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ARTICLE |
a Institute for Health Research and Policy and Departments of
b Economics
c Human Nutrition, University of Illinois, Chicago, Illinois
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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METHODS. We drew samples of top-rated television shows by using ratings data to examine the nutritional content for fat, saturated fat, sugar, sodium, and fiber of food-product advertisements seen on television by both children and adolescents. Food products were examined in aggregate and by 5 separate categories that included cereal, sweets, snacks, drinks, and other food products. For 2- to 11-year-olds and 12- to 17-year-olds, respectively, a sample of 50351 and 47955 30-second-equivalent food-product advertisements and their related nutritional content were weighted by television ratings data to provide actual exposure measures of the nutritional content of food advertising seen by children and adolescents.
RESULTS. Study results showed that 97.8% and 89.4% of food-product advertisements viewed by children 2 to 11 years old and adolescents 12 to 17 years old, respectively, were high in fat, sugar, or sodium. On average, 46.1% and 49.1% of total calories among the products advertised came from sugar in the advertisements seen by these respective age groups. A total of 97.6% of cereal advertisements seen by children 2 to 11 years old were for high-sugar cereals. No substantial differences were found in the nutritional content of advertisements seen by black and white children 2 to 11 years old. However, a slightly higher proportion of food advertisements in general and across all food-product categories seen by black versus white adolescents were for high-sugar products.
CONCLUSION. The overwhelming majority of food-product advertisements seen on television by American children and adolescents are of poor nutritional content.
Key Words: nutrition • food advertising • media • obesity
Abbreviations: NMR—Nielsen Media Research • TRP—targeted rating point • PCC—product-classification code • NDS—Nutrient Data System • FDA—Food and Drug Administration
Recent statistics have shown that the prevalence of obesity among children in the United States has continued to rise at a rapid pace. Obesity (age- and gender-specific BMI 
95th percentile) rates reached 13.9%, 18.8%, and 17.4% among children aged 2 to 5, 6 to 11, and 12 to 19 years, respectively, in 2003–2004.1 Differences in obesity rates by race persist, although the gap is closing: in 2003–2004, the rate among white, black, and Mexican American children was 17.7%, 22.0%, and 22.5%, respectively, for children aged 6 to 11 years and 17.3%, 21.8%, and 16.3%, respectively, among adolescents aged 12 to 19 years. Studies have also demonstrated that both younger children and adolescents consume excessive dietary fat and sugar, whereas fruit, vegetable, and various micronutrient intake is lower than that recommended.2–6
A recent report by the Institute of Medicine provided a comprehensive examination of food advertising to children and youth and concluded that there is strong evidence for children 2 to 11 years old that television advertising influences short-term food consumption patterns and moderate evidence that it influences usual dietary intake, but insufficient corresponding evidence for teens 12 to 18 years old. With respect to health, the Institute of Medicine report concluded that there is strong evidence for both children 2 to 11 years old and adolescents 12 to 18 years old that exposure to television advertising is significantly associated with adiposity.7
In 2005, both children and teens watched, on average, 3 hours and 19 minutes of television per day.8 Black youths 8 to 18 years old were estimated to watch 48% more television daily compared with white youths.9 Earlier content analyses10–18 and 1 recent study19 of television advertising on children's programming found that among all product advertising, food products made up the majority of advertisements. However, several other recent studies found food advertisements to comprise a somewhat lower proportion (30%–42%) of all product advertisements.20–22
A smaller number of studies have examined the nutritional content of food advertisements on television and have found the majority of all food items advertised to be unhealthy, being high in either sugar or fat.14,17 Several studies paid particular attention to the nutritional content of cereal advertisements shown on children's programming and found the vast majority of cereals in these advertisements to be high in sugar.12,14,16–18 To date, studies have evaluated a relatively small number of television advertisements for nutritional content, and none have evaluated the actual level of exposure to nutritional content on the basis of television ratings data. Rather, previous food advertisement content analyses have given each commercial equal weight based on its airing. We used television ratings data first to draw a large sample that was representative of the viewing patterns of children and adolescents and then second to weight each advertisement given that some advertisements were viewed more than others. In addition, despite significant differences across racial groups for childhood obesity, differences in exposure for nutrient content by race for advertisements have not been previously evaluated.
We examined the nutritional content of food advertisements seen on television by children 2 to 11 years old and adolescents 12 to 17 years old, with separate estimates provided by race. Each food-product advertisement and its related nutritional content were weighted by television ratings data to provide actual exposure measures of the nutritional content across each age/race category.
Food products were examined in aggregate and by 5 separate food categories that included cereal, sweets, snacks, drinks and other food products. The products were assessed for caloric content and nutrient content on the basis of fat, saturated fat, sugar, sodium, and fiber.
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Standardized to a 30-second advertisement (eg, two 15-second advertisements were weighted as equivalent to one 30-second advertisement or one 1-minute advertisement was weighted as equivalent to two 30-second advertisements), the advertising data totaled 167838 and 182340 product advertisements (eg, nonprogram content time not including network promotions or public service announcements) for children 2 to 11 years old and teens 12 to 17 years old, respectively. Among the product advertisements in the full sample of children aged 2 to 11 years, 36.4% were for food-related products: 30% for food products, 2% for non–fast-food restaurants, and 4.4% for fast-food restaurants. Among the product advertisements for the adolescent sample, 26.3% were food related: 18.3% for food products, 1.5% for non–fast-food restaurants, and 6.0% for fast-food restaurants. Among the total food-related products, this study did not assess the nutritional content of the 2 restaurant categories, nor was alcohol included as part of food products. Our nutritional analyses focused on the sample of food products which comprise 50351 and 47955 30-second-equivalent advertisements among the full sample of children 2 to 11 years old and adolescents 12 to 17 years old, respectively. Similarly, food-product samples were derived separately by race for each age group.
NMR assigned each product advertisement a product-classification code (PCC) that identified it with a product category. Each of the product categories had a corresponding aggregated major group PCC and industry group PCC. The structure of PCCs used by NMR was based on that used by the Publisher's Information Bureau.24 The PCC codes allowed us to break down the aggregate set of food products into subcategories to provide a nutritional assessment based on the following food groups: cereal, sweets, snacks, beverages, and other food products.
Nutritional Assessment
The nutrient content for energy, grams of fat, saturated fat, sugar, fiber, milligrams of sodium, and percentage of energy from fat, saturated fat, and sugar for advertised foods were determined by 1 of 3 methods: (1) the Minnesota Nutrient Data System (NDS) based on their Food and Drug Administration (FDA)-approved serving sizes; (2) those foods not found in the NDS data were assessed by using the nutrition-fact panel on their food labels, with serving sizes standardized to the FDA-approved serving sizes (when an FDA-approved serving size did not exist, the serving sizes listed by the manufacturer were used); and (3) foods that were not included in the NDS, could not be found in local area food stores, or did not have a food label had their nutrient content determined by contacting their manufacturer.
There were 451 and 613 distinct food-brand items advertised in our full samples of 2- to 11-year-olds and 12- to 17-year-olds, respectively. Details on the number of distinct food-brand items by food category are shown in Table 1. Among the 2- to 11-year-old sample of food items advertised, nutritional information on 50.2% of these product items was gathered by using method (1), 40.1% by using method (2), and 3.5% by using method (3) We were unable to obtain nutritional information on 6.1% of the food items in this sample because they were either a nonspecific food product (2.1%) (ie, Dairy Association or Web site cereal company ad) or we were unable to obtain the nutritional content from our sources noted above (4%). In the 12- to 17-year-old sample, nutritional information on 51% of food-product items was gathered by using method (1), 41% by using method (2), and 3.2% by using method (3), and we were unable to obtain nutritional information on the remaining 4.9% of food advertisements (3.7% of brand items were not a specific food product, and we were unable to obtain nutritional information on 1.2% of items).
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Table 2 reports the nutritional content of food advertisement exposure for 2- to 11-year-olds and 12- to 17-year-olds for all foods and by food group by the percentage content of high fat, high saturated fat, high sugar, high sodium, and low fiber as defined by the nutritional cut points described in "Methods." We also present summary statistics that reflect percentages of food content that are either high in fat or sugar and either high in fat, sugar, or sodium. The data show that 97.8% of all food-product advertisements viewed by children 2 to 11 years old were unhealthy, being either high in fat, sugar, or sodium. Among the food advertisements seen by children 2 to 11 years old, almost all (97.6%) cereal products were high in sugar, and the majority (78.6%) had low fiber content. Sweets were not only high in sugar (88.6%), but almost one half (47.4%) were high in saturated fat. Almost two thirds of advertised snacks were high in sugar, with over one third being high in fat and one quarter being high in saturated fat. Virtually all beverage advertisements (99.5%) were for high-sugar beverages. The other food category was made up of a combination of high-sodium, high-fat, and high-sugar products. Examples of the most common food types in the "other" category included yogurt, frozen waffles, and prepared and frozen entrees.
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Table 3 reports the findings from our nutritional assessment based on separate samples by race. For children 2 to 11 years old, Table 3 shows generally small differences in magnitude in the nutritional content of food products across black and white children, although in many cases such differences although small were statistically significant. Among adolescents, however, slightly larger differences in nutritional content were found to exist by race. A higher proportion of food advertisements in general and across all food-product categories seen by black adolescents were for high-sugar products compared with food advertisements seen by white teens. In particular, among black adolescents, 50.9% of snacks product advertisements seen were high in sugar versus 38.1% among white teens. On the other hand, a slightly higher proportion of food advertisements seen by white versus black adolescents for were high in fat (25.7% vs 24.9%), although the proportion of food advertisements seen that were high in saturated fat did not differ by race.
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Cereal, comprising one third of food-product advertisements, was the most frequently seen food-product type among children 2 to 11 years old. Previous studies showed that the majority of cereal advertisements were for high-sugar products, with estimates ranging from 83.3% to 95.1% of such advertisements.12,14,16–18 These studies were based on sample sizes that consisted of 106 to 957 food advertisements, of which 31% to 41% were cereals advertisements, and most of the previous studies defined high sugar on the basis of the percentage of calories from sugar being >20%. Using a more conservative definition in this study (high sugar defined as >25% of calories from sugar), we found that 97.6% of cereal advertisements seen by children 2 to 11 years old were for high-sugar cereals. This study contained both the largest number of advertisements that have been systematically evaluated and the highest percentage of advertisements for high-sugar cereals that have ever been reported to our knowledge.
In our adolescent sample, the largest food category of advertisements seen was for sweets products at 31.5% of all food advertisements. The majority of these sweets products were not only high-sugar (83.2%) products but were also particularly high in saturated fat (52.7%). Only 16.1% of food-product advertisements viewed were for cereal, although these were still very high in sugar (94.1%). Note that this distribution was among food products and excluded both fast-food and non–fast-food restaurants, which when considered, show that fast-food advertisements made up the largest category of all food-related advertisements seen by teens. Among all food-product and total restaurant advertisements, fast-food restaurants (defined as quick-service restaurants, such as McDonalds and Burger King) accounted for 23% of advertisements followed by sweets advertisements (22%).
Recent studies reported that more food advertisements appear on black versus general audience after-school27 and prime-time28 programming, although these studies have not examined the nutritional content of the advertisements. We found very small differences in the nutritional content of food-product advertisements seen by black and white children 2 to 11 years old. Among adolescents, slightly larger differences in nutritional content were found to exist by race. A higher proportion of food advertisements in general (76.4% vs 72.8%) and across all food-product categories seen by black adolescents were for high-sugar products compared with food advertisements seen by white teens. On average, white teens were exposed to a slightly higher proportion of high-fat content food advertisements, although the 2 groups did not differ in their exposure to food advertisements for products high in saturated fat. Across all food products, 91.1% of advertisements seen by black adolescents were high either in sugar, fat, or sodium compared with 88.8% for white teens. Although these differences by race among adolescents were found to be statistically significant and were larger than those found in the 2- to 11-year-old sample, the differences were still relatively small in magnitude.
The study findings in this article that 97.8% and 89.4% of food-product advertisements seen by children and adolescents, respectively, were for products of poor nutritional content combined with the proportion of food-product advertisements of total product advertisements, average daily television viewing times of 3 hours and 19 minutes, and estimates of 9.5 minutes per hour of product commercial time on children's programming15,17,22 suggest that children and adolescents see an average of 18 and 10, respectively, 30-second-equivalent advertisements daily for food products (excluding all restaurant advertisements) of poor nutritional content. Note that these daily advertisement estimates are likely to be upper bounds, because they were calculated on the basis that total daily viewing time did not include any commercial-free program viewing, such as public television. However, the estimate for adolescents may be higher because nonchildren's television programming tends to have higher minutes per hour of commercial time. Overall, these findings have important implications given that previous studies showed that exposure to food advertising significantly influences children's food preferences/choices,29–31 food intake,32–36 and product-specific food purchase requests among young children.36–39 In addition, young children are estimated to directly influence $330 billion of parental spending.40 Among older children, it is estimated that approximately three quarters of youth 8 to 17 years old influence family food purchases.7 In addition, adolescents on their own represent an important consumer market given that they spend a significant amount of their own money. US adolescents 12 to 19 years old were estimated to have spent $159 billion in 2005.41
This study is subject to 2 key limitations. First, the study was based on national advertising and did not include local area spot advertising. However, this was unlikely to introduce a significant bias given that the majority of the content of spot advertising is adult-oriented (ie, automotive, telecommunications, financial, insurance, real estate, etc).42 Therefore, the nutritional content of local area spot food advertising would have to differ substantially from that in the national advertising sample to alter the findings in this study. Second, the racial comparison in this study was limited to content differences across white and black children and adolescents viewed on non-Hispanic television. The study did not include Spanish-language programming, and it did not address ethnic differences in exposure to the nutrient content of foods advertisements seen by Hispanic versus non-Hispanic children because of the lack of ratings available by ethnicity.
The current obesity epidemic among children and adolescents and the parallel pervasiveness of advertising for unhealthy food products on television have led to calls for restrictions on food advertising and, in the absence of such restrictions, efforts to improve media literacy among young viewers.43 Currently, no formal product advertising restrictions are in place, although such restrictions exist in other countries. However, the food and beverage industries have been urged to change their marketing practices directed at children.44 Kraft was the first company to pledge to curb its advertising of many of its popular unhealthy snacks items to children under the age of 12.45 In addition, General Mills promised to tighten its marketing guidelines to meet certain nutritional standards in food advertisements aimed at children 
12 years old.46 Pressure for self-regulation recently culminated with joint commitments by a number of companies (10 charter companies include Cadbury Schweppes USA, Campbell Soup, Coca-Cola Company, General Mills, Hershey, Kellogg, Kraft, McDonald's, PepsiCo, and Unilever) to limit television advertisements for products of poor nutritional content:
"Advertisers representing two thirds of television food and beverage ad expenditures targeted to children under 12 have agreed to commit 50% of their media budgets for those advertisements to spots either for foods that meet government standards for healthy products or that include messages encouraging healthier lifestyles."47
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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Address correspondence to Lisa M. Powell, PhD, University of Illinois, Institute for Health Research and Policy, 1747 W Roosevelt Rd, Room 558, MC 275, Chicago, IL 60608. E-mail: powelll{at}uic.edu
The authors have indicated they have no financial relationships relevant to this article to disclose.
The funding organization had no role in the design or conduct of the study, collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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