Jennifer A Emond1, Meghan R Longacre2, Keith M Drake3, Linda J Titus4, Kristy Hendricks5, Todd MacKenzie6, Jennifer L Harris7, Jennifer E Carroll8, Lauren P Cleveland9, Gail Langeloh8, Madeline A Dalton2. 1. Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Electronic address: jennifer.a.emond@dartmouth.edu. 2. Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. 3. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Greylock McKinnon Associates, Cambridge, Massachusetts. 4. Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. 5. Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. 6. Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. 7. Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, Connecticut. 8. Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. 9. Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, Massachusetts.
Abstract
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.
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.
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