Healthiness of Foods and Beverages in Outdoor Advertisements in Xela, Guatemala: A Commercial Determinants of Health Interpretation

This study measured the spatial exposure to outdoor advertising of foods and beverages (and their healthiness) in central Xela, a Western Guatemalan city that is home to 181,000 people, 65% of whom are indigenous. We geotagged outdoor advertisements (ads) for foods and beverages in a square mile of Xela, coding for the modality of the advertisement, the types of items marketed, and their healthiness: “most healthy,” “middle healthy,” or “least healthy.” We observed 92 commercial-grade outdoor food and beverage ads across eight modalities, with vehicles (52%, 48/92), branded storefronts (25%, 23/92), and bus stops (13%, 12/92) the most prevalent. While all kinds of food and beverage businesses promoted their products on vehicles, branded storefronts were a modality almost exclusively used by soda companies, while bus stops were disproportionately used by fast food restaurants. We also identified 21 home-based ads, 86% (18/21) of which denoted households selling items they produce or make. Commercial-grade ads promoted largely least healthy foods and beverages, while home-based ads largely exposed people to most and middle healthy items. We interpret the results through the Commercial Determinants of Health Framework.