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Brunacci KA, Salmon L, McCann J, Gribble K, Fleming CAK. The big squeeze: a product content and labelling analysis of ready-to-use complementary infant food pouches in Australia. BMC Public Health 2023; 23:656. [PMID: 37024884 PMCID: PMC10077707 DOI: 10.1186/s12889-023-15492-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy. METHODS Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims. RESULTS 276 products from 15 manufacturers were analysed, targeting infants from 4 + to 12 + months. Total sugar content ranged 0.8-17.5 g/100 g, 20% (n = 56) of products had added sugars, 17% (n = 46) had added fruit juice, 71% (n = 196) had added fruit puree. Saturated fat content ranged from 0.0 to 5.0 g/100 g, sodium 0.0-69 mg/100 g and dietary fibre 0.0-4.3 g/100 g. Only two products were nutritionally adequate according to a nutrient profiling tool. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of 'no added sugar' were made for 59% of pouches, despite the addition of free sugars. CONCLUSIONS Squeeze pouch products available in Australia are nutritionally poor, high in sugars, not fortified with iron, and there is a clear risk of harm tothe health of infant and young children if these products are fed regularly. The marketing messages and labelling on squeeze pouches are misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0-36 months and better inform parents.
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Affiliation(s)
- Kaitlyn A Brunacci
- School of Health Sciences, Western Sydney University, Sydney, Australia.
| | - Libby Salmon
- School of Regulation and Global Governance, The Australian National University, Canberra, Australia
| | | | - Karleen Gribble
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Catharine A K Fleming
- School of Health Sciences, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Western Sydney University, Sydney, Australia
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Packer J, Croker H, Goddings AL, Boyland EJ, Stansfield C, Russell SJ, Viner RM. Advertising and Young People's Critical Reasoning Abilities: Systematic Review and Meta-analysis. Pediatrics 2022; 150:e2022057780. [PMID: 36377381 PMCID: PMC9724173 DOI: 10.1542/peds.2022-057780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Young people are exposed to an abundance of advertising for unhealthy products (eg, unhealthy foods, tobacco, alcohol). Because of their developing cognition, children may not be able to understand the intent of advertising. However, advertising restrictions often assume that adolescents have critical reasoning capacity and can resist the effects of advertising. This review seeks to assess whether the evidence supports this assumption. METHODS Ten databases were searched in December 2020. Inclusion criteria were participants aged 6 to 17 years, any advertising exposure, objectively measured understanding or attitudinal outcome, a comparison, control, and between-group comparison. This study included all languages and excluded studies published pre-2010. Two reviewers independently extracted data and assessed study quality. RESULTS Thirty-eight articles were included. Meta-analysis of 9 studies with attitudinal outcomes indicated that unhealthy product advertising generated more positive brand or product attitudes compared with neutral or no advertising control in all ages. There were significant effects for digital and nondigital advertising formats. We found greater understanding did not protect against the impact of advertising on brand or product attitudes. Limitations include the inability to meta-analyze the impact of advertising on understanding or the influence of age. CONCLUSIONS Evidence shows that the attitudes of young people were influenced by advertising. Critical reasoning abilities did not appear to be fully developed during adolescence and not found to be protective against the impact of advertising. Policymakers should ensure regulations to restrict marketing of unhealthy commodities protects adolescents as well as younger children.
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Affiliation(s)
- Jessica Packer
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Helen Croker
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Anne-Lise Goddings
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Emma J. Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Claire Stansfield
- EPPI-Centre, UCL Social Research Institute, University College London, United Kingdom
| | - Simon J. Russell
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Russell M. Viner
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Boyland E, McGale L, Maden M, Hounsome J, Boland A, Angus K, Jones A. Association of Food and Nonalcoholic Beverage Marketing With Children and Adolescents' Eating Behaviors and Health: A Systematic Review and Meta-analysis. JAMA Pediatr 2022. [PMID: 35499839 DOI: 10.1001/jamapediatrics.2022.1037%jjamapediatrics] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
IMPORTANCE There is widespread interest in the effect of food marketing on children; however, the comprehensive global evidence reviews are now dated. OBJECTIVE To quantify the association of food and nonalcoholic beverage marketing with behavioral and health outcomes in children and adolescents to inform updated World Health Organization guidelines. DATA SOURCES Twenty-two databases were searched (including MEDLINE, CINAHL, Web of Science, Embase, and The Cochrane Library) with a publication date limit from January 2009 through March 2020. STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Inclusion criteria were primary studies assessing the association of food marketing with specified outcomes in children and adolescents (aged 0-19 years). Exclusion criteria were qualitative studies or those on advertising of infant formula. Of 31 063 articles identified, 96 articles were eligible for inclusion in the systematic review, and 80 articles in the meta-analysis (19 372 participants). DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data. Random-effects models were used for meta-analyses; meta-regressions, sensitivity analyses, and P curve analyses were also performed. Where appropriate, pooling was conducted using combining P values and vote counting by direction of effect. Grading of Recommendations Assessment, Development, and Evaluation was used to judge certainty of evidence. MAIN OUTCOMES AND MEASURES Critical outcomes were intake, choice, preference, and purchasing. Important outcomes were purchase requests, dental caries, body weight, and diet-related noncommunicable diseases. RESULTS Participants totaled 19 372 from 80 included articles. Food marketing was associated with significant increases in intake (standardized mean difference [SMD], 0.25; 95% CI, 0.15-0.35; P < .001), choice (odds ratio, 1.77; 95% CI, 1.26-2.50; P < .001), and preference (SMD, 0.30; 95% CI, 0.12-0.49; P = .001). Substantial heterogeneity (all >76%) was unexplained by sensitivity or moderator analyses. The combination of P values for purchase requests was significant but no clear evidence was found for an association of marketing with purchasing. Data on dental health and body weight outcomes were scarce. The certainty of evidence was graded as very low to moderate for intake and choice, and very low for preference and purchasing. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, food marketing was associated with increased intake, choice, preference, and purchase requests in children and adolescents. Implementation of policies to restrict children's exposure is expected to benefit child health.
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Affiliation(s)
- Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Lauren McGale
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Juliet Hounsome
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Kathryn Angus
- Institute for Social Marketing & Health, University of Stirling, Stirling, Scotland
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
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Nanchahal K, Vasiljevic M, Petticrew M. A content analysis of the aims, strategies, and effects of food and nonalcoholic drink advertising based on advertising industry case studies. Obes Sci Pract 2022; 8:208-218. [PMID: 35388346 PMCID: PMC8976544 DOI: 10.1002/osp4.561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 01/29/2023] Open
Abstract
Background Placing limitations on advertising of food and nonalcoholic drinks to children is an effective strategy in addressing childhood obesity. The industry maintains that further restrictions are unnecessary. Aims To ascertain whether the advertising campaigns were successful according to the industry evaluations and more specifically the effects of marketing on children. Materials & Methods A total of 117 case studies (1980–2016) published by the advertising industry which evaluate the effects of advertising campaigns were reviewed. This industry data source had been previously used to analyze the effects of alcohol advertising campaigns. The nutrition profile of the products was assessed by applying the World Health Organisation Nutrition Profile model designed to restrict the marketing of foods and beverages to children. Results The food and drink industry advertising campaigns target specific consumers including children, use several persuasive marketing techniques (utilizing celebrities and gamification), often position unhealthy products as healthy, and lead to increased sales of the advertised product with good returns on investment. The health‐related claims made, and aspects of the campaigns related to the marketing of the products to children are summarized. Discussion Our analysis of food and non‐alcoholic drinks case studies aligns with similar analyses of tobacco and alcohol advertising Conclusion This analysis, based on internal industry data, presents important evidence on the effects of advertising on consumption‐related outcomes and the mechanisms by which they are achieved.
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Affiliation(s)
- Kiran Nanchahal
- Department of Public Health, Environments and Society London School of Hygiene & Tropical Medicine London UK
| | | | - Mark Petticrew
- Department of Public Health, Environments and Society London School of Hygiene & Tropical Medicine London UK
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Richter APC, Duffy EW, Smith Taillie L, Harris JL, Pomeranz JL, Hall MG. The Impact of Toddler Milk Claims on Beliefs and Misperceptions: A Randomized Experiment with Parents of Young Children. J Acad Nutr Diet 2022; 122:533-540.e3. [PMID: 34391941 PMCID: PMC8840993 DOI: 10.1016/j.jand.2021.08.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been marketed increasingly in the United States with structure/function claims on product packaging that are potentially misleading. OBJECTIVE This study examined how structure/function claims impact parents' beliefs and perceptions about a toddler milk product. DESIGN This was a 3-arm between-subjects randomized experiment. PARTICIPANTS A diverse sample of 2,190 US parents of children aged 1 to 5 years were chosen to take an online survey. INTERVENTION Participants were randomly assigned to view a toddler milk package with either an unrelated claim ("new and improved," ie, control condition), a "brain development" claim (ie, "brain" claim), or an "immunity-related" claim (ie, "immunity" claim). MAIN OUTCOME MEASURES Outcomes included perceptions, intentions, and beliefs about the toddler milk product. STATISTICAL ANALYSES PERFORMED Linear regression for continuous outcomes and logistic regression for dichotomous outcomes. RESULTS Parents who were exposed to the "brain" claim or the "immunity" claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow's milk compared with those who saw the control claim (89% for brain claim, 87% for immunity claim, and 79% for control; P < .001 for both comparisons). Parents exposed to either the brain or immunity claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared with parents exposed to the control (all, P < .001). CONCLUSIONS These findings suggest that structure/function claims on toddler milk packaging may mislead parents and increase the appeal of toddler milk. Our findings support calls for public health policies to regulate marketing on toddler milk packaging.
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Bragg M, Lutfeali S, Greene T, Osterman J, Dalton M. How Food Marketing on Instagram Shapes Adolescents' Food Preferences: Online Randomized Trial. J Med Internet Res 2021; 23:e28689. [PMID: 34677136 PMCID: PMC8571690 DOI: 10.2196/28689] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Worldwide obesity rates have prompted 16 countries to enact policies to reduce children’s exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents’ preferences. Objective This study examined whether adolescents could identify food companies’ Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents’ preferences. Methods In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame—which includes the logo, comments, and “likes.” In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the “labeled ad condition.” In the “unlabeled ad condition,” however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features.
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Affiliation(s)
- Marie Bragg
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States
| | - Samina Lutfeali
- Stanford Graduate School of Business, Palo Alto, CA, United States
| | - Tenay Greene
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States
| | - Jessica Osterman
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States
| | - Madeline Dalton
- Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, NH, United States
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Brownbill AL, Miller CL, Smithers LG, Braunack-Mayer AJ. Selling function: the advertising of sugar-containing beverages on Australian television. Health Promot Int 2021; 36:143-154. [PMID: 32388552 DOI: 10.1093/heapro/daaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Reducing population consumption of sugar-containing beverages has become a public health priority in many countries due to causal evidence between high consumption, weight gain and non-communicable diseases. This study aims to explore how sugar-containing beverages are associated with health and wellness in television advertisements. Our sample consisted of all televised advertisements from sugar-containing beverage manufacturers aired on free-to-air television from one Australian network (four channels) in 2016 (n = 30 unique advertisements). We transcribed advertisements for audio and visual information. We analysed data inductively using methods from thematic, discourse and multi-modal analysis. Advertisements for sugar-containing beverages reflected both traditional (physical health and reduced risk of disease) and broader (wellbeing) conceptualizations of health. Beverages were positioned in advertisements as contributing a functional role to promote and enhance health and wellbeing within the physical, mental and social domains. Beverages were advertised as correcting suboptimal states of being to achieve desirable outcomes, including relaxation, increased resistance to disease, enhanced performance, better cognitive functioning and improved social connections. Positioning beverages within a wider conceptualization of health and wellbeing aligns with how health and nutrition are increasingly being understood and sought out by consumers, creating increased opportunities for the marketing of sugar-containing beverages as 'healthy'.
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Affiliation(s)
- Aimee L Brownbill
- School of Public Health, The University of Adelaide, SA 5000, Australia.,Health Policy Centre, South Australian Health and Medical Research Institute, SA 5000, Australia
| | - Caroline L Miller
- School of Public Health, The University of Adelaide, SA 5000, Australia.,Health Policy Centre, South Australian Health and Medical Research Institute, SA 5000, Australia
| | - Lisa G Smithers
- School of Public Health, The University of Adelaide, SA 5000, Australia.,Robinson Research Institute, University of Adelaide, SA 5000, Australia
| | - Annette J Braunack-Mayer
- School of Public Health, The University of Adelaide, SA 5000, Australia.,School of Health and Society, University of Wollongong, NSW 2522, Australia
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Castronuovo L, Guarnieri L, Tiscornia MV, Allemandi L. Food marketing and gender among children and adolescents: a scoping review. Nutr J 2021; 20:52. [PMID: 34099000 PMCID: PMC8186097 DOI: 10.1186/s12937-021-00706-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pervasive marketing of unhealthy foods is a contributing factor to the growth of the global epidemic of childhood and adolescent overweight and obesity. Sex and gender differences come into play in the design of and responses to these marketing strategies, contributing to the perpetuation of stereotyped behavior and generating disparities in food choices and health. The purpose of this paper is to review the current literature regarding gender differences in food marketing design and perception among children and adolescents to facilitate evidence-based policy dialogues to address gender-based health disparities in NCD prevention. METHODS Scoping review of articles published in scientific journals in English and Spanish, from 2003 to 2018, that addressed the influence of food marketing among children and adolescents including a gender perspective. The methodological quality of each article was assessed following criteria specific to each study design. RESULTS From a total of 37 articles (39 studies) included in the review, 17 were experimental and 22 had descriptive, cross-sectional designs. Twenty-one studies were found to have low methodological quality, while 10 and 8 were of medium and high quality, respectively. A total of 23 studies among children and adolescents found gender-based differences. Differences were found in the following dimensions: food marketing on intake; responses to specific marketing; perceptions and attitudes towards food marketing and marketing regulation initiatives; exposure to food advertising and gendered marketing content. The evidence was not conclusive in any of the dimensions. CONCLUSIONS The evidence suggests that food marketing has a similar impact on the consumption of unhealthy foods on boys and girls, but boys were found to be exposed to food advertising more intensively and their preferences to be more affected by this exposure, coinciding with a male-dominant advertising content. Limitations of these studies include taking gender as an unproblematic construct equivalent to biological sex and the lack of studies focused on developing countries. As gender is a cross-sectional dimension that interacts with other factors driving health disparities, an integrated gender perspective is needed to develop effective, evidence-based policies to control food marketing and tackle the childhood overweight and obesity pandemic.
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Affiliation(s)
- Luciana Castronuovo
- Fundación Interamericana del Corazón Argentina, Arévalo 2364 1° A, 1425 Caba, Argentina
| | - Leila Guarnieri
- Fundación Interamericana del Corazón Argentina, Arévalo 2364 1° A, 1425 Caba, Argentina
| | | | - Lorena Allemandi
- PanAmerican Health Organization (consultant), Calle 43 n 1095, 6360 General Pico, La Pampa Argentina
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Taillie LS, Busey E, Stoltze FM, Dillman Carpentier FR. Governmental policies to reduce unhealthy food marketing to children. Nutr Rev 2021; 77:787-816. [PMID: 31329232 DOI: 10.1093/nutrit/nuz021] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Reducing children's exposure to food marketing is an important obesity prevention strategy. This narrative review describes current statutory regulations that restrict food marketing; reviews available evidence on the effects of these regulations; and compares policy design elements in Chile and the United Kingdom. Currently, 16 countries have statutory regulations on unhealthy food marketing to children. Restrictions on television advertising, primarily during children's programming, are most common. Schools are also a common setting for restrictions. Regulations on media such as cinema, mobile phone applications, print, packaging, and the internet are uncommon. Eleven evaluations of policies in 4 jurisdictions found small or no policy-related reductions in unhealthy food advertising, in part because marketing shifted to other programs or venues; however, not all policies have been evaluated. Compared with the United Kingdom, Chile restricts marketing on more products, across a wider range of media, using more marketing techniques. Future research should examine which elements of food marketing policy design are most effective at reducing children's exposure to unhealthy food marketing.
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Affiliation(s)
- Lindsey Smith Taillie
- UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Busey
- UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fernanda Mediano Stoltze
- UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ha OR, Killian HJ, Davis AM, Lim SL, Bruce JM, Sotos JJ, Nelson SC, Bruce AS. Promoting Resilience to Food Commercials Decreases Susceptibility to Unhealthy Food Decision-Making. Front Psychol 2020; 11:599663. [PMID: 33343472 PMCID: PMC7738621 DOI: 10.3389/fpsyg.2020.599663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023] Open
Abstract
Children are vulnerable to adverse effects of food advertising. Food commercials are known to increase hedonic, taste-oriented, and unhealthy food decisions. The current study examined how promoting resilience to food commercials impacted susceptibility to unhealthy food decision-making in children. To promote resilience to food commercials, we utilized the food advertising literacy intervention intended to enhance cognitive skepticism and critical thinking, and decrease positive attitudes toward commercials. Thirty-six children aged 8–12 years were randomly assigned to the food advertising literacy intervention or the control condition. Eighteen children received four brief intervention sessions via video over 1 week period. In each session, children watched six food commercials with interspersed embedded intervention narratives. While watching food commercials and narratives, children were encouraged to speak their thoughts out loud spontaneously (“think-aloud”), which provided children's attitudes toward commercials. Eighteen children in the control condition had four control sessions over 1 week, and watched the same food commercials without intervention narratives while thinking aloud. The first and last sessions were held in the laboratory, and the second and third sessions were held at the children's homes. Susceptibility to unhealthy food decision-making was indicated by the decision weights of taste attributes, taste perception, food choices, ad libitum snacking, and cognitive and affective attitudes toward food commercials. As hypothesized, the intervention successfully decreased susceptibility to unhealthy food decision-making evidenced by reduced decision weights of the taste in food decisions, decreased tasty perception of unhealthy foods, and increased cognitive skepticism and critical thinking toward food commercials. In addition, as children's opinions assimilated to intervention narratives, their cognitive skepticism and critical thinking toward commercials increased. The aforementioned results were not shown in the control condition. However, this brief intervention was not enough to change actual food choices or food consumption. Results of this study suggest that promoting resilience to food commercials by enhancing cognitive skepticism and critical thinking effectively reduced children's susceptibility to unhealthy food-decision making.
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Affiliation(s)
- Oh-Ryeong Ha
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Haley J Killian
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Ann M Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, United States
| | - Seung-Lark Lim
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Jarrod J Sotos
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Samuel C Nelson
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Amanda S Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, United States
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Fernández-Escobar C, Monroy-Parada DX, Ordaz Castillo E, Lois D, Royo-Bordonada MÁ. Effect of health-promoting messages in television food commercials on adolescents' attitudes and consumption: A randomized intervention study. Appetite 2020; 158:105014. [PMID: 33132112 DOI: 10.1016/j.appet.2020.105014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The HAVISA plan is a Spanish government's policy for the promotion of healthy lifestyles via health messages in television food advertisements. This study evaluated the positive or negative impact (health halo effect) of health messages on food choices and predisposition towards healthy habits of Spanish adolescents. METHODS Randomized controlled study in 11-14 years old adolescents. The intervention group watched television advertisements for unhealthy foods with HAVISA health messages, while the control group watched the same advertisements without them. A self-administered questionnaire measured participants' attitudes towards the products advertised, to diet and physical activity, and recognition of messages. Afterwards they chose between fruit and unhealthy snacks. The differences between the two groups were then compared. RESULTS A total of 27.2% of the control group versus 29.6% of the intervention group chose fruit (p = 0.54). Both groups displayed high desire for (7.24 vs. 7.40, p = 0.29) and intention to consume (6.67 vs. 6.73, p = 0.63) the unhealthy products advertised. There were no differences in perceived healthiness of these foods (4.11 vs. 4.19, p = 0.74), or perceived importance of a healthy diet (3.17 vs. 3.12, p = 0.55) or physical activity (4.53 vs. 4.51, p = 0.73). Desire for vegetables (2.49 vs. 2.66, p = 0.08) and fruit (3.15 vs. 3.30, p = 0.09) were higher in the intervention group, but the differences were not significant. Only 47.6% of participants noticed the presence of health messages; of these, 31% correctly recalled their content. CONCLUSION HAVISA health messages changed neither the attitudes nor immediate eating behaviors of adolescents. There was no immediate healthy-lifestyle promoter or adverse health halo effect, probably due to the messages' low prominence. Further research should evaluate the long-term effect of repeated exposure to health messages.
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Affiliation(s)
- Carlos Fernández-Escobar
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III. Calle Sinesio Delgado 10, 28029, Madrid, Spain.
| | | | - Elena Ordaz Castillo
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III. Calle Sinesio Delgado 10, 28029, Madrid, Spain.
| | - David Lois
- Social Psychology Department, Universidad Nacional de Educación a Distancia, Calle de Juan Del Rosal, 10, 28040, Madrid, Spain.
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Binder A, Naderer B, Matthes J, Spielvogel I. Fiction Is Sweet. The Impact of Media Consumption on the Development of Children's Nutritional Knowledge and the Moderating Role of Parental Food-Related Mediation. A Longitudinal Study. Nutrients 2020; 12:nu12051478. [PMID: 32438773 PMCID: PMC7284628 DOI: 10.3390/nu12051478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 11/20/2022] Open
Abstract
Nutritional knowledge is an important cognitive facilitator that potentially helps children to follow a healthy diet. Two main information agents influence children’s development of nutritional knowledge: the media and their parents. While a high amount of media consumption potentially decreases children’s nutritional knowledge, parents may shape the amount of information children can gather about nutrition through their food-related mediation styles. In addition, children’s individual preconditions predict how children can process the provided nutritional information. This two-wave panel study with children (N = 719; 5–11 years) and their parents (N = 719) investigated the main effects and interplay of children’s amount of media consumption and their parents’ food-related mediation styles by performing linear regression analysis. Children’s individual preconditions were also considered. We measured children’s self-reported amount of media consumption, children’s age, sex, weight, and height (BMI). Additionally, in a parent survey we asked parents about how they communicate their rules about eating while especially focusing on active and restrictive food rule communication styles. As a dependent measure, we examined children’s nutritional knowledge at Time 1 and 2. The results show that the amount of media consumption has a negative effect on children’s nutritional knowledge over time. Parents’ restrictive or active food-related mediation asserted no main effects and could not lever out the negative effect of the amount of media consumption. Therefore, we argue that parents should limit children’s amount of media consumption to avoid the manifestation of misperceptions about nutrition.
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Affiliation(s)
- Alice Binder
- Advertising and Media Effects Research Group, Department of Communication, University of Vienna, 1090 Vienna, Austria; (J.M.); (I.S.)
- Correspondence:
| | - Brigitte Naderer
- Department of Media and Communication, Ludwig-Maximilians-University Munich, 80538 Munich, Germany;
| | - Jörg Matthes
- Advertising and Media Effects Research Group, Department of Communication, University of Vienna, 1090 Vienna, Austria; (J.M.); (I.S.)
| | - Ines Spielvogel
- Advertising and Media Effects Research Group, Department of Communication, University of Vienna, 1090 Vienna, Austria; (J.M.); (I.S.)
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Pomeranz JL, Harris JL. Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health. Am J Public Health 2020; 110:871-880. [PMID: 32298182 DOI: 10.2105/ajph.2020.305621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations.Methods. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, identified top-selling children's "juice" drinks in fruit punch flavors, gathered labels in store and online, and extracted data from the principal display and information panels.Results. FDA regulations permit a wide range of names, claims, and fruit vignettes on drinks that contain or purport to contain juice, reflecting the product's flavor and not necessarily its ingredients. We identified 39 brands of children's drinks, including 100% juice (n = 7), diluted juices (n = 11), juice drinks (n = 8), fruit-flavored drinks (n = 8), and flavored waters (n = 5), with nonuniform statements of identity; vitamin C and low-sugar claims; and fruit vignettes representing 19 fruits. Many products contained added sugar and nonnutritive sweeteners but little to no juice.Conclusions. Principal display panels rendered it difficult to differentiate among product types, identify those with added sweeteners, and distinguish healthier products. Revised labeling regulations are warranted to support public health.
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Affiliation(s)
- Jennifer L Pomeranz
- Jennifer L. Pomeranz is with the School of Global Public Health, New York University, New York. Jennifer L. Harris is with the Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford
| | - Jennifer L Harris
- Jennifer L. Pomeranz is with the School of Global Public Health, New York University, New York. Jennifer L. Harris is with the Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford
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Coates AE, Hardman CA, Halford JCG, Christiansen P, Boyland EJ. "It's Just Addictive People That Make Addictive Videos": Children's Understanding of and Attitudes Towards Influencer Marketing of Food and Beverages by YouTube Video Bloggers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020449. [PMID: 31936672 PMCID: PMC7013645 DOI: 10.3390/ijerph17020449] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 01/02/2023]
Abstract
Exposure to influencer marketing of foods and beverages high in fat, sugar, and/or salt (HFSS) increases children's immediate intake. This study qualitatively explored children's understanding of, and attitudes towards, this marketing, to elucidate potential mechanisms through which exposure affects behavior. In six focus groups (n = 4) children (10-11 years) were shown a YouTube video featuring influencer marketing of an HFSS product. Inductive thematic analysis identified six themes from children's discussions of this marketing: (1) YouTubers fill a gap in children's lives, (2) the accessibility of YouTubers increases children's understanding of their actions, (3) influencer marketing impacts all-the influencer, the brand, and the viewer, (4) attitudes towards influencer marketing are most affected by a YouTuber's familiarity, (5) YouTuber influencer marketing is effective because they are not 'strangers', (6) children feel able to resist influencer marketing of HFSS products. Children had an understanding of the persuasive intent of this marketing, and although most were sceptical, familiar YouTubers elicited particularly sympathetic attitudes. Children felt affected by influencer marketing of HFSS products, but believed they were able to resist it. Beyond theoretical insight, this study adds to the growing body of evidence to suggest children's exposure to HFSS influencer marketing should be reduced.
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Norman J, Kelly B, McMahon AT, Boyland E, Chapman K, King L. Remember Me? Exposure to Unfamiliar Food Brands in Television Advertising and Online Advergames Drives Children’s Brand Recognition, Attitudes, and Desire to Eat Foods: A Secondary Analysis from a Crossover Experimental-Control Study with Randomization at the Group Level. J Acad Nutr Diet 2020; 120:120-129. [DOI: 10.1016/j.jand.2019.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Coates AE, Hardman CA, Halford JCG, Christiansen P, Boyland EJ. The effect of influencer marketing of food and a "protective" advertising disclosure on children's food intake. Pediatr Obes 2019; 14:e12540. [PMID: 31168959 DOI: 10.1111/ijpo.12540] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/16/2019] [Accepted: 05/01/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Children are active on social media and consequently are exposed to new and subtle forms of food marketing. OBJECTIVES To examine whether exposure to a YouTube video featuring influencer marketing of an unhealthy snack affects children's ad libitum snack intake and whether inclusion of an advertising disclosure moderates this effect. METHODS In a randomized between-subjects design, 151 children (aged 9-11 y; mean, 10.32 y ± 0.6) were exposed to influencer marketing of a non-food product (n = 51), or an unhealthy snack with (n = 50) or without (n = 50) an advertising disclosure. Participants' ad libitum intake of the marketed snack and an alternative brand of the same snack was measured. RESULTS Children exposed to food marketing with (P < .001, d = 1.40) and without (P < .001, d = 1.07) a disclosure consumed more (kcals) of the marketed snack relative to the alternative; the control did not differ (.186, d = 0.45). Consumption of the alterative brand did not differ across conditions (.287, ηp2 = .02). Children who viewed food marketing with a disclosure (and not those without) consumed 41% more of the marketed snack (.004, ηp2 = .06), compared with control. CONCLUSIONS Influencer marketing increases children's immediate intake of the promoted snack relative to an alternative brand. Advertising disclosures may enhance the effect.
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Smith R, Kelly B, Yeatman H, Boyland E. Food Marketing Influences Children's Attitudes, Preferences and Consumption: A Systematic Critical Review. Nutrients 2019; 11:E875. [PMID: 31003489 PMCID: PMC6520952 DOI: 10.3390/nu11040875] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Exposure to the marketing of unhealthy foods and beverages is a widely acknowledged risk factor for the development of childhood obesity and noncommunicable diseases. Food marketing involves the use of numerous persuasive techniques to influence children's food attitudes, preferences and consumption. This systematic review provides a comprehensive contemporary account of the impact of these marketing techniques on children aged 0-18 years and critically evaluates the methodologies used. Five electronic academic databases were searched using key terms for primary studies (both quantitative and qualitative) published up to September 2018; 71 eligible articles were identified. Significant detrimental effects of food marketing, including enhanced attitudes, preferences and increased consumption of marketed foods were documented for a wide range of marketing techniques, particularly those used in television/movies and product packaging. Together, these studies contribute strong evidence to support the restriction of food marketing to children. However, the review also signposted distinct gaps: Firstly, there is a lack of use of qualitative and physiological methodologies. Secondly, contemporary and sophisticated marketing techniques used in new media warrant increased research attention. Finally, more research is needed to evaluate the longer-term effects of food marketing on children's weight.
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Affiliation(s)
- Rachel Smith
- Early Start, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
| | - Bridget Kelly
- Early Start, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
| | - Heather Yeatman
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
| | - Emma Boyland
- Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Bedford Street South, Liverpool L69 7ZA, UK.
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The Health Halo Trend in UK Television Food Advertising Viewed by Children: The Rise of Implicit and Explicit Health Messaging in the Promotion of Unhealthy Foods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030560. [PMID: 29558457 PMCID: PMC5877105 DOI: 10.3390/ijerph15030560] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 11/17/2022]
Abstract
Monitoring the creative content within food marketing to children is strongly advocated by public health authorities, but few studies address the prevalence of health-related messaging in television adverts. Food and beverage adverts (n = 18,888 in 2008, n = 6664 in 2010) from UK television channels popular with children were coded and analyzed. Physical-activity depiction displayed an 18.8 percentage point increase from 2008 (4.4%) to 2010 (23.2%). Of the food adverts containing physical-activity depiction in 2010, 81.1% were for non-core foods. The appearance of health claims in food adverts in 2010 increased 4.1 percentage points from 2008 levels (20.7% to 24.8%) where the majority of food adverts featuring health and nutrition claims were for non-core foods (58.3%). Health-related (e.g., health/nutrition, weight loss/diet) appeals were used in 17.1% of food adverts during peak child-viewing times, rising to 33.0% of adverts shown on dedicated children's channels in 2010. Implicit (physical activity) and explicit (health claims) health messages are increasingly prevalent in UK television food advertising viewed by children, and are frequently used to promote unhealthy foods. Policy makers in the UK should consider amendments to the existing statutory approach in order to address this issue.
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Adolescent perspectives of the recreational ice hockey food environment and influences on eating behaviour revealed through photovoice. Public Health Nutr 2018; 21:1255-1265. [PMID: 29493480 DOI: 10.1017/s1368980018000289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Unhealthy dietary behaviours are prevalent among adolescents. This might relate, in part, to obesogenic environments, including recreation food facilities. The REFRESH Study (Recreation Environment and Food Research: Experiences from Hockey) aimed to explore, from the perspectives of adolescent ice hockey players and parents, broad social and physical environmental influences on adolescent food behaviours associated with hockey participation. DESIGN Players used photovoice to describe their food experiences in relation to ice hockey. The approach included photos, individual interviews and focus groups. Exemplar photographs were exhibited for stakeholders, including five parents who were interviewed. Interview and focus group transcripts were thematically analysed. SETTING Recreational ice hockey environment, Ontario, Canada, 2015-16. SUBJECTS Ice hockey players (n 24) aged 11-15 years recruited from five leagues. RESULTS Dominant influences among players included: their perceived importance of nutrients (e.g. protein) or foods (e.g. chocolate milk) for performance and recovery; marketing and branding (e.g. the pro-hockey aura of Tim Horton's®, Canada's largest quick-service restaurant); social aspects of tournaments and team meals; and moral values around 'right' and 'wrong' food choices. Both players and parents perceived recreational facility food options as unhealthy and identified that travel and time constraints contributed to less healthy choices. CONCLUSIONS Results indicate recreation facilities are only one of a range of environments that influence eating behaviours of adolescent ice hockey players. Players' susceptibility to advertising/brand promotion and the value of healthy food choices for performance are findings that can inform policy and interventions to support healthy environments and behaviours.
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