title: An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador.
abstract: BACKGROUND
  Globalization and increased marketing of non-nutritious foods and beverages are driving a nutrition transition in developing countries, adversely affecting the health of vulnerable populations. This is a visual interpretive study of food, snack, and beverage advertisements (ads) in rural and urban El Salvador to discern the strategies and messages used to promote consumption of highly processed, commercialized products.
  
  
  METHODS
  Digital photographs of billboard and wall advertisements recorded a convenience sample of 100 advertisements, including 53 from rural areas and 47 from urban areas in El Salvador. Advertisements were coded for location, type of product, visual details, placement and context. Qualitative methods were used to identify common themes used to appeal to consumers.
  
  
  RESULTS
  Advertisements depicted "modern" fast foods, processed snacks and sugary beverages. Overall, the most prominent themes were: Cheap Price, Fast, Large Size, and Modern. Other themes used frequently in combination with these were Refreshment, Sports/Nationalism, Sex and Gender Roles, Fun/Happy Feelings, Family, Friendship and Community, and Health. In rural areas, beverage and snack food ads with the themes of cheap price, fast, and large size tended to predominate; in urban areas, ads for fast food restaurants and the theme of modernity tended to be more prominent.
  
  
  CONCLUSIONS
  The advertisements represented a pervasive bombardment of the public with both explicit and subliminal messages to increase consumerism and shift dietary patterns to processed foods and beverages that are low in micronutrients and high in carbohydrates, sugar, fat and salt--dietary changes that are increasing rates of child and adult diseases including tooth decay, obesity, cardiovascular disease and cancer. Global food and beverage industries must be held accountable for the adverse public health effects of their products, especially in low-middle income countries where there are fewer resources to prevent and treat the health consequences. In addition, public health and governmental authorities should learn from the advertising strategies to promote social marketing of public health messages, and enact and enforce regulations to limit the advertisement and sale of unhealthy products, particularly for children in and around schools. This will create healthier social norms and environments for the entire population.
authors.affiliation: Office of Dental Health, Alameda County Department of Public Health, Oakland, CA, USA. baharak.amanzadeh@acgov.org.|Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, San Francisco, CA, USA. baharak.amanzadeh@acgov.org.
authors.forename: Baharak
authors.initials: B
authors.lastname: Amanzadeh
authors.affiliation: UC Berkeley-UCSF Joint Medical Program, University of California Berkeley, School of Public Health, Berkeley, CA, USA. ksokalg@berkeley.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Sokal-Gutierrez
authors.affiliation: Department of Anthropology, History & Social Medicine, San Francisco, CA, USA. Judith.Barker@ucsf.edu.|Center to Address Children's Oral Health Disparities, University of California San Francisco, San Francisco, CA, USA. Judith.Barker@ucsf.edu.
authors.forename: Judith C
authors.initials: JC
authors.lastname: Barker
mesh_terms: D000328:Adult; D000329:Advertising / Q000706:statistics & numerical data*; D001628:Beverages; D002648:Child; D003132:Commerce; D004544:El Salvador; D057140:Fast Foods; D005260:Female; D005502:Food; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology; D012111:Residence Characteristics; D012424:Rural Population; D062410:Snacks; D014505:Urban Population