TY - JOUR
AU1 - Watson, Wendy, L
AU2 - Lau,, Vivien
AU3 - Wellard,, Lyndal
AU4 - Hughes,, Clare
AU5 - Chapman,, Kathryn
AB - Abstract Background In response to rising childhood obesity rates, the Australian food industry implemented two initiatives in 2009 to reduce the marketing of unhealthy food to children. This study evaluated the efficacy of these initiatives on the rate of unhealthy food advertising to children on Australian television. Methods The rates of food advertisements on three free-to-air commercial television channels and a youth-oriented digital channel in Sydney, Australia were analysed over 2 weekdays (16 h) and two weekend days (22 h). Advertisements were categorized according to the healthiness of foods advertised (non-core, core, miscellaneous) and signatory status to the food industry advertising initiatives. Results Total food advertising rates for the three channels increased from 5.5/h in 2011 to 7.3/h in 2015, due to an increase of 0.8/h for both core and miscellaneous foods. The rate of non-core food advertisements in 2015 (3.1/h) was similar to 2011 (3.0/h). The youth-oriented channel had fewer total food advertisements (3.7/h versus 7.3/h) but similar fast-food advertisement rates (1.3/h versus 1.3/h). Conclusions There was no change in the rate of unhealthy food advertising since 2011, suggesting minimal impact of the current food industry initiatives on reducing children's exposure to unhealthy food advertising. children, food advertising, food industry self-regulation, television Introduction The advertising of unhealthy food influences children's awareness of brands, positive attitudes to and preferences for products, purchase intent and consumption.1,2 Limiting exposure of children to unhealthy food marketing has been identified by the World Health Organization as a cost-effective, low-cost, population-wide intervention to reduce diet-related risk factors for non-communicable diseases, including obesity.3 Recently, the World Health Organization's Commission on Ending Childhood Obesity recommendations included to reduce exposure of children to marketing of unhealthy foods and beverages.4 Currently, regulation of food advertising to children in Australia includes limited government regulation of children's programs (C- and P- (pre-school) programs) through the Children's Television Standards 20095 and voluntary self-regulated advertising and food industry initiatives.6,7 The Australian Food and Grocery Council (AFGC) manages two initiatives introduced in 2009, the Responsible Children's Marketing Initiative (RCMI) for food and beverage grocery manufacturers and the Quick Service Restaurant Initiative (QSRI) for fast-food companies.6,7 A total of 18 food and grocery companies and seven fast food companies—some of the largest national and multinational food and beverage companies according to the AFGC—are signatories to the RCMI and QSRI, respectively.8 The initiatives aim to reduce advertising and marketing communications to children for food and beverage products that do not represent healthier choices.6,7 It is difficult to determine advertising budgets to compare profiles of signatory and non-signatory companies, however, signatories to the initiatives represented 67% of all food and beverage advertising between March and May 2011.9,10 Studies have highlighted loopholes within these initiatives including the definitions of what constitutes ‘advertising to children’ and ‘unhealthy food’.11–14 Though the clauses of the initiatives were reviewed by the industry in 2014, major loopholes were not addressed.15 In Australia, there are three main broadcasting channels on free-to-air commercial television, the Seven Network, Nine Network and Network Ten (primary channels). In recent years, digital multi-channels have been introduced by the three commercial television licensees. Since legislative amendments in 2013, licensees have been permitted to meet their quota obligations for children's programming content across their television services.16 A survey of children's viewing habits in 2013 found that the three commercial licensees screened 72% of children's programs on non-primary channels.16 Previous independent monitoring of the three primary channels showed minimal changes in the rate of unhealthy food advertising to children from 2006 to 2011,17 however, there has been no follow-up study since the introduction of non-primary channels and following extended implementation of the food industry self-regulatory initiatives. This study aims to investigate the impact of the self-regulatory initiatives four years after the last independent monitoring study of television food advertising in Sydney, Australia. Methods Sample All advertisements broadcast on four Sydney free-to-air commercial television channels (7, 9, 10 (primary channels) and GO! (a non-primary, nine network digital multi-channel)) were recorded from 06.00 to 21.00 h daily over a consecutive four-day period from 21st May 2015 (Thursday) to 24th May 2015 (Sunday). The four days selected were not holidays or when major events were held and there were no new release or finales of television shows. The channels, month and hours selected were consistent with previous studies12,17–19 to allow comparison. An additional non-primary channel (GO!) was added to reflect changes in children's viewing habits. GO! was selected as it broadcast over half of the top C- and P-rated programs in 2013 and was the free-to-air commercial channel most frequently mentioned by parents when asked their child's favourite channel.20,21 Consistent with the most recent study,17 advertisements that aired during children's peak viewing times were analysed. Peak viewing times were defined as 06.00 to 09.00 and 16.00 to 21.00 on weekdays and 06.00 to 12.00 and 16.00 to 21.00 on weekends. Of the 152 h analysed, there was a 40-min error in the recorded data on one channel, which accounted for one advertisement period (0.1% total advertisements coded). Coding The coding framework from the previous study was used to ensure comparability.17 Food advertisements were identified and coded into categories (core, non-core and miscellaneous) and subcategories according to food groups; and fast-food advertisements were further coded into subcategories (core, non-core and miscellaneous)17 (Supplementary Table). For food subcategories with nutrient criteria (e.g. low-sugar and high-fibre breakfast cereals), nutrition information of products was sourced from the nutrition information panel on the packaging or the manufacturer's website. Core foods were defined as those recommended (in the Australian Dietary Guidelines) to be selected daily. Non-core foods were those considered as discretionary foods in the Australian Dietary Guidelines, i.e. those foods higher in energy, sugar, fat and/or sodium and low in micronutrients and not considered essential for a healthy diet.22 The miscellaneous grocery category included dietary supplements, supermarkets, flavours and seasonings; and the miscellaneous fast-food category included advertisements for brands without food specified. This study used a different classification system to that used in the AFGC self-regulatory initiatives because the criteria used by the initiatives are not standardized or independently derived.14 Under the RCMI, each individual signatory company sets its own nutrition criteria in its company action plan and some companies who state they do not advertise to children do not have criteria.6 The QSRI applies a single nutrition standard, but it is only applicable to children's meals comprising a main and a beverage and does not consider other food items.7 Criteria based on the Australian Dietary Guidelines provided a single evidence-based nutrition standard for this study. Signatory status of advertising companies to the RCMI and QSRI were coded. Inter-coder reliability Coding was performed by two researchers independently. A researcher from the previous study17 was consulted to clarify coding. Inter-coder reliability was determined by Cohen's κ tests. On 10 random unique fast-food advertisements, perfect agreement (1.00) was achieved. In addition, agreements of 0.93 were achieved for coding the advertisements (food or non-food), food categories and subcategories on two random half-hour programs. Analysis The number and mean rate (frequency per hour per channel) of food advertisements were calculated and analysed according to: (i) healthiness of foods advertised based on the food category; and (ii) RCMI or QSRI signatory status. Mean rates for primary channels 7, 9 and 10 were aggregated to compare with 2011 results. Statistical analyses were conducted using SPSS version 19.0 (IBM Corporation, Armonk, USA). Data for 2011 were obtained from the authors of the previous study17 and mean rates were compared using independent-sample T-tests. P-values of <0.05 were considered statistically significant. Results A total of 6023 advertisements were identified, of which 16% (n = 973) were food advertisements. Of food advertisements, non-core advertisements accounted for the largest proportion (44%), including 21% fast-food advertisements. Healthiness of foods advertised on primary channels On primary channels there were 7.3 food advertisements per hour per channel. Non-core foods were advertised at a significantly higher mean rate than core foods (3.1/h versus 2.1/h), t(226) = 4.01, P < 0.001; and miscellaneous foods (3.1/h versus 2.2/h), t(226) = 3.32, P = 0.001. Of non-core food advertisements, fast-food was the most frequently advertised subcategory (1.3/h), followed by chocolate and confectionery (0.7/h), and sugar-sweetened drinks (0.4/h) (Supplementary Table). Categories of core foods with the highest mean rate of advertisements were dairy products (0.6/h), meat and alternatives (0.5/h), and fruit and vegetable products (0.4/h). Supermarkets or fresh produce markets (45%) and producer-owned organizations, e.g. Meat and Livestock Australia (5%) were the main core food advertisers. In the miscellaneous food category, dietary supplements (0.9/h) were advertised most frequently. Comparison with 2011 results Total food advertising rates increased significantly from 5.5/h in 2011 to 7.3/h in 2015, (t(226) = −3.81, P < 0.001), due to an increase of 0.8/h for both core foods and miscellaneous foods (Table 1). The rate of non-core food advertisements was not significantly different in 2011 (3.0/h) compared to 2015 (3.1/h), t(226) = 0.26, P = 0.79. There was no significant difference between the rates of fast-food advertisements in 2011 (1.4/h) and 2015 (1.3/h), t(226) = 0.47, P = 0.63 and other non-core food advertisements in 2011 (1.6/h) and 2015 (1.8/h), t(226) = 0.75, P = −0.44. Table 1 Mean rate of food advertisements during children's peak viewing times on a youth orientated digital channel (GO!) and in 2011 and 2015 on primary channels Food category and subcategory . Mean frequency per hour . Primary channelsa 2011 . Primary channelsa 2015 . GO! 2015 . Total food 5.53b 7.32b 3.66 Core and healthy food 1.17b 2.06b 0.87 Non-core and unhealthy food 3.00 3.08 2.00  All fast-food restaurants/meals 1.41 1.32 1.34  Non-core excluding fast-food restaurants/meals 1.59 1.75 0.66 Miscellaneous food 1.37b 2.18b 0.79 Food category and subcategory . Mean frequency per hour . Primary channelsa 2011 . Primary channelsa 2015 . GO! 2015 . Total food 5.53b 7.32b 3.66 Core and healthy food 1.17b 2.06b 0.87 Non-core and unhealthy food 3.00 3.08 2.00  All fast-food restaurants/meals 1.41 1.32 1.34  Non-core excluding fast-food restaurants/meals 1.59 1.75 0.66 Miscellaneous food 1.37b 2.18b 0.79 aMean of Sydney channels 7, 9 and 10. bSignificant P < 0.05. Table 1 Mean rate of food advertisements during children's peak viewing times on a youth orientated digital channel (GO!) and in 2011 and 2015 on primary channels Food category and subcategory . Mean frequency per hour . Primary channelsa 2011 . Primary channelsa 2015 . GO! 2015 . Total food 5.53b 7.32b 3.66 Core and healthy food 1.17b 2.06b 0.87 Non-core and unhealthy food 3.00 3.08 2.00  All fast-food restaurants/meals 1.41 1.32 1.34  Non-core excluding fast-food restaurants/meals 1.59 1.75 0.66 Miscellaneous food 1.37b 2.18b 0.79 Food category and subcategory . Mean frequency per hour . Primary channelsa 2011 . Primary channelsa 2015 . GO! 2015 . Total food 5.53b 7.32b 3.66 Core and healthy food 1.17b 2.06b 0.87 Non-core and unhealthy food 3.00 3.08 2.00  All fast-food restaurants/meals 1.41 1.32 1.34  Non-core excluding fast-food restaurants/meals 1.59 1.75 0.66 Miscellaneous food 1.37b 2.18b 0.79 aMean of Sydney channels 7, 9 and 10. bSignificant P < 0.05. The increase in the mean rate of miscellaneous advertisements was due to an increase of 0.5/h in both dietary supplement and supermarket advertisements. The increase in core food advertisements was due to increases in advertisements for dairy products (0.2/h), core protein foods (0.3/h), fruit and vegetables (0.4/h) and low-sugar, high-fibre breakfast cereals (0.3/h) and a decrease in core meal advertisements (0.3/h). Rates of advertising on the youth-oriented channel GO! had a lower total advertisement rate than the primary channels (33.7/h versus 41.6/h). The mean food advertisement rate on GO! was half that of the primary channels (3.7/h versus 7.3/h), while the mean rate of fast-food advertisements (1.3/h) was similar to the mean of the three primary channels (1.3/h) (Table 1). Of the fast-food advertisements on GO! 69% were for a children's meal compared with 4% on Channel nine while no advertisements for children's meals were captured on Channels 7 and 10. Foods advertised by RCMI and QSRI signatories (all channels) RCMI signatories had significantly lower mean advertising rates for total food, core food and miscellaneous food advertisements than non-signatories (Table 2). There was no significant difference in non-core food advertisement rates between RCMI signatories and non-signatories, with signatories contributing 55% of non-core advertisements. Table 2 Mean rate of food advertisements on four channels during children's peak viewing times by RCMI and QSRI signatory and non-signatory Food industry initiatives . Food category . Mean frequency per hour per channel . Non-signatory . Signatory . RCMI Total food (excluding fast-food) 3.41a 1.66a  Core food 1.17a 0.59a  Non-core food 0.67 0.81  Miscellaneous 1.57a 0.26a QSRI Total fast-food 0.24a 1.09a  Non-core fast-food 0.23a 1.09a Food industry initiatives . Food category . Mean frequency per hour per channel . Non-signatory . Signatory . RCMI Total food (excluding fast-food) 3.41a 1.66a  Core food 1.17a 0.59a  Non-core food 0.67 0.81  Miscellaneous 1.57a 0.26a QSRI Total fast-food 0.24a 1.09a  Non-core fast-food 0.23a 1.09a RCMI, Responsible Children's Marketing Initiative; QSRI, Quick Service Restaurant Initiative. aSignificant P < 0.05. Table 2 Mean rate of food advertisements on four channels during children's peak viewing times by RCMI and QSRI signatory and non-signatory Food industry initiatives . Food category . Mean frequency per hour per channel . Non-signatory . Signatory . RCMI Total food (excluding fast-food) 3.41a 1.66a  Core food 1.17a 0.59a  Non-core food 0.67 0.81  Miscellaneous 1.57a 0.26a QSRI Total fast-food 0.24a 1.09a  Non-core fast-food 0.23a 1.09a Food industry initiatives . Food category . Mean frequency per hour per channel . Non-signatory . Signatory . RCMI Total food (excluding fast-food) 3.41a 1.66a  Core food 1.17a 0.59a  Non-core food 0.67 0.81  Miscellaneous 1.57a 0.26a QSRI Total fast-food 0.24a 1.09a  Non-core fast-food 0.23a 1.09a RCMI, Responsible Children's Marketing Initiative; QSRI, Quick Service Restaurant Initiative. aSignificant P < 0.05. In contrast, 83% of non-core fast-food advertisements were by QSRI signatories, with the mean rate significantly higher than non-signatories (Table 2). Of the 202 fast-food advertisements, only two advertised core fast-foods and they were by a non-signatory. Of all QSRI signatory advertisements, the dominant advertisers were McDonald's (47%), KFC (26%) and Hungry Jack's (16%). There were 38 advertisements for children's meals (19%), of which 34 (17%) were McDonald's Happy Meals®. All advertisements for McDonald's Happy Meals® showed three chicken nuggets, apple slices and water which is considered a healthier meal according to the QSRI. Discussion Main finding of this study Advertising rates for both non-core groceries and fast-food were unchanged in 2015 compared to 2011,17 contradicting the RCMI and QSRI objective to ‘reduce advertising and marketing communications to children for food and beverage products that do not represent healthier choices’.6,7 RCMI signatories advertised non-core foods at a similar rate to non-signatories and QSRI signatories advertised at a much higher rate than non-signatories, The proportion of non-core advertising contributed by signatory companies slightly decreased from 2011 with 55% and 83% of non-core advertisements from RCMI and QSRI signatories respectively in 2015 compared to 62% and 90% in 2011.17 The number of signatories to the RCMI has changed minimally and there have been no changes to the signatories of the QSRI since they were implemented in 2009, despite recommendations to the AFGC in 2012 to undertake a recruitment strategy.9 What is already known on this topic The 2014 AFGC Annual Audit showed high adherence to voluntary codes.8 The difference between that result and our study is consistent with international studies.23 By defining children's viewing periods as either within C- and P-programs or when children are at least 35% of the audience, the voluntary self-regulatory initiatives fail to reflect children's actual viewing patterns. As well, the initiatives do not capture high numbers of children watching popular shows where the 35% threshold is not reached because the ratio of children to total audience is diminished by the high total audience. If the objective of the RCMI and QSRI is to reduce children's exposure to advertisements that are not healthier choices then the definition of children's viewing periods needs to incorporate times when high numbers of children are viewing, irrespective of the ratio to total audience numbers. Highest audiences are in the early evening during movies targeting children and families and during reality shows and light-entertainment programs.16 With growing evidence of the effect of advertising on children's diets,24 initiatives must reduce advertising of unhealthy foods at times when children are watching to protect them from the power of food marketing. What this study adds In 2013, GO! broadcast over half of the most popular C- and P-programs.16 Although we found advertising rates lower on GO!, the high rate of fast-food advertisements and the move by the commercial broadcasters of C- and P-programs from the primary channels to digital multi-channels16 warrants continued monitoring. As found previously, advertisements for fast-food and chocolate and confectionery were the most common.17,25 This is concerning given an Australian qualitative study found that children named food advertisements for confectionery and fast foods as most appealing26 and that 38% of 4–13 year olds’ total daily energy comes from energy-dense nutrient-poor foods and drinks.27 Improved regulation regarding food marketing to children must include criteria for ‘healthiness’ of foods suitable to advertise consistent with Australian Dietary Guidelines. In 2015, all fast-foods advertised by QSRI signatories contained at least some non-core food or drink products. However, the QSRI specifically sets criteria for only children's meals.7 The foods depicted in the McDonald's Happy Meal® were the ‘healthier’ options according to the QSRI criteria, however, the chicken nuggets would likely be considered a discretionary choice in government guidelines.22 As well, in-store options include healthier and unhealthy Happy Meals®28 and the brand effect is likely to extend beyond the meal advertised.29–32 Under the RCMI, each company defines their own criteria to determine the ‘healthiness’ of foods that can be marketed to children.14 This allows companies to set lenient criteria that don't align with Australian Dietary Guidelines.14 Advertising for meat, fruit and vegetables were the primary contributors to an increase in the core food advertising rate since 2011. This increase is encouraging and most likely due to the popularity of cooking shows on television.33 Fresh food advertisements were fact-based and generally not child-directed although due to their placement in light entertainment shows they would have been seen by a large child audience.16 In its 2009 report on primary prevention, the National Preventative Health Taskforce highlighted the same limitations of the self-regulatory approach as we have discussed and recommended changes included phasing out marketing of unhealthy food and beverages on free-to-air and pay television before 9 pm within four years and adopting criteria for determining ‘healthy’ food and drink.34 Little progress has been made in 6 years despite mandatory regulation of food marketing to children being widely supported by parents.35,36 Limitations of this study A limitation of this study was the potential variability in coding between 2011 and 2015, although this was mitigated by regular meetings with one of the 2011 researchers. Another limitation was the underestimation of advertisements due to the recording error although this was limited to only one advertisement period. The results are for four Sydney commercial television channels and may not be generalizable to other locations. Future studies targeting multi-channels and adding audience data would broaden insight into children's advertising exposure on television. As a consistent coding framework was used, this study could contribute to future studies for analysing advertising trends over time. Conclusions Since 2011, there has been no change in unhealthy food advertising suggesting that the current self-regulatory initiatives are inadequately protecting Australian children. Improvements to regulation including definitions of advertising to children taking into account children's viewing times and Government-endorsed standards for what constitutes a healthy food, are required to protect children and provide an advertising environment supportive of healthy eating. Supplementary data Supplementary data are available at the Journal of Public Health online. Acknowledgements The authors would like to thank See Wai Grace Kwok for assisting with data collection and analysis. The authors acknowledge and thank Lesley King, Lana Hebden, Anne Grunseit and Bridget Kelly for allowing us to access the 2011 data from their study. References 1 Kelly B , King L, Chapman K et al. . A hierarchy of unhealthy food promotion effects: identifying methodological approaches and knowledge gaps . Am J Public Health 2015 ; 105 ( 4 ): e86 – e95 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Cairns G , Angus K, Hastings G et al. . 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TI - Advertising to children initiatives have not reduced unhealthy food advertising on Australian television
JF - Journal of Public Health
DO - 10.1093/pubmed/fdx004
DA - 2017-12-01
UR - https://www.deepdyve.com/lp/oxford-university-press/advertising-to-children-initiatives-have-not-reduced-unhealthy-food-Yr4FhwN9Qj
SP - 787
VL - 39
IS - 4
DP - DeepDyve
ER -