Autism in children

The Impact of TV Advertisements on Elementary School Children's Food Behaviors

I. Introduction

a. Motivation to study this topic

• Estimates suggest 37 percent of all school-age children are overweight or obese

(Harris, et al.)

• Longitudinal studies support television screen time is directly related to increased risk

for children being overweight or obese (Robinson, et al.)

• Unhealthy food advertising comprises a majority of television food advertisements

(Story, et al.)

• Review of current literature can provide an opportunity to better understand the

relationship between food television advertisements and obesity risks in elementary

school children to guide public health policies

b. Objectives

• To determine the public health implication of TV advertisements on elementary

school-age children’s food consumption behaviors

c. Organizational overview of paper

• Review of the current literature regarding television advertising and its effect on

children’s attitudes and behaviors regarding food consumption and its relationship to

obesity risk

• Review of five primary research articles concerning the subject of television

advertising and child food consumption effects

• Presentation of the results of the five primary research articles reviewed

• Discussion of results, noted gaps and limitations, and conclusions drawn from

Evidence

II. Literature Review

a. Background information on topic

• Childhood obesity represents a persistent public health crisis in the U.S. affecting

more than a third of elementary school-age children

• Causes of childhood obesity are multifactorial and involve physical activity

behaviors, food consumption behaviors, nutritional knowledge, parental and peer

influences, food access, and genetics

Excessive television viewing has been identified as a risk for child obesity both due to

its association with sedentary activity as well as food consumption behaviors

• Television food advertisements have been shown to affect food consumption attitudes

and behaviors

• Public health recommendations concerning television food advertising have not been

adequately defined to guide clear public policies

b. Specific information to assist the reader’s understanding

• Television food advertising includes ads promoting unhealthy foods, healthy foods,

and food education

• Potential impacts of television food advertising on children include effects on

nutritional knowledge, attitudes about food types, and food consumption behaviors

c. Key terms

• Body mass index is a measure of calculation based on height and weight used to

assess obesity

• Overweight children are defined as having a BMI greater than 25 kg/m2

• Obese children are defined as having a BMI greater than 30 kg/m2

III. Analysis Approach

· Description of search methodologies, search databases, inclusion criteria, exclusion

· criteria, and key words to be described.

a. Harris, et al.

• AIM: To assess the effect that watching food ads versus non-food ads had on

children’s eating behaviors while watching television

• SUBJECTS: A total of 118 children, ages 7-11 years, were randomized to an

experimental group and a control group

• METHODS: Children were randomized to an intervention group that watched a 14-

minute cartoon with food ads while the other control group watched a similar length

cartoon with non-food ads. Both groups were provided snacks and water for

consumption if they chose. Measures of snack consumption were assessed using

ANOVA statistical analysis.

• RESEARCH TYPE: Randomized controlled trial

b. Dixon, et al.

• AIM: To assess the impact of television viewing of various television ads on

children’s knowledge, attitudes, and behaviors concerning healthy and unhealthy

foods

• SUBJECTS: A total of 919 5th and 6th graders in Australia sampled by survey and

enrolled in experimental trial involving 3 treatment groups and one control group

• METHODS: Pre-test survey regarding television viewing habits and eating attitudes

and behavior was collected a week before the experiment. Children were then

randomized into one of four groups: (1) junk food ads, (2) junk food and healthy food

ads, (3) healthy food ads, and (4) no food ads (control). Pretest responses and posttest responses were analyzed by AONVA statistics to determine variations in

responses based on existing knowledge and behaviors and the interventions

• RESEARCH TYPE: Cross-sectional survey and randomized controlled trial

c. Andreyeva, et al.

• AIM: To assess the impact of watching television ads promoting soft drinks, fast

food, and cereals on consumption of these food types in elementary school-age

children

• SUBJECTS: Large cross-sectional survey of 55 consumer markets involving

thousands of children in elementary school grades collected from the Early Childhood

Longitudinal Survey

• METHODS: Data from the ECLS was compared to Neilson Company data regarding

television viewing habits matched with television content involving ads related to fast

food, cereals and soft drinks. This data was then compared to body weight and food

consumption behaviors identified in the cross-sectional survey. Statistical analysis

using ANOVA was used to determine significance.

• RESEARCH TYPE: Cross-sectional surveys

d. Hanks, et al.

• AIM: To determine the impact of healthy food advertisements on healthy food

choices and behaviors among elementary school-age children

• SUBJECTS: Ten elementary schools participated in this experiment involving over

22,000 elementary school-age children.

• METHODS: Schools were divided into three groups with one displaying a banner

along its salad bar depicting vegetable cartoon characters. The second group provided

students with a short segment health education cartoon featuring vegetable characters.

The third group received both of the above interventions. Pre-intervention food

behaviors and post-intervention food behaviors were assessed and compared by

statistical analysis.

• RESEARCH TYPE: Pre-test, post-test research design with multiple interventions

e. Halford, et al.

• AIM: To determine if food ads increase food consumption behaviors in elementary

children

• SUBJECTS: A total of 42 children ages 9-11 years from Liverpool were recruited and

divided into three groups based on body mass index: lean, overweight, and obese.

• METHODS: Pre-experimental questionnaires were administered to determine food

consumption and television viewing patterns. Half of the participants watched cartoon

followed by 8 food ads while the other half were watched the same cartoon and 8

non-food ads. Participants were then assessed in a post-test format to determine

which ads they recalled watching. The participants were then invited back and

performed the same experiment but switched the ad content. Data was then collected

from all students and compared based on body weight and ad recognition.

• RESEARCH TYPE: Observational, crossover design

IV. Results

a. Harris, et al.

• Children watching food ads consumed 45 percent more than those viewing nonfood ads. The children’s consumption behavioral changes were not related to

hunger. The authors concluded that food ads prime automated eating behaviors in

children and are unrelated to food brand being advertised.

b. Dixon, et al.

• Findings showed that increased television use and increased exposure to

television ds promoting junk foods were associated with a more positive attitude

about junk foods. Likewise, increased television use alone was linked to increased

junk food consumption. However, ads for healthy foods also increased attitudes

and beliefs for healthy foods. The authors concluded that varying television ad

content could be an effective way to promote healthy food attitudes and behaviors

in children and reduce junk food preferences.

c. Andreyeva, et al.

• Results demonstrated that for every 100 soft drink ads watched, consumption of

soft drinks increased by 9.4 percent. For every 100 fast food ads seen,

consumption increased 1.1 percent. No correlation existed between ad exposure

and overall body weight, but fast food ads were more commonly viewed in

children with BMI meeting overweight criteria. The authors concluded that

unhealth food ad viewing increasing consumption of unhealthy foods, and this

consumption is junk food group specific to an extent.

d. Hanks, et al.

• The researchers found that children exposed to the vegetable cartoon banners

increased vegetable food consumption by 90.5 percent. They also found that

children exposed to both interventions (group 3) increased vegetable consumption

by 239.2 percent. They concluded that healthy food ads involving age-appropriate

content was effective in improving healthy vegetable consumption in elementary

school0age children.

e. Halford, et al.

• Results of the final analysis showed that the obese group of children recognized

more of the food ads than lean children. Likewise, those children who recognized

food ads had higher food consumption behaviors. Finally, all groups increased

food consumption after seeing the food ads. The authors concluded that exposure

to food ads cues food intake behaviors, and also that some children have a

heightened alertness to these ads.

V. Discussion

a. Heading for discussion

• Relationship between television food advertisements and food consumption in

elementary school children

b. Gaps in the research reviewed

• Each of the five articles examined the relationship between food ads on television

and children’s attitudes and behaviors regarding food consumption. However,

variations exist regarding experimental designs, ad content, measures of

children’s behaviors and attitudes, and duration of interventions. Gaps therefore

exist regarding the degree of influence these ads have on children’s food

consumption behaviors.

c. Overall strengths and weaknesses of the research articles

• Of the five research experiments, strengths included large participant numbers,

sound experimental methodologies, positive associations in each between

television ad viewing and changes in food consumption behaviors, and detailed

statistical analyses

• Weaknesses of the studies demonstrated significant variance in measures in

assessing food consumption and attitude among participants, variations in the

content of television ads seen, and variations in the duration of the interventions

d. Needed future work in the field

• Greater consistency in metrics used to assess children’s attitudes and behaviors

regarding food consumption is needed

• Longer duration studies to assess long-term impacts of television ad changes would

be beneficial

• Additional studies to assess the impact of healthy food ads versus the impact of

unhealthy food ads would help identify weighted effects of each

• Studies are needed to better define the role television ads can serve in relation to other

anti-obesity interventions including cost assessments

VI. Conclusions

a. Summary of objectives and approach of this paper

• The review explored the effect that television advertisements have on food

consumption attitudes and behaviors among elementary school children by examining

five primary research studies

b. Major findings of this paper

• The research shows that television ads clearly affect children’s food consumption

attitudes and behaviors in both positive and negative ways and can serve as a strategy

to guide healthier behaviors. However, the degree of impact this has in reducing

overall obesity among children is not well defined

c. Important implications of this paper’s findings

• Further studies are needed to better define the role that food advertisement policies

may play in reducing childhood obesity among elementary school children. The

positive correlations noted in these five research studies support further investigation

into how such policies may be implemented and how their effect measured

d. Recommendations based upon the review of these 5 research articles

• The evidence supports practices among educators and parents to limit exposure to

unhealthy food television advertisements among elementary school children while

encouraging exposure to healthy food ads and those providing nutritional education.

Policymakers may also consider public health policies to place restrictions on

unhealthy food ads, but further evidence is likely needed before the public is

convinced of these approaches. Researchers, as such, should further explore the

degree of impact these policies could have by assessing effects over longer periods of

time and in combination with other interventions.

References

Harris, JL, Bargh, JA, & Brownell, KD. (2009). Priming effects of television food advertising on

eating behavior. Health Psychol. 2009; 28(4): 404-413. doi.org/10.1037/a0014399

Dixon HG, Scully ML, Wakefield MA, & White VM, Crawford DA. The effects of television

advertisements for junk food versus nutritious food on children's food attitudes and

preferences. Soc Sci Med. 2007; 65(7): 1311-23.

doi.org/10.1016/j.socscimed.2007.05.011

Andreyeva T, Kelly IR, & Harris JL. Exposure to food advertising on television: associations

with children's fast food and soft drink consumption and obesity. Econ Hum Biol. 2011;

9(3): 221-33. doi.org/10.1016/j.ehb.2011.02.004

Hanks AS, Just DR, & Brumberg A. Marketing vegetables in elementary school cafeterias to

increase uptake. Pediatrics. 2016; 138(2): e20151720. doi.org/10.1542/peds.2015-1720

Halford JC, Gillespie J, Brown V, Pontin EE, & Dovey TM. Effect of television advertisements

for foods on food consumption in children. Appetite. 2004; 42(2): 221-5.

doi:10.1016/j.appet.2003.11.006

Robinson TN, Banda JA, Hale L, Lu AS, Fleming-Milici F, Calvert SL, & Wartella E. Screen

media exposure and obesity in children and adolescents. Pediatrics. 2017;

140(Supplement 2): S97-101. doi:10.1542/peds.2016-1758K

Story M, & French S. Food advertising and marketing directed at children and adolescents in the

US. Int J Behav Nutri Phy. 2004; 1(1): 3. doi.org/10.1186/1479-5868-1-3