portuguese children could continue to be exposed to a considerable amount of unhealthy food commercials on TV. Hence, the aim of this study was to assess the effectiveness of Act 30/2019 in terms of reducing Portuguese children\u0026rsquo;s exposure to TV advertising of unhealthy foods and beverages.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and subjects\u003c/h2\u003e \u003cp\u003eWe conducted a before-and-after study, using continuous measurement of TV advertising impacts over the course of a full two weeks of broadcasting ─the first week, four months before the entry into force of the Act (18 to 24 February 2019) and the second week, almost three years after the Act\u0026rsquo;s implementation (21 to 27 February 2022)─ in respective samples of 1121 and 983 children and adolescents aged 4 to 14 years, representative of the Portuguese population in this age group. Advertising impact is the measure of a given commercial\u0026rsquo;s viewing. The sample was drawn from a consumer panel made up of 1100 households which uses audiometers to record TV viewing by all the members\u003c/p\u003e \u003cp\u003eThe sample was obtained through stratified random sampling by region (North, Centre, Lisbon and South). Sampling points were selected on the basis of the census sections used by Statistics Portugal (\u003cem\u003eInstituto Nacional de Estat\u0026iacute;stica\u003c/em\u003e). Sample sections were chosen with a probability proportional to their size, so that all households would be equiprobable. To obtain the greatest sample dispersion possible in each census section, we allowed for no more than 1 panellist household. Households in each section were selected randomly, with quotas being set to ensure proportions similar to those of the target population, in terms of sex, age, social class, professional occupation, and access to pay television. Similarly, provided that there was a sufficient number of towns for the intersections targeted for the setting of sample quotas, there was no more than 1 panellist household per town\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData-collection and study variables\u003c/h3\u003e\n\u003cp\u003eTo measure the number and profile of the viewers who were watching TV during the course of any given day, the households belonging to the consumer panel used an audiometer. This is a remote-control device, similar in appearance to a TV remote, which registers the TV programme being watched at any given time and the person or persons in the household who are watching it, by means of a pre-coded key for each household member present in front of the TV set.\u003c/p\u003e \u003cp\u003eThe consumer panel provided aggregate information on the number of total advertising impacts received from the food sector, and from each food or drink advertised on the 9 TV channels having the highest audience shares of the target population (children and adolescents aged 4 to 14 years) in three categories of socio-economic level. The panel also furnished data on total insertions (advertisements broadcast) and impacts, by time slot (02:30\u0026thinsp;\u0026minus;\u0026thinsp;07:00, 07:00\u0026ndash;14:00, 14:00\u0026ndash;17:00, 17:00\u0026ndash;20:30, 20:30\u0026thinsp;\u0026minus;\u0026thinsp;24:00 and 24:00\u0026ndash;02:30).\u003c/p\u003e\n\u003ch3\u003eNutritional information about advertised products\u003c/h3\u003e\n\u003cp\u003eThe nutritional composition of the food and beverages advertised was obtained from the websites of the manufacturing companies or from the online platforms of product retail chains. Where a product\u0026rsquo;s nutritional information could not be located on the Internet, its label was consulted after the item had been purchased at a food store or supermarket. The nutritional quality of the foods and beverages advertised was analysed using the nutrient profile drawn up by the \u003cem\u003eDGS\u003c/em\u003e to implement the statutory restrictions. The \u003cem\u003eDGS\u003c/em\u003e profile is based on the profile used by the WHO Regional Office for Europe, which classifies products into 16 food categories (OMS 2015), in which some adaptations were made in order to bring the nutrient thresholds for some food categories into line with the values defined by EU legislation.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Other adaptations also reflect Portuguese food reformulation agreements, an analysis of the nutrition composition of Portuguese foods, and adjustment of the model to the limits imposed by the wording of Act 30/2019l. According to the category to which the product belongs and its nutritional composition, the system ascertains whether it is considered healthy or unhealthy and, by extension, whether it may or may not be advertised. Individual restaurant advertising that makes no mention of a specific product or menu does not correspond to any category of the nutritional profile model, and thus renders it inapplicable.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eTo assess the effect of Act 30/2019, we calculated the difference in the weekly mean impacts of unhealthy food and beverage (UF\u0026amp;B) advertisements from 2019 to 2022, overall and by social class, and the difference in coverages (percentage of the target population exposed to food sector advertisements), overall and by time slot. Before-and-after differences in coverage were compared using the Chi-squared test. Similarly, before-and-after differences in the percentages of food sector advertisements, food sector UF\u0026amp;B advertisements, and total UF\u0026amp;B advertisements were analysed by time slot.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the socio-economic characteristics of the samples. Girls represented 48.9% of the sample in 2019 and again in 2022. In both years, most of the participants were of a low social class (56.7% in 2019 and 55.6% in 2022). The socio-demographic distribution of the samples was similar to that of Portuguese population aged 4 to 14 years in both years, with a slight under-representation of the high-class population (22.5% vs. 25.3% in 2019, and 23.3% vs. 25.7% in 2022).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the study samples, representative of the Portuguese population aged 4 to 14 years, in 2019 and 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e% population\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSocial class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the total number and weekly mean impacts of UF\u0026amp;B advertising before and after implementation of Act 30/2019. The overall mean number of weekly impacts remained stable, with 18.9 impacts in 2019 and 18.7 in 2022. When the data were analysed by social class, however, in 2022 there was a mean reduction of 3 weekly impacts in low-class participants and an increase of 5.9 and 1.7 weekly impacts in middle and high-class participants respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeekly impacts of unhealthy food and beverage advertising on children aged 4 to 14 years, before and after implementation of the Act.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e \u003cp\u003eSocial class\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows food sector coverage before and after the implementation of Act 30/2019. No differences were observed in overall coverage (79.9% vs. 77.3%; p\u0026thinsp;=\u0026thinsp;0.15). Even so, coverage fell in the morning (41.6% vs. 34%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and afternoon time slots (28.7% vs. 17.9%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and rose in the night time slot (62.5% vs. 66.6%; p\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoverage of food sector advertisements among children aged 4 to 14 years, by time slot, before and after implementation of the Act.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime slot\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e02:30\u0026thinsp;\u0026minus;\u0026thinsp;07:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e07:00\u0026ndash;14:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14:00\u0026ndash;17:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17:00\u0026ndash;20:30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20:30\u0026thinsp;\u0026minus;\u0026thinsp;24:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24:00\u0026ndash;02:30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs compared to 2019, the percentage of food sector advertisements in 2022 increased (8% vs. 6.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and the percentage of those that were for UF\u0026amp;B decreased slightly (88.8% vs. 91.9%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), resulting in a 25.5% increase in the weekly number of UF\u0026amp;B advertisements, which went from 1325 to 1659 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInsertions and impacts of food sector and unhealthy food and beverage advertisements on children aged 4 to 14 years, before and after implementation of the Act.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll sectors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eFood sector\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eUnhealthy food and beverages\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1869\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBy time slot, the frequency of UF\u0026amp;B advertisements rose in the afternoon (16.8% vs. 22.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and night time slots (20.9% vs. 23%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), hardly changed in the morning time slot, and fell in the remaining time slots (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Weekly mean impacts increased in the morning (3 vs. 2.8) and night time slots (9.8 vs. 9.2), showed almost no change in the evening time slot, and decreased in the afternoon time slot (1.4 vs. 2.4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInsertions and impacts of unhealthy food and beverage advertisements, by time slot, on children aged 4 to 14 years, before and after implementation of the Act.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eInsertions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eImpacts\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime slot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2019 Mean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2022 Mean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDifference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e02:30\u0026thinsp;\u0026minus;\u0026thinsp;07:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e07:00\u0026ndash;14:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14:00\u0026ndash;17:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17:00\u0026ndash;20:30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20:30\u0026thinsp;\u0026minus;\u0026thinsp;24:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24:00\u0026ndash;02:30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThree years after implementation of Act 30/2019, which introduced restrictions on UF\u0026amp;B advertising in Portugal, children\u0026rsquo;s coverage and exposure to this type of TV advertising were similar to those before the Act\u0026rsquo;s entry into force. There was, however, a slight reduction in the exposure of low-class children, and an increase in that of middle and high-class children. Food sector coverage fell in the morning and afternoon time slots, and rose during peak audience time slots, with similar trends in the mean impacts of UF\u0026amp;B commercials. As compared to 2019, the absolute weekly number of UF\u0026amp;B advertisements increased by 25% in 2022.\u003c/p\u003e \u003cp\u003eMost countries with mandatory food marketing policies apply restrictions to UF\u0026amp;B advertising directed at children, i.e., commercials broadcast during children\u0026rsquo;s viewing time, either in programmes targeted at children or in those in which children exceed a given audience percentage (around 25%), as in Portugal.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In South Korea, with a law that restricted advertising during children\u0026rsquo;s viewing time (5 to 7 pm) and in children\u0026rsquo;s programmes outside this time slot, there was a reduction in total exposure to unhealthy food advertising, which was of greatest intensity during the scheduled time slot.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e In Quebec, where advertising targeted at children has been banned since 2018, the frequency of food sector advertisements increased by 11% from 2011 to 2019, including on children\u0026rsquo;s channels, and though children\u0026rsquo;s exposure fell, this was due to a reduction in the time that they spent watching TV.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e In the United Kingdom (UK), in contrast, with almost universal adhesion to the ban and the ensuing reduction in children\u0026rsquo;s exposure in terms of statutorily regulated channels and time slots,\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e total exposure, taking into account all time slots and commercial channels, did not fall post-regulation,\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e a phenomenon similar to what we observed in Portugal, where there was also evidence of a high degree of adherence to the regulations.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Another study undertaken in the UK, on commercial channels popular among children, found that TV advertising of unhealthy foods remained more or less stable after restrictions, with a slight reduction in total frequency and a 5% increase during peak children viewing times.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e The official report of the UK Advertising Standards Authority noted an increase in advertisements on unscheduled channels and time bands, which would account for the restrictions\u0026rsquo; lack of effectiveness.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e In Chile, the restrictions were applied in two stages. In the first stage, implemented in 2016, unhealthy food advertisements were banned in programmes targeted at children or in those where children represented at least 20% of the audience, which translated as a fall in the percentage of unhealthy food advertisements in children\u0026rsquo;s programmes and, to a lesser extent, in those intended for generalist audiences.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e In the second stage, implemented in 2018, the ban was extended to all TV channels and programmes during the 6 am-8 pm time slot. As a result of the restrictions, children\u0026rsquo;s exposure decreased by 57% after stage 1 and by 73% after stage 2.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlong similar lines to what happened in the UK, our results indicate that the Portuguese Act\u0026rsquo;s lack of effectiveness in reducing children\u0026rsquo;s exposure to unhealthy food advertising can be assumed to be due to the increase in the frequency of UF\u0026amp;B commercials, and their being redirected to peak children\u0026rsquo;s audience viewing times. The effectiveness of the Chilean legislation after implementation of the first stage, with provisions of a type similar to the restrictions contained in the Portuguese law, could be due to the fact that Chilean corporate advertisers, aware of the fact that advertising restrictions were going to be extended after just one year to all channels during the 6 am \u0026minus;\u0026thinsp;8 pm time slot, started preparing for what was about to happen, and instead of redirecting their advertising to generalist programmes or channels, reduced it on these as well.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e In the UK, in view of the lack of effectiveness of advertising restrictions exclusively targeted at children, the 2022 Health Care Act, which is scheduled to come into force on 1 October 2025, bans TV advertising of unhealthy foods and beverages between 5:30 am and 9 pm, regardless of the intended recipients of the messages or the target public.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Moreover, the House of Lords Food, Diet and Obesity Committee has gone on to call for a total ban on the advertising of unhealthy foods across all physical and digital media.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to assess the effect of Act 30/2019 on exposure to TV advertising of UF\u0026amp;B in samples representative of the Portuguese population aged 4 to 14 years. Our study has several limitations, however. Firstly, the audience panels only provided us with aggregate data, so that statistical tests could not be applied to check the main hypothesis. Nevertheless, the weekly mean impact was practically identical in 2019 and 2022, and even in a case where it would be most unlikely for the minimal difference observed to be attributable to random chance (18.9 vs. 18.7), this would be of no public health relevance whatsoever. Secondly, the distribution of the sample by social class displayed differences with respect to the population of origin. This could affect the results, since exposure to advertising was far higher among children of low social class, both in 2019 and in 2022, in much the same way as is observed in other countries in the region, such as Spain.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Yet this bias in distribution was similar before and after the implementation of Act 30/2019, with an over-representation in both years of low-class participants, the only group in whom a possible positive effect of the regulation was observed, with the result that this may not account for the law\u0026rsquo;s overall lack of effect. Lastly, this study solely considered exposure to TV advertising. To assess the Act\u0026rsquo;s global effectiveness, it would be necessary to measure exposure to all media, and to the Internet in particular, because TV advertising could be redirected to unregulated media or to media whose monitoring and control are more complicated.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, Act 30/2019, which bans television advertising of UF\u0026amp;B targeted at children in Portugal, has not been effective in reducing Portuguese children\u0026rsquo;s overall exposure to this type of TV advertising. Portugal\u0026rsquo;s experience, along with previous experiences of the UK and Chile, may be of help to other countries willing to implement effective policies for reducing children\u0026rsquo;s exposure to UF\u0026amp;B advertising. To achieve this would require a total ban on advertising to which children are exposed, regardless of the intended recipients of the messages, target public or percentage of children\u0026rsquo;s audience. In the case of television, this ban would, at minimum, have to cover the time band from 7 am to 12 pm.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUF\u0026amp;B\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eunhealthy foods and beverages\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etelevision\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from our resident Ethics Research Committee (Carlos III Institute of Health). All procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its subsequent amendments or comparable ethical standards. Participants\u0026rsquo; informed consent was obtained through Statistics Portugal (\u003cem\u003eInstituto Nacional de Estat\u0026iacute;stica\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed in the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was funded by a grant from the Spanish Health Research Fund, Carlos III Institute of Health (Project ENPY 337/22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMAR conceived the study and wrote the first draft of the manuscript. CCE participated in the data management, analysis of nutritional profile, statistical analysis, and presentation of the results, with the supervision of MAR. MMRF made relevant contributions to the manuscript. All authors contributed to the review and approval of the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReport of the Commission on Ending Childhood Obesity: implementation plan: executive summary. World Health Organization; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet. 2002;360:473\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Liu J, Ni Y, Yi C, Fang Y, Ning Q, et al. 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Obes Facts. 2019;12:244\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhelps NH, Singleton RK, Zhou B, Heap RA, Mishra A, Bennett JE, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403:1027\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta CS, Del-Ponte B, Assun\u0026ccedil;\u0026atilde;o MCF, Santos IS. Consumption of ultra-processed foods and body fat during childhood and adolescence: a systematic review. Public Health Nutr. 2018;21:148\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVedovato GM, Vilela S, Severo M, Rodrigues S, Lopes C, Oliveira A. Ultra-processed food consumption, appetitive traits and BMI in children: a prospective study. Br J Nutr. 2021;125:1427\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePurohit BM, Dawar A, Bansal K, Nilima K, Malhotra S, Mathur VP, et al. Sugar-sweetened beverage consumption and socioeconomic status: A systematic review and meta-analysis. Nutr Health. 2023;29:465\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFood marketing exposure and power and their associations with food-related attitudes, beliefs and behaviours: a narrative review. World Health Organization; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBackholer K, Gupta A, Zorbas C, Bennett R, Huse O, Chung A, et al. Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: A systematic review of the evidence. Obes Rev. 2021;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly B, Vandevijvere S, Ng SH, Adams J, Allemandi L, Bahena-Espina L, et al. Global benchmarking of children\u0026rsquo;s exposure to television advertising of unhealthy foods and beverages across 22 countries. Obes Rev. 2019;20 (Suppl 2):116\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRussell SJ, Croker H, Viner RM. The effect of screen advertising on children\u0026rsquo;s dietary intake: A systematic review and meta-analysis. Obes Rev. 2019;20:554\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eResolution WHA63.14. Marketing of food and non-alcoholic beverages to children. In: Sixty-third World Health Assembly, Geneva, 21 May 2010. Geneva: World Health Organization; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRegional Office for Europe. Nutrient Profile Model. World Health Organization; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRegional Office for Europe. Better food and nutrition in Europe: a progress report monitoring policy implementation in the WHO European Region. World Health Organization; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalbraith-Emami S, Lobstein T. The impact of initiatives to limit the advertising of food and beverage products to children: a systematic review. Obes Rev. 2013;14:960\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssembleia da Rep\u0026uacute;blica da Portugal. Lei n.o 30/2019 | DR. Introduz restricoes a publicidade dirigida a menores de 16 anos de g\u0026eacute;neros alimenticios e bebidas que contenham elevado valor energ\u0026eacute;tico, teor de sal, ac\u0026uacute;car, \u0026aacute;cidos gordos saturados e \u0026aacute;cidos gordos transformados. Di\u0026aacute;rio da Rep\u0026uacute;blica, 1.\u0026ordf; s\u0026eacute;rie N.\u0026ordm; 79; 23 de abril de 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreg\u0026oacute;rio MJ, Casimiro A, Lima R, Bico P. Estudo de avalia\u0026ccedil;\u0026atilde;o de impacto da Lei n.o 30/2019, de 23 de abril, que introduziu restri\u0026ccedil;\u0026otilde;es \u0026agrave; publicidade de alimentos n\u0026atilde;o saud\u0026aacute;veis a menores de 16 anos. Relatorio do grupo de trabalho criado pelo despacho no 12980. Lisboa: Dire\u0026ccedil;\u0026atilde;o-Geral da Sa\u0026uacute;de; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParlamento Europeu e do Conselho. DIRETIVA (UE) 2018/1808 DO PARLAMENTO EUROPEU E DO CONSELHO de 14 de novembro de 2018 que altera a Diretiva 2010/13/UE relativa \u0026agrave; coordena\u0026ccedil;\u0026atilde;o de certas disposi\u0026ccedil;\u0026otilde;es legislativas, regulamentares e administrativas dos Estados-Membros respeitantes \u0026agrave; oferta de servi\u0026ccedil;os de comunica\u0026ccedil;\u0026atilde;o social audiovisual (Diretiva Servi\u0026ccedil;os de Comunica\u0026ccedil;\u0026atilde;o Social Audiovisual), para a adaptar \u0026agrave; evolu\u0026ccedil;\u0026atilde;o das realidades do mercado. Jornal Oficial da Uni\u0026atilde;o Europeia L 303/69; 28 de novembro de 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinist\u0026eacute;rio da Sa\u0026uacute;de. Dire\u0026ccedil;\u0026atilde;o-Geral da Sa\u0026uacute;de. Perfil Nutricional \u0026ndash; Restri\u0026ccedil;\u0026otilde;es \u0026agrave; publicidade alimentar dirigida a crian\u0026ccedil;as. Lisboa: Dire\u0026ccedil;\u0026atilde;o-Geral da Sa\u0026uacute;de, 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyland E, McGale L, Maden M, Hounsome J, Boland A, Jones A. Systematic review of the effect of policies to restrict the marketing of foods and non-alcoholic beverages to which children are exposed. Obes Rev. 2022;23:e13447.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim S, Lee Y, Yoon J, Chung SJ, Lee SK, Kim H. Restriction of television food advertising in South Korea: impact on advertising of food companies. Health Prom Intern. 2013;28:17\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePauz\u0026eacute; E, Remedios L, Potvin Kent M. Children\u0026rsquo;s measured exposure to food and beverage advertising on television in a regulated environment, May 2011\u0026ndash;2019. Public Health Nutr. 2021;24:5914\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUK Office of Communications. HFSS Advertising Restrictions: Final Review. London: Ofcom; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdams J, Tyrrell R, Adamson AJ, White M. Effect of Restrictions on Television Food Advertising to Children on Exposure to Advertisements for \u0026lsquo;Less Healthy\u0026rsquo; Foods: Repeat Cross-Sectional Study. PLoS ONE 2012;7:e31578.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhalen R, Harrold J, Child S, Halford J, Boyland E. Children\u0026rsquo;s exposure to food advertising: the impact of statutory restrictions. Health Prom Inter. 2019;34:227\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorrea T, Reyes M, Taillie LS, Corval\u0026aacute;n C, Dillman Carpentier FR. Food Advertising on Television Before and After a National Unhealthy Food Marketing Regulation in Chile, 2016\u0026ndash;2017. Am J Public Health. 2020;110:1054\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDillman Carpentier FR, Correa T, Reyes M, Taillie LS. Evaluating the impact of Chile\u0026rsquo;s marketing regulation of unhealthy foods and beverages: pre-school and adolescent children\u0026rsquo;s changes in exposure to food advertising on television. Public Health Nutr. 2020;23:747\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUK Office of Communications. Statement: Regulation of advertising of less healthy food and drink. London: Ofcom; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWise J. Obesity: Peers call for total ban on junk food advertising. BMJ. 2024:q2329.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoyo-Bordonada M\u0026Aacute;, Cavero-Esponera C, Romero-Fern\u0026aacute;ndez MM, Gonz\u0026aacute;lez-D\u0026iacute;az C, Ordaz Castillo E. Differences in children\u0026rsquo;s exposure to television advertising of unhealthy foods and beverages in Spain by socio-economic level. BMC Public Health. 2024;24:739.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Childhood obesity, food advertising, nutritional marketing, socio-economic inequalities, television","lastPublishedDoi":"10.21203/rs.3.rs-6013827/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6013827/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePortugal has one of the highest prevalences of childhood obesity in the world. Food advertising, which largely affects the most vulnerable children, contributes to childhood obesity by fostering the consumption of ultra-processed foods and beverages. To prevent this pernicious influence, Portugal passed Act 30/2019 which introduces food advertising restrictions targeted at children and adolescents under 16 years of age. The aim of this study was to assess the Act\u0026rsquo;s effectiveness in reducing the exposure of children and adolescents under14 years of age to television advertising of unhealthy foods and beverages.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a before-and-after study by measuring the impact of food sector television advertising over the course of two, week-long periods, the first in February 2019 and the second in February 2022. The respective samples included 1121 and 983 children and adolescents aged 4 to 14 years, representative of the Portuguese population in this age range. The nutritional quality of the products advertised was analysed using the nutritional profile issued by the Directorate-General of Health. Before-and-after mean impacts and coverages were compared, using the Chi-squared test to analyse differences in the latter.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe weekly mean impacts of unhealthy food and beverage advertisements remained stable from 2019 to 2022 (18.9 vs. 18.7). Even so, impacts decreased in the case of low-class children and increased in the case of middle and high-class children. While overall coverage did not vary, it decreased in the morning and afternoon time slots, and increased across the night time slot. As compared to 2019, the weekly number of unhealthy food and beverage commercials increased by 25% in 2022.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAct 30/2019 did not reduce Portuguese children\u0026rsquo;s overall exposure to advertisements for unhealthy foods and beverages. In order to be effective, restrictions would, at minimum, have to cover television advertising during the 7 am-12 pm time band, regardless of the intended recipients of the messages, target public or percentage of children\u0026rsquo;s audience.\u003c/p\u003e","manuscriptTitle":"Impact of Food Advertising Restrictions in Portugal on Children’s Exposure to Unhealthy Foods and Beverages: A Before-and-After Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-14 05:35:02","doi":"10.21203/rs.3.rs-6013827/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"efe347e2-66e2-4ce1-8601-ec8a8ccb497d","owner":[],"postedDate":"February 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-20T04:38:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-14 05:35:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6013827","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6013827","identity":"rs-6013827","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}