Kathy Chapman

Television Food Advertising to Children: A Global Perspective

OBJECTIVES We compared television food advertising to children in several countries. METHODS We undertook a collaboration among 13 research groups in Australia, Asia, Western Europe, and North and South America. Each group recorded programming for 2 weekdays and 2 weekend days between 6:00 and 22:00, for the 3 channels most watched by children, between October 2007 and March 2008. We classified food advertisements as core (nutrient dense, low in energy), noncore (high in undesirable nutrients or energy, as defined by dietary standards), or miscellaneous. We also categorized thematic content (promotional characters and premiums). RESULTS Food advertisements composed 11% to 29% of advertisements. Noncore foods were featured in 53% to 87% of food advertisements, and the rate of noncore food advertising was higher during childrens peak viewing times. Most food advertisements containing persuasive marketing were for noncore products. CONCLUSIONS Across all sampled countries, children were exposed to high volumes of television advertising for unhealthy foods, featuring child-oriented persuasive techniques. Because of the proven connections between food advertising, preferences, and consumption, our findings lend support to calls for regulation of food advertising during childrens peak viewing times.

Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

BackgroundThis study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups.MethodsA systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition.ResultsIn total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials.ConclusionsTo tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.

A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors

PurposeLittle is known about how to improve and create sustainable lifestyle behaviors of cancer survivors. Interventions based on social cognitive theory (SCT) have shown promise. This review examined the effect of SCT-based physical activity and nutrition interventions that target cancer survivors and identified factors associated with their efficacy.MethodsA systematic search of seven databases identified randomized controlled trials that (i) targeted adult cancer survivors (any point from diagnosis); (ii) reported a primary outcome of physical activity, diet, or weight management; and (iii) included an SCT-based intervention targeting physical activity or diet. Qualitative synthesis and meta-analysis were conducted. Theoretical constructs and intervention characteristics were examined to identify factors associated with intervention efficacy.ResultsEighteen studies (reported in 33 publications) met review inclusion criteria. Meta-analysis (n = 12) revealed a significant intervention effect for physical activity (standardized mean difference (SMD) = 0.33; P < 0.01). Most studies (six out of eight) that targeted dietary change reported significant improvements in at least one aspect of diet quality. No SCT constructs were associated with intervention effects. There were no consistent trends relating to intervention delivery method or whether the intervention targeted single or multiple behaviors.ConclusionsSCT-based interventions demonstrate promise in improving physical activity and diet behavior in cancer survivors, using a range of intervention delivery modes. Further work is required to understand how and why these interventions offer promise for improving behavior.Implications for Cancer SurvivorsSCT-based interventions targeting diet or physical activity are safe and result in meaningful changes to diet and physical activity behavior that can result in health improvements.

Fruit and vegetables should be targeted separately in health promotion programmes: differences in consumption levels, barriers, knowledge and stages of readiness for change

OBJECTIVE The aim of the present study was to investigate whether fruit and vegetables should be treated as separate groups in health promotion programmes by examining consumption levels, barriers, knowledge and the association between stage of change and potential predictors of fruit and vegetable intake. DESIGN Computer-assisted telephone interview survey of the target population. SETTING Hunter and New England regions of New South Wales, Australia. SUBJECTS A total of 1403 parents and carers of primary-school-aged children. RESULTS Consumption levels and knowledge of recommended intakes and serving size were greater for fruit than for vegetables. There were some differences in the main barriers to the consumption of fruit compared with those cited for vegetables. There was little congruence between the stages of change for fruit consumption and those for vegetable consumption. For fruit, knowledge of serving size and recommended intake, perceptions of adequate consumption, changes made to family intake and educational attainment were all correlated with stage of change categorisation. For vegetables, knowledge of recommended intake, perceptions of adequate consumption and changes made to family intake were correlated with stage of change categorisation. CONCLUSIONS Significant differences in consumption levels, barriers, knowledge and stages of readiness for change can be shown when fruit and vegetables are treated as separate groups. Health promotion planners may need to consider interventions that focus on improving vegetable consumption in preference to fruit consumption. Messages about the recommended number of servings and serving size must be simplified and this may be achieved by targeting messages towards vegetable consumption.

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 childrens websites and food product websites in Australia. METHODS Food product websites (n 119) and popular childrens 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 childrens 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 childrens sections (21.8%). Food references on popular childrens 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 childrens food preferences and consumption, and regulatory options to protect children.

Effects of nutrient content claims, sports celebrity endorsements and premium offers on pre‐adolescent children's food preferences: experimental research

Food marketing has come under scrutiny for its likely contribution to promoting unhealthy eating and obesity in children. There is limited published evidence regarding the effects of food packaging promotions on children. Nutrient content claims and sports celebrity endorsements on food packs influence adults to prefer energy‐dense and nutrient‐poor (EDNP) products bearing such promotions, especially among the majority who do not read the nutrition information panel.

Industry self regulation of television food advertising: responsible or responsive?

INTRODUCTION This study evaluated the impact of the Australian Food and Grocery Council (AFGC) self-regulatory initiative on unhealthy food marketing to children, introduced in January 2009. The study compared patterns of food advertising by AFGC and non-AFGC signatory companies in 2009, 2007 and 2006 on three Sydney commercial free-to-air television channels. METHODS Data were collected across seven days in May 2006 and 2007, and four days in May 2009. Advertised foods were coded as core, non-core and miscellaneous. Regression for counts analyses was used to examine change in rates of advertisements across the sampled periods and differential change between AFGC-signatory or non-signatory companies between 2007 and 2009. RESULTS Of 36 food companies that advertised during the 2009 sample period, 14 were AFGC signatories. The average number of food advertisements decreased significantly from 7.0 per hour in 2007 to 5.9 in 2009. There was a significant reduction in non-core food advertising from 2007 to 2009 by AFGC signatories compared with non-signatory companies overall and during peak times, when the largest numbers of children were viewing. There was no reduction in the rate of non-core food advertisements by all companies, and these advertisements continue to comprise the majority during peak viewing times. DISCUSSION While some companies have responded to pressures to reduce unhealthy food advertising on television, the impact of the self-regulatory code is limited by the extent of uptake by food companies. The continued advertising of unhealthy foods indicates that this self-regulatory code does not adequately protect 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 childrens 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 childrens 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 childrens consumption in 2010 provided energy far in excess of childrens requirements. CONCLUSIONS Childrens exposure to unhealthy fast-food advertising has not changed following the introduction of self-regulation, and some fast foods advertised for childrens 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 extent and nature of alcohol advertising on Australian television.

INTRODUCTION AND AIMS Current alcohol guidelines in Australia recommend minimising alcohol consumption, especially among minors. This study investigated (i) the extent to which children and the general population are exposed to television advertisements that endorse alcohol consumption and (ii) the themes used in these advertisements. DESIGN AND METHODS A content analysis was conducted on alcohol advertisements aired over two months in major Australian cities. The advertisements were coded according to the products that were promoted, the themes that were employed, and the time of exposure. Advertising placement expenditure was also captured. RESULTS In total, 2810 alcohol advertisements were aired, representing one in 10 beverage advertisements. Advertisement placement expenditure for alcohol products in the five cities over the two months was

Parental awareness and attitudes about food advertising to children on Australian television

15.8 million. Around half of all alcohol advertisements appeared during childrens popular viewing times. The most common themes used were humour, friendship/mateship and value for money. DISCUSSION AND CONCLUSIONS Children and adults are regularly exposed to advertisements that depict alcohol consumption as fun, social and inexpensive. Such messages may reinforce existing alcohol-related cultural norms that prevent many Australians from meeting current intake guidelines.