Impact of policies restricting advertising, promotion, and sponsorship of sugar-sweetened beverages: A systematic review.
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BACKGROUND: Motivation for the study. Restrictions on advertising, promotion, and sponsorship (APS) of unhealthy food and beverage products aim to reduce their consumption and protect public health. No reviews have yet evaluated the impact of restricting APS of sugary drinks (SD). Main findings. We found that comprehensive policies that include TV advertising restrictions, as well as restrictions at points of sale and in schools, can effectively reduce SD consumption, especially among children and adolescents, decrease obesity, cardiovascular disease, diabetes, and cancer, and generate economic benefits. Implications. Evidence on the health impact of such interventions is essential to promote effective measures. OBJECTIVES.: To summarize the evidence on the impact of the implementation of the ban on the advertising, promotion and sponsorship (APS) of sugar-sweetened beverages (SSBs) in terms of decreased consumption, advertising exposure and relevant clinical outcomes. MATERIALS AND METHODS.: Systematic review of articles published between 2001-2021 in the PubMed, Embase, Global Health, CINAHL and LILACS databases written in English, Portuguese or Spanish. We included experimental, observational and economic model studies. Risk of bias was assessed using RoB2, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group and Consolidated Health Economic Evaluation Reporting Standards 2022. We carried out a descriptive synthesis of the studies. RESULTS.: We selected 11 out of 1146 identified studies. Due to the heterogeneity of the outcomes, it was not possible to conduct a meta-analysis. The interventions corresponded to a comprehensive policy; restrictions on television advertising, promotions, point-of-sale advertising and advertising in schools. We found changes in clinical outcomes (obesity, cardiovascular disease, diabetes, cancer), economic outcomes (purchase, sale, cost-effectiveness, other economic outcomes), exposure and consumption. Most of the effect measures decreased as a result of the interventions. More studies on effectively implemented policies are still needed. The results of the included studies should be interpreted taking into account their methodological limitations. CONCLUSIONS.: Policies to restrict the APS of SSBs may be effective, particularly in reducing their consumption in children and adolescents, with a positive impact on their health.