Exposure to food advertising on television: Associations with children's fast food and soft drink consumption and obesity

There is insufficient research on the direct effects of food advertising on children's diet and diet-related health, particularly in non-experimental settings. We employ a nationally-representative sample from the Early Childhood Longitudinal Survey–Kindergarten Cohort (ECLS-K) and the Nielsen Company data on spot television advertising of cereals, fast food restaurants and soft drinks to children across the top 55 designated-market areas to estimate the relation between exposure to food advertising on television and children's food consumption and body weight. Our results suggest that soft drink and fast food television advertising is associated with increased consumption of soft drinks and fast food among elementary school children (Grade 5). Exposure to 100 incremental TV ads for sugar-sweetened carbonated soft drinks during 2002–2004 was associated with a 9.4% rise in children's consumption of soft drinks in 2004. The same increase in exposure to fast food advertising was associated with a 1.1% rise in children's consumption of fast food. There was no detectable link between advertising exposure and average body weight, but fast food advertising was significantly associated with body mass index for overweight and obese children (≥85th BMI percentile), revealing detectable effects for a vulnerable group of children. Exposure to advertising for calorie-dense nutrient-poor foods may increase overall consumption of unhealthy food categories.     

Internet marketing directed at children on food and restaurant websites in two policy environments

Objective:

Food and beverage marketing has been associated with childhood obesity yet little research has examined the influence of advertising policy on children's exposure to food/beverage marketing on the Internet. The purpose of this study was to assess the influence of Quebec's Consumer Protection Act and the self‐regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) on food manufacturer and restaurant websites in Canada.

Design and Methods:

A content analysis of 147 French and English language food and restaurant websites was undertaken. The presence of child‐directed content was assessed and an analysis of marketing features, games and activities, child protection features, and the promotion of healthy lifestyle messages was then examined on those sites with child‐directed content.

Results:

There were statistically no fewer French language websites (n = 22) with child‐directed content compared to English language websites (n = 27). There were no statistically significant differences in the number of the various marketing features, or in the average number of marketing features between the English and French websites. There were no fewer CAI websites (n = 14) with child‐directed content compared to non‐CAI websites (n = 13). The CAI sites had more healthy lifestyle messages and child protection features compared to the non‐CAI sites.

Conclusion:

Systematic surveillance of the Consumer Protection Act in Quebec is recommended. In the rest of Canada, the CAI needs to be significantly expanded or replaced by regulatory measures to adequately protect children from the marketing of foods/beverages high in fat, sugar, and sodium on the Internet.     

Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial

Relatively little research has assessed the association between obesogenic behaviors in parents and their children. The objective of the present analysis was to examine cross-sectional associations in television (TV)/video viewing, sugar-sweetened beverage intake, and fast food intake between mothers and their preschool aged children. We studied baseline data among 428 participants in High Five for Kids, a randomized controlled trial of behavior change among overweight and obese children of ages 2-6.9 years. The main exposures were whether mothers viewed TV/videos <1 h/day, drank <1 serving/day of sugar-sweetened beverages, and ate fast food <1 time/week. The main outcomes were whether children met these goals for the same behaviors. Using multivariate logistic regression adjusted for maternal and child characteristics, we estimated odds ratios of children meeting the behavioral goals. The majority of mothers ate fast food <1 time/week (73%) and drank <1 serving/day of sugar-sweetened beverages (73%), while few mothers viewed <1 h/day of TV/videos (31%). Most children met the fast food goal (68%), but not the goals for sugar-sweetened beverages (31%) or TV/video viewing (13%). In adjusted models, the odds ratios for a child meeting the goal were 3.2 (95% confidence interval (CI) 1.7, 6.2) for TV/video viewing, 5.8 (95% CI 2.8, 12.0) for sugar-sweetened beverage intake, and 17.5 (95% CI 9.8, 31.2) for fast food intake if their mothers met the goal for the same behavior. Obesogenic behaviors of mothers and preschool aged children were strongly associated. Our findings lend support to obesity prevention strategies that target parental behavior and the family environment.     

Neighborhood-based tobacco advertising targeting adolescents.

Adolescent tobacco use remains a serious problem, and adolescents may be particularly receptive to the glamorous images tobacco companies use in advertisements. A relatively new form of neighborhood-based outdoor advertising, the illuminated bus-stop-shelter billboard, was studied to determine tobacco companies'' use of this medium. We hypothesized that in 2 distinct San Francisco, California, neighborhoods, 1 predominantly white and the other mostly Latino, we would find a predominance of tobacco advertising on these billboards in both neighborhoods, that tobacco advertisements would be more prevalent in the minority Latino neighborhood, and that tobacco advertising would target adolescents in both neighborhoods. Each bus-stop-shelter billboard advertisement in the study areas from April 1992 to March 1993 was recorded. The type and frequency of products advertised and qualitative content of tobacco advertisements were analyzed. Adolescents'' possible exposure to these advertisements was noted. Our main outcome measures were the percentage of tobacco advertising, possible adolescent exposure to this advertising, and themes of the tobacco advertisements. About 10% of all bus-stop-shelter billboard advertisements in each area promoted tobacco use. Possible exposures to these advertisements were greater in the Latino neighborhood because of a greater adolescent population. Qualitative analyses of tobacco advertisements suggested that adolescents are the primary targets. We urge physicians and educators to explicitly address this form of tobacco advertising, and we urge a ban on neighborhood-based tobacco advertising.     

US ad uses lure of prompt treatment to entice Canadians needing joint replacement.

A Virginia hospital has used newspaper advertisements to solicit Ontario patients who are waiting for hip- or knee-replacement surgery. The ads promote the medical services of US orthopedic surgeons and call attention to exasperatingly long waiting lists for the same surgery in Canada. "Pain doesn''t wait," they state. "Neither should you." The hospital says it has been receiving more than 100 calls a week inquiring about the procedure, which costs $15000 (US).     

Medicine and the Media: Un-health promotion: results of a survey of alcohol promotion on television

To estimate how widely and to whom alcoholic drinks are promoted 1258 television advertisements were studied over a 10 week period that included the Christmas and New Year holidays in 1986-7. A total of 156 advertisements (12%) promoted alcohol, and this percentage increased significantly over the holiday period to 17%. These advertisements were longer than those advertising other products, and just over half (56%) occupied the first position in commercial breaks. During sports programmes and between the hours of 1800 and 1900 there was an increase in the number of advertisements for alcohol, but there was no difference before and after 2100.It was found that the extent and influence of the promotion of alcohol were great and that such advertising is seen by many children and adolescents.     

Alcohol Advertising in Sport and Non-Sport TV in Australia,during Children’s Viewing Times

Estimate the amount of alcohol advertising in sport vs. non-sport programming in Australian free-to-air TV and identify children’s viewing audience composition at different times of the day. Alcohol advertising and TV viewing audience data were purchased for free-to-air sport and non-sport TV in Australia for 2012. We counted alcohol advertisements in sport and non-sport TV in daytime (6am-8.29pm) and evening periods (8.30pm-11.59pm) and estimated viewing audiences for children and young adults (0–4 years, 5–13 years, 14–17 years, 18–29 years). During the daytime, most of the alcohol advertising (87%) was on sport TV. In the evening, most alcohol advertising (86%) was in non-sport TV. There was little difference in the mean number of children (0–17 years) viewing TV in the evening (N = 273,989), compared with the daytime (N = 235,233). In programs containing alcohol advertising, sport TV had a greater mean number of alcohol adverts per hour (mean 1.74, SD = 1.1) than non-sport TV (mean 1.35, SD = .94). Alcohol advertising during the daytime, when large numbers of children are watching TV, is predominantly in free-to-air sport TV. By permitting day-time advertising in sport programs and in any programs from 8.30pm when many children are still watching TV, current regulations are not protecting children from exposure to alcohol advertising.     

Energy‐Dense Snack Food Intake in Adolescence: Longitudinal Relationship to Weight and Fatness

Objective: The longitudinal relationship between the consumption of energy‐dense snack (EDS) foods and relative weight change during adolescence is uncertain. Using data from the Massachusetts Institute of Technology Growth and Development Study, the current analysis was undertaken to examine the longitudinal relationship of EDS food intake with relative weight status and percentage body fat and to examine how EDS food consumption is related to television viewing. Research Methods and Procedures: One hundred ninety‐six nonobese premenarcheal girls 8 to 12 years old were enrolled between 1990 and 1993 and followed until 4 years after menarche. At each annual follow‐up visit, data were collected on percentage body fat (%BF), BMI z score, and dietary intake. Categories of EDS foods considered were baked goods, ice cream, chips, sugar‐sweetened soda, and candy. Results: At study entry, girls had a mean ± SD BMI z score of ?0.27 ± 0.89, consumed 2.3 ± 1.7 servings of EDS foods per day, and consumed 15.7 ± 8.1% of daily calories from EDS foods. Linear mixed effects modeling indicated no relationship between BMI z score or %BF and total EDS food consumption. Soda was the only EDS food that was significantly related to BMI z score over the 10‐year study period, but it was not related to %BF. In addition, a significant, positive relationship was observed between EDS food consumption and television viewing. Discussion: In this cohort of initially nonobese girls, overall EDS food consumption does not seem to influence weight status or fatness change over the adolescent period.     

Parental Weight Status and Girls’ Television Viewing,Snacking, and Body Mass Indexes

Objective: The purpose of this study was to examine whether television viewing (TVV) provides a context for patterns of snacking fostering overweight in young girls from overweight and non‐overweight families. Research Methods and Procedures: Participants were 173 non‐Hispanic white girls and their parents from central Pennsylvania, assessed longitudinally when girls were 5, 7, and 9 years old. Path analysis was used to test patterns of relationships among girls’ TVV, snacking while watching television, snacking frequency, fat intake from energy‐dense snack food, and girls’ increase in body mass index (BMI) from age 5 to 9. Results: In both overweight and non‐overweight families, girls who watched more television consumed more snacks in front of the television. In families where neither parent was overweight, television viewing was the only significant predictor of girls’ increase in BMI. In families where one or both parents were overweight, girls who watched more television snacked more frequently, and girls who snacked more frequently had higher intakes of fat from energy‐dense snacks, which predicted their increase in BMI from age 5 to 9. TVV did not directly predict girls’ increase in BMI in girls from overweight families. Discussion: The results of this study support and extend previous findings that have shown that excessive television viewing and snacking patterns are risk factors for the development of overweight in children; however, patterns of relationships may differ based on parental weight status. For overweight families, TVV may provide a context for excessive snack consumption, in addition to inactivity.     

Health of nations: lessons from Victoria,Australia.

In its white paper The Health of the Nation the government has announced its intention to give more priority to preventive health care. Two examples from Victoria, Australia, show how coordinated legislative and voluntary sector action can have a substantial impact on public behaviour. The introduction and enforcement of strict drink-driving laws and speed limits backed up by forceful television advertisements produced a large reduction in deaths from road traffic accidents, the death rate in relation to the number of vehicles in 1991 being among the lowest in the world. Smoking has also declined in parallel with a phased ban on advertising and use of taxes from tobacco sales to replace tobacco sponsorship of sports and arts and fund health promotion.     

Patterns of Overweight,Inactivity, and Snacking in Chinese Children

Objective: To examine patterns of inactivity and snacking and their relationship with overweight status in Chinese children. Research Methods and Procedures: The study population was drawn from the 1997 China Health National Survey (1385 children, ages 6 to 11 years), conducted with a representative sample from nine provinces. The 2000 Centers for Disease Control and Prevention BMI charts were used to calculate “at risk of overweight” as those above the 85th percentile. Three days of 24‐hour recall dietary data and detailed questions on physical activity and inactivity for the previous 7 days were used. Results: 9.4% of the children were classified as overweight. Weekly mean and range of hours spent watching television/videos, playing video games, studying, and in inactive transport were 5.1 (0 to 35), 0.3 (0 to 10), 4.7 (0 to 60), and 0.14 (0 to 4.2), respectively. Television/video viewing and studying did not differ in any meaningful manner between overweight and normal weight children. Snacking is inconsequential in China, comprising only 0.9% of energy intake. Discussion: Chinese children are less overweight, less inactive, and less likely to ingest calories as snacks than children in the U.S. The absence of impact of these measures of inactivity, which are below an hour per day for the average Chinese child, indicate the possible value of limiting television viewing and other types of inactivity in other countries. Modern Western‐style television programming and advertising started to come to China after 1997; therefore, extensive changes in television viewing patterns are expected to emerge.     

The association of television and video viewing with fast food intake by preschool-age children

Objective: To examine the extent to which television (TV) and video viewing is associated with consumption of fast food by preschool‐age children. Research Methods and Procedures: In a cross‐sectional study of 240 parents of children ages 2.0 to 5.9 years, parents reported the number of hours their child watched TV/videos on an average weekday and weekend day in the past month; a daily, weighted average of TV/video viewing was then calculated. The main outcome was parents’ report of their children's fast food intake, using the question, “How many times a week does your child eat at fast food restaurants such as McDonald's, Burger King, or Kentucky Fried Chicken?” dichotomized to (never/<1 vs. ≥1 time/wk). The association of TV/video viewing with fast food intake was evaluated by multiple logistic regression before and after adjusting for several potential confounders. Results: Twenty‐two percent of parents reported that their child ate at fast food restaurants at least once per week. After adjusting for parents’ age, race/ethnicity, and household income as well as child's age and sex, for each 1‐hour increase of TV/video watched per day, the odds ratio (OR) for consuming fast food ≥1 time per week was 1.60 (95% confidence interval, 1.03 to 2.49). After further adjustment for socio‐environmental factors that might serve as proxies for the availability of healthy food options, such as parental time constraints and the availability and high cost of fresh fruits and vegetables in their neighborhoods, the OR for consuming fast food ≥1 time per week was minimally attenuated (OR, 1.55; 95% confidence interval, 1.04 to 2.31). Discussion: TV/video viewing was correlated with fast food consumption among preschool children in this study. Our findings raise the possibility that greater exposure to TV and videos may influence preschool children's consumption of unhealthful foods.     

Differences in the desire to eat in children and adults in the presence of an obese eater

Previous research has shown that the desire to eat foods decreases in adults in the presence of an obese eater compared to a normal-weight eater. This study investigated whether or not this decrease in eating desire was observed in younger children in the same way as in adults. Children aged 5 and 8 years old, as well as adults, were presented with photographs of liked and disliked foods presented either alone or with normal-weight and obese eaters expressing three different emotions--pleasure, disgust, and neutrality--toward these food products. The results showed that the eater's weight status had a greater effect on the adults' desire to eat than on that of the children. Adults were influenced by the eater's weight status, regardless of the facial expression or the food category. Compared to adults, the impact of the eater's weight status on the children's desire to eat depended on the emotional facial expression and the children's food preferences. Thus, when children did not like the foods, their eating desire was negatively influenced by the eater's obese status, as was that of adults. On the other hand, when children liked the food products, the eater's weight status had no effect on their eating desire. They were more influenced by the eater's facial expressions. Thus, an expression of pleasure increased the desire to eat the liked foods in the younger children, whereas an expression of disgust decreased it. These results are discussed in terms of the high sensitivity of young children to emotional facial expressions.     

When Sex Doesn't Sell: Using Sexualized Images of Women Reduces Support for Ethical Campaigns

Images of scantily clad women are used by advertisers to make products more attractive to men. This “sex sells” approach is increasingly employed to promote ethical causes, most prominently by the animal-rights organization PETA. Yet sexualized images can dehumanize women, leaving an unresolved paradox – is it effective to advertise an ethical cause using unethical means? In Study 1, a sample of Australian male undergraduates (N = 82) viewed PETA advertisements containing either sexualized or non-sexualized images of women. Intentions to support the ethical organization were reduced for those exposed to the sexualized advertising, and this was explained by their dehumanization of the sexualized women, and not by increased arousal. Study 2 used a mixed-gender community sample from the United States (N = 280), replicating this finding and extending it by showing that behaviors helpful to the ethical cause diminished after viewing the sexualized advertisements, which was again mediated by the dehumanization of the women depicted. Alternative explanations relating to the reduced credibility of the sexualized women and their objectification were not supported. When promoting ethical causes, organizations may benefit from using advertising strategies that do not dehumanize women.     

Regulatory Agencies and Food Safety

Prior to Confederation, food control legislation in Canada consisted of only a few simple laws governing the quality, grading, packing and inspection of certain staple foods. The Inland Revenue Act of 1875 provided the first real control in Canada over adulteration of liquor, foods and drugs. Since then, food legislation has evolved in scope and complexity as the industries involved have developed, as consumers have become better informed, and as scientific advances have provided a sound basis for regulations. Present regulations under the Food and Drugs Act are intended to give consumers broad protection against health hazards and fraud in the production, manufacture, labelling, packaging, advertising, and sale of foods. This principle is well illustrated by present requirements for the control of pesticide residues, chemical additives, and the addition of vitamins to foods. In today''s era of rapid technological change, application of current scientific knowledge to the food industry obviously involves the possibility of hazards to health. Regulatory agencies with responsibility for food safety must, therefore, fully utilize scientific knowledge in order to reduce the risks involved to a minimum.     

Systematic review of effective strategies for reducing screen time among young children

Screen-media use among young children is highly prevalent, disproportionately high among children from lower-income families and racial/ethnic minorities, and may have adverse effects on obesity risk. Few systematic reviews have examined early intervention strategies to limit TV or total screen time; none have examined strategies to discourage parents from putting TVs in their children's bedrooms or remove TVs if they are already there. In order to identify strategies to reduce TV viewing or total screen time among children <12 years of age, we conducted a systematic review of seven electronic databases to June 2011, using the terms "intervention" and "television," "media," or "screen time." Peer-reviewed intervention studies that reported frequencies of TV viewing or screen-media use in children under age 12 were eligible for inclusion. We identified 144 studies; 47 met our inclusion criteria. Twenty-nine achieved significant reductions in TV viewing or screen-media use. Studies utilizing electronic TV monitoring devices, contingent feedback systems, and clinic-based counseling were most effective. While studies have reduced screen-media use in children, there are several research gaps, including a relative paucity of studies targeting young children (n = 13) or minorities (n = 14), limited long-term (>6 month) follow-up data (n = 5), and few (n = 4) targeting removing TVs from children's bedrooms. Attention to these issues may help increase the effectiveness of existing strategies for screen time reduction and extend them to different populations.