Predicting support for restricting food marketing to youth

Revisiting 42 Years of literature on food marketing to children: A morphological analysis

Despite the preventive measures taken by the WHO, childhood obesity is still on the rise and is expected to increase by 100% between 2020 and 2035. Food marketing continues to permeate children's environments in numerous ways and influence the food behaviour of children, thus significantly contributing to the rise of obesity. Studies suggest that the literature on the effects of food marketing on children is complex and multidimensional. To fully understand these effects, a comprehensive and systematic approach is required. Nonetheless, existing reviews have focused only on specific aspects and have not comprehensively covered the literature on food marketing to children. Therefore, this review aims to navigate potential research gaps in the existing literature through a comprehensive examination of the literature by using morphological analysis (MA) methodology, the first time in this domain. Using PRISMA, 202 papers were considered eligible for inclusion and further analysed using MA. The articles were categorised into three dimensions to develop the MA framework: Stimuli (Food well-being), Organism, and Response, and 34 variants. The review has presented future research prospects by identifying at least 218 research gaps. With these findings, researchers can further explore the gaps and develop new research questions that could foster an understanding of the multifarious literature. Moreover, these findings can also provide marketers and practitioners with a better comprehension of the current state of the literature and develop more effective strategies for responsible marketing practices and policies.

Public Opinion on Food Policies to Combat Obesity in Spain

(1) Introduction: Poor diet is the fourth-leading cause of mortality in Spain, where adherence to the Mediterranean diet has declined in recent decades. To remedy this situation, a series of food policies have been proposed that would be easier to implement if they had public support. (2) Material and methods: Cross-sectional study covering a representative sample of the Spanish population (n = 1002), using telephone interviews that addressed nine food policies under four headings, namely, advertising, labeling, composition, and provision and sale. The sociodemographic determinants of support for these policies were analyzed using the chi-squared (χ²) test and Poisson multiple regression models with robust variance. (3) Results: All the proposed measures received more than 60% support. The policies that received greatest support were those targeting labeling at 96.6%, while the policies that received the least support were those directed at banning free refills at restaurants, at 63%. Support for policies was higher among women, older adults, and persons professing left-wing ideological affiliations. Compared with men, women’s support for advertising policies was 21% higher: similarly, compared with the youngest age group (18–29 years), support by the over-65 segment for provision and sale policies was 52% higher. Support for composition policies was 28% lower among persons with right-wing as opposed to left-wing political sympathies. (4) Conclusions: The authorities enjoy the support of the Spanish public as regards implementing food policies proposed by experts and overcoming the resistance of sectors opposed to such measures.

Parents' Perceptions of Children's Exposure to Unhealthy Food Marketing: a Narrative Review of the Literature

Purpose of Review

A key driver of unhealthy diets in children is the marketing of unhealthy foods and beverages. Attempts to regulate children’s exposure to unhealthy food marketing through government-led policies are challenged by commercial interests. Parents shoulder the responsibility of counteracting the effects of omnipresent unhealthy food marketing that children are exposed to within the food environment. In this narrative review we aimed to synthesise the evidence over the last 10 years on parents' perceptions of children’s exposure to unhealthy food marketing and parents support for policies to restrict this marketing.

Recent Findings

The evidence indicates that unhealthy food marketing leads parents to feel undermined in their ability to provide healthy foods to their children. Despite this concern, parents tend to underestimate the levels of exposure to, and impacts of, unhealthy food marketing to their children, especially in the digital ecosystem.

Summary

The voices and support of parents represent a significant opportunity to accelerate policy action on food marketing. Increasing awareness among parents and caregivers to the high levels and harmful impacts of children’s exposure to unhealthy food marketing, focusing on their right not to be undermined by such action, may drive support for policy change. Further research is needed to understand parents’ attitudes and perceptions related to their children’s exposure to contemporary unhealthy food marketing, specifically in digital environments, and the perspectives of fathers and parents from low and middle-income countries. 

Food marketing to children in the United States: Can industry voluntarily do the right thing for children's health?

Food marketing is a major contributor to high rates of obesity and diet-related disease among children. Researchers, advocates, and policymakers have called for improvements in the nutrition quality of foods marketed to children to improve children's health. In the United States, for over 10 years, the food and beverage industry has responded with self-regulatory initiatives, touting the success of these efforts. However, public health researchers have documented very limited improvements. As a product of conference proceedings, we briefly summarize US self-regulation of food and beverage marketing to children, argue that reliance on industry self-regulation limits meaningful change, and explain why existing food companies cannot market truly healthy foods to children. After over a decade of self-regulation, industry continues to exploit loopholes and bombard children with marketing for foods that can negatively impact their health. Still, the political will to advocate for effective government regulation remains a challenge. Shifts in parents' attitudes toward supporting policies to protect children from food marketing and local government actions to improve the food environment are promising indicators of increasing demand for action. However, sustained and well-publicized research and advocacy are necessary to generate broader support to enact such policies at the state and federal level in order to effectively address this public health crisis.

Evaluating the influence of racially targeted food and beverage advertisements on Black and White adolescents' perceptions and preferences

INTRODUCTION

The present study measures how racially-targeted food and beverage ads affect adolescents' attitudes toward ads and brands, purchase intentions for advertised products, and willingness to engage with brands on social media.

METHODS

Black and White adolescents were recruited through Survey Sampling International in 2016. Participants completed an online survey in which they were randomized to view either four food and beverage ads (e.g., soda, candy commercials) featuring Black actors or four food and beverage ads featuring White actors.

RESULTS

For the two components of the attitudinal outcome, Black participants were more likely to report a positive affective response toward racially-similar ads compared to Whites. However, White participants were more likely to like ads that were racially-dissimilar compared to Black participants. Data were analyzed in 2016-2017, and we used an alpha level of 0.05 to denote statistical significance.

CONCLUSIONS

Both Black and White adolescents reported more positive affective responses to ads that featured Blacks compared to ads that featured Whites. Because there were no differences on two outcomes, future research should examine the influence of racially-targeted marketing in real-world contexts (e.g., social media) and longitudinal exposure to targeted advertising on dietary behavior.

Race, Ethnicity, and Other Factors Predicting U.S. Parents' Support for Policies to Reduce Food and Beverage Marketing to Children and Adolescents

Purpose: Examine parents' support for policies to reduce unhealthy food and beverage marketing to children and adolescents and identify racial, ethnic, and other sociodemographic characteristics that predict support. Methods: Online survey of U.S. parents (N=3356) with children 2-17 years of age conducted annually (2009-2012). Participants provided attitudes about food marketing to their children, including perceived negative impact and support for food marketing-related policies. Sociodemographic characteristics examined were as follows: race, ethnicity, income, gender, political orientation, and child characteristics. Results: Overall, parents agreed that food marketing negatively impacts their children's eating habits (M=6.87±2.08 out of 10) and supported food marketing-related policies (M=6.73±2.37). Perceived negative impact predicted support and was highest among black and Hispanic parents. Controlling for income and age of children in the household, Hispanic and black parents expressed highest support for policies, as did women and parents who identified as liberal or moderate in political orientation. A significant interaction between parents' political orientation and race/ethnicity indicated similarly high support among all parents, except white non-Hispanic conservative parents. Conclusion: These findings are encouraging for efforts to enact policies to address unhealthy food marketing to youth. High levels of support among parents suggest advocates should continue to engage parents in their efforts. Findings also suggest that families of color would welcome policies limiting unhealthy food marketing to youth in their communities. Issues of targeted marketing and disproportionate exposure to unhealthy food marketing by black and Hispanic youth may be incorporated into campaigns to address food justice and health inequities in communities of color.

Perspectives on learning to cook and public support for cooking education policies in the United States: A mixed methods study

Declines in cooking skills in the United States may contribute to poor diet quality and high obesity rates. Little is known about how Americans learn to cook or their support for cooking education policies. The objective of this study was to examine how Americans learn to cook, attributions of responsibility for teaching children how to cook, and public support for policies to teach cooking skills. We used a concurrent, triangulation mixed-methods design that combined qualitative focus group data (from 7 focus groups in Baltimore, MD (N = 53)) with quantitative survey data from a nationally representative, web-based survey (N = 1112). We analyzed focus group data (using grounded theory) and survey data (using multivariable logistic regression). We find that relatively few Americans learn to cook from formal instruction in school or community cooking classes; rather, they primarily learn from their parents and/or by teaching themselves using cookbooks, recipe websites or by watching cooking shows on television. While almost all Americans hold parents and other family members responsible for teaching children how to cook, a broad majority of the public supports requiring cooking skills to be taught in schools either through existing health education (64%) or through dedicated home economics courses (67%). Slightly less than half of all Americans (45%) support increasing funding for cooking instruction for participants in the Supplemental Nutrition Assistance Program (SNAP). Broad public support for teaching cooking skills in schools suggests that schools are one promising avenue for policy action. However, school-based strategies should be complemented with alternatives that facilitate self-learning. More research is needed to identify effective means of teaching and disseminating the key cooking skills and knowledge that support healthy eating.

Restricting Advertisements for High-Fat, High-Sugar Foods during Children's Television Programs: Attitudes in a US Population-Based Sample

BACKGROUND

Children in the United States (US) are frequently exposed to advertisements for high-fat, high-sugar (HFHS) foods, which is linked to greater demand for and consumption of those foods. Restricting advertisements for HFHS foods may be a viable obesity prevention strategy-however, public support for policy change is unclear.

METHODS

A secondary analysis of the 2012 Annenberg National Health Communication Survey was conducted. Respondents (N = 1838) were 53.2% female, mean age 50.0 ± 16.5 years. Race/ethnic composition was 76.8% white, 7.4% black, 9.2% Hispanic, and 6.6% other. The percentage of respondents supporting and opposing the regulation was calculated and logistic regression models identified predictors of support. Potential predictors included sociodemographic variables, attitudes towards other health regulations (e.g., smoking bans in public places), and various health behaviors (e.g., fruit and vegetable intake).

RESULTS

A total of 56.3% of respondents supported or strongly supported advertisement restrictions, while only 8.2% strongly opposed. Approximately 20% had no opinion. Greatest support was found among respondents who supported smoking bans in public settings (OR = 4.3), who supported banning trans fats in restaurants (OR = 1.7), and who were older (OR = 1.7).

CONCLUSION

The US adult population appears to have an appetite for restricting HFHS advertising to children, with more than half the populace supporting such a policy in 2012. This may be an opportune time to implement and rigorously evaluate such childhood obesity prevention strategies.

BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth

INTRODUCTION

Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years.

METHODS

We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014.

RESULTS

We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years.

CONCLUSIONS

Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

The role of parents in public views of strategies to address childhood obesity in the United States

POLICY POINTS: The American public--both men and women and those with and without children in the household--holds parents highly responsible and largely to blame for childhood obesity. High attributions of responsibility to parents for reducing childhood obesity did not universally undermine support for broader policy action. School-based obesity prevention policies were strongly supported, even among those viewing parents as mostly to blame for childhood obesity. Americans who viewed sectors outside the family (such as the food and beverage industry, schools, and the government) as helping address childhood obesity were more willing to support a wider range of population-based obesity prevention policies.

CONTEXT

The public's views of parents' behaviors and choices--and the attitudes held by parents themselves--are likely to influence the success of efforts to reverse obesity rates.

METHODS

We analyzed data from 2 US national public opinion surveys fielded in 2011 and 2012 to examine attributions of blame and responsibility to parents for obesity, both among the general public and parents themselves, and we also explored the relationship between views of parents and support for obesity prevention policies.

FINDINGS

We found that attribution of blame and responsibility to parents was consistently high, regardless of parental status or gender. Support for policies to curb childhood obesity also did not differ notably by parental status or gender. Multivariable analyses revealed consistent patterns in the association between public attitudes toward parents' responsibility and support for policies to curb childhood obesity. High parental responsibility was linked to higher support for school-targeted policies but generally was not associated with policies outside the school setting. Attribution of greater responsibility to entities external to children and their parents (schools, the food and beverage industry, and the government) was associated with greater support for both school-targeted and population-based obesity prevention policies.

CONCLUSIONS

Our findings suggest that the high attribution of responsibility to parents for reducing childhood obesity does not universally undermine support for broader policy action. But appealing to parents to rally support for preventing obesity in the same way as for other parent-initiated social movements (eg, drunk driving) may be challenging outside the school setting.

Public opinion on nutrition-related policies to combat child obesity, Los Angeles County, 2011

We assessed public opinion on nutrition-related policies to address child obesity: a soda tax, restrictions on advertising unhealthy foods and beverages to children, and restrictions on siting fast food restaurants and convenience stores near schools. We analyzed data from 998 adults (aged ≥18 years) in the 2011 Los Angeles County Health Survey. Support was highest for advertising restrictions (74%), intermediate for a soda tax (60%), and lowest for siting restrictions on fast food restaurants and convenience stores (44% and 37%, respectively). Support for food and beverage advertising restrictions and soda taxation is promising for future policy efforts to address child obesity.

Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis

BACKGROUND

Governments can intervene to change health-related behaviours using various measures but are sensitive to public attitudes towards such interventions. This review describes public attitudes towards a range of policy interventions aimed at changing tobacco and alcohol use, diet, and physical activity, and the extent to which these attitudes vary with characteristics of (a) the targeted behaviour (b) the intervention and (c) the respondents.

METHODS

We searched electronic databases and conducted a narrative synthesis of empirical studies that reported public attitudes in Europe, North America, Australia and New Zealand towards interventions relating to tobacco, alcohol, diet and physical activity. Two hundred studies met the inclusion criteria.

RESULTS

Over half the studies (105/200, 53%) were conducted in North America, with the most common interventions relating to tobacco control (110/200, 55%), followed by alcohol (42/200, 21%), diet-related interventions (18/200, 9%), interventions targeting both diet and physical activity (18/200, 9%), and physical activity alone (3/200, 2%). Most studies used survey-based methods (160/200, 80%), and only ten used experimental designs. Acceptability varied as a function of: (a) the targeted behaviour, with more support observed for smoking-related interventions; (b) the type of intervention, with less intrusive interventions, those already implemented, and those targeting children and young people attracting most support; and (c) the characteristics of respondents, with support being highest in those not engaging in the targeted behaviour, and with women and older respondents being more likely to endorse more restrictive measures.

CONCLUSIONS

Public acceptability of government interventions to change behaviour is greatest for the least intrusive interventions, which are often the least effective, and for interventions targeting the behaviour of others, rather than the respondent him or herself. Experimental studies are needed to assess how the presentation of the problem and the benefits of intervention might increase acceptability for those interventions which are more effective but currently less acceptable.

Caregiver perceptions of the food marketing environment of African-American 3-11-year-olds: a qualitative study

OBJECTIVE

To assess caregivers’ perceptions of the extent to which the food marketing environment influences food consumption among African-American children (aged 3–11 years) in order to generate potential strategies to make the marketing environment more favourable to healthier eating.

DESIGN

Individual semi-structured interviews with caregivers were conducted by trained community leaders to ascertain their awareness of and perceptions about food marketing environments contributing to African-American children's food consumption.

SETTING

Six predominantly African-American communities in metro Birmingham, Alabama, USA with high proportions of school-age children and lower-income residents.

SUBJECTS

Caregivers (n 25) were predominantly female (93 %) and either parents/guardians (64 %) or grandparents (28 %) of African-American children aged 3–11 years. Caregiver mean age was 43 years and 46 % had lived in their current residence for over 10 years.

RESULTS

Caregivers reported all aspects of the food marketing matrix as supporting unhealthy eating among African-American youth. Child preference for foods higher in fat and sugar, lower pricing of less healthy foods, limited access to healthier food retailers and targeted advertisements were particularly influential on the food selection, acquisition and consumption of children. Company loyalty, corporate sponsorship of local events and conflicts over parental v. food company responsibility contributed to less consensus about the overall impact (positive or negative) of food companies in African-American communities.

CONCLUSIONS

While caregivers perceived aspects of their food marketing environments as primarily contributing to unhealthy eating among African-American children, framing the demand for changes in the food marketing environments of African-American youth may be particularly challenging.

Using theory to identify beliefs associated with support for policies to raise the price of high-fat and high-sugar foods

Public policies designed to dramatically raise the price of high-fat and high-sugar foods have received substantial attention from researchers and the media. Although econometric studies suggest that these policies could reduce obesity rates, they are likely to face substantial public opposition. This study used the theory of perceived responsibility and social motivation as a framework to analyze data from a politically diverse convenience sample of 500 adults in upstate New York. The authors examined associations between attribution beliefs and policy support to identify what types of scientific evidence and accompanying messages appear most likely to generate public support for price-raising policies. Results suggest that public health advocates and health communicators could benefit from an increased emphasis on advertising for unhealthy foods as a cause of obesity and the food industry's (manufacturers, advertisers, markets, and restaurants) responsibility for addressing the problem.

Parental perceptions of weight terminology that providers use with youth

OBJECTIVES

Little research has been performed to examine patient perceptions of weight-related language, especially related to childhood obesity. In this study we assessed parental perceptions of weight-based terminology used by health care providers to describe a child's excess weight and assessed perceived connotations associated with these terms including stigma, blame, and motivation to reduce weight.

METHODS

A national sample of American parents with children aged 2 to 18 years (N = 445) completed an online survey to assess their perceptions of 10 common terms to describe excess body weight in youth (including "extremely obese," "high BMI," "weight problem," "unhealthy weight," "weight," "heavy," "obese," "overweight," "chubby," and "fat"). Parents were asked to use a 5-point rating scale to indicate how much they perceived each term to be desirable, stigmatizing, blaming, or motivating to lose weight.

RESULTS

Regression models revealed that the terms "weight" and "unhealthy weight" were rated as most desirable, and "unhealthy weight" and "weight problem" were rated as the most motivating to lose weight. The terms "fat," "obese," and "extremely obese" were rated as the most undesirable, stigmatizing, blaming, and least motivating. Parents' ratings were consistent across sociodemographic variables, body weight, and child's body weight.

CONCLUSIONS

The results of this study have important implications for the improvement of health care for youth with obesity; it may be advantageous for health care providers to use or avoid using specific weight-based language during discussions about body weight with families. Pediatricians play a key role in obesity prevention and treatment, but their efforts may be undermined by stigmatizing or offensive language that can hinder important discussions about children's health.

"Too much of that stuff can't be good": Canadian teens, morality, and fast food consumption

Recently, public health agents and the popular media have argued that rising levels of obesity are due, in part, to "obesogenic" environments, and in particular to the clustering of fast food establishments in Western urban centers that are poor and working class. Our findings from a multi-site, cross-national qualitative study of teenaged Canadians' eating practices in urban and rural areas offer another perspective on this topic, showing that fast food consumption is not simply a function of the location of fast food outlets, and that Canadian teens engage in complex ways with the varied dimensions of choosing (or rejecting) fast foods. Drawing on evidence gleaned from semi-structured interviews with 132 teenagers (77 girls and 55 boys, ages 13-19 years) carried out between 2007 and 2009, we maintain that no easy relationship exists between the geographical availability of fast food and teen eating behaviors. We use critical obesity literature that challenges widely accepted understandings about obesity prevalence and etiology, as well as Lamont's (1992, 2000) concept of "moral boundary work," to argue that teen fast food consumption and avoidance is multifaceted and does not stem exclusively nor directly from spatial proximity or social class. Through moral boundary work, in which teens negotiated with moralistic notions of healthy eating, participants made and re-made themselves as "good" and successful subjects by Othering those who were "bad" in references to socially derived discourses of healthy eating.