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 favored 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.

The authors have declared no competing interest.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The data collected was observational and did not involve human subjects but was part of a larger ethnographic project that was approved by Emory University IRB on 9.22.2016 (#IRB00091185).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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All relevant data are within the manuscript and its Supporting Information files. The dataset provided omits geolocation information for 21 home-based ads to protect individual residences from being identified.