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Bosshart N, Bearth A, Stutz SE, Wermelinger S, Daum MM, Siegrist M. Avoiding unintentional injuries from household chemicals: Comparing the appeal to children from the perspectives of children, caregivers, and experts. APPLIED ERGONOMICS 2024; 122:104401. [PMID: 39396407 DOI: 10.1016/j.apergo.2024.104401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 10/04/2024] [Accepted: 10/05/2024] [Indexed: 10/15/2024]
Abstract
This study investigated whether caregivers and regulatory experts can predict the appeal of household chemicals for children and explored determinants of differences between adults' and children's child-appeal rating. We invited N = 95 4-year-old children and their caregivers to a laboratory study. Both independently ranked 16 household chemicals from the least to the most child-appealing product. In addition to the laboratory study, we sent an online adaptation of this ranking task to N = 46 experts involved in the monitoring and authorizing of household chemicals. Our findings show that the aggregated child-appeal rating of household chemicals was highly similar among caregivers, experts, and children. When comparing child-appeal ratings of household chemicals with and without child-appealing images, caregivers and experts did well in predicting which products might appeal to children. Finally, our findings show that the similarity between individual caregivers' and their own children's child-appeal ratings of household chemicals varied substantially. To conclude, although adults can assess the general child-appeal of household chemicals, they need to consider that the actual appeal of a household chemical can vary considerably among individual children. Instead of regulating specific product attributes, policymakers should prioritize educating caregivers about pitfalls and misconceptions that hinder effective injury prevention.
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Affiliation(s)
- Noah Bosshart
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), CH.
| | - Angela Bearth
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), CH
| | - Sandro E Stutz
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), CH; Jacobs Center for Productive Youth Development, UZH, CH
| | - Stephanie Wermelinger
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), CH; Jacobs Center for Productive Youth Development, UZH, CH
| | - Moritz M Daum
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), CH; Jacobs Center for Productive Youth Development, UZH, CH
| | - Michael Siegrist
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), CH
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2
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Prithviraj MM, Alam MR, Devi N. The cartoon character syndrome: Navigating the impact on childhood development in the digital age. Indian J Psychiatry 2024; 66:463-465. [PMID: 38919563 PMCID: PMC11195749 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_201_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 06/27/2024] Open
Affiliation(s)
- M Manoj Prithviraj
- Department of Psychiatry, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Mohd R. Alam
- Department of Psychiatry, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Nisha Devi
- Department of Psychiatry, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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Mulligan C, Remedios L, Ramsay T, Pauzé E, Bagnato M, Potvin Kent M. The impact of characters like Tony the Tiger and other child-targeted techniques used in food and beverage marketing. Front Nutr 2023; 10:1287473. [PMID: 38115882 PMCID: PMC10728630 DOI: 10.3389/fnut.2023.1287473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Food marketing's impact is a function of exposure and power, both of which contribute to children's poor diet quality and obesity risk. Children's exposure to food marketing is well documented, however, few studies have assessed the impact of specific persuasive marketing techniques or aspects of 'power' on children. Methods This study administered an online survey to 1,341 Canadian children (9-12 years) aiming to determine the impact of: (1) child-targeted vs. adult-targeted marketing, and (2) licensed characters vs. spokes characters on children's food preferences and behavioral intentions. Participants were randomized to a single condition in each survey part and viewed 3 static food advertisements displaying the features of that condition (e.g., child-targeted advertising or licensed characters), and answered 3 Likert-scale (5-point) questions after each exposure. For each condition within each research question, there were four outcome variables related to the impact of marketing on children: food preference, purchase intent, pester power, and total impact. ANOVA tested the difference in impact (Likert scores) between conditions overall and for each outcome, with Bonferroni post-hoc tests where necessary. Results A greater average total impact was observed among children exposed to child-targeted ads (mean Likert score 3.36) vs. adult-targeted ads (mean score 2.75; p < 0.001) or no marketing (mean score 2.81; p < 0.001). Children exposed to ads featuring spokes characters had a higher average total impact (mean score 3.98) vs. licensed characters (mean score 3.80; p < 0.001) and the control (i.e., no characters) (mean score 3.19; p < 0.001), and the total impact of licensed characters was greater than that of no characters. Similar trends were observed for all other outcomes. Discussion Overall, this study showed that child-targeted ads and those using characters - especially spokes characters - have a strong overall impact on children's food preferences, purchase intents, and pester power, and support the implementation of comprehensive marketing restrictions to protect children.
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Affiliation(s)
- Christine Mulligan
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lauren Remedios
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tim Ramsay
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elise Pauzé
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Mariangela Bagnato
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Lianbiaklal S, Rehman V. Revisiting 42 Years of literature on food marketing to children: A morphological analysis. Appetite 2023; 190:106989. [PMID: 37524244 DOI: 10.1016/j.appet.2023.106989] [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: 03/11/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Despite the preventive measures taken by the WHO, childhood obesity is still on the rise and is expected to increase by 100% between 2020 and 2035. Food marketing continues to permeate children's environments in numerous ways and influence the food behaviour of children, thus significantly contributing to the rise of obesity. Studies suggest that the literature on the effects of food marketing on children is complex and multidimensional. To fully understand these effects, a comprehensive and systematic approach is required. Nonetheless, existing reviews have focused only on specific aspects and have not comprehensively covered the literature on food marketing to children. Therefore, this review aims to navigate potential research gaps in the existing literature through a comprehensive examination of the literature by using morphological analysis (MA) methodology, the first time in this domain. Using PRISMA, 202 papers were considered eligible for inclusion and further analysed using MA. The articles were categorised into three dimensions to develop the MA framework: Stimuli (Food well-being), Organism, and Response, and 34 variants. The review has presented future research prospects by identifying at least 218 research gaps. With these findings, researchers can further explore the gaps and develop new research questions that could foster an understanding of the multifarious literature. Moreover, these findings can also provide marketers and practitioners with a better comprehension of the current state of the literature and develop more effective strategies for responsible marketing practices and policies.
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Affiliation(s)
- S Lianbiaklal
- Department of Management Studies, Indian Institute of Technology Madras, India.
| | - Varisha Rehman
- Department of Management Studies, Indian Institute of Technology Madras, India.
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Varela P, De Rosso S, Ferreira Moura A, Galler M, Philippe K, Pickard A, Rageliene T, Sick J, van Nee R, Almli VL, Ares G, Grønhøj A, Spinelli S, van Kleef E. Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system. Nutr Res Rev 2023:1-21. [PMID: 37746804 DOI: 10.1017/s0954422423000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.
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Affiliation(s)
| | - Sofia De Rosso
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | | | | | - Kaat Philippe
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | | | | | - Julia Sick
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | - Roselinde van Nee
- Wageningen University, Marketing & Consumer Behaviour Group, Wageningen, The Netherlands
| | | | - Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | | | - Sara Spinelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | - Ellen van Kleef
- Wageningen University, Marketing & Consumer Behaviour Group, Wageningen, The Netherlands
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Graham DJ, Lucas-Thompson RG, Slejko G. The Role of Front-of-Package Nutrition Labels with and without Explanatory Videos on Parent and Child Food Choices. Nutrients 2023; 15:4082. [PMID: 37764865 PMCID: PMC10537255 DOI: 10.3390/nu15184082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/12/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this research was to determine whether parent/child pairs choosing products from a grocery aisle labeled with front-of-package (FOP) nutrition labels would make more healthful choices than pairs who viewed the same items without labels, and to determine the added value of viewing an explanatory video before choosing. In this experiment, 175 parent/child pairs chose USD 20 worth of packaged foods and beverages from a grocery aisle in a research laboratory and were randomly assigned to see products that either did or did not have 0-4-star FOP labels, with more stars indicating more healthful products. Among those participants with access to FOP labels, half were randomly assigned to view a 30 s video explaining the FOP labels before selecting foods. Participants who saw the explanatory video before selecting among products with FOP labels chose foods with significantly more stars than participants who saw the FOP-labeled products without the video; however, there was no significant difference in mean stars on selected products between the group that saw the videos and the control group that saw neither the video nor FOP labels. We conclude that explaining new FOP labels to consumers may be necessary for the labels to prompt more healthful choices.
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Affiliation(s)
- Dan J Graham
- Department of Psychology, College of Natural Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Rachel G Lucas-Thompson
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gina Slejko
- Department of Marketing, College of Business, Colorado State University, Fort Collins, CO 80523, USA
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Velázquez AL, Vidal L, Antúnez L, Alcaire F, Varela P, Ares G. Children's reaction to sugar reduced dairy desserts in the context of the implementation of nutritional warning labels: An exploratory study. Food Res Int 2023; 170:113001. [PMID: 37316071 DOI: 10.1016/j.foodres.2023.113001] [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: 02/26/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Abstract
The aim of the present work was to explore children's reaction to sugar reduction in the context of the implementation of nutritional warnings in Uruguay. The study was composed of two sessions involving three evaluation conditions: tasting without package information, package evaluation without tasting, and tasting with package information. A total of 122 children, ages ranging between 6 and 13 years old (47% girls) were involved in the study. In the first session, children's hedonic and emotional response to a regular and a sugar-reduced chocolate dairy dessert (without other sweeteners) was evaluated. In the second session, children first evaluated their expected liking, emotional associations and choice of packages differing in the presence of warning labels for excessive sugar content and cartoon character (2x2 design). Finally, they tasted the selected sample in the presence of the package and evaluated their liking, emotional associations, and intention to re-taste it. Although sugar reduction led to a significant reduction in overall liking, the dessert with 40% sugar reduction showed a mean overall score of 6.5 in a 9-point hedonic scale and was described using positive emoji (, , ). When the desserts were tasted with package information, no significant differences in the expected overall liking of the regular and sugar-reduced dessert were found. Regarding the effect of packaging elements, the presence of a warning label highlighting excessive content of sugar did not have a significant effect on children's choice. Instead, children's choices were defined by the presence of a cartoon character. Results from the present work provide additional evidence about the feasibility of reducing the sugar content and sweetness of dairy products targeted at children and stress the need to regulate the use of cartoon characters on products with an unfavorable nutritional profile. Methodological recommendations for sensory and consumer research with children are also discussed.
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Affiliation(s)
- Ana Laura Velázquez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay; Graduate Program in Chemistry, Facultad de Química, Universidad de la República, Uruguay
| | - Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay
| | - Lucía Antúnez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay
| | | | - Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay.
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Amson A, Pauzé E, Remedios L, Pritchard M, Potvin Kent M. Adolescent exposure to food and beverage marketing on social media by gender: a pilot study. Public Health Nutr 2023; 26:33-45. [PMID: 36321517 PMCID: PMC11077454 DOI: 10.1017/s1368980022002312] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/24/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this research was to determine if, based on gender, adolescents were exposed to different marketing techniques that promoted food and beverages over social media. DESIGN A secondary analysis of adolescent boy (n 26) and girl (n 36) exposures (n 139) to food and beverage marketing was conducted. Mann-Whitney U and Fisher's exact tests were conducted to compare the number, healthfulness and the marketing techniques of exposures viewed by boys and girls. SETTING Ottawa, Ontario, Canada. PARTICIPANTS Sixty-two adolescents aged 12-16 years. RESULTS Boys and girls were exposed to similar volumes of food marketing instances (median = 2 for both boys and girls, Mann-Whitney U = 237, P = 0·51) per 10-min period of social media use. More girls viewed products that were excessive in total fat compared to boys (67 % v. 35 %, P = 0·02). Boys were more likely to view instances of food marketing featuring a male as the dominant user (50 % v. 22 %, P = 0·03), appeals to achievement (42 % v. 17 %, P = 0·04), an influencer (42 % v. 14 %, P = 0·02) and appeals to athleticism (35 % v. 11 %, P = 0·03), whereas girls were more likely to view instances of food marketing featuring quizzes, surveys or polls (25 % v. 0 %, P = 0·01). CONCLUSIONS Food and beverage companies utilise marketing techniques that differ based on gender. More research examining the relationship between digital food and beverage marketing and gender is required to inform the development of gender-sensitive policies aimed at protecting adolescents from unhealthy food marketing.
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Affiliation(s)
- Ashley Amson
- University of Ottawa, Interdisciplinary School of Health Sciences, Ottawa, ON, Canada
| | - Elise Pauzé
- University of Ottawa, Interdisciplinary School of Health Sciences, Ottawa, ON, Canada
| | - Lauren Remedios
- University of Ottawa, School of Epidemiology and Public Health, 600 Peter Morand, Room 301J, Ottawa, ONK1N 7K4, Canada
| | - Meghan Pritchard
- University of Ottawa, School of Epidemiology and Public Health, 600 Peter Morand, Room 301J, Ottawa, ONK1N 7K4, Canada
| | - Monique Potvin Kent
- University of Ottawa, School of Epidemiology and Public Health, 600 Peter Morand, Room 301J, Ottawa, ONK1N 7K4, Canada
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Bosshart N, Bearth A, Wermelinger S, Daum M, Siegrist M. Seeing household chemicals through the eyes of children-Investigating influential factors of preschoolers' perception and behavior. JOURNAL OF SAFETY RESEARCH 2022; 83:400-409. [PMID: 36481033 DOI: 10.1016/j.jsr.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/24/2022] [Accepted: 09/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Children who encounter household chemicals run the risk of unintentional injury. The aim of this study was to understand which factors heighten children's attention or misguide their decision-making concerning household chemicals. We hypothesized that certain product attributes (i.e., label, packaging, closure types), storage context, and parental beliefs play a role in this setting. METHOD We conducted a laboratory study with N = 114 children (M = 45 months, SD = 6.5) and their parents (M = 38 years, SD = 4.92). Children completed a series of behavioral tasks in which they had to choose between products with different attributes, identify products in different storage contexts, and sort household chemicals. RESULTS The results confirmed that the children preferred products with cartoon-style labels compared to products without such labels. However, children's decision-making did not differ for products with different closure types (child-resistant vs sprayer-type closures). Regarding the storage context, our results showed that the children particularly struggled to identify dishwashing tabs when they were stored with other food items rather than household chemicals. In terms of parental beliefs, our study found that parents rated more household chemicals as child-safe than their children did. PRACTICAL APPLICATION Parents should buy household chemicals with neutral labels and pay attention to how their household chemicals are stored. Manufacturers should consider potential adverse effects when developing new product designs.
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Affiliation(s)
- Noah Bosshart
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), Switzerland.
| | - Angela Bearth
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), Switzerland
| | - Stephanie Wermelinger
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), Switzerland; Jacobs Center for Productive Youth Development, UZH, Switzerland
| | - Moritz Daum
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), Switzerland; Jacobs Center for Productive Youth Development, UZH, Switzerland
| | - Michael Siegrist
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), Switzerland
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Psychological Impact and Influence of Animation on Viewer’s Visual Attention and Cognition: A Systematic Literature Review, Open Challenges, and Future Research Directions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8802542. [PMID: 36092789 PMCID: PMC9453061 DOI: 10.1155/2022/8802542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
Animation is an excellent method to associate with the audience in a fun and innovative manner. In recent span, animation has been employed in various fields to enhance knowledge, marketing, advertisement, and age groups from infants to adults. The present communication expounds the systematic review on the impact created by animation on the viewer’s visual attention. For this review, a database such as Google Scholar, ScienceDirect, Taylor & Francis, and IEEE Xplore were pursued for publications on the impact of animation on viewer’s visual attention from January 2015 to December 2021. The search results showcased 175 titles with 114 full articles, out of which 35 were related to viewers’ visual attention towards animation. These reviewed studies comprised of physical outcome (
), psychological outcome (
), and cognitive outcome (
) from which the attention-related factors, physical effects, and cognitive effects of animation were assessed. The animation has influenced the viewer’s visual attention through the integration of the different stimuli and the highly organized presentation. Furthermore, the animation has also aided the viewer in attaining greater conceptual understanding, thereby facilitating their cognitive response. As a result, the animation was found to be helpful in enhancing learning skills, food marketing, and teaching strategy. Furthermore, the drawbacks and future recommendations of the studies were elaborated. In addition, challenges and open issues faced during the studies were discussed. Finally, the priority areas in animation identified for promising future directions to visualize large pool data, provide smart communication, and design 3D modeling structures were highlighted.
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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: 61] [Impact Index Per Article: 30.5] [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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Packer J, Russell SJ, McLaren K, Siovolgyi G, Stansfield C, Viner RM, Croker H. The impact on dietary outcomes of licensed and brand equity characters in marketing unhealthy foods to children: A systematic review and meta-analysis. Obes Rev 2022; 23:e13443. [PMID: 35261144 PMCID: PMC9285539 DOI: 10.1111/obr.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 01/02/2023]
Abstract
Licensed and brand equity characters are used to target children in the marketing of products high in fat, salt, and sugar (HFSS), but the impact of characters on dietary outcomes is unclear. The primary aim of this review was to quantify the impact of both licensed and brand equity characters on children's dietary outcomes given that existing regulations often differentiates between these character types. We systematically searched eight interdisciplinary databases and included studies from 2009 onwards until August 2021, including all countries and languages. Participants were children under 16 years, exposure was marketing for HFSS product with a character, and the outcomes were dietary consumption, preference, or purchasing behaviors of HFSS products. Data allowed for meta-analysis of taste preferences. A total of 16 articles (including 20 studies) met the inclusion criteria, of which five were included in the meta-analysis. Under experimental conditions, the use of characters on HFSS packaging compared with HFSS packaging with no character was found to result in significantly higher taste preference for HFSS products (standardized mean difference on a 5-point scale 0.273; p < 0.001). Narrative findings supported this, with studies reporting impact of both character types on product preferences including food liking and snack choice. There was limited evidence on the impact on purchase behaviors and consumption. These findings are supportive of policies that limit the exposure of HFSS food marketing using characters to children.
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Affiliation(s)
- Jessica Packer
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Simon J Russell
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie McLaren
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Gabriela Siovolgyi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire Stansfield
- EPPI-Centre, UCL Social Research institute, University College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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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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14
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Elliott C, Truman E, Stephenson N. Food Marketing and Power: Teen-Identified Indicators of Targeted Food Marketing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137815. [PMID: 35805473 PMCID: PMC9265287 DOI: 10.3390/ijerph19137815] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/10/2022]
Abstract
Food marketing is powerful and prevalent, influencing young people’s food attitudes, preferences, and dietary habits. Teenagers are aggressively targeted by unhealthy food marketing messages across a range of platforms, prompting recognition of the need to monitor such marketing. To monitor, criteria for what counts as teen-targeted food marketing content (i.e., persuasive techniques) must first be established. This exploratory study engaged teenagers to explore the “power” of food marketing by identifying what they consider to be teen-targeted marketing techniques within various food marketing examples. Fifty-four teenagers (ages 13–17) participated in a tagging exercise of 19 pre-selected food/beverage advertisements. Assessed in light of age and gender, the results showed clear consistency with what indicators the participants identified when it comes to selecting “teen-targeted” ads—with advertisements most frequently chosen as “teen-targeted” containing humor (particularly irony) and celebrities. When it comes to specific indicators used by teenagers, visual style dominated, standing as the marketing technique with the most “power” for teenagers. The findings shed much needed insight into the elements of power—and more precisely, the specific marketing techniques persuasive to teenagers—which are necessary to inform monitoring efforts and to create evidence-based policy.
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Affiliation(s)
- Charlene Elliott
- Department of Communication, Media and Film, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Correspondence: ; Tel.: +1-403-220-3180
| | - Emily Truman
- Department of Communication, Media and Film, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Nikki Stephenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
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Spitzer AN, Oselinsky K, Lucas-Thompson RG, Graham DJ. Environmental Physical Activity Cues and Children's Active vs. Sedentary Recreation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031874. [PMID: 35162896 PMCID: PMC8834769 DOI: 10.3390/ijerph19031874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 12/10/2022]
Abstract
Physical activity (PA) benefits health, and intensive environmental modifications can increase children’s PA. Research has not yet addressed if subtle environmental cues, such as posters depicting PA, increase child PA. In the current study, it was hypothesized that children exposed to active posters (vs. nature posters) would spend a larger proportion of free play time engaging with active toys (relative to sedentary toys). Participants were randomly assigned to one of two conditions in which posters on a laboratory wall depicted 1. People being active, or 2. Nature scenes. Children aged 5–10 years (N = 175) could play with up to eight toys (four active, four sedentary) while parents completed study-related surveys. The proportion of playtime that was active was compared between groups. Poster type did not have a significant effect on proportion of active playtime. Previous environmental interventions that increase children’s PA have done so through enhancing access to active opportunities, rather than via signage. It is possible that poster interventions such as this may not influence children’s PA, or perhaps other types of cues would have been more effective. Future research should investigate subtle environmental cues that match both the target audience and the accessible PA options (e.g., posters depicting children playing with available active toys) and explore other low-investment environmental modifications to boost children’s PA.
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Affiliation(s)
- Amanda N. Spitzer
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA; (K.O.); (D.J.G.)
- Correspondence:
| | - Katrina Oselinsky
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA; (K.O.); (D.J.G.)
| | - Rachel G. Lucas-Thompson
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA;
- Department of Community and Behavioral Health, Colorado School of Public Health, Fort Collins, CO 80523, USA
| | - Dan J. Graham
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA; (K.O.); (D.J.G.)
- Department of Community and Behavioral Health, Colorado School of Public Health, Fort Collins, CO 80523, USA
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Ares G, Velázquez AL, Vidal L, Curutchet MR, Varela P. The role of food packaging on children's diet: Insights for the design of comprehensive regulations to encourage healthier eating habits in childhood and beyond. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2021.104366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Manjareeka M, Kanungo P, Mishra S, Mondal H, Mishra J. Challenges and acceptance of synchronized e-learning for undergraduates during COVID-19 pandemic: Teachers' views from a health school of India. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Zhang Q. Positive Effects of Prosocial Cartoon Viewing on Aggression Among Children: The Potential Mediating Role of Aggressive Motivation. Front Psychol 2021; 12:742568. [PMID: 35069323 PMCID: PMC8782158 DOI: 10.3389/fpsyg.2021.742568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Prosocial cartoon is characterized by helping others solve difficulties, including helping, donating, sharing, comforting, and cooperating. The current study examined whether viewing a prosocial cartoon decreases aggression immediately upon exposure and the potential mediating role of aggressive motivation. Participants involve 168 children (M age = 5.87 years, SD = 0.41) nominated by teachers as aggressive from three Chinese kindergartens. Children in the treatment group watched a prosocial cartoon (American cartoon "Handy Manny"), while children in the control group watched a nonprosocial cartoon (Chinese cartoon "Fruity Robo"). Afterward, the Hot Sauce Task (HST) was employed to assess aggressive behavior, and Aggressive Motivation Questionnaire (AMQ) was employed to assess aggressive motivation. Results revealed that viewing a prosocial cartoon (vs. a nonprosocial cartoon) did reduce children's aggression immediately upon exposure. Specifically, males showed less aggressive behavior than females upon prosocial cartoon exposure, while males showed more aggressive behavior than females upon nonprosocial cartoon exposure. Mediational analysis suggested that the prosocial cartoon effect on aggression was partially mediated by aggressive motivation, especially for males. Consistent with general aggression model (GAM), findings of the study indicated that short-term exposure to a prosocial cartoon decreased children's aggression by reducing aggressive motivation.
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Affiliation(s)
- Qian Zhang
- Center for Studies of Education and Psychology of Minorities in Southwest Area, Southwest University, Chongqing, China
- Department of Early Childhood Education, Faculty of Education, Southwest University, Chongqing, China
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19
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Velázquez AL, Alcaire F, Vidal L, Varela P, Næs T, Ares G. The influence of label information on the snacks parents choose for their children: Individual differences in a choice based conjoint test. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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20
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Mus S, Rozas L, Barnoya J, Busse P. Gender representation in food and beverage print advertisements found in corner stores around schools in Peru and Guatemala. BMC Res Notes 2021; 14:402. [PMID: 34717738 PMCID: PMC8557525 DOI: 10.1186/s13104-021-05812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022] Open
Abstract
Objective The objective of this study is to assess gender representation in food and beverage print advertisements. Results The study follows a quantitative descriptive approach. Using a content analysis technique, we assessed the gender representation in 200 food and beverage print advertisements found in corner stores located in four areas around schools in Lima, Peru, and Guatemala City, Guatemala (100 advertisements per country). A total of 36% of the print advertisements exhibited a male main character for the case of Guatemala, while in Peru 14% of the print advertisements presented a male main character. Furthermore, in Guatemala, 22% of the main characters were male animated characters. Moreover, 27% of the print advertisements in Guatemala and 17%, in Peru were visually male-oriented. Overall, male characters appeared alongside sports references and in varied settings, whereas female characters were usually holding or consuming the product. In conclusion, although the majority of variables used to assess the representation of gender in food and beverage print advertisements were gender-neutral, those showing gender representation were mostly male-oriented. Despite its limited findings, the study provides evidence for the formulation of public policies and educational content aimed to protect children’s and adolescents’ health from the effects of food marketing.
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Affiliation(s)
- Sophia Mus
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala, 8-00 9th Avenue, 11th zone, 01011, Guatemala City, Guatemala
| | - Lucila Rozas
- Grupo de Investigación en Comunicación y Salud, Instituto de Investigación Científica, Universidad de Lima, 4600 Javier Prado Este Avenue, Tower A, 11th Floor, 15023, Lima, Peru
| | - Joaquin Barnoya
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala, 8-00 9th Avenue, 11th zone, 01011, Guatemala City, Guatemala
| | - Peter Busse
- Grupo de Investigación en Comunicación y Salud, Instituto de Investigación Científica, Universidad de Lima, 4600 Javier Prado Este Avenue, Tower A, 11th Floor, 15023, Lima, Peru.
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21
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Halbeisen G, Walther E. How to promote healthy eating in preschool children: Evidence from an associative conditioning procedure with non-food stimuli. Appetite 2021; 166:105472. [PMID: 34153424 DOI: 10.1016/j.appet.2021.105472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
Given the increasing rates and severe consequences of childhood obesity, how to encourage children to eat low-calorie and healthy foods is an important question. Building on evaluative conditioning research, this study investigated how associating fruits and vegetables with positive, non-food stimuli influences preschool children's food choice and consumption. Consistent with this idea, it was found in two experiments that 3- to 6-year-old children's healthy food choice and consumption increased by pairing a healthy food's picture systematically with a positive, non-food image. These findings highlight a simple yet effective means of changing young children's eating behavior, which may complement existing intervention procedures.
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Affiliation(s)
- Georg Halbeisen
- Department of Psychology, University of Trier, Universitätsring 15, 54296, Trier, Germany.
| | - Eva Walther
- Department of Psychology, University of Trier, Universitätsring 15, 54296, Trier, Germany
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22
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Castronuovo L, Guarnieri L, Tiscornia MV, Allemandi L. Food marketing and gender among children and adolescents: a scoping review. Nutr J 2021; 20:52. [PMID: 34099000 PMCID: PMC8186097 DOI: 10.1186/s12937-021-00706-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pervasive marketing of unhealthy foods is a contributing factor to the growth of the global epidemic of childhood and adolescent overweight and obesity. Sex and gender differences come into play in the design of and responses to these marketing strategies, contributing to the perpetuation of stereotyped behavior and generating disparities in food choices and health. The purpose of this paper is to review the current literature regarding gender differences in food marketing design and perception among children and adolescents to facilitate evidence-based policy dialogues to address gender-based health disparities in NCD prevention. METHODS Scoping review of articles published in scientific journals in English and Spanish, from 2003 to 2018, that addressed the influence of food marketing among children and adolescents including a gender perspective. The methodological quality of each article was assessed following criteria specific to each study design. RESULTS From a total of 37 articles (39 studies) included in the review, 17 were experimental and 22 had descriptive, cross-sectional designs. Twenty-one studies were found to have low methodological quality, while 10 and 8 were of medium and high quality, respectively. A total of 23 studies among children and adolescents found gender-based differences. Differences were found in the following dimensions: food marketing on intake; responses to specific marketing; perceptions and attitudes towards food marketing and marketing regulation initiatives; exposure to food advertising and gendered marketing content. The evidence was not conclusive in any of the dimensions. CONCLUSIONS The evidence suggests that food marketing has a similar impact on the consumption of unhealthy foods on boys and girls, but boys were found to be exposed to food advertising more intensively and their preferences to be more affected by this exposure, coinciding with a male-dominant advertising content. Limitations of these studies include taking gender as an unproblematic construct equivalent to biological sex and the lack of studies focused on developing countries. As gender is a cross-sectional dimension that interacts with other factors driving health disparities, an integrated gender perspective is needed to develop effective, evidence-based policies to control food marketing and tackle the childhood overweight and obesity pandemic.
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Affiliation(s)
- Luciana Castronuovo
- Fundación Interamericana del Corazón Argentina, Arévalo 2364 1° A, 1425 Caba, Argentina
| | - Leila Guarnieri
- Fundación Interamericana del Corazón Argentina, Arévalo 2364 1° A, 1425 Caba, Argentina
| | | | - Lorena Allemandi
- PanAmerican Health Organization (consultant), Calle 43 n 1095, 6360 General Pico, La Pampa Argentina
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Mulligan C, Potvin Kent M, Vergeer L, Christoforou AK, L’Abbé MR. Quantifying Child-Appeal: The Development and Mixed-Methods Validation of a Methodology for Evaluating Child-Appealing Marketing on Product Packaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094769. [PMID: 33947116 PMCID: PMC8124606 DOI: 10.3390/ijerph18094769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
There is no standardized or validated definition or measure of “child-appeal” used in food and beverage marketing policy or research, which can result in heterogeneous outcomes. Therefore, this pilot study aimed to develop and validate the child-appealing packaging (CAP) coding tool, which measures the presence, type, and power of child-appealing marketing on food packaging based on the marketing techniques displayed. Children (n = 15) participated in a mixed-methods validation study comprising a binary classification (child-appealing packaging? Yes/No) and ranking (order of preference/marketing power) activity using mock breakfast cereal packages (quantitative) and focus group discussions (qualitative). The percent agreement, Cohen’s Kappa statistic, Spearman’s Rank correlation, and cross-classification analyses tested the agreement between children’s and the CAP tool’s evaluation of packages’ child-appeal and marketing power (criterion validity) and the content analysis tested the relevance of the CAP marketing techniques (content validity). There was an 80% agreement, and “moderate” pairwise agreement (κ [95% CI]: 0.54 [0.35, 0.73]) between children/CAP binary classifications and “strong” correlation (rs [95% CI]: 0.78 [0.63, 0.89]) between children/CAP rankings of packages, with 71.1% of packages ranked in the exact agreement. The marketing techniques included in the CAP tool corresponded to those children found pertinent. Pilot results suggest the criterion/content validity of the CAP tool for measuring child-appealing marketing on packaging in accordance with children’s preferences.
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Affiliation(s)
- Christine Mulligan
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.M.); (L.V.); (A.K.C.)
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - Laura Vergeer
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.M.); (L.V.); (A.K.C.)
| | - Anthea K. Christoforou
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.M.); (L.V.); (A.K.C.)
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.M.); (L.V.); (A.K.C.)
- Correspondence:
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24
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Cruz-Casarrubias C, Tolentino-Mayo L, Nieto C, Théodore FL, Monterrubio-Flores E. Use of advertising strategies to target children in sugar-sweetened beverages packaging in Mexico and the nutritional quality of those beverages. Pediatr Obes 2021; 16:e12710. [PMID: 32783401 DOI: 10.1111/ijpo.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND A product package can be a powerful marketing tool to persuade and attract consumers at the point-of-sale. Evidence shows that most advertised products have low nutritional quality. Currently, Mexico has incorporated advertising regulations on food and beverage packaging. OBJECTIVES To analyze the advertising strategies used to target children on packaging and to assess the nutritional quality of sugar-sweetened beverages available in the Mexican market. METHODS Photographs of 2380 beverages available in retail stores in Mexico City from January to March 2017 were analyzed. Beverages were classified as displaying child-directed strategies or nondirected strategies. Nutrition quality was evaluated using the Pan American Health Organization nutrient profile model. RESULTS The use of characters was the most frequent strategy among beverages with child-directed strategies (82.0%). The evaluation of nutrition quality found that 88.0% (P < .001) of sugar-sweetened beverages with child-directed strategies were excessive in free sugars and 56.9% (P < .001) contained other sweeteners. Beverages with more than two advertising strategies have the highest proportion of excessive free sugars (93.4%, 95% CI 82.8-98.6). CONCLUSIONS The use of characters and other visual strategies were frequently used in the packaging of sugar-sweetened beverages with child-directed strategies. In addition, these beverages are excessive in free sugars and contain a large number of products with other sweeteners.
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Affiliation(s)
- Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Florence L Théodore
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Eric Monterrubio-Flores
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Sipple LR, Barbano DM, Drake M. Invited review: Maintaining and growing fluid milk consumption by children in school lunch programs in the United States. J Dairy Sci 2020; 103:7639-7654. [PMID: 32819617 DOI: 10.3168/jds.2020-18216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/13/2020] [Indexed: 01/18/2023]
Abstract
Fluid milk consumption among children has declined for decades. Adequate consumption of milk and dairy products, especially during childhood, has beneficial health outcomes for growth, development, and reduced risk of osteoporosis, hypertension, obesity, and cancer during adulthood. Satisfaction with milk flavor, perceived health benefits derived from milk, and habit are primary drivers of lifelong milk consumption. Child preferences and attitudes for milk may differ from those of adults, and as such, understanding and fulfilling the needs of children is crucial to reverse the decline in milk consumption. School meal programs make fluid milk accessible to millions of children each day; however, regulations and school lunch procurement systems in the United States sometimes make it difficult to provide novel or value-added milk products in these programs. Total consumption of all milk types in US schools declined by 14.2% from 2008 to 2017, and the percentage of children participating in the school lunch program has also declined. This decline has also been driven by declining average daily participation in the school meal program and may also reflect children's dissatisfaction with the sensory characteristics and the form of milk offered in schools. The change in form of milk offered in schools to lower fat and lower added sugar content in the United States has been driven by government-mandated school lunch calorie and fat requirements. This review describes the current milk consumption trends among children; the structure and basic requirements of the school lunch program in total and for milk; and the intrinsic, extrinsic, and environmental factors that influence child perception, preference, and consumption of fluid milk in the US school system.
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Affiliation(s)
- Lauren R Sipple
- Department of Food, Bioprocessing, and Nutrition Sciences, Southeast Dairy Foods Research Center, North Carolina State University, Raleigh 27695
| | - David M Barbano
- Department of Food Science, Northeast Dairy Foods Research Center, Cornell University, Ithaca, NY 14853
| | - MaryAnne Drake
- Department of Food, Bioprocessing, and Nutrition Sciences, Southeast Dairy Foods Research Center, North Carolina State University, Raleigh 27695.
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Food Marketing as a Special Ingredient in Consumer Choices: The Main Insights from Existing Literature. Foods 2020; 9:foods9111651. [PMID: 33198136 PMCID: PMC7698179 DOI: 10.3390/foods9111651] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
The choices and preferences of food consumers are influenced by several factors, from those related to the socioeconomic, cultural, and health dimensions to marketing strategies. In fact, marketing is a determinant ingredient in the choices related to food consumption. Nonetheless, for an effective implementation of any marketing approach, the brands play a crucial role. Creating new brands in the food sector is not always easy, considering the relevant amount of these goods produced within the agricultural sector and in small food industries. The small dimension of the production units in these sectors hinders both brand creation and respective branding. In this context, it would seem important to analyse the relationships between food marketing and consumer choice, highlighting the role of brands in these frameworks. For this purpose, a literature review was carried out considering 147 documents from Scopus database for the topics of search “food marketing” and “choices” (search performed on 16 October 2020). As main insights, it is worth highlighting that the main issues addressed by the literature, concerning food marketing and consumer choices, are the following: economic theory; label and packaging; marketing strategies; agriculture and food industry; market segments; social dimensions; brand and branding. In turn, food marketing heavily conditions consumer choices; however, these related instruments are better manipulated by larger companies. In addition, this review highlights that bigger companies have dominant positions in these markets which are not always beneficial to the consumers’ objectives.
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From foods to artifacts: Children’s evaluative and taxonomic categorization across multiple domains. COGNITIVE DEVELOPMENT 2020. [DOI: 10.1016/j.cogdev.2020.100894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Allemandi L, Castronuovo L, Tiscornia MV, Gutkowski P, Gijena J, Nessier C. Nutritional quality, child-oriented marketing and health/nutrition claims on sweet biscuit, breakfast cereal and dairy-based dessert packs in Argentina. CAD SAUDE PUBLICA 2020; 36:e00196619. [PMID: 32965379 DOI: 10.1590/0102-311x00196619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/04/2020] [Indexed: 11/21/2022] Open
Abstract
As children are particularly vulnerable to marketing, this study analyzes marketing techniques and health/nutrition claims in food packaging and evaluates the nutritional quality in three food categories: sweet biscuits, breakfast cereals and dairy-based desserts. This descriptive study analyzed marketing techniques and claims included in food packaging (n = 301) in one of the largest retailers in Argentina. Trained researchers coded data following an adapted version of the INFORMAS protocol to account for local food packaging regulations. Nutritional quality was assessed using both Pan American Health Organization Nutrient Profile (PAHO NPM) and the WHO Regional Office for Europe Nutrient Profile (WHO Euro NPM) models. Under the PAHO model, 87% (n 262) of the product sample presented excess content of at least one nutrient ("less healthy" products), and 91% (n = 273) should not be marketed to children according to the WHO Euro model. Almost 40% of less healthy food products displayed nutrition claims on their package. Characters or celebrity endorsements, which are particularly attractive to children, featured in 32% of less healthy products, being more frequent in less healthy food products than in healthier ones. Results indicate that packaging for food products with low nutritional value often includes powerful marketing elements in Argentina, which renders young children very vulnerable to obesogenic influence. Moreover, the real nutritional value of the products analyzed were often at odds with the health claims shown on its package. Food labeling policies must be improved in Argentina to guarantee people's health protection against deceptive advertising.
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Affiliation(s)
- Lorena Allemandi
- Fundación InterAmericana del Corazón Argentina, Buenos Aires, Argentina
| | | | | | | | - Julieta Gijena
- Facultad de Ciencias de la Salud, Universidad Católica de Santa Fe, Santa fe, Argentina
| | - Celeste Nessier
- Facultad de Ciencias de la Salud, Universidad Católica de Santa Fe, Santa fe, Argentina
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Abstract
PURPOSE OF REVIEW This scoping review examines literature from the past 5 years (June 2014 to June 2019) across three databases (PubMed, MEDLINE, and Scopus) to detail how the persuasive power of child-targeted food marketing content is addressed and evaluated in current research, to document trends and gaps in research, and to identify opportunities for future focus. RECENT FINDINGS Eighty relevant studies were identified, with varied approaches related to examining food marketing techniques to children (i.e., experimental, survey, meta-analyses, mixed methods, content analyses, focus groups). Few studies specifically defined power, and studies differed in terms of techniques examined. Spokes-characters were the predominant marketing technique measured; television was the platform most analyzed; and dominant messages focused on health/nutrition, taste appeals, and appeals to fun/pleasure. Mapping the current landscape when it comes to the power of food marketing to children reveals concrete details about particular platforms, methods, and strategies, as well as opportunities for future research-particularly with respect to definitions and techniques monitored, digital platforms, qualitative research, and tracking changes in targeted marketing techniques over time.
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Chattopadhyay D, Ma T, Sharifi H, Martyn-Nemeth P. Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e18839. [PMID: 32729837 PMCID: PMC7426801 DOI: 10.2196/18839] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. OBJECTIVE The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. METHODS Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. RESULTS Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). CONCLUSIONS We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.
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Affiliation(s)
- Debaleena Chattopadhyay
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Tengteng Ma
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Hasti Sharifi
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, United States
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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Contreras-Manzano A, Jáuregui A, Nieto C, Hall MG, Vargas-Meza J, Thrasher JF, Illescas-Zárate D, Barquera S, Hammond D. The impact of a cartoon character on adults perceptions of Children's breakfast cereals: a randomized experiment. Nutr J 2020; 19:43. [PMID: 32418538 PMCID: PMC7232833 DOI: 10.1186/s12937-020-00565-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cartoon characters on processed food packaging increase the perception of product preference among children, but their effect among adults has rarely been examined. We evaluated the effect of a cartoon character on breakfast cereals on beliefs about buying them for children, as well as whether demographic characteristics modified this effect. METHODS An experimental study was conducted with adults from online consumer panels in Mexico (n = 3755). Participants were randomly assigned to a "cartoon" condition (n = 1789), in which they viewed a breakfast cereal box with a Minion character on the front of the package, or the "control" condition (n = 1966), in which the same cereal box was displayed with no character on the package. Participants were asked: "Is this a good cereal to buy children?" with the response options "Yes", "No", or "Don't know". Multinomial adjusted logistic models regressed responses to this question (Yes = 0, No = 1, 2 = Don't know) on experimental condition. Differences in the effect of the cartoon character across demographic characteristics were tested by introducing multiplicative interaction terms. RESULTS The adjusted model showed that participants in the "cartoon character" condition were 1.67 (1.45-1.94) times more likely to consider the cereal as being "Not good to buy for children" than those in the control condition (p < 0.001). This effect was smaller among parents (RRR = 1.39, 1.13-1.72) compared to those without children (RRR = 2.01, 1.63-2.47). No differences were observed in the proportion of participants answering "Don't know" across experimental groups. CONCLUSION Among this sample of Mexican adults, a cereal with a cartoon character on the packaging was more often perceived as "not good to buy for children" compared to a cereal without it. This effect was smaller among parents, potentially due to children influences of parental decisions during food purchasing.
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Affiliation(s)
- Alejandra Contreras-Manzano
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico.
| | - Claudia Nieto
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Jorge Vargas-Meza
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - James F Thrasher
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
| | - Daniel Illescas-Zárate
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Simón Barquera
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - David Hammond
- School of Demography, ANU College of Arts and Social Sciences, The Australian National University, 9 Fellows Road Acton ACT, Canberra, 260, Australia
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Cotwright CJ, Alvis C, de Jesus Jimenez F, Farmer P, Okoli C, Delane J, Cox GO. Improving Willingness to Try Fruits and Vegetables Among Low-Income Children Through Use of Characters. Health Equity 2020; 4:84-90. [PMID: 32258959 PMCID: PMC7104895 DOI: 10.1089/heq.2019.0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Low-income children are disproportionately affected by high rates of food insecurity and obesity, placing them at risk for poor health outcomes. Diets that are rich in fruits and vegetables (FV) are associated with health benefits such as reducing the risk of obesity. Despite these benefits, American children do not consume nationally recommended amounts of fruits (63%) and vegetables (90%) per day. Data reveal that young children exhibit increased food neophobia toward vegetables. One way to decrease food neophobia is to introduce FV to young children via recipe tasting. The purpose of the study was to increase willingness to try FV among low-income children using live characters at Summer Food Service Program Sites. Methods: The study design was a small-scale pilot study to conduct taste tests of recipes with 125 low-income children. Researchers created recipe-tasting stations at two different sites. At Site 1, characters promoting FV characters were present at the recipe-tasting station. At Site 2, researchers presented recipes without characters being present. Taste tests were conducted once per week for a period of 4 weeks using two previously validated instruments, Taste Test Tool and the Taste and Rate Questionnaire. Results: Results demonstrated that introducing FV recipes with characters showed a trend toward increasing willingness to try FV among low-income children. Data also suggested that low-income children had limited exposure to specific FV before recipe tastings. Conclusion: The use of characters is a promising approach to increase willingness to try FV among low-income children.
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Affiliation(s)
- Caree J Cotwright
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Courtney Alvis
- Medical College of Georgia, Augusta University, Athens, Georgia
| | - Fabiola de Jesus Jimenez
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Paula Farmer
- Clarke County School District Office of Nutrition, Athens, Georgia
| | - Chisom Okoli
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Jennine Delane
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Ginnefer O Cox
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
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Elliott C, Truman E. The Power of Packaging: A Scoping Review and Assessment of Child-Targeted Food Packaging. Nutrients 2020; 12:nu12040958. [PMID: 32235580 PMCID: PMC7230356 DOI: 10.3390/nu12040958] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 12/15/2022] Open
Abstract
Child-targeted food marketing is a significant public health concern, prompting calls for its regulation. Product packaging is a powerful form of food marketing aimed at children, yet no published studies examine the range of literature on the topic or the “power” of its marketing techniques. This study attempts such a task. Providing a systematic scoping review of the literature on child-targeted food packaging, we assesses the nutritional profile of these foods, the types of foods examined, and the creative strategies used to attract children. Fifty-seven full text articles were reviewed. Results identify high level trends in methodological approaches (content analysis, 38%), outcomes measured (exposure, 44%) and with respect to age. Studies examining the nutritional profile of child-targeted packaged foods use various models, classifying from anywhere from 41% to 97% of products as unhealthy. Content analyses track the prevalence of child-targeted techniques (cartoon characters as the most frequently measured), while other studies assess their effectiveness. Overall, this scoping review offers important insights into the differences between techniques tracked and those measured for effectiveness in existing literature, and identifies gaps for future research around the question of persuasive power—particularly when it comes to children’s age and the specific types of techniques examined.
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A "Forbidden Fruit Effect": An Eye-Tracking Study on Children's Visual Attention to Food Marketing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061859. [PMID: 32183015 PMCID: PMC7142814 DOI: 10.3390/ijerph17061859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
Obesity in children is an international health concern. Against this background, there is an increasing interest in understanding how healthy and unhealthy food marketing in narrative media can affect children. In particular, children’s implicit reactions, such as visual attention and emotional arousal, are far from being sufficiently understood. We conducted an eye-tracking study, presenting children one of two versions of a narrative media-stimulus, either presenting an unhealthy food (i.e., candy condition; N = 34), or a healthy food (i.e., fruit condition; N = 34). As dependent variables, we investigated dwell time (i.e., visual attention) and pupil dilation (i.e., emotional arousal). As moderators, we included children’s prohibition of candy at home and children’s level of BMI in our models. Our results indicate that mean dwell time did not differ between conditions and that the moderators did not exert any effect. Moreover, pupil dilation did not differ between conditions but was moderated by parents’ candy prohibition at home (ηp2 = 0.080). The results show that children who are not allowed to consume candy at home react with higher emotional arousal when exposed to candy placements than children allowed to eat candy at home. Thus, depending on children’s contextual factors, children react differently to unhealthy food cues.
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Hall MG, Lazard AJ, Grummon AH, Mendel JR, Taillie LS. The impact of front-of-package claims, fruit images, and health warnings on consumers' perceptions of sugar-sweetened fruit drinks: Three randomized experiments. Prev Med 2020; 132:105998. [PMID: 31982477 PMCID: PMC7085890 DOI: 10.1016/j.ypmed.2020.105998] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/20/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
We aimed to examine the impact of claims, fruit images, and health warnings on consumers' perceptions of fruit-flavored drinks with added sugar (i.e., "fruit drinks"). We conducted three 2x2x2 randomized experiments with online convenience samples of U.S. adults (Study 1 n = 2139 in 2018, current e-cigarette users and smokers; Study 2 n = 670 in 2018, current e-cigarette users; Study 3 n = 1006 in 2019, general sample). Participants viewed a fruit drink that differed in the presence of a "100% Vitamin C" claim, a fruit image, or a health warning. On average across the three studies, consumers who saw a claim on a fruit drink believed that the drink was more healthful than those who did not see the claim (mean average differential effect (ADE) = 0.66, p < .001); they were also more interested in consuming the drink (mean ADE = 0.38, p = .001). The health warning decreased perceived product healthfulness (mean ADE = -0.65, p < .001) and consumption interest (mean ADE = -0.49, p < .001). The fruit image had no effect on perceived product healthfulness (mean ADE = 0.03, p = .81) or purchase intentions (mean ADE = -0.04, p = .77). In Study 1 and Study 2, there were no interactions between claims, images, or warnings (all p > .05). In Study 3, the "100% Vitamin C" nutrition claim only increased perceived product healthfulness when the drink did not also have a health warning (interaction p < .05). These findings suggest that 100% Vitamin C claims increase the appeal of fruit drinks, whereas health warnings decrease the appeal. Together, these studies support policies to restrict marketing and require health warnings on sugar-sweetened beverage packaging.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America; Hussman School of Media and Journalism, University of North Carolina, United States of America
| | - Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Carolina Population Center, University of North Carolina, United States of America
| | - Jennifer R Mendel
- Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, United States of America; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, United States of America
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De Veirman M, Hudders L, Nelson MR. What Is Influencer Marketing and How Does It Target Children? A Review and Direction for Future Research. Front Psychol 2019; 10:2685. [PMID: 31849783 PMCID: PMC6901676 DOI: 10.3389/fpsyg.2019.02685] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 11/14/2019] [Indexed: 11/13/2022] Open
Abstract
Children nowadays spend many hours online watching YouTube videos in which their favorite vloggers are playing games, unboxing toys, reviewing products, making jokes or just going about their daily activities. These vloggers regularly post attractive and entertaining content in the hope of building a large follower base. Although many of these vloggers are adults, the number of child vloggers is flourishing. The famous child vlogger Ryan of Ryan's World, for instance, has more than 19 million viewers and he is (at age seven) a social media influencer. The popularity of these vloggers incited advertisers to include them as a new marketing communication tool, also referred to as influencer marketing, in their marketing strategy. Accordingly, many influential vloggers now receive free products from brands in return for a mention in one of their videos and their other social media (e.g., TikTok or Instagram) and some are even paid to create a sponsored post or video and distribute it to their followers. This sponsored content appears to be highly influential and may affect young children's brand preferences. Given the limited advertising literacy skills (i.e., knowledge of advertising and skills to critically reflect on this advertising) of children under age 12, they are a vulnerable target group when it comes to persuasion. Therefore, caution is needed when implementing this marketing tactic to target them. However, research on how influencer marketing affects young children (under 12) is scarce and it is unclear how these young children can be empowered to critically cope with this fairly new form of persuasion. This paper therefore aims to shed light on why and how social media influencers have persuasive power over their young followers. The paper starts with providing insights into how and why social media influencers became a new source in advertising. We then discuss the few studies that have been conducted on influencer marketing among young children (under 12), based on a systematic literature review, and take these findings to formulate societal and policy implications and develop a future research agenda.
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Affiliation(s)
| | - Liselot Hudders
- Department of Communication Sciences, Ghent University, Ghent, Belgium.,Department of Marketing, Ghent University, Ghent, Belgium
| | - Michelle R Nelson
- Department of Advertising, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Prevalence of Child-Directed Marketing on Breakfast Cereal Packages before and after Chile's Food Marketing Law: A Pre- and Post-Quantitative Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224501. [PMID: 31731577 PMCID: PMC6888536 DOI: 10.3390/ijerph16224501] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
Food marketing has been identified as a contributing factor in childhood obesity, prompting global health organizations to recommend restrictions on unhealthy food marketing to children. Chile has responded to this recommendation with a restriction on child-directed marketing for products that exceed certain regulation-defined thresholds in sugars, saturated fats, sodium, or calories. Child-directed strategies are allowed for products that do not exceed these thresholds. To evaluate changes in marketing due to this restriction, we examined differences in the use of child-directed strategies on breakfast cereal packages that exceeded the defined thresholds vs. those that did not exceed the thresholds before (n = 168) and after (n = 153) the restriction was implemented. Photographs of cereal packages were taken from top supermarket chains in Santiago. Photographed cereals were classified as “high-in” if they exceeded any nutrient threshold described in the regulation. We found that the percentage of all cereal packages using child-directed strategies before implementation (36%) was significantly lower after implementation (21%), p < 0.05. This overall decrease is due to the decrease we found in the percentage of “high-in” cereals using child-directed strategies after implementation (43% before implementation, 15% after implementation), p < 0.05. In contrast, a greater percentage of packages that did not qualify as “high-in” used child-directed strategies after implementation (30%) compared with before implementation (8%), p < 0.05. The results suggest that the Chilean food marketing regulation can be effective at reducing the use of child-directed marketing for unhealthy food products.
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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Truman E, Elliott C. Identifying food marketing to teenagers: a scoping review. Int J Behav Nutr Phys Act 2019; 16:67. [PMID: 31426809 PMCID: PMC6700978 DOI: 10.1186/s12966-019-0833-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background Teenagers are aggressively targeted by food marketing messages (primarily for unhealthy foods) and susceptible to this messaging due to developmental vulnerabilities and peer-group influence. Yet limited research exists on the exposure and power of food marketing specifically to teenage populations. Research studies often collapse “teenagers” under the umbrella of children or do not recognize the uniqueness of teen-targeted appeals. Child- and teen-targeted marketing strategies are not the same, and this study aims to advance understanding of teen-targeted food marketing by identifying the teen-specific promotion platforms, techniques and indicators detailed in existing literature. Methods A systematic scoping review collected all available literature on food marketing/advertising with the term “teenager” or “adolescent” from nine databases, as well as Google Scholar for grey literature, and a hand search of relevant institutional websites. Included were all peer-reviewed journal articles, book chapters, and grey literature in which food marketing to youth was the central topic of the article, of any study type (i.e., original research, reviews, commentaries and reports), and including any part of the 12–17 age range. Results The 122 articles reviewed define the scope of existing literature on food marketing to young people age 17 and under, identifying leading trends in countries studied (United States, 52%), populations identified (children and teens studied concurrently, 36%), outcomes measured (advertising exposure, 54%), study type (cross-sectional, 58%) and methods used (content analysis, 46%). The promotion platforms and techniques used by food marketers to appeal to young people (as reported in the literature) are also identified and classified. Few studies (7%) use indicators to identify teen-targeted food marketing. Conclusions Unique treatments of teen populations are limited in food marketing literature, as is the application of clear indicators to identify and differentiate teen-targeted food marketing from child- or adult-targeted content. Given the need to better measure the presence and power of teen food marketing, this is a significant oversight in existing literature. The indicators identified will help researchers to develop more accurate strategies for researching and monitoring teen-targeted food promotion.
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Affiliation(s)
- Emily Truman
- Department of Communication, Media and Film, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Charlene Elliott
- Department of Communication, Media and Film, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Tracking Kids' Food: Comparing the Nutritional Value and Marketing Appeals of Child-Targeted Supermarket Products Over Time. Nutrients 2019; 11:nu11081850. [PMID: 31404967 PMCID: PMC6722619 DOI: 10.3390/nu11081850] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/17/2022] Open
Abstract
Marketing unhealthy foods negatively impacts children’s food preferences, dietary habits and health, prompting calls for regulations that will help to create an “enabling” food environment for children. One powerful food marketing technique is product packaging, but little is known about the nature or quality of child-targeted food products over time. This study assesses how child-targeted supermarket foods in Canada have transformed with respect to nutritional profile and types of marketing appeals (that is, the power of such marketing). Products from 2009 (n = 354) and from 2017 (n = 374) were first evaluated and compared in light of two established nutritional criteria, and then compared in terms of marketing techniques on packages. Overall, child-targeted supermarket foods did not improve nutritionally over time: 88% of child-targeted products (across both datasets) would not be permitted to be marketed to children, according to the World Health Organization (WHO) criteria, and sugar levels remained consistently high. Despite this poor nutritional quality, the use of nutrition claims increased significantly over time, as did the use of cartoon characters and appealing fonts to attract children’s attention. Character licensing—using characters from entertainment companies—remained consistent. The findings reveal the critical need to consider packaging as part of the strategy for protecting children from unhealthy food marketing. Given the poor nutritional quality and appealing nature of child-oriented supermarket foods, food product packaging needs to be included in the WHO’s call to improve the restrictions on unhealthy food marketing to children.
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Cao M, Zhu Y, Sun F, Luo J, Jing J. Short sleep duration is associated with specific food intake increase among school-aged children in China: a national cross-sectional study. BMC Public Health 2019; 19:558. [PMID: 31088522 PMCID: PMC6515588 DOI: 10.1186/s12889-019-6739-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
Background The relationship between sleep duration and food intake is unclear. This study aims to examine the relationship among children aged 6–17 years in China. Methods The sample consisted of 70,519 children aged 6–17 years, which were randomly selected from 7 representative areas from China, from September to November, 2013. In the structured questionnaire, children reported daily sleep hours (less than 7 h, 7–9 h and more than 9 h), weekly food intake amount (including vegetables, fruit, sugar beverages and meat), physical activity and sedentary time. The relationship of sleep duration with vegetable, sugar beverage, fruit and meat intake was evaluated by multi-nominal logistic regression and multi-variable adjusted. Results A total of 62,517 children (51.6% boys) completed the study. Short sleep duration (SSD, < 7 h) was independently associated with increased sugar beverage intake (SBI, Odd Ratio, OR: 1.29, 95% CI: 1.19–1.40) but decreased vegetable (VI, OR: 0.94, 95% CI: 0.90–0.98) & fruit intake (FI, OR: 0.94, 95% CI: 0.88–0.99). Stratified by age and gender, SSD increased SBI for boys of both young (6–12 years) & older (13–17 years) groups and older girls (ORs: 1.25, 1.25, 1.49, 95% CI: 1.08–1.44, 1.04–1.50, 1.22–1.81, respectively), but decreased VI and FI for older girls (ORs: 0.84& 0.81, 95% CI: 0.74–0.96& 0.68–0.96, respectively). Conclusions Among school-aged children in China, short sleep duration was associated with increased risks of more sugar beverage intake among those younger and boys but less vegetable & fruit intake among those older and girls. Longitudinal research is needed to clarify the causation in between.
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Affiliation(s)
- Muqing Cao
- Department of Maternal and Child Health, Faculty of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu, Guangzhou, 510080, China
| | - Yanna Zhu
- Department of Maternal and Child Health, Faculty of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu, Guangzhou, 510080, China
| | - Fan Sun
- Department of Maternal and Child Health, Faculty of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu, Guangzhou, 510080, China
| | - Jingyin Luo
- Department of Maternal and Child Health, Faculty of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu, Guangzhou, 510080, China
| | - Jin Jing
- Department of Maternal and Child Health, Faculty of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu, Guangzhou, 510080, China.
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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: 204] [Impact Index Per Article: 40.8] [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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A treat for the eyes. An eye-tracking study on children's attention to unhealthy and healthy food cues in media content. Appetite 2018; 125:63-71. [DOI: 10.1016/j.appet.2018.01.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 01/04/2023]
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Prowse RJL, Naylor PJ, Olstad DL, Carson V, Mâsse LC, Storey K, Kirk SFL, Raine KD. Reliability and validity of a novel tool to comprehensively assess food and beverage marketing in recreational sport settings. Int J Behav Nutr Phys Act 2018; 15:38. [PMID: 29848321 PMCID: PMC5977740 DOI: 10.1186/s12966-018-0667-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Current methods for evaluating food marketing to children often study a single marketing channel or approach. As the World Health Organization urges the removal of unhealthy food marketing in children’s settings, methods that comprehensively explore the exposure and power of food marketing within a setting from multiple marketing channels and approaches are needed. The purpose of this study was to test the inter-rater reliability and the validity of a novel settings-based food marketing audit tool. Methods The Food and beverage Marketing Assessment Tool for Settings (FoodMATS) was developed and its psychometric properties evaluated in five public recreation and sport facilities (sites) and subsequently used in 51 sites across Canada for a cross-sectional analysis of food marketing. Raters recorded the count of food marketing occasions, presence of child-targeted and sports-related marketing techniques, and the physical size of marketing occasions. Marketing occasions were classified by healthfulness. Inter-rater reliability was tested using Cohen’s kappa (κ) and intra-class correlations (ICC). FoodMATS scores for each site were calculated using an algorithm that represented the theoretical impact of the marketing environment on food preferences, purchases, and consumption. Higher FoodMATS scores represented sites with higher exposure to, and more powerful (unhealthy, child-targeted, sports-related, large) food marketing. Validity of the scoring algorithm was tested through (1) Pearson’s correlations between FoodMATS scores and facility sponsorship dollars, and (2) sequential multiple regression for predicting “Least Healthy” food sales from FoodMATS scores. Results Inter-rater reliability was very good to excellent (κ = 0.88–1.00, p < 0.001; ICC = 0.97, p < 0.001). There was a strong positive correlation between FoodMATS scores and food sponsorship dollars, after controlling for facility size (r = 0.86, p < 0.001). The FoodMATS score explained 14% of the variability in “Least Healthy” concession sales (p = 0.012) and 24% of the variability total concession and vending “Least Healthy” food sales (p = 0.003). Conclusions FoodMATS has high inter-rater reliability and good validity. As the first validated tool to evaluate the exposure and power of food marketing in recreation facilities, the FoodMATS provides a novel means to comprehensively track changes in food marketing environments that can assist in developing and monitoring the impact of policies and interventions. Electronic supplementary material The online version of this article (10.1186/s12966-018-0667-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel J L Prowse
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, AB, Canada. .,Centre for Health & Nutrition, University of Alberta, Edmonton, AB, Canada.
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Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Hodder RK, Stacey FG, O'Brien KM, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 1:CD008552. [PMID: 29365346 PMCID: PMC6491117 DOI: 10.1002/14651858.cd008552.pub4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Putnam MM, Richmond EM, Brunick KL, Wright CA, Calvert SL. Influence of a Character-Based App on Children's Learning of Nutritional Information: Should Apps Be Served with a Side of Media Characters? Games Health J 2018; 7:121-126. [PMID: 29364706 PMCID: PMC5905944 DOI: 10.1089/g4h.2017.0116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Childhood obesity is a health issue in the United States, associated with marketing practices in which media characters are often used to sell unhealthy products. This study examined exposure to a socially contingent touch-screen gaming app, which replied immediately, reliably, and accurately to children's actions. Children's recall of nutritional content and their liking of the character were assessed. Materials and Methods: Four- and five-year-old children (N = 114) received no-exposure, single-exposure, or repeated-exposure to a character-based iPad app rewarding healthy and penalizing unhealthy behaviors. Children reported how much they liked the character and recalled healthy and unhealthy items from the app. An ordinary least squares regression was conducted on how much children liked the character by condition. Poisson regressions were conducted on the number of items recalled by condition alone, and in an interacted model of treatment condition by liking the character. Results: Children liked the character more in the repeated app-exposure condition than in the control group (P = 0.018). Children in the repeated and single app-exposure conditions recalled more healthy (P < 0.001) and unhealthy (P < 0.001) items than the control group. Within treatment conditions, liking the character increased recall of healthy items in the single app-exposure compared to the repeated app-exposure condition (P = 0.005). Conclusions: Results revealed that repeated exposure increased children's learning of nutritional information and liking of the character. The results contribute to our understanding of how to deliver effective nutrition information to young children in a new venue, a gaming app.
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Affiliation(s)
- Marisa M Putnam
- Children's Digital Media Center, Georgetown University , Washington, District of Columbia
| | - Elana M Richmond
- Children's Digital Media Center, Georgetown University , Washington, District of Columbia
| | - Kaitlin L Brunick
- Children's Digital Media Center, Georgetown University , Washington, District of Columbia
| | - Charlotte A Wright
- Children's Digital Media Center, Georgetown University , Washington, District of Columbia
| | - Sandra L Calvert
- Children's Digital Media Center, Georgetown University , Washington, District of Columbia
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Putnam MM, Cotto CE, Calvert SL. Character Apps for Children's Snacks: Effects of Character Awareness on Snack Selection and Consumption Patterns. Games Health J 2018; 7:116-120. [PMID: 29297713 PMCID: PMC5938642 DOI: 10.1089/g4h.2017.0097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Media characters are used to market snacks that are typically of poor nutritional value, which has been linked to childhood obesity. This study examines whether children's snack selections and consumption patterns are influenced by an app depicting a popular children's media character, as well as the role that children's awareness of the character plays. The results can increase our understanding of how to encourage healthier snack selection and consumption in newer game-based marketing venues, such as apps. MATERIALS AND METHODS Four- and 5-year-old children (N = 132) played a bowling game on an iPad with no character or with a character holding either healthier or unhealthy snacks. After app-play, children selected and consumed healthier or unhealthy snacks. Children's awareness of the character was measured by children's verbalizations of the character's name during or after app-play. RESULTS An ordered logistic regression found no significant effect of treatment conditions compared with the control group. Within treatment conditions, awareness of the character led to selection and consumption of more healthy snacks in the healthier condition (odds ratio β = 10.340, P = 0.008), and of unhealthy snacks in the unhealthy condition (odds ratio β = 0.228, P = 0.033), but children were unaware that the character influenced their decisions. CONCLUSIONS Results suggest that young children will choose and consume healthier, not just unhealthy, products when they are aware that a popular character in an app is associated with the snack, potentially leading to healthier eating patterns.
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Affiliation(s)
- Marisa M Putnam
- Children's Digital Media Center, Department of Psychology, Georgetown University , Washington, District of Columbia
| | - Caroline E Cotto
- Children's Digital Media Center, Department of Psychology, Georgetown University , Washington, District of Columbia
| | - Sandra L Calvert
- Children's Digital Media Center, Department of Psychology, Georgetown University , Washington, District of Columbia
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Scherr RE, Laugero KD, Graham DJ, Cunningham BT, Jahns L, Lora KR, Reicks M, Mobley AR. Innovative Techniques for Evaluating Behavioral Nutrition Interventions. Adv Nutr 2017; 8:113-125. [PMID: 28096132 PMCID: PMC5227983 DOI: 10.3945/an.116.013862] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Assessing outcomes and the impact from behavioral nutrition interventions has remained challenging because of the lack of methods available beyond traditional nutrition assessment tools and techniques. With the current high global obesity and related chronic disease rates, novel methods to evaluate the impact of behavioral nutrition-based interventions are much needed. The objective of this narrative review is to describe and review the current status of knowledge as it relates to 4 different innovative methods or tools to assess behavioral nutrition interventions. Methods reviewed include 1) the assessment of stress and stress responsiveness to enhance the evaluation of nutrition interventions, 2) eye-tracking technology in nutritional interventions, 3) smartphone biosensors to assess nutrition and health-related outcomes, and 4) skin carotenoid measurements to assess fruit and vegetable intake. Specifically, the novel use of functional magnetic resonance imaging, by characterizing the brain's responsiveness to an intervention, can help researchers develop programs with greater efficacy. Similarly, if eye-tracking technology can enable researchers to get a better sense as to how participants view materials, the materials may be better tailored to create an optimal impact. The latter 2 techniques reviewed, smartphone biosensors and methods to detect skin carotenoids, can provide the research community with portable, effective, nonbiased ways to assess dietary intake and quality and more in the field. The information gained from using these types of methodologies can improve the efficacy and assessment of behavior-based nutrition interventions.
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Affiliation(s)
| | - Kevin D Laugero
- Department of Nutrition
- USDA, Agricultural Research Service, Western Human Nutrition Research Center, University of California, Davis, Davis CA
| | - Dan J Graham
- Department of Psychology and Colorado School of Public Health, Colorado State University, Fort Collins, CO; Department of
| | - Brian T Cunningham
- Electrical and Computer Engineering and
- Bioengineering, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Lisa Jahns
- USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND
| | - Karina R Lora
- Center for Public Health and Health Policy, University of Connecticut Health, Farmington, CT
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, MN; and
| | - Amy R Mobley
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
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