Selling Sickness—One Subway Station at a Time

How Subway Ads for Unhealthy Foods Target the Vulnerable

[Also available through U.S. News & World Report]

Advertisements that entice us to eat junk foods are a daily threat to healthful eating. That threat may be greatest for the most vulnerable among us. 

Targeted Advertising

How much advertising we encounter in our daily lives depends in no small part on where we live and who advertisers think we are.  That ads on television and other screens target certain populations is well-established.  But targeting also occurs through outdoor ads in the spaces where people go about their daily activities.

Ads for high-calorie, low-nutrition foods and beverages can be abundant, particularly in lower-income black and Latino neighborhoods. A walk through such neighborhoods can be a like journey down the junk-food aisle—images of unhealthy food and beverages flanking on both sides.  Such flanking is not limited to the street level.

The Subway Scene

Colleagues and I, at the Albert Einstein College of Medicine in the Montefiore Health System, recently published a study on food-and-beverage advertising in the Bronx subway system.  For this research, we assessed the more than 1,500 ads, in the 68 stations, on all 7 subway lines running through the borough.  We then linked what we observed to data on subway ridership and to demographic and health data on the neighborhoods in which stations were located. 

What we found was this: precisely zero ads promoting healthier foods or beverages like fruits, vegetables, whole grains, nuts, milk, or water. Instead, we found plenty of ads promoting unhealthy items like candies, chips, sugary cereals, frozen pizza, and alcohol.

Station Situation 

The number and proportion of unhealthy food-and-beverage ads differed by station and did not correspond with the counts of riders entering the subway system at these locations.  In other words, advertisers did not seem to be directing their messages to the biggest possible audiences. 

Rather, the number and proportion of unhealthy food-and-beverage ads corresponded with characteristics of the neighborhoods in which stations were located. Unhealthy ads (specifically ads in Spanish, directed at youth, and/or featuring minorities), were located excessively in neighborhoods with higher poverty, lower high-school graduation rates, higher percentages of Hispanic residents, and/or higher percentages of children.

Estimating Exposure

According to ridership data from the Metropolitan Transit Authority, each week (on average) more than a million people enter the Bronx subway stations that we found were displaying unhealthy food-and-beverage ads. The station having the greatest number of unhealthy ads has almost 170,000 riders per week (and, serving Yankee Stadium, this station undoubtedly has families and children among its riders).

As compared to other advertisements, which might only be glimpsed for short periods (say a billboard on the highway or a pop-up on our screens), subway-station ads might present an especially long exposure. Wait times for trains could extend viewing and several stations had more than 10 unhealthy food-or-beverage ads to view.

Health Implications

All this advertising may influence behavior. It is known, for example, that outdoor alcohol ads are linked to problem drinking in communities. In our study, we found alcohol ads disproportionately located in neighborhoods affected by alcohol-related health issues.

As for ads for other beverages and for food items more generally, these too may affect behavior. Research by others has shown that for every 10 percent increase in neighborhood food-or-beverage ads, there is a 5 percent increase in the chance of being overweight or obese. Our own study showed that unhealthy food-and-beverage ads were associated with low fruit-and-vegetable intake, higher sugary drink consumption, and higher rates of diabetes, hypertension, and high cholesterol in neighborhoods (particularly when these ads were directed at minorities).

Path Forward

Is an advertising ban the way to go?  Ads for tobacco products are already banned in the subway system and there is movement afoot to ban alcohol ads as well. Certainly, regulation could dictate allowable ads in allowable areas and this might be more effective than voluntary pledges by the food and beverage industries (which historically have been quite ineffective). 

In the meantime, greater awareness might help each of us guard against dietary threat. And the data may empower targeted groups to advocate for themselves and hold companies accountable.  We all might avoid products of the worst offenders (examples listed in the study for those interested).