Food ads on TV: a health hazard for children?

Utilising Media and Text-Based Sources

An often-underestimated, valuable source of naturally occurring data is that of media sources, such as television programmes, documentaries, newspapers, and magazines. Often in traditional textbooks these are positioned as secondary sources. We argue that they can be considered primary data, as well as naturally occurring data. This type of naturally occurring data is of interest for qualitative research, and in this chapter, we focus on the use of policy documents, medical notes, health guidelines, as well as other data sources such as police transcripts, court transcripts, and social care reports whereby health is invoked, to illustrate the value of analysing texts that occur naturally in the field of health.

Unhealthy food advertising directed to children on New Zealand television: extent, nature, impact and policy implications

Objective

To comprehensively assess the extent, nature and impact of unhealthy food advertising targeted to children on New Zealand television.

Design

Four weekdays and four weekend days were randomly selected over the period June–August 2015. Programming was recorded from 06.00 to 00.00 hours (midnight), for a total of 432 h. Audience ratings were used to identify children’s peak viewing times.

Setting

New Zealand.

Subjects

The three major free-to-air channels.

Results

The majority of foods advertised (n 1807) were unhealthy; 68·5 % of food advertisements included at least one food not permitted to be marketed to children according to the WHO nutrient profiling model. The mean hourly rate of unhealthy food advertising was 9·1 (sd 5·2). One-third of unhealthy food advertisements included a promotional character and one-third a premium offer. About 88 % of unhealthy food advertisements were shown during children’s peak viewing times. If unhealthy food advertisements were to be restricted during times when at least 25 % of children are watching television, this would reduce the average unhealthy food advertising impact by 24 % during weekdays and 50 % during weekend days, and if the WHO instead of the current nutrient profiling model were used to restrict unhealthy food advertising to children, the average impact would be reduced by 24 % during weekdays and 29 % during weekend days.

Conclusions

Current self-regulation is ineffective in protecting children from exposure to unhealthy food advertising on television. The WHO nutrient profiling model needs to be used to restrict unhealthy food advertising, especially during children’s peak viewing times.

Assessment of food habits in children aged 6-12 years and the risk of caries

Food is necessary for the proper growth and development of children. The excessive intake of low-molecular carbohydrates constitutes a serious health issue, which has an unfavourable impact on the dental health status. The aim of this study was to assess the food habits in healthy children aged 6–12 years and the effect on their oral risk profile. The study included 100 children. The assessment of their nutrition was done with the help of a seven-day reproduction of the food intake and a survey used to determine their underlying food habits and preferences. The results revealed unbalanced nutrition of the children and increased intake of simple sugar, which will increase the risk of development of dental caries. The observed high levels of DMFT (number of decayed, missing and filled teeth) in 54% of the children is a logical result of the frequent intake of sugary foods and beverages for a long period of time, as this will increase the acid production by microorganisms in dental plaque, which is one of the leading etiologic factors for the development of caries. It is necessary for dentists to administer control over the carbohydrate intake and the food habits of children, as well as to encourage non-cariogenic diet in order to keep their good oral health.

Gender perspectives on adolescent eating behaviors: a study on the eating attitudes and behaviors of junior secondary students in Hong Kong

OBJECTIVE

This research aimed to investigate the eating attitudes and behaviors of junior secondary students in Hong Kong, with a specific focus on possible gender differences.

DESIGN

A survey was conducted in 2005 to solicit data about participants' food knowledge, eating attitudes and behavior, perceptions of cooking skills and body weight, and related factors influencing food choice.

SETTING

Twenty-three secondary schools located in different district areas of Hong Kong.

PARTICIPANTS

The sample was composed of 836 students (41% male, 59% female) aged 11-18 years selected by random sampling.

ANALYSIS

Cross-tabulation analyses were used to compare the responses by gender.

RESULTS

Regardless of gender, less than half of the sample ate breakfast every day, and their consumption of fruits and vegetables was below recommended daily intakes. No significant differences were observed between respondents' eating habits and levels of food knowledge.Female students were more weight conscious than male students. Dissatisfaction about body weight was common among normal and underweight students. Cooking skills were generally valued as important life skills by both genders, though cooking skills were seen to be more relevant for girls.

CONCLUSIONS AND IMPLICATIONS

School nutrition education in Hong Kong should be designed to appeal to boys as well as girls, and effective implementation of nutrition education programs should inculcate healthful eating habits and sound cooking skills and address the needs of students with reference to gender differences. A more diversified approach could be employed through formal and informal curricula, prioritizing cooking skills and food advertising literacy in the curriculum.

Identifying 'unhealthy' food advertising on television: a case study applying the UK Nutrient Profile model

OBJECTIVES

To evaluate the feasibility of the UK Nutrient Profile (NP) model for identifying 'unhealthy' food advertisements using a case study of New Zealand television advertisements.

DESIGN

Four weeks of weekday television from 15.30 hours to 18.30 hours was videotaped from a state-owned (free-to-air) television channel popular with children. Food advertisements were identified and their nutritional information collected in accordance with the requirements of the NP model. Nutrient information was obtained from a variety of sources including food labels, company websites and a national nutritional database.

RESULTS

From the 60 h sample of weekday afternoon television, there were 1893 advertisements, of which 483 were for food products or retailers. After applying the NP model, 66 % of these were classified as advertising high-fat, high-salt and high-sugar (HFSS) foods; 28 % were classified as advertising non-HFSS foods; and the remaining 2 % were unclassifiable. More than half (53 %) of the HFSS food advertisements were for 'mixed meal' items promoted by major fast-food franchises. The advertising of non-HFSS food was sparse, covering a narrow range of food groups, with no advertisements for fresh fruit or vegetables.

CONCLUSIONS

Despite the NP model having some design limitations in classifying real-world televised food advertisements, it was easily applied to this sample and could clearly identify HFSS products. Policy makers who do not wish to completely restrict food advertising to children outright should consider using this NP model for regulating food advertising.

Gross for kids but good for parents: differing messages in advertisements for the same products

Objectives

There has been surprisingly little research into the effects of food advertising on parents’ perception of commonly consumed children’s food items, although the available research suggests that parents may find nutritional claims in these advertisements confusing. The purpose of the present study was to investigate parents’ perceptions of branded snack foods targeted at children, and the extent to which these perceptions are influenced by advertising messages.

Design

Using an intercept survey, participants were shown either adult-targeted or child-targeted advertisements for the same food products.

Setting

Central business district of a major Australian city.

Subjects

One hundred adults, mean age 40 years.

Results

The study results suggest that: (1) adults’ perceptions of advertised food products and, most importantly, purchase intentions for those products differ according to the version of the advertisement seen (for three of the products, 42–54% would buy the product after seeing the child version compared with 82–84% after seeing the adult version); and (2) adults clearly perceive distinctly different messages in advertisements for the same products which are targeting parents vs. those targeting children (e.g. for three of the products, 74–92% perceived that the adult version of the advertisement suggested the food was nutritionally beneficial compared with 2–14% perceiving this for the child version).

Conclusions

It is clear that the messages conveyed to children about specific foods are quite different to the messages conveyed to adults – and importantly parents – about the same foods.

Internet food marketing on popular children's websites and food product websites in Australia

OBJECTIVE

The aim of the present study was to describe the nature and extent of food marketing on popular children's websites and food product websites in Australia.

METHODS

Food product websites (n 119) and popular children's websites (n 196) were selected based on website traffic data and previous research on frequently marketed food brands. Coding instruments were developed to capture food marketing techniques. All references to food on popular children's websites were also classified as either branded or non-branded and according to food categories.

RESULTS

Websites contained a range of marketing features. On food product websites these marketing features included branded education (79.0% of websites), competitions (33.6%), promotional characters (35.3%), downloadable items (35.3%), branded games (28.6%) and designated children's sections (21.8%). Food references on popular children's websites were strongly skewed towards unhealthy foods (60.8% v. 39.2% healthy food references; P<0.001), with three times more branded food references for unhealthy foods. Branded food references displayed similar marketing features to those identified on food product websites.

CONCLUSIONS

Internet food marketing uses a range of techniques to ensure that children are immersed in brand-related information and activities for extended periods, thereby increasing brand familiarity and exposure. The relatively unregulated marketing environment and increasing use of the Internet by children point to the potential increase in food marketing via this medium. Further research is required to investigate the impact of Internet food marketing on children's food preferences and consumption, and regulatory options to protect children.

The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences

Television (TV) food advertising has attracted criticism for its potential role in promoting unhealthy dietary practices among children. Content analyses indicate junk food advertising is prevalent on Australian children's TV; healthy eating is rarely promoted. This paper presents (a) a cross-sectional survey examining associations between children's regular TV viewing habits and their food-related attitudes and behaviour; and (b) an experiment assessing the impact of varying combinations of TV advertisements (ads) for unhealthy and healthy foods on children's dietary knowledge, attitudes and intentions. The experimental conditions simulated possible models for regulating food ads on children's TV. Participants were 919 grade five and six students from schools in Melbourne, Australia. The survey showed that heavier TV use and more frequent commercial TV viewing were independently associated with more positive attitudes toward junk food; heavier TV use was also independently associated with higher reported junk food consumption. The experiment found that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. Findings are discussed in light of methodological issues in media effects research and their implications for policy and practice. It is concluded that changing the food advertising environment on children's TV to one where nutritious foods are promoted and junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.

Changes in consumption of sugars by English adolescents over 20 years

OBJECTIVE

Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16-17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods.

DESIGN

A repeat cross-sectional dietary survey of children aged 1-12 years attending the same schools as in the 1980 and 1990 surveys.

SETTING

Seven middle schools in south Northumberland.

SUBJECTS

All children aged 11-12 years old attending the seven schools.

METHOD

Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods.

RESULTS

The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; approximately 60-70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day(-1), and from breakfast cereals increased from 2 to 7 g day(-1) over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat-starch see-saw, without an adverse effect on sugars intake.

CONCLUSIONS

Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.

Associations between television viewing and consumption of commonly advertised foods among New Zealand children and young adolescents

OBJECTIVES

To explore how time spent watching television (TV) is associated with the dietary behaviours of New Zealand children and young adolescents.

DESIGN

Secondary data analysis of a nationally representative, cross-sectional survey.

SETTING

In homes or schools of New Zealand school students.

PARTICIPANTS

In total, 3275 children aged 5 to 14 years.

RESULTS

The odds of being overweight or obese increased with duration of TV viewing for children and adolescents when controlling for age, sex, ethnicity, socio-economic status and physical activity. Children and adolescents who watched the most TV were significantly more likely to be higher consumers of foods most commonly advertised on TV: soft drinks and fruit drinks, some sweets and snacks, and some fast foods. Both children and adolescents watching two or more hours of TV a day were more than twice as likely to drink soft drinks five times a week or more (P = 0.03 and P = 0.04, respectively), eat hamburgers at least once a week (both P = 0.02), and eat French fries at least once a week (both P < 0.01).

CONCLUSIONS

These findings suggest that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents. Efforts to curtail the amount of time children spend watching TV may result in better dietary habits and weight control for children and adolescents. Future studies examining the impact of advertising on children's diets through interventions and international comparisons of legislation would provide more definitive evidence of the role of advertising in child and adolescent obesity.

The effects of television food advertisement on children's food purchasing requests

BACKGROUND

Children's eating habits and their food consumption have direct relations with obesity, diabetes, cancers, hypertension and coronary heart disease. Television advertisements directly affect children's eating habits and their food consumption. This study was conducted in order to examine television advertisements and children's food consumption while watching television and their desire to purchase goods that they see on television advertisements.

METHODS

In the first stage of the study, content analysis of the television advertisements was conducted. In the second stage of the study, a questionnaire (check list) was developed in order to examine children's food consumption while watching television and their purchasing requests while shopping in the supermarket. It was given to 347 mothers who have children aged between 3 and 8 years.

RESULTS

When the results of the study were examined it was found that the time devoted to children's programs was approximately 121 min and the advertisements during this period were approximately 35 min. A total of 344 of the 775 television advertisements shown were related to food. It was also found that most of the food advertisements were about candy/chocolate, chips, milk and milk products such as cheese, yoghurt, and breakfast cereals. The results also revealed that 89.6% of the children either drank or ate something while watching television and the food they consumed most while watching television were fruits, soft drinks, popcorn/nuts, cake, chips and candy/chocolate. The results also revealed that 40.3% of the children asked their parents to purchase the goods that they saw on the television advertisements and that 8.9% of them argued with their parents and/or cried in order for their parents to buy that particular product. It was found that the children tended to request more sweetened products such as candy, ice-cream, biscuit, cake or soft drinks.

CONCLUSION

More than half of the food presented in television advertisements were rich in fat and sugar. Children ask their parents to buy the goods they see on television advertisements both while watching television and while shopping. Television advertisements especially affect young children's unhealthy food consumption.

Portrayals of branded soft drinks in popular American movies: a content analysis

Background

This study examines the portrayals of soft drinks in popular American movies as a potential vehicle for global marketing and an indicator of covert product placement.

Methods

We conducted a content analysis of America's top-ten grossing films from 1991 through 2000 that included portrayals of beverages (95 movies total). Coding reliabilities were assessed with Cohen's kappa, and exceeded 0.80. If there was at least one instance of branding for a beverage, the film was considered having branded beverages. Fisher's exact test was used to determine if soft drink portrayals were related to audience rating or genre. Data on the amount of time soft drinks appeared onscreen was log transformed to satisfy the assumption of normality, and analyzed using a repeated measures ANOVA model. McNemar's test of agreement was used to test whether branded soft drinks are as likely to appear or to be actor-endorsed compared to other branded beverages.

Results

Rating was not associated with portrayals of branded soft drinks, but comedies were most likely to include a branded soft drink (p = 0.0136). Branded soft drinks appeared more commonly than other branded non-alcoholic beverages (p = 0.0001), branded beer (p = 0.0004), and other branded alcoholic beverages (p = 0.0006). Actors consumed branded soft drinks in five times the number of movies compared to their consumption of other branded non-alcoholic beverages (p = 0.0126). About half the revenue from the films with portrayals of branded soft drinks come from film sales outside the U.S.

Conclusion

The frequent appearance of branded soft drinks provides indirect evidence that product placement is a common practice for American-produced films shown in the U.S. and other countries.

Marketing fat and sugar to children on New Zealand television

BACKGROUND

We aimed to determine the frequency and content of television food advertisements during children's viewing times on various New Zealand television channels.

METHODS

A content analysis was conducted of two free-to-air channels covering a total of 155 h of television time during children's viewing times (n = 858 food advertisements in 2005). Comparisons were made with data from 1997 and data from Australia.

RESULTS

Compared to Australian channels, both New Zealand channels (TV3 and TV2) had significantly higher proportions of food advertisements that were classified as being "high in fat and/or sugar" (54% versus 80% and 69%, respectively). Using a more detailed classification system, 70.3% of food advertisements on the New Zealand channels were for foods "counter to improved nutrition" (95% CI: 67.1%, 73.3%) compared to those "favoring improved nutrition" at 5.1% (95% CI: 3.8%, 6.9%). The number of food advertisements per hour was higher in 2005 than in 1997 for the channel (TV2) for which there was time trend data (12.8 versus 8.0 per hour for the afternoon time slot).

CONCLUSIONS

These findings provide further evidence that the majority of food advertising on New Zealand television is counter to nutritional guidelines. They suggest the need for further regulatory or other controls.

Food advertising on Australian television: the extent of children's exposure

The objective of this study was to investigate the extent and nature of food advertising during Australian children's television (TV) viewing hours and programs, and to determine whether confectionery and fast food restaurant advertisements were more likely to be broadcast during children's programs than during adults' programs on Sydney television stations. One week (390 h) of Australian advertising data broadcast during children's TV viewing hours over 15 television stations were analysed to determine the proportion of food advertisements and, in turn, the proportion of those advertisements promoting foods high in fat and/or sugar. One week (346 h) of confectionery and fast food restaurant advertisements broadcast over three Sydney television stations were analysed to determine whether these types of advertisements were more likely to be advertised during children's programs than adults' programs. Half of all food advertisements promoted foods high in fat and/or sugar. 'Confectionery' and 'fast food restaurants' were the most advertised food categories during children's TV viewing hours. Confectionery advertisements were three times as likely, and fast food restaurant advertisements twice as likely, to be broadcast during children's programs than adults' programs. It can be concluded that foods most advertised during children's viewing hours are not those foods that contribute to a healthy diet for children. Confectionery and fast food restaurant advertising appears to target children. Australian children need protection from the targeted promotion of unhealthy foods on television, but currently little exists.

Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study

BACKGROUND

Watching television in childhood and adolescence has been linked to adverse health indicators including obesity, poor fitness, smoking, and raised cholesterol. However, there have been no longitudinal studies of childhood viewing and adult health. We explored these associations in a birth cohort followed up to age 26 years.

METHODS

We assessed approximately 1000 unselected individuals born in Dunedin, New Zealand, in 1972-73 at regular intervals up to age 26 years. We used regression analysis to investigate the associations between earlier television viewing and body-mass index, cardiorespiratory fitness (maximum aerobic power assessed by a submaximal cycling test), serum cholesterol, smoking status, and blood pressure at age 26 years.

FINDINGS

Average weeknight viewing between ages 5 and 15 years was associated with higher body-mass indices (p=0.0013), lower cardiorespiratory fitness (p=0.0003), increased cigarette smoking (p<0.0001), and raised serum cholesterol (p=0.0037). Childhood and adolescent viewing had no significant association with blood pressure. These associations persisted after adjustment for potential confounding factors such as childhood socioeconomic status, body-mass index at age 5 years, parental body-mass index, parental smoking, and physical activity at age 15 years. In 26-year-olds, population-attributable fractions indicate that 17% of overweight, 15% of raised serum cholesterol, 17% of smoking, and 15% of poor fitness can be attributed to watching television for more than 2 h a day during childhood and adolescence.

INTERPRETATION

Television viewing in childhood and adolescence is associated with overweight, poor fitness, smoking, and raised cholesterol in adulthood. Excessive viewing might have long-lasting adverse effects on health.

Poverty and obesity: the role of energy density and energy costs

Many health disparities in the United States are linked to inequalities in education and income. This review focuses on the relation between obesity and diet quality, dietary energy density, and energy costs. Evidence is provided to support the following points. First, the highest rates of obesity occur among population groups with the highest poverty rates and the least education. Second, there is an inverse relation between energy density (MJ/kg) and energy cost (US dollars/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer. Third, the high energy density and palatability of sweets and fats are associated with higher energy intakes, at least in clinical and laboratory studies. Fourth, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets. A reduction in diet costs in linear programming models leads to high-fat, energy-dense diets that are similar in composition to those consumed by low-income groups. Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high palatability of sugar and fat. This economic framework provides an explanation for the observed links between socioeconomic variables and obesity when taste, dietary energy density, and diet costs are used as intervening variables. More and more Americans are becoming overweight and obese while consuming more added sugars and fats and spending a lower percentage of their disposable income on food.

Snowballing obesity: Australians will get run over if they just sit there

Overweight and obesity are very common in Australian adults (56%) and children (27%). Rates of overweight and obesity are snowballing and will place greater burdens on health services for the treatment and care of chronic diseases. Prevention is urgently required from health, social and economic perspectives, but the response to date has been inadequate. A long-term, sustained action plan starting with a focus on young people is needed. This should particularly address the "obesogenic" environments causing the epidemic. Although whole-of-government action is required, support from and involvement by parents, carers, community leaders, healthcare professionals, teachers, childcare workers, urban planners, recreation managers, food manufacturers, employers, advertisers, and communicators is essential. The health sector should take the lead, but success will only come from concerted and integrated action across the whole of society. There are now signs of political commitment to addressing overweight and obesity. Doctors should get behind this and help mobilise community support.

Couch potatoes or french fries: are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents?

OBJECTIVE

To describe the demographic characteristics of adolescent boys and girls who engage in three sedentary behaviors (television/video use, computer use, and reading/homework), and to explore how each sedentary activity is associated with body mass index (BMI), dietary behaviors, and leisure time physical activity.

DESIGN

This study draws on data collected from Project EAT (Eating Among Teens), a school-based survey examining personal, behavioral, and socioenvironmental factors that are associated with nutritional intake among adolescents.

SUBJECTS

The study sample consists of 4746 middle and high school students from 31 public schools in a metropolitan area of the upper Midwest. All students were invited to participate. The overall response rate for Project EAT was 81.5%. Data collection was completed during the 1998-1999 school year.

STATISTICAL ANALYSIS

Multivariate linear regression was used for examining associations between independent and dependent variables, controlling for age, race/ethnicity, and socioeconomic status. All differences were considered statistically significant at P<.05.

RESULTS

Among boys, television/video use and time spent reading/doing homework were positively associated with BMI (P<.05), whereas for girls television/video and computer use were positively associated with BMI (P<.05). High television/video use among boys and girls was associated with more unhealthful dietary behaviors (eg, increased consumption of soft drinks, fried foods, and snacks) (P<.05). In contrast, time spent reading/doing homework was associated with more healthful dietary behaviors (eg, increased consumption of fruits and vegetables) (P<.05). Leisure time physical activity was not associated with television/video use among boys or girls, but was positively associated with computer use and time spent reading/doing homework (P<.05). Applications/Conclusions Messages and advice aimed at reducing time spent in sedentary activities should be targeted at television/video use instead of time spent reading, doing homework, or using a computer. Nutrition education should incorporate messages about the influence of the media and advertising on dietary behaviors.

Preventive strategies against weight gain and obesity

A well-resourced, comprehensive, population-based set of strategies is needed to attenuate and eventually reverse the current trends of increasing obesity prevalence now apparent in most countries. The Epidemiological Triad (host, vector, environment) has proven to be a robust model for other epidemics and is applied to obesity. Host-based strategies are primarily educational and these tend to be most effective among people with higher incomes and higher educational attainment. The main vectors for a high-energy intake are energy-dense foods and drinks and large portion sizes and, for low energy expenditure, machines that promote physical inactivity. Vector-based strategies that alter food formulation can have a significant impact, particularly through influencing common, high-volume foods. The increasingly 'obesogenic' environments are probably the main driving forces for the obesity epidemic. There are many environmental strategies that can influence the physical, economic, policy or socio-cultural environments, but the evidence base for these potentially powerful interventions is small. Children should be the priority population for interventions, and improving the general socio-economic conditions for disadvantaged, marginalized or poor population sectors is also a central strategy for obesity prevention. The key settings for interventions are schools, homes, neighbourhoods, primary health care services and communities. The key macroenvironments for interventions are the transport and infrastructure sector, the media and the food sector.