Philadelphia Beverage Tax's Impact on Beverage Ad Expenditures and Number of Ads Purchased.

INTRODUCTION: On January 1, 2017, Philadelphia implemented a beverage excise tax. The study's objective was to determine whether beverage advertising expenditures and the number of beverage ads purchased changed in Philadelphia compared to Baltimore because of this tax. METHODS: Monthly beverage ad expenditures and the number of beverage ads purchased by brand from January 2016 through December 2019 were obtained. Ads were coded as being for taxed or not taxed beverages and analyzed in 2023. The primary outcomes were quarterly taxed beverage ad expenditures and number of ads purchased. A controlled interrupted time series design on segmented linear regression models was used. Models (aggregated and stratified by internet, spot TV, and local radio) compared whether levels and trends in the outcomes changed from pre- to post-tax in Philadelphia compared to Baltimore. RESULTS: There were no significant differences in taxed beverage advertising expenditures between Philadelphia and Baltimore for trends pretax, at implementation, or post-tax. There were 0.13 (95% CI: -0.25, -0.003) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore at baseline. Among internet advertising, there were 0.42 (95% CI: -0.77, -0.06) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore immediately post-tax. For spot TV ads, the percentage of taxed beverages ads purchased per quarter was greater at baseline in Philadelphia by 28.0 percentage points (95% CI: 1.9, 54.1). CONCLUSIONS: This study found little evidence of changes in mass media advertising on the examined platforms between 2016 and 2019 due to the Philadelphia beverage tax.

Effects of a front-of-package disclosure on accuracy in assessing children's drink ingredients: two randomised controlled experiments with US caregivers of young children.

OBJECTIVE: Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children's drinks. DESIGN: In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children's drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children's drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored. SETTING: Online survey. PARTICIPANTS: Six hundred and forty-eight US caregivers of young children (1-5 years). RESULTS: FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research. CONCLUSIONS: FOP disclosures on children's drink packages can increase caregivers' understanding of product ingredients and aid in selecting healthier children's drinks.

Are U.S. food and beverage companies now advertising healthy products to children on television? An evaluation of improvements in industry self-regulation, 2017-2021.

BACKGROUND: Through the Children's Food and Beverage Advertising Initiative (CFBAI), U.S. food companies pledge to only advertise healthier products in children's television (TV) programming, but previous research shows that highly advertised products do not qualify as nutritious according to independent nutrition criteria. In 2020, the CFBAI implemented stricter nutrition criteria for products that may be advertised to children, but the potential impact of these changes has not been assessed. This observational study evaluates (1) improvements in energy and individual nutrient composition of products that companies indicated may be advertised to children (i.e., CFBAI-listed products) in 2020 versus 2017, (2) amount of advertising on children's TV for CFBAI-listed versus other products in 2021, and 3) the nutrition quality of advertised versus non-advertised CFBAI-listed products. METHODS: Data include energy, saturated fat, sodium, and sugar content and overall nutrition quality (Nutrition Profile Index [NPI] scores) of CFBAI-listed products in 2017 (n = 308) and 2020 (n = 245). Nielsen data provided total ad spending and children's exposure to ads on children's TV channels for all foods and beverages in 2021. RESULTS: From 2017 to 2021, energy, saturated fat and sugar declined for CFBAI-listed products in three of six food categories (yogurt, sweet and salty snacks). Although CFBAI-listed products accounted for 79% of food ads viewed by children on children's TV channels, just 50% of CFBAI-listed food and 36% of drink brands were advertised on children's TV. Moreover, advertised products were significantly less nutritious than non-advertised CFBAI-listed products. CONCLUSION: Despite revised nutrition standards and improvements in nutrient content of some product categories, participating companies continued to primarily advertise nutritionally poor food and beverages on children's TV. CFBAI companies have not delivered on their promises to advertise healthier products to children.

Prevalence of food and beverage brands in "made-for-kids" child-influencer YouTube videos: 2019-2020.

BACKGROUND: Child health experts raise numerous concerns about the negative effects of children's exposure to unhealthy digital food marketing, including advertising and branded product placements on child-oriented videos. OBJECTIVES: YouTube banned food advertising on "made-for-kids" channels in 2020, but research is needed to assess food-related appearances on increasingly popular child-influencer videos. METHODS: Content analysis examined a sample of videos (n = 400) uploaded in 2019-2020 by popular child-influencers on YouTube "made-for-kids" channels. We identified and coded all branded and non-branded food-related appearances (i.e., food, beverages, restaurants), ads, promotions, and sponsorship disclosures, and compared 2019 to 2020. RESULTS: Two-thirds of videos (n = 260) had at least one food-related appearance, including branded product appearances (n = 153), other brand appearances (n = 60), and non-branded food-related appearances (n = 203). Branded products appeared 592 times (M = 3.9/video), including candy brands (42% of appearances) and sweet/salty snacks, sugary drinks, and ice cream (32% combined). Total food-related appearances did not change (2019-2020), but candy brand appearances increased significantly. Videos with non-branded healthy food category appearances also increased, but 70% also showed unhealthy branded and/or unbranded foods. Just one video disclosed a food-brand sponsorship. CONCLUSIONS: Additional policies are needed to protect young children from potential exposure to unhealthy branded foods on popular YouTube child-influencer channels.

Effects of Sugary Drink Countermarketing Videos on Caregivers' Attitudes and Intentions to Serve Fruit Drinks and Toddler Milks to Young Children.

Objectives. To test the effects of countermarketing videos addressing common misperceptions about ingredients and claims on children's sugary drinks. Methods. We conducted an online randomized controlled experiment in January 2021 with US caregivers (n = 600) of young children (aged 8‒37 months) to assess the effects of watching countermarketing versus control videos on intentions to serve sugary and healthy drinks (6-point scales) and attitudes (10-point scales) about fruit drinks and toddler milks. Results. The countermarketing videos significantly reduced positive attitudes about fruit drinks (mean difference = 0.92) and toddler milks (mean difference = 2.10), reduced intentions to serve both (mean difference = 0.50 and 0.92, respectively), and increased intentions to serve plain milk (mean difference = 0.52) versus control videos (all Ps < .001). Intentions differed by individual characteristics, but the videos remained effective after we controlled for these characteristics. Moreover, the videos were more effective for toddler milks versus fruit drinks, and effects on fruit drink intentions were greater for Black versus White caregivers and caregivers of children aged 24 months or younger. Conclusions. A countermarketing campaign aimed at diverse caregivers of young children designed to correct misleading children's drink marketing presents a promising public health approach for reducing sugary drink consumption in the first 1000 days. (Am J Public Health. 2022;112(S8):S807-S816. https://doi.org/10.2105/AJPH.2022.307024).

Exploring Infant Caregivers' Provision of Modified Formulas: Potential Demographic Differences and Reasons for Provisions.

Background: Formula brands have modified the ingredients in standard infant formulas and extensively market modified formulas, claiming benefits for infants that are not supported by scientific evidence. This exploratory study examined the proportion of infant caregivers who reported serving modified formula, demographic differences, and reasons for providing them. Methods: This is a cross-sectional online survey of US caregivers of infants (6-11 months) who provided formula in the past month (N = 436). Participants reported the type of formula served most often and agreement with potential reasons for provision. Logistic regression assessed the odds of serving modified formula by demographic characteristics. MANOVA examined differences in agreement with purchase reasons between caregivers by the type of formula provided. Results: Approximately one-half (47%) of participants reported serving modified formula most often; sensitive and organic/non-GMO were the most common types provided. Caregivers in the middle-income group were most likely to serve modified formulas, but the provision did not differ by other demographic characteristics. Agreement with reasons for providing was highest for "pediatricians recommend" and "benefits my child" (M = 4.2 out of 5). Agreement with "my pediatrician prescribed" and "natural ingredients" was significantly higher for modified vs. standard formula providers. Conclusion: Widespread provision of modified formula by infant caregivers raises concerns due to its higher cost and the lack of scientific evidence supporting benefits for babies. These findings suggest that regulations limiting unsubstantiated formula claims and restrictions on misleading marketing to consumers are necessary. Additional research is needed to understand pediatricians' perceptions of modified formulas and reasons for recommending them to patients.

Caregivers' provision of sweetened fruit-flavoured drinks to young children: importance of perceived product attributes and differences by socio-demographic and behavioural characteristics.

OBJECTIVE: Drinks containing added sugar and/or non-nutritive sweeteners are not recommended for children under 6 years. Yet, most young children consume these products. The current study examined factors associated with caregivers' provision of sweetened drinks to their young child. DESIGN: Caregivers reported frequency of providing sweetened fruit-flavoured drinks (fruit drinks and flavoured water) and unsweetened juices (100 % juice and juice/water blends) to their 1- to 5-year-old child in the past month and perceived importance of product attributes (healthfulness, product claims and other characteristics), other drinks provided, reading the nutrition facts panel and socio-demographic characteristics. A partial proportional odds model measured the relationship between these factors and frequency of providing sweetened fruit-flavoured drinks. SETTING: Online cross-sectional survey. PARTICIPANTS: U.S. caregivers (n 1763) with a young child (ages 1-5). RESULTS: The majority (74 %) of caregivers provided sweetened fruit-flavoured drinks to their child in the past month; 26 % provided them daily. Provision frequency was positively associated with some drink attributes, including perceived healthfulness, vitamin C claims and box/pouch packaging; child requests and serving other sweetened drinks and juice/water blends. Provision frequency was negatively associated with perceived importance of 'no/less sugar' and 'all natural' claims. Reading nutrition facts panels, serving water to their child and child's age were not significant. CONCLUSION: Misunderstanding of product healthfulness and other marketing attributes contribute to frequent provision of sweetened drinks to young children. Public health efforts to address common misperceptions, including counter marketing, may raise awareness among caregivers about the harms of providing sweetened drinks to young children.

Marketing of sugar-sweetened children's drinks and parents' misperceptions about benefits for young children.

Despite expert recommendations, US parents often serve sugar-sweetened children's drinks, including sweetened fruit-flavoured drinks and toddler milks, to young children. This qualitative research explored parents' understanding of common marketing tactics used to promote these drinks and whether they mislead parents to believe the drinks are healthy and/or necessary for children. We conducted nine focus groups in Washington, DC and Hartford, CT with parents of children (9-36 months) of diverse race/ethnicity and socioeconomic status (N = 50). Semistructured discussions elicited parents' responses to four concepts designed to correct common misperceptions about toddler milks and sweetened fruit-flavoured drinks (fruit drinks and flavoured waters) by providing information about drink ingredients and potentially misleading marketing tactics. Participants expressed widespread misperceptions about sweetened fruit-flavoured drinks and toddler milks, including perceived healthfulness and benefits for children and confusion between sweetened and unsweetened drink categories (sweetened fruit-flavoured drinks vs. juice, toddler milk vs. infant formula). They confirmed that common marketing strategies contributed to misperceptions, including front-of-package claims and marketing messages that imply benefits for children and/or hide problematic ingredients; cross-branding and product extensions from trusted brands; side-by-side shelf placement at retailers; lower price than healthier products; and targeted marketing to children and parents. Some parents expressed anger about deceptive marketing and supported increased regulation and consumer education campaigns. Findings support the need for policies to address potentially misleading marketing of sweetened fruit-flavoured drinks and toddler milks and revealed opportunities to reduce parents' provision of these drinks through countermarketing campaigns communicated via trusted sources.

Caregivers' Understanding of Ingredients in Drinks Served to Young Children: Opportunities for Nutrition Education and Improved Labeling.

BACKGROUND: Against expert recommendations, sugar-sweetened beverages, especially fruit drinks, are consumed by young children. Misperceptions about drink ingredients and healthfulness can contribute to caregivers' provision. OBJECTIVES: To assess caregivers' reasons for serving sweetened fruit-flavored drinks and unsweetened juices to their young children (1-5 y) and perceptions of product healthfulness and drink ingredients. METHODS: A cross-sectional online survey assessed participants' (n = 1614) perceptions of sweetened fruit-flavored drinks (fruit drinks and flavored water) and unsweetened juices (100% juice and water/juice blends) provided to their child in the past month, including product healthfulness, reasons for providing, and knowledge of product ingredients [added sugar, nonnutritive sweeteners (NNSs), percentage juice]. One-factor ANOVA compared perceived healthfulness of drink categories and types of sugar and NNSs, and differences between participants who could compared with those who could not accurately identify drink ingredients. RESULTS: Participants' top reasons for providing sweetened drinks included child liking it, being inexpensive, child asking for it, and being a special treat. Participants perceived 100% juice as healthiest, followed by juice/water blends, flavored waters, and, lastly, fruit drinks (P < 0.05). Many participants inaccurately believed the fruit drink or flavored water they served their child most often did not contain NNSs (59.0% and 64.9%) and/or added sugars (20.1% and 42.2%), when in fact they did, and 81.3-91.1% overestimated the percentage juice in the drink. Perceived healthfulness of fruit drinks was associated with caregivers' belief that the drink contained added sugar (P < 0.05), but not with their belief that it contained NNS; increased accuracy was associated with decreased perceived healthfulness (P < 0.05). CONCLUSIONS: Inaccurate understanding of added sugar, NNSs, and percentage juice in drinks served to young children was common and could contribute to sugary drink provision. Public health efforts should seek to improve labeling practices and revise nutrition education messages.

U.S. Households' Children's Drink Purchases: 2006-2017 Trends and Associations With Marketing.

INTRODUCTION: Sugar-sweetened beverages contribute a large proportion of added sugar in young children's diets; yet, companies market sugar-sweetened children's drinks extensively to children and parents. This study examines the changes in children's drink purchases by U.S. households with young children and the associations with marketing practices. METHODS: Longitudinal Nielsen U.S. household panel data provided monthly volume purchases by children's drink category (sugar-sweetened fruit drinks and flavored water and unsweetened juices) among households with young children (aged 1-5 years) from 2006 to 2017. Differences by household race/ethnicity and income were assessed. The 2-part models examined the associations between household purchases and marketing (including price and brand TV advertising) for each category, controlling for sociodemographics. Data were collected and analyzed in 2019-2020. RESULTS: Households' volume purchases of children's fruit drinks and unsweetened juices declined from 2006 to 2017, whereas flavored water purchases increased. Non-Hispanic Black households purchased significantly more fruit drinks (351.23 fluid ounces/month, 95% CI=342.63, 359.82) than non-Hispanic White (204.43 fluid ounces/month, 95% CI=201.81, 207.05) and Hispanic (222.63 fluid ounces/month, 95% CI=217.11, 228.15) households. Low-income households purchased more fruit drinks and fewer unsweetened juices than higher-income households (p<0.001). TV brand advertising was positively associated with purchases across all categories, and this relationship was stronger for low-income households (p<0.05). CONCLUSIONS: Despite expert recommendations that young children do not consume Sugar-sweetened beverages, households with young children purchase more sweetened fruit drinks than unsweetened juices. Extensive TV advertising for children's drink brands may exacerbate the racial and income disparities in sugar-sweetened beverage purchases. Public health initiatives to address sugar-sweetened beverage consumption by young children and restrictions on marketing sugar-sweetened beverages to children are necessary.

TV exposure, attitudes about targeted food ads and brands, and unhealthy consumption by adolescents: Modeling a hierarchical relationship.

Public health experts raise concerns that extensive exposure to advertising for calorie-dense nutrient-poor food negatively influences adolescents' diets, but few studies have explored how food advertising affects children over age 12. This study examines adolescents' attitudes about highly targeted unhealthy food brands and assesses the hierarchical relationship between TV exposure, intermediary measures of advertising effects, and healthy and unhealthy food consumption. A cross-sectional online survey of 1566 adolescents (13-17 years) measured TV exposure, attitudes about eight highly advertised teen-targeted food brands and their advertising, and unhealthy and healthy food consumption. A theory-based structural equation model (SEM) tested hypothesized paths from TV exposure to unhealthy food consumption, with attitudes about teen-targeted TV ads and brands as intermediary variables, controlling for healthy food consumption and demographic characteristics. Participants reported high liking of targeted-brand advertising (M = 4.05/5.0, SD = 0.65), strong perceptions that the ads were targeted to someone like them (M = 4.07/5.0, SD = 0.66), positive brand attitudes (M = 4.07/5.0, SD = 0.56), brand popularity (M = 4.01/5.0, SD = 0.63), and consuming the brands a few times in the past month on average. As hypothesized, the SEM supported significant positive paths from TV exposure to ad attitudes (ß = 0.50, 95% CI = 0.40-0.60) to brand attitudes (ß = 0.90, 95% CI = 0.87-0.92) to unhealthy food consumption (ß = 0.41, 95% CI = 0.32-0.50). Contrary to expectations, healthy consumption was positively associated with both brand attitudes (ß = 0.11, 95% CI = 0.04-0.18) and unhealthy consumption (ß = 0.42, 95% CI = 0.33-0.51). These results further public health concerns about the potential impact of adolescents' exposure to unhealthy food advertising on brand consumption and unhealthy food consumption more broadly. They also support marketing theories that ad liking and perceived targeting may increase the influence of ad exposure on brand attitudes and unhealthy consumption.

Voluntary healthier kids' meals policies: Are caregivers choosing kids' meals and healthier items for their child?

BACKGROUND: Children's fast-food consumption increases risks for obesity and other diet-related diseases. To address concerns, from 2010 to 2016 U.S. fast-food restaurants implemented voluntary policies to offer healthier drinks and/or sides with kids' meals. OBJECTIVES: Examine the effectiveness of voluntary kids' meal policies. METHODS: Online repeated cross-sectional survey (2010, 2013, 2016) of U.S. caregivers (N = 2093) who purchased fast-food for their child (2-11 years) in the past week. Logistic regression examined associations between healthier kids' meal policy implementation and caregivers' purchases of kids' meals and selection of healthier sides and drinks. Separate models investigated caregivers' attitudes about McDonald's kids' meal items. RESULTS: Overall, 55% of caregivers reported choosing a kids' meal for their child, and approximately one-half of those caregivers selected a healthier drink and/or side. Healthier kids' meal policy implementation was associated with increased selection of healthier sides, but not healthier drinks or choice of kids' meals over higher-calorie menu items. Child's age, caregiver gender and visit frequency were significant in most models. Caregivers' perceptions that their child(ren) like healthier drinks and sides were positively associated with selection of those items. CONCLUSIONS: Existing healthier kids' meal policies may not improve children's fast-food consumption. Public health initiatives should examine more effective alternatives.

Food marketing to children in the United States: Can industry voluntarily do the right thing for children's health?

Food marketing is a major contributor to high rates of obesity and diet-related disease among children. Researchers, advocates, and policymakers have called for improvements in the nutrition quality of foods marketed to children to improve children's health. In the United States, for over 10 years, the food and beverage industry has responded with self-regulatory initiatives, touting the success of these efforts. However, public health researchers have documented very limited improvements. As a product of conference proceedings, we briefly summarize US self-regulation of food and beverage marketing to children, argue that reliance on industry self-regulation limits meaningful change, and explain why existing food companies cannot market truly healthy foods to children. After over a decade of self-regulation, industry continues to exploit loopholes and bombard children with marketing for foods that can negatively impact their health. Still, the political will to advocate for effective government regulation remains a challenge. Shifts in parents' attitudes toward supporting policies to protect children from food marketing and local government actions to improve the food environment are promising indicators of increasing demand for action. However, sustained and well-publicized research and advocacy are necessary to generate broader support to enact such policies at the state and federal level in order to effectively address this public health crisis.

Adolescents' engagement with unhealthy food and beverage brands on social media.

INTRODUCTION: Food-related promotion of brands via social media represents an increasingly important youth-targeted marketing strategy, but little is known about how adolescents interact with these brands online. This study measures adolescents' social media engagement with food/beverage brands, sociodemographic differences in level of engagement, and relationships between engagement and screen time. METHODS: Cross-sectional online survey of US adolescents (ages 13-17, N = 1564), oversampled for non-Hispanic Black and Hispanic (more- and less-acculturated) participants, assessed restaurant, food, and beverage brands ever liked, shared, or followed of on social media. Multivariate logistic regression models examined associations between brand engagement, sociodemographic variables (race/ethnicity, acculturation, age, gender, and parent education), and screen time (TV and other screens). RESULTS: Seventy percent of adolescents reported engaging with any food/beverage brands on social media (ranging from 1 to 48), and 35% engaged with 5 + brands. Non-Hispanic Black and less-acculturated Hispanic adolescents were more likely than non-Hispanic White adolescents to engage with brands. Approximately one-half reported engaging with brands of fast food (54% of participants), sugary drinks (50%), candy (46%), and snacks (45%), while just 7% reported engaging with all other categories of food/beverage brands. Watching TV more than 2 h-per-day was associated with any brand engagement; while using other screens more than 2 h-per-day was associated with following 5 + brands. CONCLUSIONS: Engagement with unhealthy food brands on social media is common among adolescents. Disproportionate engagement by non-Hispanic Black and less-acculturated Hispanic youth raises additional concerns. Research is needed to understand how such marketing affects adolescents' food preferences, diets, and health.

Race, Ethnicity, and Other Factors Predicting U.S. Parents' Support for Policies to Reduce Food and Beverage Marketing to Children and Adolescents.

Purpose: Examine parents' support for policies to reduce unhealthy food and beverage marketing to children and adolescents and identify racial, ethnic, and other sociodemographic characteristics that predict support. Methods: Online survey of U.S. parents (N=3356) with children 2-17 years of age conducted annually (2009-2012). Participants provided attitudes about food marketing to their children, including perceived negative impact and support for food marketing-related policies. Sociodemographic characteristics examined were as follows: race, ethnicity, income, gender, political orientation, and child characteristics. Results: Overall, parents agreed that food marketing negatively impacts their children's eating habits (M=6.87±2.08 out of 10) and supported food marketing-related policies (M=6.73±2.37). Perceived negative impact predicted support and was highest among black and Hispanic parents. Controlling for income and age of children in the household, Hispanic and black parents expressed highest support for policies, as did women and parents who identified as liberal or moderate in political orientation. A significant interaction between parents' political orientation and race/ethnicity indicated similarly high support among all parents, except white non-Hispanic conservative parents. Conclusion: These findings are encouraging for efforts to enact policies to address unhealthy food marketing to youth. High levels of support among parents suggest advocates should continue to engage parents in their efforts. Findings also suggest that families of color would welcome policies limiting unhealthy food marketing to youth in their communities. Issues of targeted marketing and disproportionate exposure to unhealthy food marketing by black and Hispanic youth may be incorporated into campaigns to address food justice and health inequities in communities of color.

Screen Media Exposure and Obesity in Children and Adolescents.

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children's preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

The Effect of Advertising on Children and Adolescents.

In ∼100 years, marketing to children went from a severely frowned upon practice to an integral part of growing up as companies came to realize that investing in marketing to children and adolescents provides excellent immediate and future dividends. Each year, enormous sums of money are spent to reach this valuable audience because children and adolescents spend billions on their own purchases, influence family decisions about what to buy, and promise a potential lifetime of brand loyalty. The channels to reach youth have grown, and marketers are increasingly using them, often blurring the distinction between entertainment and advertising. Because advertising to children and adolescents has become ubiquitous, researchers who study its influence raise significant concerns about the practice, especially as it relates to dietary behavior, family conflict, marketer tactics, and children's potential vulnerability as an audience. In this review by the Workgroup on Marketing and Advertising, we highlight the state of the research in this area and suggest that more research needs to be conducted on understanding the following: the effects of advertising exposure, how psychological development affects children's responses to marketing, the problems associated with advertising in newer media, and how researchers, parents, and practitioners might be able to mitigate the most deleterious advertising effects. We then present avenues of future research along with recommendations for key stakeholders.

Parental support for policy actions to reduce weight stigma toward youth in schools and children's television programs: trends from 2011 to 2013.

BACKGROUND: Despite the pervasiveness and negative physical and psychosocial implications of weight-based victimization (WBV) in youth, antibullying polices in schools rarely address this issue. Additionally, children's media perpetuates weight stigma, but regulation of stigmatizing media content is nonexistent. METHODS: In 2011-2013, a diverse national sample of 2185 parents (n=716 in 2011, 755 in 2012, and 714 in 2013) was analyzed to evaluate parental support for four proposed policies across the 3 years. Actions addressed (1) strengthening policies to reduce weight stigma, (2) media portrayals of children with diverse body sizes, (3) media portrayals of such children engaged in healthy behaviors, and (4) antibullying policies in schools. Chi-square tests with Bonferroni's corrections and multiple logistic regression analyses were conducted. RESULTS: Across time, support for policies to address weight stigma remained consistent or increased, primarily in 2012-2013. At least 86% of participants consistently favored implementing antibullying policies in schools. Parents became increasingly supportive of policies regulating television content to positively portray children of diverse body sizes and show such children engaged in health behaviors, as well as establishing weight-related antibullying policies. Specific predictors of support included gender, race, and political affiliation. CONCLUSIONS: There is a consistent and high level of parental support for weight stigma-related policies, particularly for antibullying policies. Findings can inform development of policies to rectify health and social disparities faced by overweight and obese youth.