This study identified 1806 brand appearances during the 13 matches selected for analysis. The McDonald’s brand was the most commonly observed (33.3%) followed by Budweiser (30.5%), Coca-Cola (25.7%) and Powerade (10.5%). HFSS brand appearance accounted for about 69.5% (McDonald’s, Coca-Cola, and Powerade) of all brand appearances during the selected matches, while alcohol brand appearance accounted for the remaining 30.5% (Budweiser). Brand appearance (both HFSS and alcohol) across Group G matches was higher than group A matches, and higher in matches played by the host country (Russia, despite the prohibition of alcohol advertisement) than other group G matches, though these difference are not statistically significant. The duration of brand appearance accounted for 22.5% of the total playing time for the 13 selected matches and the appearance of McDonald’s, Budweiser, Coca Cola, and Powerade accounted for 7, 6.9, 5.6, and 3% of playing time respectively. The majority of brand appearance (46.5%) occurred along pitch side-lines alone while 40.6% of all brand appearance occurred simultaneously on the side-line and goal line. These brand appearances generated substantial audience exposure, delivering 3.7 billion of alcohol and 6.7 billion of HFSS total gross impressions. This study also revealed that 852 million HFSS and 354 million alcohol impressions were also delivered to UK children who watched the 13 selected matches. Our study thus provides evidence that the 2018 FIFA World Cup was a source of significant exposure of children, young people, and adults to branded HFSS and alcohol advertising through sports sponsorship and is likely to be a contributor to alcohol and HFSS consumption by young people and adults.

Available evidence indicates that advertising of alcohol and HFSS, particularly among children, can influence eating behaviour [33, 34] and food choices [14], leading to an increased risk of obesity and related morbidities [35, 36]. Advertising during sporting events is a common practice and has been identified as the dominant medium for the promotion of alcohol and drinking among the general population [34]. Budweiser and Coca Cola have historically been major sponsors of several sporting events, such as stock car racing, the Olympics and major football competitions [37]. Budweiser and Coca Cola spent $350 million and $265 million respectively for sports sponsorship in 2016 [37]. McDonald’s has been top sponsor of the Olympics and contributed around $1 billion every four years before ending the sponsorship in 2018 [38]. Powerade is also an official sponsor of many international sport events, including Rio 2016 Olympic Games, Australian Olympic Committee, football events, rugby union, and cricket [27].

Though the advertising of alcohol and HFSS to adults is allowed in the UK, such advertisements are subject to regulations intended to protect children and young adults, particularly when the percentage of young viewers exceeds 30% of the target audience [39]. With respect to alcohol, the code seeks to prevent the general appeal of these products to children and young adults [18, 19, 39]. However, while the Ofcom broadcasting code restricts content in programmes, the regulator has no remit over sponsorship at televised sporting events and the Advertising Standards Authority, the UK’s regulator of advertising, does not regulate advertisements at the venue of televised sporting events due to their definition of advertising [1]. Alcohol and HFSS advertising through sponsorship at televised sporting events is thus, to practical purposes, currently unregulated.

Our analysis shows that the 2018 FIFA world cup was a major source of exposure to children and young people in the UK and is likely to be a contributor to HFSS consumption and alcohol use. These results are in accordance with findings reporting that advertising of alcohol, particularly among children, can influence behaviour [33], leading to an increase in the risk of related morbidities [35]. The earlier children are exposed to alcohol advertising, the earlier they start drinking [40, 41]. Children who otherwise might not have been thinking about alcohol start thinking to themselves ‘is this the product for me’ whenever they see alcohol advertisements [40, 41]. If these young people are already drinking, exposure to alcoholic content increases their chances of drinking at hazardous levels [40]. Despite EU regulations which prohibit media advertisement of HFSS and alcohol related contents to children, pitch-side promotional appearances during active play of the FIFA 2018 World Cup totalled over 2.5 h for HFSS brands and approximately 1.5 h for alcohol brands. Given the potential influence of this exposure on food choices and alcohol consumption among children and young adults, it is important that current regulations include televised sporting events in their remit to prevent young people being exposed to this content. In France, the “Loi Evin” otherwise referred to as the Evin’s Law largely controls alcohol marketing and bans alcohol advertising. However, Big Alcohol keeps breaking the law or tries to circumvent it despite the legal repercussions [42]. It is also imperative that global advertisement strategies which ensure benefits to sporting event sponsors without jeopardizing the health and well-being of the population are developed for the future.

Our findings lend support to studies calling for comprehensive regulation of food (and beverage) advertising during peak viewing hours accessible to children. Similar to our study, Kelly et al. recommend that regulation of TV advertising aimed at children should concentrate on the type of programs where advertisements are broadcast, the type of product, the target audience, the time of day, and the subject matter of advertisements [43]. At the same time, regulators must also consider focusing on the addition of sponsorship and sport to the scope of comprehensive regulations. Current self-regulatory marketing codes targeting alcohol and food are ineffective since most ignore the sponsorship of sport.

The cross-sectional nature of our study means that we are unable to estimate the effect of the documented exposure on HFSS or alcohol content consumption in our study population. However, there is evidence from elsewhere that exposure to such imagery through other media increases consumption of alcohol and HFSS [44]. We only coded a sample of 13 of the 48 matches in the entire FIFA World Cup competition. However, we have no reasons to suspect that the other groups and games would have been different, given our finding of the similarity of alcohol appearances in games featuring countries with different controls on alcohol advertising in place.

The 13 games delivered an estimated 6.7 billion gross branded HFSS impressions and 3.7 billion gross branded alcohol impressions to UK viewers. Our estimation of both gross and per capita impressions in this study assumes that viewers watched the entire broadcast of matches selected for coding and analysis, when in fact many may have watched only parts of the games. Calculating the gross and per capita impressions to measure population exposure has certain implications. The alcohol industry frequently cites gross impressions as a more suitable means to measure alcohol advertising [45]. However, the disparity in population size causes more impressions per person for youth and fewer per person for adults. Moreover, we also only coded a small proportion of the matches featured in the 2018 World Cup (21% of matches) and this indicates that exposure arising from the full competition is likely to be substantially higher. Also, the study is unable to capture impressions to viewers who watched selected matches online, from within the stadia or viewers of other matches played throughout the tournament. For this reason, figures we have provided are likely to underestimate true exposure. The British Broadcasting Corporation (BBC) indicated that 44.5 million people watched its coverage of the FIFA World Cup on television while a further 49.2 million people watched online via the BBC Sport website [46]. England played in some of the matches coded in this study and this may partly account for higher viewing figures for those matches, compared to matches involving other countries. The global viewership of the FIFA World Cup has been estimated at 3.4 billion, which is nearly half the global population [47]. This includes home TV audiences (estimated at 160 million), those who watched the game online and others who watched in public places such as bars, outdoor locations and pubs [46]. The UK exposure figures therefore probably represent a very small proportion of the true total global exposure.