Trying to eat healthy? Many of us are. Unfortunately, our attempts are often challenged by pervasive less-healthful fare. Diet-challenging foods and beverages are all around us, often in unexpected places. And ads pushing us to consume less-healthful items are everywhere.

Omnipresent Advertising

It’s no secret that ads for less-healthful foods and beverages are ubiquitous on TV (commercials interrupt programs, companies place products on shows, event sponsors inconspicuously brand and message). And now that viewer attention is turning to other screens, food and beverage companies are becoming more creative with various “digital marketing.”

Yet even when we can pull our eyes away from our glowing devices, we are not safe from ads promoting less-healthful foods and beverages. As we go about our daily lives we encounter additional ads in the form of billboards, posters, banners, and other print.

Targeted Marketing

How much print advertising we encounter depends in no small part on where we live and who we advertisers think we are. Advertisers target their marketing to specific groups. For food and beverage companies, those groups include vulnerable adults and children.

The targeting of vulnerable adults and children through screen ads (e.g., television, computer, and portable devices) is well-established. Research also suggests that such targeting is seen with outdoor ads, in the spaces where people go about their daily lives.

For example, ads for high-calorie, low-nutrition foods and beverages are seen more often in lower-income black and Latino communities. Such ads often cluster around child-serving institutions like day-care centers, libraries, and schools.

In effect, there can be targeting in people’s homes, and around homes, and around various non-home destinations. There can also be targeting along the paths in between.

Subway ad for “fresh groceries”

Lurking Beneath

City residents often travel by subway. My colleagues and I just published a study on food-and-beverage advertising in a subway system — the Bronx subway system to be precise. To do the research, we rode all 7 lines and assessed all 1,586 ads in all 68 stations. We then linked our observations to data on subway ridership and to demographic and health data from the communities in which stations were located.

The results of our analyses were striking. First, there were no ads promoting more-healthful food-or-beverage items (e.g., fruits, vegetables, whole grains, nuts, milk or water). However, there were plenty of ads promoting less-healthful items (e.g., candies, chips, sugary cereals, frozen pizza, hard alcohol, and beer).

Station by Station

Placement of less-healthful food-and-beverage ads across stations was uneven and did not correspond with station ridership. Said another way, advertisers did not seem to be directing their messages to the biggest possible audiences.

Instead, placement of less-healthful food-and-beverage ads corresponded to characteristics of the communities in which stations were located. Less-healthful ads (specifically ads in Spanish, directed at youth, and/or featuring minorities), were located disproportionately in communities with higher poverty, lower high-school graduation rates, higher percentages of Hispanic residents, and/or higher percentages of children.

Subway ad for candy

Quantifying Ad Exposure

In a given week on average, well over one million people enter Bronx subway stations having less-healthful food-and-beverage ads. The station having the greatest number of less-healthful ads (34 ads to be exact) has almost 170,000 riders per week alone. Serving Yankee Stadium, this station undoubtedly counts families and children among its regular riders.

Compared to other advertising in in the landscape — or even to ads on our glowing screens (which might only be glimpsed briefly) — subway station ads might represent a particularly lengthy exposure. Wait times for trains might prolong viewing, and the concentration of ads along platforms can be considerable. Notably, several stations had more than 10 less-healthful food-and-beverage ads each.

Implications for Health

All these ads may influence behavior. For example, exposure to outdoor alcohol advertising has been tied to subsequent intentions to use alcohol and to problem drinking. In our study, we found alcohol ads overly present in communities highly affected by alcohol-related health issues.

Considering ads for foods and beverages more generally, for every 10% increase in outdoor advertising, other researchers have reported a 5% greater odds of being overweight or obese. In our study, we found less-healthful food-and-beverage ads (in general, and specifically when directed at minorities) were tied to low fruit-and-vegetable consumption, higher sugary drink intake, and higher rates of diabetes, hypertension, and high cholesterol.

Sunlight as Disinfectant

Advertising of unhealthful products is a problem. Historically, voluntary pledges by industry to eliminate ads to select groups (e.g., to children) have been ineffective.

Community activists could inspire government’s action to regulate allowable areas for allowable ads. Existing bans on tobacco advertising could provide a model.

In the interim, shining light on the issue of unhealthful food advertising — to empower targeted groups to advocate for themselves and hold companies accountable — could be part of the solution. Potential consumers might choose to avoid products of the worst offenders (examples listed in the mentioned study for those interested)

Subway entrance with ad linking snack chips to sport

Originally published at on March 9, 2017.

Originally published at


  • Sean C. Lucan

    Family physician, public health and health policy researcher, MD, MPH, MS

    Sean Lucan is a practicing family physician in the Bronx, NY. He is also an award-winning NIH-funded investigator, who has published numerous peer-reviewed articles and thought pieces on food-related issues.  Additionally, he has co-authored one textbook on nutrition and another on biostatistics, epidemiology, preventive medicine, and public health.   Dr. Lucan earned his MD and MPH degrees at Yale before completing residency training in Family Medicine and Community Health at the University of Pennsylvania.  After residency, he completed a fellowship in the Robert Wood Johnson Foundation Clinical Scholars Program, where he earned an MS in Health Policy Research.  Dr. Lucan was also a fellow at the National Academy of Medicine (formerly Institute of Medicine).  He is currently a member of the research faculty in the Department of Family and Social Medicine at Albert Einstein College of Medicine, Montefiore Health System.   A focus of Dr. Lucan's research is how different aspects of urban food environments may influence what people eat, and what the implications are for obesity and chronic diseases, particularly in low-income and minority communities.  Another focus of his work is the critical examination of clinical guidance and public health initiatives.