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Zhang Z, Carlson D, Gilbert-Diamond D, Emond JA. Associations between sleep and appetitive traits in higher-income preschoolers: A six-month study. Appetite 2024; 196:107254. [PMID: 38346496 DOI: 10.1016/j.appet.2024.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Short sleep is consistently linked with childhood obesity, possibly via disrupting appetite hormones and increasing food responsiveness. Few studies have objectively examined this association in early childhood. OBJECTIVE To evaluate associations of sleep quantity and quality with child appetitive traits and eating in the absence of hunger (EAH) in a higher-income cohort of 86 preschool-age children (age 4.0 ± 0.8 years; 42% female; 93% non-Hispanic white, Northern New England, US). METHODS Children's sleep duration and quality were assessed via parent report (Children's Sleep Habits Questionnaire, CSHQ) at baseline and 6-month follow-up and via accelerometry at baseline. Parents also completed the Child Eating Behaviors Questionnaire to assess the child's appetitive traits. EAH, an objective measure of overeating, was observed at baseline during an in-person visit. Associations between sleep measures and appetitive traits were examined with linear mixed-effect or linear regression models, as appropriate, adjusting for child age, sex, and household income. RESULTS Shorter sleep duration per parent report was associated with less satiety responsiveness (standardized ß = 0.14, 95% CI: 0.01, 0.26; p = 0.03). Further, satiety responsiveness was inversely related to EAH (Pearson's r = -0.35, p = 0.02). No associations were found between accelerometer-measured sleep parameters and appetitive traits, and no sleep measures were related to EAH. CONCLUSIONS Shorter usual sleep, per the parent report, was cross-sectionally associated with reduced satiety responsiveness in this sample of higher-income preschoolers. Future studies should consider whether socioeconomic status may modify the impact of poor sleep on appetitive traits in early childhood.
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Affiliation(s)
- Zhuoya Zhang
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, NH 03756, USA.
| | - Delaina Carlson
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, NH 03756, USA
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, NH 03756, USA; Department of Pediatrics, Geisel School of Medicine at Dartmouth College, NH 03756, USA; Department of Medicine, Geisel School of Medicine at Dartmouth College, NH, 03756, USA
| | - Jennifer A Emond
- Department of Pediatrics, Geisel School of Medicine at Dartmouth College, NH 03756, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, NH, 03756, USA
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Brand J, Yeum D, Stewart T, Emond JA, Gilbert-Diamond D. The associations between attentional bias to food cues, parent-report appetitive traits, and concurrent adiposity among adolescents. Eat Behav 2024; 53:101874. [PMID: 38636439 PMCID: PMC11144077 DOI: 10.1016/j.eatbeh.2024.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To assess whether attentional bias to food cues and appetitive traits are independently and interactively associated with adiposity in adolescents. METHOD Eighty-five adolescents, 14-17-years had their attentional bias to food images measured in a sated state by computing eye tracking measures of attention (first fixation duration, cumulative fixation duration) to food and control distractor images that bordered a computer game. Parents reported adolescent appetitive traits including the food approach domains of enjoyment of food, food responsiveness, emotional overeating, and the food avoidance domains of satiety responsiveness and emotional overeating through the Children's Eating Behavior Questionnaire. RESULTS First fixation bias to food cues was positively associated with enjoyment of food, and negatively associated with satiety responsiveness. In a series of regression models adjusted for relevant covariates, first fixation bias to food cues (β = 0.83, p = 0.007), higher food responsiveness (β = 0.74, p < 0.001), higher emotional overeating (β = 0.51, p = 0.002), and a composite appetite score (β = 1.42, p < 0.001) were each significantly associated with greater BMI z-scores. In models assessing the interactive effects between attentional bias and appetitive traits, higher first fixation bias to food cues interacted synergistically with food responsiveness and emotional overeating in relation to BMI z-score. A synergistic interaction between first fixation bias to food cues and the composite appetite score in relation to BMI z-score was also observed. CONCLUSION Individuals with high attentional bias to food cues and obesogenic appetitive traits may be particularly susceptible to weight gain.
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Affiliation(s)
- John Brand
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States; Dartmouth Cancer Center, Lebanon, NH, United States.
| | - Dabin Yeum
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Tessa Stewart
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Jennifer A Emond
- Department of Pediatrics, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States; Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States; Dartmouth Cancer Center, Lebanon, NH, United States; Department of Pediatrics, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Arrona-Cardoza P, Labonté K, Cisneros-Franco JM, Nielsen DE. The Effects of Food Advertisements on Food Intake and Neural Activity: A Systematic Review and Meta-Analysis of Recent Experimental Studies. Adv Nutr 2023; 14:339-351. [PMID: 36914293 DOI: 10.1016/j.advnut.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
Food advertisements are ubiquitous in our daily environment. However, the relationships between exposure to food advertising and outcomes related to ingestive behavior require further investigation. The objective was to conduct a systematic review and meta-analysis of behavioral and neural responses to food advertising in experimental studies. PubMed, Web of Science, and Scopus were searched for articles published from January 2014 to November 2021 using a search strategy following PRISMA guidelines. Experimental studies conducted with human participants were included. A random-effects inverse-variance meta-analysis was performed on standardized mean differences (SMD) of food intake (behavioral outcome) between the food advertisement and nonfood advertisement conditions of each study. Subgroup analyses were performed by age, BMI group, study design, and advertising media type. A seed-based d mapping meta-analysis of neuroimaging studies was performed to evaluate neural activity between experimental conditions. Nineteen articles were eligible for inclusion, 13 for food intake (n = 1303) and 6 for neural activity (n = 303). The pooled analysis of food intake revealed small, but statistically significant, effects of increased intake after viewing food advertising compared with the control condition among adults and children (adult SMD: 0.16; 95% CI: 0.03, 0.28; P = 0.01; I2 = 0; 95% CI: 0, 95.0%; Children SMD: 0.25; 95% CI: 0.14, 0.37; P < 0.0001; I2 = 60.4%; 95% CI: 25.6%, 79.0%). The neuroimaging studies involved children only, and the pooled analysis corrected for multiple comparisons identified one significant cluster, the middle occipital gyrus, with increased activity after food advertising exposure compared with the control condition (peak coordinates: 30, -86, 12; z-value: 6.301, size: 226 voxels; P < 0.001). These findings suggest that acute exposure to food advertising increases food intake among children and adults and that the middle occipital gyrus is an implicated brain region among children. (PROSPERO registration: CRD42022311357).
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Affiliation(s)
| | - Katherine Labonté
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada
| | - José Miguel Cisneros-Franco
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada; Desautels Faculty of Management, McGill University, Montreal, Canada
| | - Daiva E Nielsen
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada.
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Ryu S, Jang H, Oh H. Smartphone Usage Patterns and Dietary Risk Factors in Adolescents. J Nutr 2022; 152:2109-2116. [PMID: 35511219 DOI: 10.1093/jn/nxac098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/08/2022] [Accepted: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whereas earlier studies have shown that traditional screen time such as TV watching influences dietary behaviors in adolescents, little is known about the effects of modern screen time such as smartphone use. OBJECTIVES We examined the associations of smartphone usage duration and content type with dietary risk factors among adolescents. METHODS We conducted a cross-sectional analysis using a nationally representative sample of 54,601 middle- and high-school students (aged 12-18 y; 26,928 boys and 27,673 girls) in the Korea Youth Risk Behavior Web-Based Survey 2017. Smartphone use (average duration and most frequently used content type) and dietary intakes [frequent breakfast skipping; less frequent intakes of fruits and vegetables; more frequent intakes of instant noodles, fast food, chips/crackers, and sugar-sweetened beverages (SSBs)] were self-reported via an online-based questionnaire. Multivariable logistic regression was performed to estimate ORs and 95% CIs for the associations of smartphone usage duration and content type with prevalence of dietary risk factors, adjusting for potential confounders. All analyses accounted for complex survey sampling. RESULTS Prolonged smartphone use (≥300 compared with 1-59 min/d) was associated with (OR; 95% CI) higher prevalence of frequent breakfast skipping (1.60; 1.45, 1.76); frequent intakes of instant noodles (1.65; 1.47, 1.84), fast food (1.36; 1.20, 1.53), and SSBs (1.92; 1.75, 2.11); and less frequent intakes of fruits (1.44; 1.30, 1.59) and vegetables (1.32; 1.18, 1.47). Adjusting for usage duration, using smartphones mainly for messenger/e-mail, social networking service (SNS)/forum, and games were associated with less frequent intakes of fruits (OR: 1.21; 95% CI: 1.12, 1.31; OR: 1.28; 95% CI: 1.17, 1.40; and OR: 1.20; 95% CI: 1.10, 1.32, respectively) and vegetables (OR: 1.24; 95% CI: 1.12, 1.37; OR: 1.26; 95% CI: 1.13, 1.40; and OR: 1.25; 95% CI: 1.12, 1.40, respectively) than was using smartphones for education/information search. Using smartphones mainly for messenger/e-mail (OR: 1.24; 95% CI: 1.14, 1.35) and SNS/forum (OR: 1.18; 95% CI: 1.08, 1.29) were also associated with more frequent intake of SSBs. CONCLUSIONS Our data suggest that both duration and content type of smartphone use are independently associated with dietary risk factors among adolescents.
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Affiliation(s)
- Seaun Ryu
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hajin Jang
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea.,Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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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; 176:e221037. [PMID: 35499839 PMCID: PMC9062773 DOI: 10.1001/jamapediatrics.2022.1037] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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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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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Evaluating the impact of Chile's marketing regulation of unhealthy foods and beverages: pre-school and adolescent children's changes in exposure to food advertising on television. Public Health Nutr 2019; 23:747-755. [PMID: 31822317 DOI: 10.1017/s1368980019003355] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effects of Chile's 2016 regulation restricting child-directed marketing of products high in energy, saturated fats, sodium and sugars on reducing children's exposure to 'high-in' television food advertising. DESIGN Television use by pre-schoolers and adolescents was assessed via surveys in the months prior to implementation and a year after implementation. Hours and channels of television use were linked with the amount of high-in food advertising observed in corresponding content analyses of food advertisements (ads) from popular broadcast and cable channels to estimate changes in exposure to food ads from these channels. SETTING Middle-lower and lower-income neighbourhoods in Santiago, Chile. PARTICIPANTS Pre-schoolers (n 879; mothers reporting) and adolescents (n 753; self-reporting). RESULTS Pre-schoolers' and adolescents' exposure to high-in food advertising in total decreased significantly by an average of 44 and 58 %, respectively. Exposure to high-in food advertising with child-directed appeals, such as cartoon characters, decreased by 35 and 52 % for pre-schoolers and adolescents, respectively. Decreases were more pronounced for children who viewed more television. Products high in sugars were the most prevalent among the high-in ads seen by children after implementation. CONCLUSIONS Following Chile's 2016 child-directed marketing regulation, children's exposure to high-in food advertising on popular broadcast and cable television decreased significantly but was not eliminated from their viewing. Later stages of the regulation are expected to eliminate the majority of children's exposure to high-in food advertising from television.
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Masterson TD, Gilbert-Diamond D, Lansigan RK, Kim SJ, Schiffelbein JE, Emond JA. Measurement of external food cue responsiveness in preschool-age children: Preliminary evidence for the use of the external food cue responsiveness scale. Appetite 2019; 139:119-126. [PMID: 31047939 DOI: 10.1016/j.appet.2019.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Conditioned eating in response to external food cues may contribute to obesity risk in young children. OBJECTIVES To develop a brief, parent-reported scale to measure external food cue responsiveness for preschool-age children. METHODS Focus groups with parents of preschool-age children were conducted to create an initial pool of items reflecting children's behavioral responses to external food cues. Items were included in a nationally-distributed online survey of parents of preschool-age children (n = 456). Factor analysis was used to reduce the initial item pool, the scale's psychometric properties were assessed, and scores were correlated with reported snacking behaviors. RESULTS Nine items met inclusion criteria in the final scale, which had high internal consistency (alpha = 0.86). Final scores were the mean across the nine items. External food cue responsiveness was greater among children with, versus without, usual TV advertisement exposure. Furthermore, greater external food cue responsiveness mediated the relationship between children's usual TV advertisement exposure and snacking during TV viewing. Findings remained statistically significant when adjusted for food responsiveness as measured with the Child Eating Behavior Questionnaire. CONCLUSIONS Findings provide preliminary evidence that external food cue responsiveness is measurable by parental report in preschool-age children.
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Affiliation(s)
- Travis D Masterson
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Reina K Lansigan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jenna E Schiffelbein
- Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Jennifer A Emond
- Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; 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
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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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Russell SJ, Croker H, Viner RM. The effect of screen advertising on children's dietary intake: A systematic review and meta-analysis. Obes Rev 2019; 20:554-568. [PMID: 30576057 PMCID: PMC6446725 DOI: 10.1111/obr.12812] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/11/2022]
Abstract
Evidence indicates that screen advertising for unhealthy food results in significant increases in dietary intake among children. This review was undertaken with the main aim of estimating the quantitative effect of screen advertising in experimental and nonexperimental conditions on children's dietary intake. Systematic searches were undertaken of interdisciplinary databases. Studies from 1980 to April 2018, all geography and languages, were included; participants were children and adolescents aged between 2 and 18 years; the intervention was screen advertising; and the outcome was dietary intake. Meta-analyses were conducted for measured and nonmeasured outcomes. Food advertising was found to increase dietary intake among children (age range 2-14, mean 8.8 years) in experimental conditions for television (TV) advertising and advergames. Meta-analysis revealed that children exposed to food advertising on TV (11 studies) and advergames (five studies) respectively consumed an average 60.0 kcal (95% confidence interval [CI], 3.1-116.9) and 53.2 kcal (95% CI, 31.5-74.9) more than children exposed to nonfood advertising. There was also an effect by body mass index (BMI). Findings from nonexperimental studies revealed that exposure to TV food advertising was positively associated with and predictive of dietary intake in children. Short-term exposure to unhealthy food advertising on TV and advergames increases immediate calorie consumption in children.
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Affiliation(s)
- Simon J Russell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Helen Croker
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Russell M Viner
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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11
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Emond JA, Longacre MR, Drake KM, Titus LJ, Hendricks K, MacKenzie T, Harris JL, Carroll JE, Cleveland LP, Langeloh G, Dalton MA. Exposure to Child-Directed TV Advertising and Preschoolers' Intake of Advertised Cereals. Am J Prev Med 2019; 56:e35-e43. [PMID: 30573338 PMCID: PMC6340774 DOI: 10.1016/j.amepre.2018.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
| | - Meghan R Longacre
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Keith M Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Greylock McKinnon Associates, Cambridge, Massachusetts
| | - Linda J Titus
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Kristy Hendricks
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Todd MacKenzie
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, Connecticut
| | - Jennifer E Carroll
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lauren P Cleveland
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, Massachusetts
| | - Gail Langeloh
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Madeline A Dalton
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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The prevalence and audience reach of food and beverage advertising on Chilean television according to marketing tactics and nutritional quality of products. Public Health Nutr 2018; 22:1113-1124. [PMID: 30486917 DOI: 10.1017/s1368980018003130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE In the light of Chile's comprehensive new restriction on unhealthy food marketing, we analyse food advertising on Chilean television prior to the first and final phases of implementation of the restriction. DESIGN Content analysis of marketing strategies of 6976 advertisements, based on products' nutritional quality. Statistical analysis of total and child audience reached using television ratings data. SETTING Advertising from television aired between 06.00 and 00.00 hours during two random composite weeks across April-May 2016 from the four broadcast and four cable channels with the largest youth audiences. RESULTS Food ads represented 16 % of all advertising; 34 % of food ads featured a product high in energy, saturated fats, sugars and/or salt (HEFSS), as defined by the initial regulation. HEFSS ads were seen by more children and contained more child-directed marketing strategies than ads without HEFSS foods. If HEFSS advertising was restricted only in programmes where 20 % are children aged 4-12 years, 31 % of children's and 8 % of the general audience's HEFSS advertising exposure would be reduced. The newest 06.00-22.00 hours restriction captures 80 % of all audience exposure. CONCLUSIONS HEFSS advertising was seen by a large proportion of children before Chile's regulation. Chile's first implementation based on audience composition should reduce a third of this exposure and its second restriction across the television day should eliminate most of the exposure. The current study is a crucial first step in evaluating how Chile's regulation efforts will impact children's diets and obesity prevalence.
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13
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Household chaos and screen media use among preschool-aged children: a cross-sectional study. BMC Public Health 2018; 18:1210. [PMID: 30373557 PMCID: PMC6206857 DOI: 10.1186/s12889-018-6113-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/11/2018] [Indexed: 01/08/2023] Open
Abstract
Background Excess screen media use is a robust predictor of childhood obesity. Understanding how household factors may affect children’s screen use is needed to tailor effective intervention efforts. The preschool years are a critical time for obesity prevention, and while it is likely that greater household disorder influences preschool-aged children’s screen use, data on that relationship are absent. In this study, our goal was to quantify the relationships between household chaos and screen use in preschool-aged children. Methods A cross-sectional, online survey was administered to 385 parents of 2–5 year-olds recruited in 2017. Household chaos was measured with the Confusion, Hubbub and Order Scale (i.e., the chaos scale), a validated, parent-reported scale. The scale consists of 15 items, each scored on a 4-point Likert scale. Final scores were the sum across the 15 items and modeled as quartiles for analyses. Parents reported their children’s screen use for nine electronic media activities. Adjusted linear and Poisson regression were used to model associations between household chaos and children’s total weekly screen use, screen use within one hour of bedtime and screen use in the bedroom. Results Children averaged 31.0 (SD = 23.8) hours per week with screens, 49.6% used screens within one hour of bedtime and 41.0% used screens in their bedrooms. In adjusted regression models, greater household chaos was positively associated with weekly screen use (P = 0.03) and use of screens within one hour of bedtime (P < 0.01) in a dose-dependent manner. Children in the fourth versus the first quartile of household chaos were more likely to use screens in their bedroom (P = 0.03). Conclusions Greater household chaos was associated with increased total screen use as well as screen use behaviors that are related to disrupted nighttime sleep. Findings suggest that household chaos may be an obesity risk factor during the preschool years because of such effects on screen use, and highlight the need to consider household chaos when implementing home-based obesity prevention programs for young children. Electronic supplementary material The online version of this article (10.1186/s12889-018-6113-2) contains supplementary material, which is available to authorized users.
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Gonzalez-Nahm S, Grossman ER, Frost N, Babcock C, Benjamin-Neelon SE. Media and Young Minds: Comparing State Screen Media Use Regulations for Children Under 24 Months of Age in Early Care and Education to a National Standard. Matern Child Health J 2018; 22:445-453. [PMID: 29427016 DOI: 10.1007/s10995-018-2487-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Excessive screen media use has been associated with a number of negative health outcomes in young children, including increased risk for obesity and comparatively lagging cognitive development. The purpose of this study was to assess state licensing regulations restricting screen media use for children under 24 months old in early care and education (ECE) and to compare regulations to a national standard. Methods We reviewed screen media use regulations for all US states for child care centers ("centers") and family child care homes ("homes") and compared these regulations to a national standard discouraging screen media use in children under 24 months of age. We assessed associations between state geographic region and year of last update with the presence of regulations consistent with the standard. In centers, 24 states had regulations limiting screen media use for children under 24 months of age and 19 states had regulations limiting screen media use in homes. Results More states in the South and fewer states in the Midwest had regulations limiting screen media use. The association between geographic region and regulations was not significant for centers (p = 0.06), but was for homes (p = 0.04). The year of last update (within the past 5 years versus older than 5 years) was not associated with regulations for centers (p = 0.18) or homes (p = 0.90). Discussion Many states lacked screen media use regulations for ECE. States should consider adding screen media use restrictions for children under 24 months based on current research data and current recommendations in future regulations updates.
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Affiliation(s)
- Sarah Gonzalez-Nahm
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Elyse R Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Natasha Frost
- Public Health Law Center, Mitchell Hamline School of Law, St Paul, MN, 55105, USA
| | - Carly Babcock
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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Granheim SI, Vandevijvere S, Torheim LE. The potential of a human rights approach for accelerating the implementation of comprehensive restrictions on the marketing of unhealthy foods and non-alcoholic beverages to children. Health Promot Int 2018; 34:591-600. [DOI: 10.1093/heapro/dax100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Summary
Overweight and obesity in children is rising at the global level, particularly in low- and middle-income countries. Among the causes for this increase is the marketing of unhealthy food and beverage products, which affects children’s food preferences, purchasing requests and consumption patterns. The need to address harmful marketing to children has been recognized at the World Health Organization, with Member States having agreed in 2010 to implement a set of recommendations to restrict such practices. Concurrently, there is an increasing understanding of unhealthy food and malnutrition as human rights concerns. This paper explores the potential of existing legally and non-legally binding human rights instruments for accelerating the implementation of comprehensive restrictions to reduce harmful marketing of unhealthy foods and beverages to children. Four relevant themes were identified in existing human rights instruments: (i) the best interest of the child should be considered above all other interests; (ii) the rights to health and adequate food cannot be realized without supportive healthy environments; (iii) children should be protected from economic exploitation; and (iv) the persuasive marketing of unhealthy food and beverage products is explicitly recognized as a threat to the rights to food and health. In conclusion, existing human rights instruments could be harnessed to advance public health measures to restrict the marketing of unhealthy food and beverage products to children. Policy-makers and advocates should draw from these instruments and refer to State’s obligations within international and domestic human rights law to strengthen their efforts to restrict harmful marketing practices to children.
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