Television food advertising to children: the extent and nature of exposure

Unhealthy food advertising on Costa Rican and Guatemalan television: a comparative study

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.

Recall of food marketing on videogame livestreaming platforms: Associations with adolescent diet-related behaviours and health

Digital media has become an integral part of adolescents' lives. Mirroring this trend, food and non-alcoholic beverage (hereafter: food) brands increasingly promote products in digital media to maximise reach with young consumers. Videogame livestreaming platforms, where individuals can broadcast or watch streamed videogame footage, are a growing form of digital media. The top three platforms (market share by hours watched) are Twitch (72%), YouTube Gaming (13%), and Facebook Gaming Live (9%), with a combined 34.6 billion hours watched in 2021. These platforms represent a hybridisation of two popular digital trends amongst teenagers: viewing online video content and playing videogames. On these platforms, gaming influencers promote food brands and products, with energy drinks and fast-food restaurants representing the most frequently promoted categories. Evidence suggests that food marketing via Twitch is associated with food craving, purchasing and consumption in adults. Yet, despite the evident teenage appeal and prevalence of food marketing on these platforms, research is yet to explore its associations with adolescent eating behaviour. Adolescents (n = 490, M_age = 16.81, 30.2% female) completed an online cross-sectional questionnaire exploring their recall of food marketing on the top three videogame livestreaming platforms, and relevant behavioural (purchase, consumption) and health (Body Mass Index) outcomes. Structural equation modelling was used to explore hierarchical relationships between the key variables. Results showed that recall of unhealthy food marketing on these platforms was significantly associated with purchase and consumption of marketed food categories. Attitudes towards unhealthy foods mediated this relationship. Findings are the first to demonstrate the relationships between unhealthy food marketing via videogame livestreaming platforms and adolescent eating behaviours, which has implications for the design of policies to restrict digital food marketing to young people.

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016–18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

Cross-Sectional Evaluation of Food Items Preferred by Adolescents under the Influence of Television Advertisements

BACKGROUND

Food and beverage advertisements on television play a significant role in food preferences, especially among children and adolescents. This study aimed to evaluate foods and beverages advertised on television and purchased by adolescents or their families using the World Health Organization (WHO) nutrient profiling model.

STUDY DESIGN

A cross-sectional study.

METHODS

This cross-sectional study was performed on 2,699 students (1380 males and 1319 females) aged 11-16 in Ankara, Turkey, in 2015. Socio-demographic characteristics, television-viewing habits, and the tendency to purchase foods and beverages under the influence of TV advertisements were recorded. The body weight and height were measured by the researchers. All reported food and beverage items (n  =  284) were evaluated and classified as permitted or not permitted to advertise, according to the WHO nutrient profile model (2015).

RESULTS

The majority (69.8%) of students were underweight/normal weight, whereas 13.3% and 16.9% were classified as overweight and obese, respectively. A total of 69.6% of adolescents declared that they were influenced by food advertisements, and 66.4% bought those foods. The most purchased products included cakes and sweet biscuits (63.8%), chocolate and confectionery (44.9%), savory snacks (39.6%), and soft drinks (25.4%). Only 8.5% of all the advertised products (n  =  284) were permitted to be advertised, according to the WHO nutrient profile model (2015). Dairy products, meat products, grains, fruits and vegetables, soup, and some traditional Turkish foods (e.g., cig kofte and Turkish pizza) were permitted. The permitted products were preferred by only 13.6% of the adolescents.

CONCLUSIONS

Unhealthy foods are advertised on television for adolescents, and food advertisement management may be an essential strategy to provide healthy food choices.

Can point-of-sale nutrition information encourage reduced preference for sugary drinks among adolescents?

OBJECTIVE

To test whether point-of-sale (POS) information about the nutrition content of sugar-sweetened beverages (SSB) promotes healthier drink choices among teenagers, and explore whether POS intervention effects vary based on prior exposure to a sugary drink public health campaign (13 Cancers).

DESIGN

Between-subjects online experiment with three POS signage conditions: no signage (control); sugar content (SC) and Health Star Rating (HSR). Participants viewed their assigned POS sign alone, then alongside a drinks product display and chose which drink they would buy. Perceptions of various drink products and campaign recall were assessed.

SETTING

Australia.

PARTICIPANTS

Adolescents aged 13-17 years (n 925) recruited via an online panel.

RESULTS

POS signs did not promote a significant reduction in preference for SSB (cf. control condition). Cognitive and emotional responses to POS signs were strongest for the SC sign, which was rated higher than the HSR sign on various perceived effectiveness measures. Participants who saw the SC sign rated SSB as less healthy (cf. control condition) and were more likely to accurately estimate the number of teaspoons of sugar in soft drink (cf. HSR sign and control conditions). There was no significant interaction between prior exposure to the 13 Cancers campaign and POS signage condition regarding preferences for and perceptions of SSB.

CONCLUSIONS

SSB POS interventions may not have the desired effect on adolescents' drink preferences. Testing SSB POS signs in real-world retail settings is needed to determine whether positive educational impacts extend to promoting healthier drink purchases and reduced SSB consumption among teenagers.

Sugary drink advertising expenditure across Australian media channels 2016-2018

OBJECTIVE

The aim of this study was to describe advertising expenditure for sugary drinks compared with alternative cold non-alcoholic beverages (artificially sweetened beverages, plain water, plain milk) between 2016 and 2018 across Australian media channels.

METHODS

Monthly estimates of advertising expenditure for non-alcoholic beverages were obtained from Nielsen Media and aggregated by product type and media.

RESULTS

Total sugary drink advertising expenditure between 2016 and 2018 ($129.5M) significantly exceeded expenditure on artificially sweetened drinks ($23.26M), plain water ($14.27M), and plain milk ($31.30M). Television and out-of-home advertising accounted for the largest share of sugary drink advertising (45%, 35%). Expenditure on out-of-home advertising was more heavily dominated by sugary drinks (75%) than advertising in all media combined (65%). Sugary drink advertising peaked in warmer months and was lowest in August. Soft drinks (26%), flavoured milks (24%) and energy drinks (21%) accounted for the majority of sugary drink advertising.

CONCLUSIONS

Cold non-alcoholic beverage advertising in Australian media is dominated by the advertising of sugary drinks. Implications for public health: Restricting unhealthy beverage advertising on television and out-of-home media may be most effective initially. However, comprehensive restrictions capturing a broader range of media and settings would be optimal to prevent displacement and limit advertising reach and exposure.

Compensation and transfer effects of eating behavior change in daily life: Evidence from a randomized controlled trial

Pursuing specific eating goals may lead to the adoption of other healthy behaviors (transfer) or compensation with unhealthy behaviors. Previous research has mostly investigated such processes using non-experimental studies focusing on interindividual differences. To investigate transfer or compensation of eating behavior in daily life, we analyzed data from a 2 (eating goal: more fruit and vegetables [FV] vs. fewer unhealthy snacks) x 2 (intervention vs. control group) factorial randomized trial. Adopting a within-person perspective, we studied potential transfer and compensation 1) between different eating behaviors and physical activity (PA), and 2) in response to an eating behavior change intervention. Participants (N = 203) received either goals to increase FV intake or decrease unhealthy snack intake and completed a daily e-diary. Eating more unhealthy snacks predicted 0.16 less FV portions (β = -0.07; p < 0.001) and 18% less unhealthy snack intake the next day (p < 0.001). Eating more FV predicted 0.42 less FV portions the next day (β = -0.07; p < 0.001). Participants with the FV eating goal intervention decreased unhealthy snacks (p = 0.012) and PA (p = 0.019) by 8% compared to controls, respectively. Similar but non-significant patterns were observed for participants with the decreasing unhealthy snack goal intervention (p > 0.05). Results indicated both compensation and transfer processes in daily life. Relationships mostly occur within the same behavior and rather support compensatory effects. In turn, a behavior change intervention to promote FV intake potentially enhances non-assigned eating behaviors, indicating transfer, but may lower PA.

Regulating children's exposure to food marketing on television: are the restrictions during children's programmes enough?

Due to rising global rates of childhood obesity, the World Health Organization (WHO) has recommended the adoption of policies to restrict children's exposure to the advertising of unhealthy foods and beverages. In 2017, the Slovenian government introduced regulations to restrict the advertisement of unhealthy foods and beverages during designated children's television programming. The objective of our study was to assess the impact of these regulations on children's exposure to food advertising, including during children's programmes and at peak viewing times for children. Using a standardised methodology, we investigated a large sample of 6479 food advertisements broadcast during 1652 h of television programming between 2016 and 2018 on the five most popular television channels for children aged 4-9 years. Advertised food products were coded using the WHO Regional Office for Europe Nutrient Profile Model, modified for Slovenia. The average overall frequency of not permitted (unhealthy) food advertising (±SD; standard deviation) per hour was 2.90 ± 3.22 (2016), 2.66 ± 3.55 (2017), or 2.13 ± 3.04 (2018) ads/h/channel. The frequency of not permitted food ads decreased to 0.02 ± 0.01 per h/channel during cartoons and other children's programmes in 2018. The new Slovenian food marketing regulations have reduced the advertising of unhealthy foods during children's programmes. However, children's viewership rates are also high outside of this designated programming and, as such, children's overall exposure to unhealthy food advertising is unlikely to have been reduced considerably by the regulations. Future policy interventions should be planned to cover not only children's programmes but also broadcasting periods that include the greatest numbers of child viewers. The implementation of such policies would be more challenging given that children's peak viewing times often intersect with prime time.

30+ years of media analysis of relevance to chronic disease: a scoping review

BACKGROUND

Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area.

METHODS

We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies.

RESULTS

Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work.

CONCLUSIONS

The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.

Identifying food marketing to teenagers: a scoping review

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.

Television food and beverage marketing to children in Costa Rica: current state and policy implications

OBJECTIVE

To examine the frequency of television (TV) food and beverage advertisements (F&B ads) to which children (4-11 years) are likely exposed and the nutrient profile of products advertised.

DESIGN

TV broadcasting between September and November 2016 was recorded (288 h of children's programming; 288 h of family programming) resulting in 8980 advertisements, of which 1862 were F&B ads. Of those, 1473 could be classified into one of the seventeen food groups, and into permitted/non-permitted according to the WHO-EU nutrient profile model. Persuasive marketing techniques used were also identified.

SETTING

TV programming was recorded for four weekdays and four weekend days, between 06.00 and 00.00 hours (576 total hours), for four channels (two national and two cable), in Costa Rica.

RESULTS

Mean (sd) number of F&B ads/h was greater in cable than national channels (3·7 (0·4) v. 2·8 (0·4), P < 0·05) and during children's peak viewing hours (4·4 (0·4) v. 2·9 (0·3)). Of F&B ads classified with WHO-EU nutrient profile model (n 1473, 71·1 %), 91·1 % were non-permitted to be marketed to children. Categories most frequently advertised were ready-made/convenience foods (16 %), chocolates/confectionery/desserts (15 %), breakfast cereals (14 %), beverages (15 %), edible ices (9 %) and salty snacks (8 %). Non-permitted F&B ads were more likely to use promotional characters, brand benefit claims, and nutrition and health claims than permitted F&B ads.

CONCLUSIONS

Children watching popular TV channels in Costa Rica are exposed to a high number of unhealthy F&B ads daily. Our findings help justify the need for regulatory actions by national authorities.

Food Marketing Influences Children's Attitudes, Preferences and Consumption: A Systematic Critical Review

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.

A content analysis of Australian television advertising: focus on child and adolescent oral health

Background

Children’s preferences for cariogenic foods and/or drinks has been proven to be associated with exposure to advertisements. This study aimed to assess and compare the proportion of cariogenic food and /or drink advertisements aired on three metropolitan Sydney commercial television channels at different broadcast times during school term and school holidays.

Methods

Three Sydney free-to-air television channels (Channels Seven, Nine, and Ten) were recorded between June 2016 and January 2017. Two weekdays and one weekend day were recorded for a week for each channel during the school term and school holidays, respectively. All channels were recorded from 0630 h until 2300 h. Food and/or drink advertisements were categorised according to the time they were aired and their sugar and acid content. For each channel, school holiday data was compared with school term data. Pearson chi-squared testing was used to determine the difference in advertisements rates across TV channels and broadcast times including school holidays and school term.

Results

The proportion of food and/or drink advertisements for all networks was less than 10% of all advertisements. Overall, Channel Ten had the most food and/or drink advertisements (39.74%) and Channel Seven had the lowest (28.60%). Channel Ten aired the largest proportion of food and/or drink advertisements (27.18%) during school term Channel Nine aired the highest number of food and/or drink adverts (15.50%) during school holidays. There were more food and/or drink advertisements during children’s viewing hours compared to overlap, adult, and other viewing periods respectively, with Channel Ten airing the highest advertisements (15.72%) and Channel Seven airing the least (11.35%) food and/or drink advertisements. For all analyses, Pearson chi-square tests had a p-value < 0.001.

Conclusion

Although the overall proportion of food and/or drink advertisements aired on Sydney television is low, the advertisements containing high sugar and /or acid were broadcasted more during children’s viewing times than other times and during school term compared to school holidays.

Trends in marketing foods to children in Slovenian magazines: a content analysis

OBJECTIVE

Food marketing is an important factor influencing children's food preferences. In Slovenia the use of magazines is widespread among children. We investigated food advertising in children's and teens' magazines (CTM) in 2013 and 2017. The penetration of food advertising was compared with magazines targeting the adult population.

DESIGN

A repeated cross-sectional study. Magazines were searched for branded food references (BFR). All BFR were categorised and evaluated using the WHO Europe nutrient profile model.

SETTING

Slovenia.

SUBJECTS

All issues of CTM and a selected sample of issues of adult-targeting magazines and newspapers published in Slovenia in 2013 and 2017.

RESULTS

One hundred and seventy-five issues of CTM (ninety-two in 2013, eighty-three in 2017) and 675 issues of adult-targeted magazines and newspapers were analysed (345 in 2013, 330 in 2017). In 2017, food advertising in CTM dropped notably but the opposite was found for adult-targeted magazines. Regular advertisements dominated in 2017 in CTM, while in 2013, 83 % of BFR types were games/puzzles, competitions and product placements. Chocolate and confectionery were the most advertised in CTM and food supplements in adults' magazines. Most foods in CTM were classed as 'not permitted' in both years (98 % in 2013 and 100 % in 2017).

CONCLUSIONS

The advertisements in CTM still mostly refer to unhealthy foods. The extent of food advertising has dropped considerably since 2013. On the contrary, food advertising in printed media targeting adults has increased, chiefly referring to food supplements and foods that do not pass the WHO Europe nutrient profile model criteria.

Television food advertising to children in Malta

To undertake a cross-sectional survey of the extent and nature of food and beverage advertising to children on Maltese national television stations. Seven national free-to-air channels were recorded for seven consecutive days in March 2014 between 07:00 and 22:00 h. Advertisements were coded according to predefined categories, with a focus on advertisements aired during 'peak' children's viewing times, defined as periods during which more than 25% of children were likely to be watching television on any channel. Food and beverage advertisements were classified as core (healthy), non-core (unhealthy) or miscellaneous foods. Malta. Whole population, with a focus on children. Food and drinks were the most heavily advertised product category (26.9% of all advertisements) across all channels. The proportion of non-core food/drink advertisements was significantly greater during peak compared with non-peak children's viewing times (52 vs 44.6%; p ≤ 0.001). A majority of advertisements aimed at children are for non-core foods, and are typically shown during family-oriented programmes in the late evening rather than being restricted to children's programmes. 'Taste', 'enjoyment' and 'peer status' were the primary persuasive appeals used in adolescent and child-focused advertisements. This first content analysis of television advertising in Malta suggests that there is scope for the implementation of statutory regulation regarding advertising of foods high in fat, sugar and salt (HFSS) during times when children are likely to watch television, rather than during children's programmes only. Ongoing, systematic monitoring is essential for evaluation of the effectiveness of regulations designed to reduce children's exposure to HFSS food advertising on television.

Children's everyday exposure to food marketing: an objective analysis using wearable cameras

Background

Over the past three decades the global prevalence of childhood overweight and obesity has increased by 47%. Marketing of energy-dense nutrient-poor foods and beverages contributes to this worldwide increase. Previous research on food marketing to children largely uses self-report, reporting by parents, or third-party observation of children’s environments, with the focus mostly on single settings and/or media. This paper reports on innovative research, Kids’Cam, in which children wore cameras to examine the frequency and nature of everyday exposure to food marketing across multiple media and settings.

Methods

Kids’Cam was a cross-sectional study of 168 children (mean age 12.6 years, SD = 0.5) in Wellington, New Zealand. Each child wore a wearable camera on four consecutive days, capturing images automatically every seven seconds. Images were manually coded as either recommended (core) or not recommended (non-core) to be marketed to children by setting, marketing medium, and product category. Images in convenience stores and supermarkets were excluded as marketing examples were considered too numerous to count.

Results

On average, children were exposed to non-core food marketing 27.3 times a day (95% CI 24.8, 30.1) across all settings. This was more than twice their average exposure to core food marketing (12.3 per day, 95% CI 8.7, 17.4). Most non-core exposures occurred at home (33%), in public spaces (30%) and at school (19%). Food packaging was the predominant marketing medium (74% and 64% for core and non-core foods) followed by signs (21% and 28% for core and non-core). Sugary drinks, fast food, confectionary and snack foods were the most commonly encountered non-core foods marketed. Rates were calculated using Poisson regression.

Conclusions

Children in this study were frequently exposed, across multiple settings, to marketing of non-core foods not recommended to be marketed to children. The study provides further evidence of the need for urgent action to reduce children’s exposure to marketing of unhealthy foods, and suggests the settings and media in which to act. Such action is necessary if the Commission on Ending Childhood Obesity’s vision is to be achieved.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0570-3) contains supplementary material, which is available to authorized users.

Using Smartphone-Based Support Groups to Promote Healthy Eating in Daily Life: A Randomised Trial

BACKGROUND

Although many people intend to eat healthily, they often fail to do so. We report the first randomised trial testing whether smartphone-based support groups can enhance healthy eating.

METHODS

Adults (N = 203) were randomised to the support or control condition (information), and to one of two eating goals (increasing fruit and vegetable/decreasing unhealthy snack consumption). After baseline, participants received information on their assigned eating goal, and completed a 13-day electronic diary. During Days 4-10, support participants were asked to support each other in achieving their eating goal in smartphone-based groups. The primary outcome was daily servings of fruit/vegetables or unhealthy snacks. Maintenance of intervention effects was assessed on Days 11-13, and at 1-month and 2-month follow-ups.

RESULTS

Support participants showed a gradual increase in healthy eating over time, and ate 1.4 fruits and vegetables more, 95% CI [0.3, 2.6], or 0.8 unhealthy snacks less, 95% CI [-1.4, -0.2] than controls on Day 10. Most effects were not maintained at follow-ups.

CONCLUSIONS

Smartphone-based groups can promote fruit and vegetable consumption and decrease unhealthy snack intake. This study extends previous findings of the benefits of support groups, and sheds light on the temporal dynamics of behavior change.

Food advertising on Argentinean television: are ultra-processed foods in the lead?

Objective

To describe the number of processed and ultra-processed food (PUPF) advertisements (ads) targeted to children on Argentinean television (TV), to analyse the advertising techniques used and the nutritional quality of the foods advertised, and to determine the potential exposure of children to unhealthy food advertising in our country.

Design

Five free-to-air channels and the three most popular children’s cable networks were recorded from 07.00 to 22.00 hours for 6 weeks. Ads were classified by target audience, type of product, advertised food categories and advertising strategies used. The NOVA system was used to classify food products according to industrial food processing level. Nutritional quality was analysed using the Pan American Health Organization’s nutrient profile model.

Setting

Buenos Aires, Argentina. Results are considered applicable to most of the country.

Subjects

The study did not involve human subjects.

Results

Of the sample of food ads, PUPF products were more frequently advertised during children’s programmes (98·9 %) v. programmes targeted to the general audience (93·7 %, χ2=45·92, P<0·01). The top five food categories were desserts, dairy products, non-alcoholic sugary beverages, fast-food restaurants, and salty snacks. Special promotions and the appearance of cartoon characters were much more frequent in ads targeting children. Argentinean children are estimated to be exposed to sixty-one ads for unhealthy PUPF products per week.

Conclusions

Our study showed that Argentinean children are exposed to a high number of unhealthy PUPF ads on TV. The Argentinean Government should build on this information to design and implement a comprehensive policy to reduce exposure to unhealthy food marketing that includes TV and other communication channels and places.

Television food advertising to children in Slovenia: analyses using a large 12-month advertising dataset

OBJECTIVES

The marketing of energy-dense foods is recognised as a probable causal factor in children's overweight and obesity. To stimulate policymakers to start using nutrient profiling to restrict food marketing, a harmonised model was recently proposed by the WHO. Our objective is to evaluate the television advertising of foods in Slovenia using the above-mentioned model.

METHODS

An analysis is performed using a representative dataset of 93,902 food-related advertisements broadcast in Slovenia in year 2013. The advertisements are linked to specific foods, which are then subject to categorisation according to the WHO and UK nutrient profile model.

RESULTS

Advertising of chocolate and confectionery represented 37 % of food-related advertising in all viewing times, and 77 % in children's (4-9 years) viewing hours. During these hours, 96 % of the food advertisements did not pass the criteria for permitted advertising according to the WHO profile model.

CONCLUSIONS

Evidence from Slovenia shows that, in the absence of efficient regulatory marketing restrictions, television advertising of food to children is almost exclusively linked to energy-dense foods. Minor modifications of the proposed WHO nutrient profile model are suggested.

The extent and nature of television food advertising to children in Xi'an, China

Background

To explore the extent and nature of television food advertising especially unhealthy food advertising to primary school children in Xi’an, China.

Methods

Television data were recorded for 2 weekdays and 2 weekend days between 6:00 and 22:00 during May and June in 2012 from a total of five television channels most popular with children in Xi’an. Pearson χ² tests and logistic regression were applied to determine differences in the proportion of healthy food, unhealthy food and miscellaneous food advertisements for different channels, programs, dates, viewing periods and the use of persuasive marketing tactics.

Results

Of the 5527 advertisements transcribed, 25.5 % were for food, among which 48.1 % were considered to be unhealthy. The frequency of food advertisements was 6 per hour per channel, including 3 unhealthy food advertisements. Compared with healthy and miscellaneous food advertisements, more unhealthy food advertisements were shown during afternoon, weekends and children’s non-peak viewing times as well as on children’s television channels, central television channels and non-children’s programmes. Unhealthy foods contributed the highest proportion of all food advertisements containing promotional characters (51.7 %) and premium offers (59.1 %). Both promotional characters and premium offers appeared more on non-children’s television channels.

Conclusions

The majority of food advertisements were for unhealthy food. More unhealthy food ads were shown in children’s non-peak time and afternoon as well as non-children’s channels. More children-oriented persuasive marketing tactics were used in unhealthy food ads especially in non-children’s channels. Therefore, intervening in the entrance of unhealthy foods into the market and establishing regulations related to food advertising especially unhealthy food advertisements are important strategies to prevent children’s exposure to unhealthy food and childhood obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3468-0) contains supplementary material, which is available to authorized users.

Food advertising towards children and young people in Norway

Despite the fact that no studies have been carried out to map the amount of unhealthy food advertising aimed at Norwegian children and adolescents, it is still widely held belief that this type of advertising is disproportionately common. As a consequence, one of the issues high on the agenda in Norway in the 2000s was the possibility of imposing restrictions on advertising for unhealthy foods to children. The purpose of this study is to contribute with a research-based foundation for implementing this health initiative by mapping food marketing in media channels widely used by children and adolescents. In sum, the study shows that the food industry spends a lot of resources to influence young consumers' eating and drinking habits. Compared with studies from USA, UK and Australia, however, there are, strong indications that there is significantly less unhealthy food advertising in Scandinavian countries. Similar to a previous Swedish study, this study shows that Norwegian children and young people were exposed to little advertising for unhealthy food products through media channels such as TV, the Internet, magazines, comics and cinemas. The study also supports critical remarks from some researchers that the extensive use of the international discourse as a political argument and recommendation for Norwegian conditions is not accurate. For the future it may be beneficial to look more closely at the relationship between advertising and health policy, and how this relationship can be further developed to improve children and young people's diet.

Logit modelling of food shopping behaviour of children in retail stores

Purpose

– The purpose of this study is to comprehensively uncover antecedents of food shopping behaviour of children in retail stores in India. Children form the pivot of food marketing. They accompany parents on food shopping trips and assist food purchases. Their extent of participation varies with the frequency with which they accompany parents, the presence of food promotions and other demographic variables. The present paper attempts to comprehensively uncover the variables that help in cumulatively predicting food shopping behaviour of children in retail stores.

Design/methodology/approach

– Data have been collected from 473 mothers of children in the age category 4-11 years. For the aforesaid purpose, a structured, pre-tested and non-disguised questionnaire has been prepared. Binary logistic regression has been applied to analyse the data through SPSS 19.

Findings

– Shopping behaviour of children in retail stores significantly depends upon food promotions in retail stores, frequency with which children accompany mothers on shopping trips and demographic variables such as age of mother and father and education status of mother.

Practical implications

– This study attracts attention of parents, food retailers and policy makers towards impact of food promotional strategies on food buying behaviour of children in retail stores.

Originality/value

– This piece of research is important as no such study (to the best of researchers’ knowledge) has been conducted in India even when food retailing is an important component of total retail in India and also growing tremendously.

Measuring Food Brand Awareness in Australian Children: Development and Validation of a New Instrument

Background

Children’s exposure to food marketing is one environmental determinant of childhood obesity. Measuring the extent to which children are aware of food brands may be one way to estimate relative prior exposures to food marketing. This study aimed to develop and validate an Australian Brand Awareness Instrument (ABAI) to estimate children’s food brand awareness.

Methods

The ABAI incorporated 30 flashcards depicting food/drink logos and their corresponding products. An abbreviated version was also created using 12 flashcards (ABAI-a). The ABAI was presented to 60 primary school aged children (7-11yrs) attending two Australian after-school centres. A week later, the full-version was repeated on approximately half the sample (n=27) and the abbreviated-version was presented to the remaining half (n=30). The test-retest reliability of the ABAI was analysed using Intra-class correlation coefficients. The concordance of the ABAI-a and full-version was assessed using Bland-Altman plots. The ‘nomological’ validity of the full tool was investigated by comparing children’s brand awareness with food marketing-related variables (e.g. television habits, intake of heavily promoted foods).

Results

Brand awareness increased with age (p<0.01) but was not significantly correlated with other variables. Bland-Altman analyses showed good agreement between the ABAI and ABAI-a. Reliability analyses revealed excellent agreement between the two administrations of the full-ABAI.

Conclusions

The ABAI was able to differentiate children’s varying levels of brand awareness. It was shown to be a valid and reliable tool and may allow quantification of brand awareness as a proxy measure for children’s prior food marketing exposure.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

'I saw Santa drinking soda!' Advertising and children's food preferences

BACKGROUND

The influence of advertising on children's food preferences is well documented in the research literature. In this study we aim to examine the ways in which food advertising propels children's consumer behaviour and to investigate how food advertising affects the frequency of unhealthy food consumption.

METHODS

Data were drawn from a sample of elementary school children in the region of Thessaly (Greece). Three scales were used to measure children's lifestyle patterns, food consumption frequencies, and their response to advertising. Univariate and inferential statistics were used to answer the research questions.

RESULTS

The analysis revealed that a significant proportion of children (47.4%) frequently consume unhealthy foods. Children who have little understanding of the persuasive intent of advertising rate advertised foods as healthier and more nutritious. The frequency of unhealthy food consumption is influenced by the entertaining dimension of advertising and the level of the motivational arousal after children's exposure to food advertisements.

CONCLUSIONS

Food advertising impels children's consumer behaviour through four different modes. First, advertising engenders expectations, which raise purchase motivation. Second, the purchase of advertised foods is accompanied by positive feelings (happiness, satisfaction). Third, the entertaining dimension of advertising generates pleasant mood, which positively predisposes the evaluation of advertised foods. Fourth, children do not always possess the ability to recognize the persuasive nature of advertising.

Monitoring food and non-alcoholic beverage promotions to children

Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising 'minimal', 'expanded' and 'optimal' monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.

A mixed-method examination of food marketing directed towards children in Australian supermarkets

The purpose of this study was to determine the prevalence of children's food requests, and parents' experiences of food marketing directed towards children, in the supermarket environment. A mixed-method design was used. Firstly, intercept interviews were conducted with parents accompanied by a child/children on exiting supermarkets (sampled from a large regional centre in Australia). Parents were asked about the prevalence and types of food requests by child/children during their supermarket visit and whether they purchased these foods. Secondly, focus groups (n = 13) and telephone interviews (n = 3) were conducted exploring parents' experiences of supermarket shopping with children and the impact of child-directed marketing. Of the 158 intercept survey participants (30% response rate), 73% reported a food request during the supermarket visit. Most requested food items (88%) were unhealthy foods, with chocolate/confectionery being the most common food category requested (40%). Most parents (70%) purchased at least one food item requested during the shopping trip. Qualitative interviews identified four themes associated with food requests and prompts in the supermarket: parents' experience of pester power in the supermarket; prompts for food requests in the supermarket; parental responses to pestering in the supermarket environment, and; strategies to manage pestering and minimize requests for food items. Food requests from children are common during supermarket shopping. Despite the majority of the requests being unhealthy, parents often purchase these foods. Parents reported difficulties dealing with constant requests and expressed desire for environmental changes including confectionery-free checkouts, minimization of child friendly product placement and reducing children's exposure to food marketing.

Branded food references in children's magazines: 'advertisements' are the tip of the iceberg

OBJECTIVE

While children's magazines 'blur the lines' between editorial content and advertising, this medium has escaped the calls for government restrictions that are currently associated with food advertisements aired during children's television programming. The aim of this study was to address significant gaps in the evidence base in relation to commercial food messages in children's magazines by systematically investigating the nature and extent of food advertising and promotions over a 12-month period.

METHOD

All issues of Australian children's magazines published in the calendar year 2009 were examined for references to foods or beverages.

RESULTS

Approximately 16% of the 1678 food references identified were portrayals of branded food products (or food brands). However, only 83 of these 269 were clearly identified as advertisements. Of these 269 branded food references, 86% were for non-core (broadly, less healthy) foods, including all but seven of the advertisements.

CONCLUSIONS

It appears that recent reductions in televised promotions for non-core foods, and industry initiatives to reduce the targeting of children, have not carried through to magazine advertising. This study adds to the evidence base that the marketing of unhealthy food to children is widespread, and often covert, and supports public health calls for the strengthening of advertising regulation.

Persuasive techniques used in television advertisements to market foods to UK children

The aim of this study was to quantify the nature and extent of use of persuasive marketing techniques in television advertisements (adverts) to promote foods to children. Popular UK commercial television channels broadcasting children's/family viewing were recorded for 2 days (6 am-10 pm) every month in 2008 and recordings were screened for adverts. Eighteen thousand eight hundred and eighty eight adverts were for food and these were coded for peak/non-peak children's viewing time and representation of core (healthy)/non-core (unhealthy)/miscellaneous foods. The analysis assessed use of persuasive appeals, premium offers, promotional characters (brand equity and licensed characters), celebrity endorsers and website promotion in food adverts. Promotional characters, celebrity endorsers and premium offers were used more frequently to promote non-core than core foods, even on dedicated children's channels. Brand equity characters featured on a greater proportion of food adverts than licensed characters. A food brand website was promoted in a third of food adverts (websites are not covered by the statutory regulation on food advertising). This extensive analysis of television adverts demonstrated that the use of persuasive marketing techniques to promote unhealthy foods was extensive in broadcasting popular with children despite regulations. Further studies should incorporate an analysis of the content of websites promoted during food adverts.

Adolescent weight status and receptivity to food TV advertisements

OBJECTIVE

This study examined the relationship between adolescent weight status and food advertisement receptivity.

DESIGN

Survey-based evaluation with data collected at baseline (initial and at 2 months), and at follow-up (11 months).

SETTING

New Hampshire and Vermont.

PARTICIPANTS

Students (n = 2,281) aged 10-13 in 2002-2005.

MAIN OUTCOME MEASURE

Overweight.

ANALYSIS

Generalized estimating equations to model the relationship between identifying a food advertisement as their favorite and being overweight.

RESULTS

Overall, 35.9% of the adolescents were overweight. Less than one fifth named a food advertisement as their favorite (16.1%). Most of the food advertisements were for less-healthful food (89.6%). After controlling for school, age, sex, sociodemographics, physical activity, number of TV sessions watched, and having a TV in the bedroom, overweight adolescents were significantly less likely to be receptive to food advertisements (relative risk = 0.83, 95% confidence interval 0.70, 0.98) compared to non-overweight adolescents.

CONCLUSIONS AND IMPLICATIONS

This study provides preliminary evidence that normal-weight adolescents are receptive to unhealthful food advertisements. Longitudinal studies are needed to evaluate whether consistent exposure to advertisements for unhealthful food, particularly if they are promoted with healthful behaviors such as being physically active, influence adolescents' food choices, and ultimately their body mass index, over the long term.

Art of persuasion: an analysis of techniques used to market foods to children

AIM

Persuasive marketing techniques, such as promotional characters, influence children's food preferences and requests for foods. The aim of this research was to describe the techniques used to market unhealthy foods and beverages to children on Sydney free-to-air television.

METHODS

Marketing techniques designed to appeal to children were identified from international literature and summarised into a systematic coding tool. Using this tool, the marketing techniques used in a random sample of 100 unique food advertisements, broadcasted on Sydney free-to-air television, were coded. Frequency of marketing techniques was analysed overall and for use in advertisements marketing unhealthy foods, emotionally or verbally appealing to parents, or featuring child actors.

RESULTS

Advertisers' use of persuasive techniques generally did not differ by type of food advertised. Marketing techniques with greater prominence in unhealthy food advertising were palatability (54% of unhealthy food advertisements), convenience (52%), fantasy/imagination (28%), fun/happiness (17%) and cartoon characters (9%). Advertisements emotionally appealing to parents (24%) were significantly more likely to make general health or nutrition statements (38% vs. 17%), and appealed to children concurrently through fun/happiness and fantasy/imagination appeals. Children were depicted in advertisements as eating with friends or family, situated within the home and frequently snacking on less healthy foods.

CONCLUSIONS

Food and beverage advertisers use a range of visual, audio and emotive techniques to appeal to children and their parents that do not discriminate by the type of food advertised. The range and complexity of these techniques complicate the restriction of their use in food advertising to children.

Advertising of fast food to children on Australian television: the impact of industry self-regulation

OBJECTIVE

To assess the impact of the quick-service restaurant industry (QSRI) self-regulatory initiative on fast-food advertising to children on Australian commercial television.

DESIGN AND SETTING

Analysis of advertisements for foods on the three main free-to-air commercial television channels (channels 7, 9 and 10) in Sydney, Australia, over 4 days in both May 2009 and April 2010 in terms of: number of advertisements; types of food (coded core [healthy] foods, non-core [unhealthy] foods, miscellaneous foods; or fast foods); whether advertised meals were intended for children; whether advertisements were broadcast during children's peak viewing times; and whether the company in question was a signatory to the QSRI initiative.

MAIN OUTCOME MEASURES

Change in the mean frequency and rate of food advertisements per hour from 2009 to 2010; change in the types of fast-food meals (healthier alternatives [at least one nutrient-dense, low-energy food considered part of a healthy diet for children], non-core [high in undesirable nutrients and not considered part of a healthy diet for children], and other) being advertised; and proportion of children's energy requirements provided by fast-food meals.

RESULTS

From 2009 to 2010, the mean frequency of fast-food advertisements increased from 1.1 to 1.5 per hour. While non-core fast foods comprised a lesser share of fast-food advertising in 2010 than 2009, the mean frequency at which they were advertised during times when the largest numbers of children were watching television remained the same (1.3 per hour in both 2009 and 2010). Family meals advertised for children's consumption in 2010 provided energy far in excess of children's requirements.

CONCLUSIONS

Children's exposure to unhealthy fast-food advertising has not changed following the introduction of self-regulation, and some fast foods advertised for children's consumption contain excessive energy. The limited impact of self-regulation suggests that governments should define the policy framework for regulating fast-food advertising to children.

The association between family meals, TV viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children

OBJECTIVE

Examine the relationship of family meals to children's consumption of fruit and vegetables as well as soda and chips. Additionally, to assess the relationship between viewing TV during family meals and children's diet.

DESIGN

Cross-sectional study that used a questionnaire completed by parents.

SETTING

Thirteen schools in San Diego, California.

PARTICIPANTS

Seven hundred ninety-four children and their parents.

ANALYSIS

Ordinal regression assessed associations between children's intake of fruit, vegetables, soda, and chips with family meal frequency and TV viewing during family meals.

RESULTS

Children who consumed breakfast, lunch, or dinner with their family at least 4 days per week ate fruit and vegetables 5 or more times a week 84%, 85%, and 80%, respectively. Of those children who ate breakfast, lunch, or dinner with their family at least 4 days per week, 40%, 44%, and 43% consumed soda and chips 5 or more times a week, respectively. Children who ate breakfast with their families at least 4 times a week were more likely to consume fruit and vegetables, and children whose TV was never or rarely on during family meals were less likely to consume soda and chips (P = .04 and P < .001, respectively).

CONCLUSIONS

Interventions geared at increasing the frequency of eating breakfast as a family and decreasing the amount of TV watched during family meals are needed, especially among acculturating Latino families.

The extent of food advertising to children on UK television in 2008

OBJECTIVE

To provide the most comprehensive analysis to date of the extent of food advertising on UK television channels popular with young people following regulatory reform of this type of marketing activity.

METHODS

UK television was recorded 06:00-22:00 h for a weekday and a weekend day every month between January and December 2008 for 14 of the most popular commercial channels broadcasting children's/family viewing. Recordings were screened for advertisements, which were coded according to predefined categories including whether they were broadcast in peak/non-peak children's viewing time. Food advertisements were coded as core (healthy)/non-core (unhealthy)/miscellaneous foods.

RESULTS

Food and drinks were the third most heavily advertised product category, and there were a significantly greater proportion of advertisements for food/drinks during peak compared to non-peak children's viewing times. A significantly greater proportion of the advertisements broadcast around soap operas than around children's programmes were for food/drinks. Children's channels broadcast a significantly greater proportion of non-core food advertisements than the family channels. There were significant differences between recording months for the proportion of core/non-core/miscellaneous food advertisements.

CONCLUSIONS

Despite regulation, children in the UK are exposed to more TV advertising for unhealthy than healthy food items, even at peak children's viewing times. There remains scope to strengthen the rules regarding advertising of HFSS foods around programming popular with children and adults alike, where current regulations do not apply. Ongoing, systematic monitoring is essential for evaluation of the effectiveness of regulations designed to reduce children's exposure to HFSS food advertising on television in the UK.