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PONE-D-23-10045Comparing the Density of Outdoor Sugar-Sweetened Beverage and Caffeinated Beverage Advertisements Near Schools by School Type and School-Level Economic AdvantagePLOS ONE

Dear Dr. Pasch,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear authors,

Please fully address all the concerns raised by the reviewers. These concerns are related to but not limited to the presentation of the statistical analysis in the Results section and the need for greater description of the Introduction and the methods sections.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Overall, this is a sound study and important to the field of predatory marketing of unhealthy food products. I hope you will give serious consideration to the following comments:

In the results section (and in abstract), I’d be careful of the word “significantly.” We don’t want to confuse statistical significance w. the effect size. I suppose it’s fine as it is but perhaps re-phrase to something like “schools with lower SES had a dramatically higher number of advertisements…” or something like that.

You say: ““Schools with lower SES had more sugar-sweetened/caffeinated and non-sugar-sweetened/non-caffeinated beverage advertisements, though the differences were not statistically significant.” This is not a fair statement. If it’s not statistically significant, it really shouldn’t be mentioned at all. A more academically rigorous statement would be to say: “There were no statistically significant differences between schools with lower SES and higher SES in terms of sugar-sweetened/caffeinated and non-sugar-sweetened/non-caffeinated beverage advertisements.” The results are the results (and I agree that .05 p values are arbitrary). But strong papers do not emphasize (and many don’t even mention) non-significant results. Your study is sound… don’t grasp for straws when you have some perfectly solid results to report.

The results section does seem somewhat scant. Aren’t there more interesting results that can be reported here?

In terms of recommendations: You might consider going beyond recommending that “that food and beverage advertising regulations should expand beyond television to include the outdoor environment around schools / protections for older youth. Remember that soda machines are themselves a marketing vehicle. So you might also mention limiting where these machines are placed.

In the limitations you mentioned that you didn’t consider the density of convenience stores or fast-food establishments, but again, you also might note that these places (along with machines) are effective marketing mechanisms. Keep the distinction btw advertising and marketing in mind throughout your paper (note you use “marketing” in your last sentence.”

Love that nonparametric Mann-Whitney U tests were used to compare the number of advertisements in each category by school type and school-level SES.

Reviewer #2: Thank you for the opportunity to review this article submitted to PLOS ONE, titled “Comparing the Density of Outdoor Sugar-Sweetened Beverage and Caffeinated Beverage Advertisements Near Schools by School Type and School-Level Economic Advantage”. Authors conducted a cross-sectional study of outdoor advertising of beverages in a 0.5 mile radius of middle and high schools in Texas, finding that schools with ≥60% of students eligible for FRPL had higher counts of ads for non-caffeinated sugar-sweetened beverages. While this study is timely and interesting given the increasing popularity of policy strategies to reduce SSB consumption and lack of research among youth, there are additional points of clarification that need to be addressed. Please find my comments below.

Major comments

The title, introduction, and discussion of the manuscript make reference to the density of outdoor SSB advertising, but estimates are reported as the absolute number of ads within the ½ mile radius. I do think it is more informative to report on the absolute scale (e.g. 7.5 ads) rather than the density scale (e.g. 7.5 ads/2.01 square kilometers = 3.6 ads/km^2), but authors should clarify this framing.

Abstract

1. In the methods, authors should provide a justification for why the Mann-Whitney U tests were used relative to other tests.

2. In the results, there are some inconsistencies in how results are characterized as significant. In the first sentence, authors state that lower SES schools had significantly more non-SSB caffeinated beverage ads but report a p-value of 0.07 from the Wilcoxon test. I would reframe the results by only providing the results that are statistically significant, but then discuss why analyses may have been underpowered (or other reasons why other hypothesized differences were not significant) in the discussion section of the body of the paper.

Introduction

1. What are the biological mechanisms by which increased caffeine intake may lead to the health outcomes described in the second paragraph? Are these relationships independent of the sweetener used in the beverage? Some discussion for the metabolic consequences of caffeine as it relates to health would be useful here.

2. Are there estimates of the quantity of caffeine that is consumed by school-aged children on average per day? This would help contextualize whether youth are even meeting the DGA recommendation.

3. The last two sentences of the 4th paragraph: authors state that previous research has found that neighborhood level income is associated with outdoor food/beverage advertising, but then in the next sentence state that no studies have examined densities of SSB or caffeinated beverage advertisements by neighborhood income. This seems like a contradiction to me, so some clarification is needed. In addition, there is one study by Zahid et al. (2022) that has examined differences in the density of unhealthy beverage advertising by neighborhood median household income and racial/ethnic composition: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9152783/

4. Numerous studies have also documented disparities by race/ethnicity in SSB and other types of food/beverage advertising and marketing. I think an important but missing component of this study is whether the number of ads for SSBs and caffeinated beverages differs by school-level racial/ethnic composition – especially because this demographic is provided in the descriptive statistics of the school sample.

5. Some justification is needed for the focus on school characteristics specifically, as opposed to characteristics of the neighborhood the school resides in. In this community, for example, do students generally attend schools within their neighborhoods? Or is traveling larger distances to attend a different school possible/common? Why would beverage companies make marketing decisions based on the composition of the school rather than the composition of the neighborhood?

6. The framing of the research hypotheses uses the terms “densities” and “proportion”, but authors analyzed the distributions of the absolute counts of beverage ads. Suggest rephrasing for clarity.

Methods

1. Details on study sample selection are needed. How was the sample of 34 middle schools, and 13 high schools derived? Is this sample representative of all middle/high schools in Austin? Were there any recruitment strategies needed?

2. What months/years were data collected? Since the extent and variety advertisements can change quite frequently, this information is important context to understand the results.

3. Data collection: how were location and type of advertisements classified in the field?

4. Coding: the formula for calculating the tool reliability should be reported, instead of just using the statement “using a custom formula in FileMaker”. If this is inter-rater reliability, are the estimates of reliability provided Cohen’s kappa statistic? In addition, “coding of the content of advertisements” is vague – what does this entail? Were these limited to just the coding of the types of products present? Or also the location of the ad?

5. Coding: For the estimate of percent agreement, is the standard deviation in percent units? Or should this be 2%?

6. Coding: How many advertisements included multiple beverages or products in the same ad? How were these ads coded? If an advertisement included a lineup of different Pepsi products, for example, were these coded as a single ad or multiple ads for each product?

7. Given the low number of ads broken down by school type and FRPL status, I do wonder if some of the analyses were simply underpowered. Were analyses performed that summed across the advertisement types (i.e. all SSB ads, and all caffeinated ads)?

8. School-level SES: how was the 60% threshold chosen? Is this an accepted threshold that others have used in the past?

9. Statistical analyses: School SES and type may not be the only driver of the distribution of advertisements in a neighborhood. I would consider taking an additional step in the analysis to examine how school characteristics might explain the ad distribution, independent of neighborhood level characteristics, using a regression model. It could be that neighborhood characteristics entirely drive the observed association between school SES and the number of ads in the neighborhood, so this analysis would be critical in determining whether there is something unique about the school characteristics themselves.

Results

1. Were there drivers for whether school areas had any advertisements at all? The analysis presented describes continuous exposure, but I wonder if there are aspects of the school -- such as the degree of political will of the children and families who attend the school -- that influence whether beverage companies choose to advertise their products in a given area at all.

2. Please include IQRs for the median estimates.

3. Please remove the language “approached significance”, as this is no longer standard practice for most journals and research articles.

Discussion

1. I would begin the Discussion with a summary of the findings, then move on to explanations and comparison to other literature.

2. In second paragraph, please remove language about associations “approaching” statistical significance. If there is an argument to be made about non-SSB/non-caffeinated beverages, I would just provide the medians and describe possible explanations for why the associations were not statistically significant (which the authors do, partially, in the remainder of the paragraph).

Minor comments

1. In the abstract, it would be useful if authors described when data were collected, since advertising of SSBs may experience both yearly and seasonal secular trends.

2. In the abstract methods section, please define Outdoor MEDIA.

3. In the abstract results section, I would include units for the median estimates within the parentheticals, as well as a note for which estimate corresponds to the high SES vs. low SES schools, e.g. ‘(Median for low SES schools = 7.5 ads vs. Median for high SES = 0 ads, p = 0.014)’. Estimates of dispersion (e.g. IQR for median) should also be included.

4. SSB should be defined before first use as an acronym.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-10045R1Comparing the Number of Outdoor Sugar-Sweetened Beverage and Caffeinated Beverage Advertisements Near Schools by School Type and School-Level Economic AdvantagePLOS ONE

Dear Dr. Pasch,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 13 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Habiba I. Ali, PhD, RD, CDE

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Please address the reviewers' comments.

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Nice job responding to our comments. The only suggestion I have is to update your background - or at least this sentence: "As of 2014, nearly two thirds of children in the United States consumed at least one SSB per day." Since 2014 is now ten years ago it seems odd to include data so old. This is still a problem in 2024 so I request that you add at least one sentence that demonstrates this (i.e. data from 2019 at the earliest, but ideally from 2022 or '23 perhaps?)

Reviewer #2: Thank you for your close attention to the comments from reviewers, and for being transparent and upfront about the discovery of a coding error that altered your findings. I have no additional major comments. My one additional request is that you include a reference for the bootstrapping procedure used. Apart from that, I look forward to reading the final version of the manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Comparing the Number of Outdoor Sugar-Sweetened Beverage and Caffeinated Beverage Advertisements Near Schools by School Type and School-Level Economic Advantage

PONE-D-23-10045R2

Dear Dr. Pasch,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Habiba I. Ali, PhD, RD, CDE

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have addressed the comments of the reviewers.

Reviewers' comments: