Government can regulate food advertising to children because cognitive research shows that it is inherently misleading

Children's Perception of Food Marketing Across Digital Media Platforms

Introduction

Exposure to food marketing increases the risk of poor diet. Children's perception and interpretation of food marketing across digital media platforms is understudied. Children aged 9-11 years are uniquely susceptible to food marketing because children may watch content alone, and it is unclear whether embedded ads are decipherable by children (e.g., social media influencers) and if children are receptive to advertisements.

Methods

The authors collected data from 21 child-parent dyads in 2022 to fill this gap. Children were interviewed about their food marketing exposure and media use and were asked to share their perspectives on food advertisements. Parents completed a survey for household digital devices, demographics, and perception of their child's food advertising knowledge.

Results

This study found that all children generally recognized direct food advertisements, could describe them with varying levels of confidence, and shared examples. Despite self-identifying ads and understanding the intent of advertising, many children are still receptive to advertisements on the basis of engaging content (e.g., liking the ads as entertainment, watching ads even when given the chance to skip the ad) and the food items marketed (e.g., liking the taste of foods).

Conclusions

These findings suggest that knowledge of advertisement exposure and intent of advertising are not sufficient to reduce receptiveness of unhealthy food ad exposure. Additional research on the potential impacts of embedded ads, such as through social media influencers, is needed to understand children's interaction with the current digital media landscape.

Preventing the Early Introduction of Juice and Sugar-Sweetened Beverages in Infants' Diets: A Randomized Controlled Trial

A randomized controlled trial was conducted to determine whether a simple educational intervention targeting parents of young infants could have an impact on the consumption of juice and sugar-sweetened beverages (SSBs) in early childhood and decrease overweight and obesity rates. Parents of 2- to 4-month-old infants were randomized into intervention (n = 67) and control (n = 77) groups. Parents completed questionnaires about juice and SSB consumption and knowledge at baseline and 1-year follow-up. Intervention parents received informational handouts and watched videos about the health effects of juice and SSBs. Knowledge about juice increased significantly in the intervention group compared with control (P < .01) and was significantly higher in black/African American parents (P < .05) and those with some college education (P < .05). The intervention had a significant impact on the knowledge gained by parents about the health effects of juice and SSBs but did not decrease the consumption of sugary drinks or change children's weight status.

Use of environmental scan to assess density, content, and variation of predatory food and beverage marketing in New York City

To explore the presence of predatory food and beverage marketing in different neighborhoods in New York City (NYC), this study describes the methodology of an outdoor environmental scan of the physical environment. The study was conducted in four NYC neighborhoods over a three-week period, in which pairs of trained researchers canvassed designated neighborhoods to document the presence of food and beverage marketing using photographs taken on digital smart phone devices. Commercial areas in the vicinity of NYC Public Schools and NYC Housing Authority campuses located in four neighborhoods with the highest and lowest nutrition related health indicators were studied: South Bronx, Pelham Throggs Neck, Upper West Side, Chelsea/Greenwich Village. Advertisements were coded against 50+ indicators to quantify pertinent variables including the frequency and content of food and beverages advertised and all forms of predatory marketing observed. Comparisons of prevalence and content of food and beverage advertisements and predatory marketing were made across neighborhoods with the highest and lowest health indicators, using chi-squared analysis, and a significance level of p < 0.05. This article demonstrates a disproportionate presence of predatory marketing in low income NYC neighborhoods with negative health outcomes compared to wealthier neighborhoods. Further, this paper demonstrates the benefits and limitations of using an environmental scan methodology to assess predatory food and beverage marketing in a large urban area such as NYC.

Generation Z Young People’s Perception of Sexist Female Stereotypes about the Product Advertising in the Food Industry: Influence on Their Purchase Intention

Previous studies have generated important insights into consumer behavior. However, no study has addressed how to persuade young people belonging to Generation Z to increase the purchase intention of food products from a gender perspective. Drawing on ambivalent sexism theory, this paper explores the influence of the attitude toward advertising and the ethical judgment to predict consumers’ food product purchase intention. We applied a quantitative method, partial least squares structural equation modeling, to 105 individuals. Two advertisements with different food products and female role stereotype categories are using: (1) women in a traditional role or housewife’s role (benevolent sexism), and (2) women in a decorative role or physical attractiveness (hostile). However, the results show that attitude toward advertising has a direct and positive influence on purchase intention in advertisement with benevolent sexism. In addition, the effect of ethical judgment on consumers’ food product purchase intention is not significant. In the advertisement with hostile sexism, both—attitude toward advertising and ethical judgment—directly and positively impact purchase intention. The study provides a novelty conceptual model in the food industry for Generation Z and recommendations on the use of female sexist stereotypes in food and beverage advertising.

Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity

The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.

Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity

The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.

Promotion of Meal Premiums in Child-Directed TV Advertising for Children's Fast-food Meals

BACKGROUND

Fast-food intake is a modifiable obesity risk factor in early childhood, and child-directed fast-food marketing is common. Per self-regulatory guidelines regarding deception, premiums (ie, incentives or toy giveaways) in child-directed advertisements must be secondary to the advertised product.

METHODS

Content analyses were performed of all child-directed fast-food television (TV) advertisements aired on four national US children's TV networks, February 1, 2019, through January 31, 2020, to assess the emphasis of premiums relative to food. We quantified the percent of the audio transcript (word count) and visual airtime (seconds) that included premiums or food and the on-screen size of premiums relative to food in randomly selected frames from each advertisement.

RESULTS

There were 28 unique child-directed advertisements for children's fast-food meals in the study year; 27 advertisements were from one restaurant and accounted for nearly all (99.8%) of the total airtime for the 28 advertisements. Premiums were present in 27 of the 28 unique advertisements. On average, premiums (versus food) accounted for 53.0% (vs 16.0%) of words in the audio transcript and 59.2% (vs 54.3%) of the visual airtime per advertisement. In the random subset of frames that includes both premiums and food imagery, imagery of premiums accounted for 9.7% (95% CI: 6.4%-13.0%) of the on-screen area, whereas imagery of food accounted for 5.7% (95% CI: 4.4%-7.0%), an average ratio of 1.9:1 within each frame when excluding one large outlier.

CONCLUSIONS

Child-directed fast-food TV advertisements emphasize premiums over food in violation of self-regulatory guidelines, counter to childhood obesity prevention efforts.

Children, Media and Food. A New Paradigm in Food Advertising, Social Marketing and Happiness Management

The growing number of children who are obese or overweight in certain countries or geographical areas is a fact, as evidenced by the continuous studies and reports on the subject, endorsed or carried out by the World Health Organisation and independent research. In this context, food and beverage advertising can contribute to this. The main objective of this research is to evaluate compliance with the Food and Drink Advertising Code for Children (PAOS Code) in Spain and its relationship with nutritional habits on television, specifically on channels aimed at children. The methodology is therefore mixed: on the one hand, a qualitative technique based on discourse analysis and, on the other, a quantitative technique based on the content analysis of the advertising broadcast for seven consecutive days on three specialised channels and two generalist channels on Spanish television. The results reveal a systematic noncompliance with this code, which translates into inadequate eating habits among children. The immediate conclusion is that 9 out of 10 parts of food and drink advertising do not comply with any of the rules of the PAOS Code and that self-regulation by the advertising companies is negligible and insufficient.

Overabundance of unhealthy food advertising targeted to children on Guatemalan television

To assess, for the first time, the extent (by hour channel) and nature (e.g. persuasive marketing techniques (PMT) and health-related claims) of unhealthy food advertisements (ads) targeted at children (3–11 years) on the six most-watched television (TV) channels in Guatemala. We recorded 864 h of video on the six most popular channels featuring children’s programmes. We classified food and beverage ads as permitted or non-permitted for marketing to children, according to the 2015 World Health Organisation (WHO) nutrient profile. Furthermore, we also analysed PMT (i.e. premium offers, promotional characters, brand benefit claims) and health-related claims. Most food ads (85%) were non-permitted to be marketed to children. Non-permitted food ads were six times more likely, either on weekdays or weekends, for all programme and channel categories compared with permitted food ads. There was no difference in the frequency of non-permitted food ads between peak and non-peak hours, weekend and weekdays or children and non-children programmes. PMT and health-related claims were present in all food ads (5.3 ± 1.9 techniques/claims per ad). There is a need to regulate food ads on TV channels featuring children’s programmes in Guatemala as a result of a high frequency of non-permitted food ads and extensive use of PMT together with health-related claims.

Effects of Advertising on Food Consumption Preferences in Children

(1) Background: Childhood obesity is a public health problem. The purpose of this study was to know if exposure to commercial messages which advertise food products exerts any effect on the short-term consumption preferences of 4- to 6-year-old children. (2) Methods: A double-blind and randomized experimental design. Sample consisted of 421 boys and girls from twelve schools in a city in Spain. (3) Results: In three of the four product pairs shown, the products advertised in the intervention were preferred. In the results of applying the model for the first product pair presented, sugared cereals, the predictive variable which best explains the behavior of the preferences expressed is gender (Odds Ratio 0.285 (0.19–0.42); p < 0.05). For the second pair, chocolate cookies, the family’s nationality has a strong weight in the model. As regards the regression model calculated for the last pair (filled rolls), the predictive variable which showed having more influence was gender. Boys had a 1.39 times higher risk of selecting the advertised product than girls. (4) Conclusions: The persuasive effect of commercials has shown to be influential in a general, immediate, and significant way only in the case of products with wide brand awareness. This study reinforces the importance of advertising and emphasizes the need to initiate measures to control the content of TV commercials.

Attitudinal Spillover from Misleading Natural Cigarette Marketing: An Experiment Examining Current and Former Smokers' Support for Tobacco Industry Regulation

This research examined the influence of natural cigarette advertising on tobacco control policy support, and the potential for misbeliefs arising from exposure to cigarette marketing to affect such support. Ample research indicates that natural cigarettes such as Natural American Spirit (NAS) are widely and erroneously perceived as safer than their traditional counterparts because of their marketed “natural” composition. Yet regulatory action regarding natural cigarette marketing has been limited in scope, and little research has examined whether misleading product advertising affects support for related policy, an important component of the policy process. Here, we administered a large-scale randomized experiment (n = 1128), assigning current and former smokers in the United States to an NAS advertising condition or a control group and assessing their support for tobacco industry regulation. Results show that exposure to NAS advertising reduces support for policies to ban potentially misleading terminology from cigarette advertising, and these effects are stronger for daily smokers. Further, misinformed beliefs about the healthy composition of NAS partially mediate effects on policy support. Yet interestingly, exposure to NAS marketing does not reduce support for policies to establish standards for when certain terms are permissible in cigarette advertising. The results of this analysis indicate potential spillover effects from exposure to NAS advertising in the realm of support for regulatory action pertaining to tobacco industry marketing.

Influence of child-targeted fast food TV advertising exposure on fast food intake: A longitudinal study of preschool-age children

INTRODUCTION

Fast food (FF) advertising is a potential risk factor for FF consumption among children, yet the impact of such advertising on children's FF intake has not been assessed in a longitudinal, naturalistic study. Whether parents' FF consumption mitigates advertising effects is also unknown.

METHODS

One-year, longitudinal study among 624 preschool-age children, 3-5 years old, and one parent each recruited from New Hampshire, 2014-2015. Parents completed six online surveys every eight weeks and, at each, reported the number of times their children consumed FF in the past week. Each child's advertisement exposure was determined by counting the brand-specific FF advertisements aired within the programs they viewed on children's TV networks during the study. At baseline, parents reported the frequency of their own FF consumption. Data were analyzed in 2017-2018.

RESULTS

Three FF brands targeted TV advertising to children during the study: McDonald's, Wendy's and Subway. Few children were exposed to child-targeted advertising for Wendy's or Subway. Results from adjusted Poisson regression models focused on McDonald's showed a differential effect of advertisement exposure on children's McDonald's intake in the past week (any or mean intake) by parental FF consumption (P < 0.01). Specifically, McDonald's intake was consistently high among children whose parents consumed FF more frequently (≥monthly), regardless of children's advertisement exposure. However, advertisement exposure increased the risk of McDonald's intake among children nearly two-fold when parents consumed FF less frequently (

CONCLUSIONS

Results suggest that child-targeted FF advertising may mitigate the protective effect of infrequent parental FF intake on children's FF intake.

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Key Words

• Advertising
• Childhood obesity
• Fast food
• Preschoolers

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MESH Headings

• Adult
• Advertising/statistics & numerical data
• Child Behavior
• Child, Preschool
• Diet/psychology
• Diet/statistics & numerical data
• Diet Surveys
• Eating/psychology
• Fast Foods/analysis
• Feeding Behavior/psychology
• Female
• Humans
• Longitudinal Studies
• Male
• New Hampshire
• Parents/psychology
• Restaurants
• Television

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Grants

• K01 DK117971 NIDDK NIH HHS
• P30 CA023108 NCI NIH HHS
• R01 HD071021 NICHD NIH HHS

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Affiliation(s)

Jennifer A Emond Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Meghan R Longacre Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
Keith M Drake The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
Linda J Titus Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
Kristy Hendricks Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
Todd MacKenzie Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
Jennifer L Harris Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, CT, USA
Jennifer E Carroll Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
Lauren P Cleveland Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, MA, USA
Kelly Gaynor VA Boston Healthcare System, MAVERIC, Boston, MA, USA
Madeline A Dalton Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

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Tobacco industry involvement in children's sugary drinks market

Kim H Nguyen and colleagues examine how tobacco companies applied their knowledge of flavours, colours, and child focused marketing to develop leading children’s sugar sweetened drink brands. These techniques continue to be used by drinks companies despite industry agreement not to promote unhealthy products in this way

Exposure to Child-Directed TV Advertising and Preschoolers' Intake of Advertised Cereals

INTRODUCTION

Child-directed TV advertising is believed to influence children's diets, yet prospective studies in naturalistic settings are absent. This study examined if child-directed TV advertisement exposure for ten brands of high-sugar breakfast cereals was associated with children's intake of those brands prospectively.

METHODS

Observational study of 624 preschool-age children and their parents conducted in New Hampshire, 2014-2015. Over 1 year, parents completed a baseline and six online follow-up surveys, one every 8 weeks. Children's exposure to high-sugar breakfast cereal TV advertisements was based on the network-specific TV programs children watched in the 7 days prior to each follow-up assessment, and parents reported children's intake of each advertised high-sugar breakfast cereal brand during that same 7-day period. Data were analyzed in 2017-2018.

RESULTS

In the fully adjusted Poisson regression model accounting for repeated measures and brand-specific effects, children with high-sugar breakfast cereal advertisement exposure in the past 7 days (i.e., recent exposure; RR=1.34, 95% CI=1.04, 1.72), at any assessment in the past (RR=1.23, 95% CI=1.06, 1.42), or recent and past exposure (RR=1.37, 95% CI=1.15, 1.63) combined had an increased risk of brand-specific high-sugar breakfast cereal intake. Absolute risk difference of children's high-sugar breakfast cereal intake because of high-sugar breakfast cereal TV advertisement exposure varied by brand.

CONCLUSIONS

This naturalistic study demonstrates that child-directed high-sugar breakfast cereal TV advertising was prospectively associated with brand-specific high-sugar breakfast cereal intake among preschoolers. Findings indicate that child-directed advertising influences begin earlier and last longer than previously demonstrated, highlighting limitations of current industry guidelines regarding the marketing of high-sugar foods to children under age 6 years.

Dietary intake and lifestyle behaviors of children in Mauritius

The purpose of the study was to explore the dietary intake, fruit, vegetable and energy intake and lifestyle behaviors among Mauritian children. A validated questionnaire was used, assessing dietary intake, mean energy intake, mean body mass index (BMI), lifestyle behaviors as well as nutritional knowledge (NK) among males and females. 336 children aged 6–12 years (165 males and 171 females) from 8 public primary schools were recruited. Statistical analyses revealed that children consumed less nutritious foods such as fruits, vegetables and whole grains and more of refined and calorie-laden foods, with no significant differences across genders. Mean energy intake of children was 1522 ± 282.4 kcal per day while mean BMI was 17.5 ± 4.03 kg/m². Majority of children had a low-to-moderate physical activity level (PAL), with males being more active than females on average (P = 0.021). 88.7% of children watched TV for more than an hour daily, with 84.8% of them reporting to be eating during the process. Females were more likely to be breakfast skippers (P = 0.003). Maximum frequency of snacking was twice daily (72.7%) while consumption of fast food was once or twice weekly (44.0%). Results indicate the need for intervention with aim of improving the dietary and life quality of children in Mauritius.

Community junior sport sponsorship: an online experiment assessing children’s responses to unhealthy food v. pro-health sponsorship options

Objective

To explore children’s responses to sponsorship of community junior sport by unhealthy food brands and investigate the utility of alternative, pro-health sponsorship options.

Design

Between-subjects experiment, with four sponsorship conditions: A, non-food branding (control); B, unhealthy food branding; C, healthier food branding; D, obesity prevention campaign branding.

Setting

Online experiment conducted in schools. Participants were shown a junior sports pack for their favourite sport that contained merchandise with branding representing their assigned sponsorship condition. Participants viewed and rated the sports pack, completed a distractor task, then completed questions assessing brand awareness, brand attitudes and preference for food sponsors’ products.

Subjects

Students in grades 1 to 3 (aged 5–10 years; n 1124) from schools in metropolitan Melbourne, Australia.

Results

Compared with the control condition, there were no significant effects of unhealthy food branding on awareness of, attitudes towards or preference for these brands. Exposure to healthier food branding prompted a significant increase in the proportion of children aware of these brands, but did not impact attitudes towards or preference for these brands. Exposure to either healthier food branding or obesity prevention campaign branding prompted a significant reduction in the proportion of children showing a preference for unhealthy food sponsor products.

Conclusions

The sponsorship of children’s sport by healthier food brands may promote awareness of these brands and healthier sponsorship branding may reduce preferences for some unhealthy food products. Establishing and implementing healthy sponsor criteria in sports clubs could forge healthier sponsorship arrangements and help phase out unhealthy food and beverage sponsors.

Food marketing with movie character toys: Effects on young children's preferences for unhealthy and healthier fast food meals

This study aimed to test whether movie tie-in premiums (MTIPs) accompanying unhealthy and healthier fast food meals influenced children's meal preferences and their perceptions of these meals. Nine hundred and four Grade 1 and 2 students (aged 5-9 years) from Melbourne, Australia participated in a between-subjects online experiment comprising the following conditions: (A) unhealthy and healthier meals with no MTIP (control); (B) unhealthy and healthier meals with MTIP (current situation in Australia); (C) unhealthy meals with MTIP and healthier meals without MTIP; (D) unhealthy meals without MTIP and healthier meals with MTIP. The latter condition tested a potential regulatory model restricting premiums to healthier meals. Participants were shown a trailer for a current children's movie followed by an advertisement for an associated McDonald's Happy Meal^® (conditions B-D) or an advertisement for a children's leisure activity (condition A). They were then shown four McDonald's Happy Meal^® options on screen and asked to select their preferred meal before completing detailed meal ratings. Overall, children showed a preference for unhealthy meals over healthier ones. Children were significantly more likely to select a healthier meal over an unhealthy meal when only the healthier meals were accompanied by a MTIP (condition D) compared to the other three conditions. When healthier meals were accompanied by a MTIP, children reported the meal looked better, would taste better, they would be more likely to ask their parents for this meal, and they would feel happier if their parents bought them this meal, compared to when the healthier meal was not accompanied by a MTIP. Results suggest that modifying the food marketing environment to restrict MTIPs to healthier meals should encourage healthier fast food meal choices by children.

Randomized Exposure to Food Advertisements and Eating in the Absence of Hunger Among Preschoolers

BACKGROUND

Preschoolers in the United States are heavily exposed to unhealthy food advertisements. Whether such exposure promotes cued eating has not been documented in this age group.

METHODS

Randomized experiment among 60 children, aged 2 to 5 years, recruited in 2015-2016 from New Hampshire and Vermont. Children completed the experiment at a behavioral laboratory. Children were provided with a healthy snack to consume upon arrival then randomized to view a 14-minute TV program embedded with advertisements for either a food or a department store. Children were provided 2 snack foods to consume ad libitum while viewing the TV program; 1 of those snacks was the food advertised. Eating in the absence of hunger (EAH) was operationalized as the kilocalories of snack foods consumed. t tests were used to compare EAH by advertisement condition; linear regression models assessed effect modification by the child's age, sex, BMI percentile, and parental feeding restriction.

RESULTS

Mean age was 4.1 (SD 0.9) years, 55% of children were male, 80% were non-Hispanic white, and 20% were overweight or obese. There were no differences in child or socioeconomic characteristics by advertisement condition. Child BMI was not related to EAH. Mean kilocalories consumed during the EAH phase was greater among children exposed to the food advertisements (126.8, SD: 58.5) versus those exposed to the nonfood advertisements (97.3, SD: 52.3; P = .04), an effect driven by greater consumption of the advertised food (P < .01). There was no evidence of effect modification.

CONCLUSIONS

Findings suggest that food advertisement exposure may encourage obesogenic-eating behaviors among the very young.

Reading the mind of children in response to food advertising: a cross-sectional study of Malaysian schoolchildren's attitudes towards food and beverages advertising on television

BACKGROUND

Television food advertising (TVFA) is the most dominant medium in the obesogenic environment promoting unhealthy food choices in children.

METHODS

This cross-sectional study investigated children's attitudes towards TVFA by examining four well-cited induction factors namely advertisement recognition, favourite advertisement, purchase request, and product preference. Malaysian urban schoolchildren (7 to 12 years) of equal ethnic distribution were voluntarily recruited (n = 402). Questionnaire administration was facilitated using a food album of 24 advertised food products.

RESULTS

Majority of children were older (66.2 %), girls (56.7 %) with one-third either overweight or obese. TV viewing time for weekend was greater than weekdays (4.77 ± 2.60 vs 2.35 ± 1.40 h/day) and Malay children spent more time watching TV compared to Chinese (p < 0.001) and Indian (p < 0.05) children. Chinese children spent significantly more time surfing the internet compared to either Malay or Indian (p < 0.01). Median score trend was advertisement recognition > favourite advertisement and product preference > purchase request, and significantly greater (p < 0.001) for non-core than core food advertisements. TV viewing time and ethnicity significantly influenced all induction factors for non-core foods. After correcting for all influencing factors, 'favourite advertisement' (IRRfinal adj: 1.06; 95 % CI: 1.04 to 1.08), 'purchase request' (IRRfinal adj: 1.06; 95 % CI: 1.04 to 1.08) and 'product preference' (IRRfinal adj: 1.04; 95 % CI: 1.02 to 1.07) still were significantly associated with TV viewing time. For every additional hour of TV viewing, the incidence rates increased significantly by 1.04 to 1.06 for 'favourite advertisement', 'purchase request' and 'product preference' related to non-core foods amongst Malay and Indian children. However, Chinese children only demonstrated a significant association between TV viewing time and 'favourite advertisement' (IRRadj: 1.06; 95 % CI: 1.01 to 1.10).

CONCLUSION

This study highlights TVFA as a powerful medium predisposing the mind of children to non-core foods through appealing TV commercials, promoting purchase request and generating unhealthy food preferences in early childhood.

Inverting the pyramid! Extent and quality of food advertised on Austrian television

BACKGROUND

Research showed that food marketing for children frequently contradicts national dietary guidelines. Children, unlike adults, are not able to understand the persuasiveness of the advertisements with its short- and long-term effects on health, thus the common international tenor is to restrict food marketing. In the European Union, marketing restriction based on self-regulation have been initiated (EU Pledge Nutrition Criteria). The study aims contribute to depict the status quo of television advertisement targeted at children before the pledged initiative came into full effect.

METHODS

In this study we analyze the quality and displaying frequency of a set of advertisements targeted at children broadcasted on Austrian television. Promoted food products targeted at children or adults were identified. Category-based analysis of the displayed food was performed based on the Austrian Nutrition guidelines (number of displayed food per food category). The children's food content was analyzed according to the newly established nutritional quality criteria for advertised food in the EU to assess the nutritional quality of the depicted food.

RESULTS

In total, 360 h of video material was recorded in February and March 2014. A set of 1919 food advertisements, with 15.1 % targeted at children were broadcasted. Of all food advertisements targeted at children, 92.4 % was for fatty, sweet and salty snacks, while no advertisements for vegetables, legumes or fruits were shown. From all food advertisements for children, 65.9 % originated from participating companies of the EU Pledge Nutrition Criteria. Further analysis revealed that 95.9 % of the advertised food for children showed at least one aspect of nonconformity with the EU Pledge Nutrition Criteria; on the contrary 64.7 % of the displayed food advertisement also featured at least one desirable food component (e.g. high fibre content, high protein content).

CONCLUSIONS

The present research suggests that the majority of advertised food for children do not conform with the pledged criteria as defined in the EU Pledge Nutrition Criteria and almost all advertisements would be prohibited. We discuss our findings in the context of public health nutrition and present a perspective for future directions in this important field of research.

The Frequency of Unhealthy Food Advertising on Mainland Chinese Television (TV) and Children and Adolescents' Risk of Exposure to Them

OBJECTIVE

To conduct an analysis of the frequency of unhealthy food advertising on mainland Chinese television (TV) and children and adolescents' risk of exposure to them.

METHODS

The frequencies of all types of advertisements (ads) on forty TV channels in mainland China, the exact ad broadcast times, and the name and brand of all snacks and western fast foods advertised were recorded from 0800 hours to 2400 hours on both a weekday and a weekend day in a week. The difference in the frequencies of the diverse types of ads over eight time intervals (each time interval was 2 hours) were compared, and the trends in ad frequencies during the time intervals were described.

RESULTS

The TV channels broadcast 155 (91-183) (expressed as median [P25-P75]) food ads, 87 (38-123) snack ads, 49 (11-85) beverage ads, and 58 (25-76) ads of snacks suitable for limited consumption (SSLCs) in a day. The proportion of snack ads among food ads (SPF%) was 55.5% (40.3%-71.0%), and the proportion of SSLC ads among snack ads (LPS%) was 67.4% (55.4%-79.3%). The ad frequencies for food, snacks, SSLCs, and beverages demonstrated significant differences among the eight time intervals (all P=0.000). TV channels broadcast the most frequent ads for food, snacks, SSLCs, and beverages during the time interval from 2000 hours to 2200 hours among the eight time intervals.

CONCLUSIONS

Chinese children and adolescents may be at a high risk of exposure to unhealthy food advertising on TV. Reducing the exposure risk strongly requires multisectoral cooperation.

Children's recall of fast food television advertising-testing the adequacy of food marketing regulation

Background and Aim

In the United States, the fast food companies McDonald’s and Burger King participate in marketing self-regulation programs that aim to limit emphasis on premiums and promote emphasis of healthy food choices. We determine what children recall from fast food television advertisements aired by these companies.

Methods

One hundred children aged 3–7 years were shown McDonald’s and Burger King children’s (MDC & BKC) and adult (MDA & BKA) meal ads, randomly drawn from ads that aired on national US television from 2010–11. Immediately after seeing the ad, children were asked to recall what they had seen and transcripts evaluated for descriptors of food, healthy food (apples or milk), and premiums/tie-ins.

Results

Premiums/tie-ins were common in children’s but rarely appeared in adult ads, and all children’s ads contained images of healthy foods (apples and milk). Participants were significantly less likely to recall any food after viewing the children’s vs. the adult ad (MDC 32% [95% confidence interval 23, 41] vs. MDA 68% [59, 77]) p <0.001; BKC 46% [39, 56] vs. BKA 67% [58, 76] respectively, p = 0.002). For children’s ads alone and for both restaurants, recall frequency for all food was not significantly different from premium/tie-ins, and participants were significantly more likely to recall other food items than apples or milk. Moreover, premiums/tie-ins were recalled much more frequently than healthy food (MDC 45% [35, 55] vs. 9% [3, 15] p<0.001; BKC 54% [44, 64] vs. 2% [0, 5] respectively, p<0.001).

Conclusions

Children’s net impressions of television fast food advertising indicate that industry self-regulation failed to achieve a de-emphasis on toy premiums and tie-ins and did not adequately communicate healthy menu choices. The methods devised for this study could be used to monitor and better regulate advertising patterns of practice.

Food and Beverage Marketing to Youth

After nearly a decade of concern over the role of food and beverage marketing to youth in the childhood obesity epidemic, American children and adolescents - especially those from communities of color - are still immersed in advertising and marketing environments that primarily promote unhealthy foods and beverages. Despite some positive steps, the evidence shows that the food and beverage industry self-regulation alone is not likely to significantly reduce marketing of unhealthy foods and beverages to youth. A variety of research is needed to monitor industry marketing of unhealthy products to young people, and identify the most promising approaches to improve children's food marketing environments. The continued presence of unhealthy marketing toward children despite years of industry self-regulation suggests it is time for stronger action by policymakers to protect young people from harmful marketing practices.

Food marketing to children in India: comparative review of regulatory strategies across the world

Food marketing directed to children is an issue of concern in the present day society. Revolution in food industry, increasing globalization and boom in information technology has introduced various types of food products and the way they are placed in front of likely consumers. This has resulted in rising trend of obesity and switch from communicable to non-communicable diseases, which is not cost effective for nation as a whole. Multinational companies have targeted children as a naïve audience to boost their sales. In-ethical practice of misleading claims in the advertisements is instrumental in many cases. Food marketing to children has been assumed a public health threat since times of yore. World Health Organization has resolutions and recommendations on this subject. Member countries, including India are a signatory to this declaration. However, much needs to be done to counter these multinational food giants. Regulations and policies need to be enforced at national and institutional levels. Parents must be educated; schools and social organizations to be made proactive on this aspect.

Reducing childhood obesity through U.S. federal policy: a microsimulation analysis

BACKGROUND

Childhood obesity prevalence remains high in the U.S., especially among racial/ethnic minorities and low-income populations. Federal policy is important in improving public health given its broad reach. Information is needed about federal policies that could reduce childhood obesity rates and by how much.

PURPOSE

To estimate the impact of three federal policies on childhood obesity prevalence in 2032, after 20 years of implementation.

METHODS

Criteria were used to select the three following policies to reduce childhood obesity from 26 recommended policies: afterschool physical activity programs, a $0.01/ounce sugar-sweetened beverage (SSB) excise tax, and a ban on child-directed fast food TV advertising. For each policy, the literature was reviewed from January 2000 through July 2012 to find evidence of effectiveness and create average effect sizes. In 2012, a Markov microsimulation model estimated each policy's impact on diet or physical activity, and then BMI, in a simulated school-aged population in 2032.

RESULTS

The microsimulation predicted that afterschool physical activity programs would reduce obesity the most among children aged 6-12 years (1.8 percentage points) and the advertising ban would reduce obesity the least (0.9 percentage points). The SSB excise tax would reduce obesity the most among adolescents aged 13-18 years (2.4 percentage points). All three policies would reduce obesity more among blacks and Hispanics than whites, with the SSB excise tax reducing obesity disparities the most.

CONCLUSIONS

All three policies would reduce childhood obesity prevalence by 2032. However, a national $0.01/ounce SSB excise tax is the best option.

The effects of food advertising and cognitive load on food choices

Background

Advertising has been implicated in the declining quality of the American diet, but much of the research has been conducted with children rather than adults. This study tested the effects of televised food advertising on adult food choice.

Methods

Participants (N = 351) were randomized into one of 4 experimental conditions: exposure to food advertising vs. exposure to non-food advertising, and within each of these groups, exposure to a task that was either cognitively demanding or not cognitively demanding. The number of unhealthy snacks chosen was subsequently measured, along with total calories of the snacks chosen.

Results

Those exposed to food advertising chose 28% more unhealthy snacks than those exposed to non-food-advertising (95% CI: 7% - 53%), with a total caloric value that was 65 kcal higher (95% CI: 10-121). The effect of advertising was not significant among those assigned to the low-cognitive-load group, but was large and significant among those assigned to the high-cognitive-load group: 43% more unhealthy snacks (95% CI: 11% - 85%) and 94 more total calories (95% CI: 19-169).

Conclusions

Televised food advertising has strong effects on individual food choice, and these effects are magnified when individuals are cognitively occupied by other tasks.

Nutritional quality of foods marketed to children in Honduras

Evidence suggests that exposure to advertising of unhealthy foods may contribute to increased rates of obesity in children. This study examined the extent to which television stations marketed unhealthy foods to children during after-school programming aired over one week in La Ceiba, Honduras. Content analysis was performed on four television stations, including one broadcast station and three cable networks. Eighty hours of programming were recorded and analyzed. Advertised products were categorized as food or non-food items, with food items further classified as healthy or unhealthy. Advertisements were coded as those aimed at children, adults, or both, and chi-square tests were used to compare the proportion of unhealthy advertisements by target audience. A total of 2271 advertisements aired during the observation period, with 1120 marketing products (49.3%). Of those, 397 (35.4%) promoted foods-30.2% were for healthy foods and 69.8% for unhealthy foods. The unhealthy foods were all advertised on cable networks and not the broadcast station. Children appeared to be targeted more than adults in advertisements for unhealthy foods (92.1%, p<0.001). Cable television programming during after-school hours advertised primarily unhealthy foods. Exposure to these advertisements may promote consumption of unhealthy foods by children, increasing their risk of obesity.

Redefining "child-directed advertising" to reduce unhealthy television food advertising

BACKGROUND

Food and beverage companies have pledged to reduce unhealthy marketing to children through the Children's Food and Beverage Advertising Initiative (CFBAI). However, public health experts question the initiative's effectiveness because pledges apply to only some types of marketing. For instance, the CFBAI covers only TV advertising that is "child-directed," defined as advertising during programs for which children make up 35% or more of the viewing audience.

PURPOSE

To quantify the proportion of food and beverage TV advertisements (ads) viewed by children that is covered by current CFBAI pledges and examine the potential impact of broader definitions of child-directed advertising.

METHODS

Nielsen data were used to quantify percentages of children (aged 2-11 years) in the audience (i.e., child-audience share), as well as absolute numbers of child viewers, for all national TV programs in 2009. Nielsen advertising data provided the number of food and beverage ads viewed by preschoolers (aged 2-5 years); older children (aged 6-11 years); and adults (aged 18-49 years) during programs with various child-audience compositions. Data were collected in 2010 and analyzed in 2011.

RESULTS

Just 45%-48% of food ads viewed by children met current CFBAI definitions of child-directed advertising. Expanding this definition to include advertising during programs with a child-audience share of 20% or higher and/or 100,000 or more child viewers would cover 70%-71% of food advertising seen by children but just one third of ads seen by adults.

CONCLUSIONS

Children viewed an estimated 35% fewer food ads during TV programs with a high child-audience share (≥50%) in 2009 compared with 2004. However, ensuring that nutrition standards apply to the majority of food ads viewed by children requires broader definitions of child-directed advertising.

Childhood obesity and the media

This article assesses the role played by media in contributing to the current epidemic of childhood obesity. Electronic media use, often referred to as screen time, is significantly correlated with child adiposity. Although the causal mechanism that accounts for this relationship is unclear, it is well established that reducing screen time improves weight status. Media advertising for unhealthy foods contributes to obesity by influencing children's food preferences, requests, and diet. Industry efforts have failed to improve the nutritional quality of foods marketed on television to children, leading public health advocates to recommend government restrictions on child-targeted advertisements for unhealthy foods.

Marketing foods to children: are we asking the right questions?

The childhood obesity epidemic has prompted a range of regulatory initiatives that seek to reduce the impact of food marketing on children. Policy recommendations by government and public health organizations have suggested regulating the promotion of high-sugar, -fat, and/or -salt foods to children, while the food industry has created voluntary nutrition guidelines to channel child-targeted marketing toward only "better-for-you" products. This article argues that the overarching focus on the nutrient profile of foods (nutritionism) is wrong-headed: The slippage in terms from "better-for-you" foods to "healthy dietary choices" is problematic and also makes it difficult for children to identify the healthy choice. Nutritionism further works to sidestep important questions pertaining to the ethics of food marketing, not to mention the way that marketing foods as fun and entertainment works to encourage overeating in children.