Impact of changing restaurant advertising on weight gain and disparities

摘要肥胖与13种癌症有关，在美国高达11%的癌症与肥胖有关。 体重指数（BMI）超标的人有证据表明，饮食环境与肥胖有关 风险，影响到三分之一的成年人。餐馆是食品环境的重要组成部分。第一 三分之一的美国人会在一个典型的一天在快餐店吃饭。餐馆销售额稳步上升 在过去的50年里，2015年，餐馆在广告上花费了6.3万亿美元（是NIH的100多倍）。 预算）。不健康食品的广告往往针对那些肥胖风险较高的人， 不健康食品零售店，如快餐店，更密集地位于低收入和少数民族地区， 社区.因此，餐厅环境可能会对低收入和种族 少数民族人口。到目前为止，关于餐馆广告与肥胖风险之间关系的研究 主要集中在儿童身上。现有的研究受到横截面数据的限制（限制了 因果关系）。为了弥补这些知识差距，我们将联合收割机结合多个数据源， 独特的，客观的衡量当地人均餐厅广告（采用我们以前的方法， 发达）。这将来自Kantar Media的地方级季度餐厅广告支出 美国收入最高的100家餐厅以及所有地点的年度实际地址 来自AggData的每家连锁餐厅。我们将测试人均餐厅广告与 使用客观测量的230万人的BMI数据（在40个县的217个县） 州和哥伦比亚特区，包括美国人口最多的10个县中的9个）。我们 我们将使用尼尔森广告英特尔公司的数据来测试这种关系是否是由广告曝光所介导的。的 总体目标是利用国家数据，并提供急需的了解， 当地餐馆广告的变化影响成人体重增加和差异。我们提出两个具体的 目的：1）检查2012年至2016年连锁餐厅广告支出的变化，并测试是否 这些变化因收入和种族/民族而异，2）估计连锁餐厅之间的关联， 广告和美国成年人体重增加，按种族和社会经济地位，以及这种关系是否是介导的 广告的曝光率。我们将使用一套计量经济学技术来评估这些 关系是因果关系。我们假设，人均餐馆广告的增加在2010年更大， 少数种族/族裔和低收入人口较为集中的地区， 接触餐馆广告将与更高的体重增加有关，特别是对低收入和 种族/少数民族人群和广告曝光率较高的人群。这项研究将取得高度的成果 对我们理解餐馆广告如何影响体重增加和差异做出了重大贡献 在成年人中，这对随后的癌症结果和健康公平性具有重要影响。

Summary. Obesity is associated with 13 cancers and up to 11% of cancer in the United States is associated with excess body mass index (BMI). Evidence suggests that the food environment is associated with obesity risk, which affects one third of adults. Restaurants are an important component of the food environment. One- third of Americans will eat at a fast food restaurant on a typical day. Restaurant sales have steadily increased over the past 5 decades; in 2015 restaurants spent $6.3 trillion in advertising (more than 100 times the NIH budget). Advertisements for unhealthy items are often targeted towards those at higher risk for obesity, and unhealthy food retail outlets, like fast food restaurants, are more densely located in low-income and minority communities. Therefore, the restaurant environment may more negatively impact low-income and racial minority populations. To date, research on the relationship between restaurant advertising and obesity risk has largely focused on children. Available studies are limited by cross-sectional data (limiting identification of causal relationships). To address these knowledge gaps, we will combine multiple data sources to create a unique, objective measure of local per capita restaurant advertising (adapting an approach we previously developed). This will be derived from local-level quarterly restaurant advertising spending from Kantar Media for the 100 top revenue generating restaurants in the U.S. and the annual physical addresses for all locations from each restaurant chain from AggData. We will test associations of restaurant advertising per capita with population weight gain using objectively measured BMI data for 2.3 million people (in 217 counties across 40 states and the District of Columbia, including 9 of the 10 most populous U.S. counties) from athenahealth. We will test whether this relationship is mediated by advertising exposure using data from Neilson Ad Intel. The overall objective is to leverage national data and provide a much-needed understanding of how exposure to changes in local restaurant advertising impacts adult weight gain and disparities. We propose two specific aims: 1) examine changes in chain restaurant advertising expenditures from 2012 to 2016 and test whether those changes vary by income and race/ethnicity and 2) estimate the associations between chain restaurant advertising and weight gain among U.S. adults, by race and SES and whether this relationship is mediated by the level of exposure to advertising. We will use a set of econometric techniques to assess whether these relationships are causal. We hypothesize that increases in restaurant advertising per capita were larger in areas with higher concentrations of racial/ethnic minority and low-income populations and that greater exposure to restaurant advertising will be associated with higher weight gain, particularly for low-income and racial/ethnic minority populations and those with higher advertising exposure. This research will make a highly significant contribution to our understanding of how restaurant advertising impacts weight gain and disparities among adults, with important implications for subsequent cancer outcomes and health equity.