Research Article
Exposure to Child-Directed TV Advertising and Preschoolers’ Intake of Advertised Cereals

https://doi.org/10.1016/j.amepre.2018.09.015Get rights and content

Introduction

Child-directed TV advertising is believed to influence children's diets, yet prospective studies in naturalistic settings are absent. This study examined if child-directed TV advertisement exposure for ten brands of high-sugar breakfast cereals was associated with children's intake of those brands prospectively.

Methods

Observational study of 624 preschool-age children and their parents conducted in New Hampshire, 2014–2015. Over 1 year, parents completed a baseline and six online follow-up surveys, one every 8 weeks. Children's exposure to high-sugar breakfast cereal TV advertisements was based on the network-specific TV programs children watched in the 7 days prior to each follow-up assessment, and parents reported children's intake of each advertised high-sugar breakfast cereal brand during that same 7-day period. Data were analyzed in 2017–2018.

Results

In the fully adjusted Poisson regression model accounting for repeated measures and brand-specific effects, children with high-sugar breakfast cereal advertisement exposure in the past 7 days (i.e., recent exposure; RR=1.34, 95% CI=1.04, 1.72), at any assessment in the past (RR=1.23, 95% CI=1.06, 1.42), or recent and past exposure (RR=1.37, 95% CI=1.15, 1.63) combined had an increased risk of brand-specific high-sugar breakfast cereal intake. Absolute risk difference of children's high-sugar breakfast cereal intake because of high-sugar breakfast cereal TV advertisement exposure varied by brand.

Conclusions

This naturalistic study demonstrates that child-directed high-sugar breakfast cereal TV advertising was prospectively associated with brand-specific high-sugar breakfast cereal intake among preschoolers. Findings indicate that child-directed advertising influences begin earlier and last longer than previously demonstrated, highlighting limitations of current industry guidelines regarding the marketing of high-sugar foods to children under age 6 years.

Section snippets

INTRODUCTION

Ready-to-eat, high-sugar breakfast cereals (SBCs) are heavily advertised on children's TV.1, 2, 3 More than $102 million is spent annually marketing SBCs to children on TV.1 Despite manufacturers’ claims that the nutritional quality of foods advertised to children on TV is high,4 the most frequently advertised SBCs exceed recommended sugar limits and thus fail to meet accepted nutrient standards.2, 3

Child-directed TV advertisements are designed to attract children's attention with animation,

Study Sample

Participants were recruited (March 2014–October 2015) from community-based sites in two cities in New Hampshire, U.S., including pediatric outpatient clinics, federal assistance clinics, child care centers, and community and recreational events. Facebook and participant referrals were also used for recruitment.

Eligibility criteria included children aged 3–5 years, no condition significantly impacting food intake, and living with parent ≥3 days/week or every other week; parent literacy

RESULTS

Mean age of children was 4.3 (SD=0.8) years, 44.7% were male, and 85.3% were white, non-Hispanic. Nearly all (98.4%) participants enrolled at baseline completed one of the six follow-up surveys; 579 (92.8%) completed the final survey. At baseline, 60.4% of children consumed at least one of the ten advertised SBCs. In unadjusted Poisson models (Table 1), any SBC intake over the study was more likely among racial/ethnic minorities and children attending child care/school, and intake was

DISCUSSION

In this observational study of 624 preschool-age children, exposure to child-directed TV advertisements for specific SBC brands was associated with the intake of those brands prospectively over 1 year, independent of sociodemographic and child characteristics. Children with the most sustained advertisement exposure (i.e., recent [within the past week] and past [prior to the past week] combined) were at the greatest risk of any intake and also had a greater mean frequency of intake of advertised

CONCLUSIONS

This study extends previous research by documenting significant, prospective effects of brand-specific SBC TV advertisement exposure on children's SBC intake in a natural setting. Findings provide support for the recommendations of WHO42 and others to restrict child-directed marketing of high-sugar foods, and indicate that stronger restrictions are needed to limit exposure to advertisements for SBCs specifically among children under the age of 6 years.

ACKNOWLEDGMENTS

This study was supported by NIH, grant number R01HD071021.

NIH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Drs. Longacre, Titus, Hendricks, MacKenzie, and Dalton contributed to the conception and design of the study. Drs. Longacre, Titus, Hendricks, Carroll, Cleveland, Langeloh, and Dalton acquired the data. Drs. Emond,

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