What are children watching?

The statistics are alarming: British children are watching, on average, three hours of television each day, and almost two-thirds of children have a television set in their bedroom. Over the course of one year, it has been estimated that American children are exposed to 20,000 television advertisements and figures for Australian and British children are of a similar magnitude.1 Furthermore, British children are subject to the highest levels of television advertising within Europe. In stark contrast, advertising during dedicated children's broadcasting has been banned in Sweden and Norway.

Children are clearly being targeted as a receptive market by the manufacturing industry. In 1999, 12 billion US dollars were invested in marketing strategies directly aimed at children.2 Undoubtedly, television provides one of the most powerful media through which products can be advertised. A number of studies have shown that television advertising can directly influence children's consumer choices, behaviour and attitudes.3,4

A comparative analysis of television advertisements broadcast to children in 13 developed countries found that adverts promoting food, toys and entertainment were the most common.1 However, food advertising accounted for the largest percentage of these advertisements in virtually all countries. Furthermore, advertisements for confectionery represented 20% of all food advertising, with the highest proportion of confectionery adverts recorded in Greece and the UK. A more recent study of televised food advertising to New Zealand children actually found 30% of all food advertisements related to chocolate and confectionery.5 Detailed nutritional analysis of televised food advertisements has identified that up to 90% of food products have a high fat, sugar or salt content.1,6,7 It would appear that the vast majority of food and drink products targeted at children are promoting the antithesis of a healthy diet and are in direct conflict with national dietary guidelines.

Recently broadsheet newspapers have highlighted the flow of dietary propaganda aimed at children.8,9,10 In the main, these concerns have been fuelled by evidence of escalating obesity levels and associated diseases in British children. It is not surprising, therefore, that consumer associations and health professionals are calling for greater regulation of food advertising to children.11 In view of this growing controversy, the present study sought to carry out a content analysis of television advertisements broadcast during children's television programming. The specific objectives were to determine the overall frequency of food and drink advertisements, and to identify what proportion of these promoted products could be detrimental to dental health.

Analysis of children's television advertisements

The raw material comprised 41 hours of children's television programmes and associated advertising, shown on the main British commercial and terrestrial channel, ITV1, during July and August, 2003. All programmes and adverts transmitted between 3.15pm and 5.15pm Monday to Friday, and between 9.20am and 12.30pm on Saturdays were recorded on to video cassette for subsequent analysis. Each advertisement was then viewed carefully, timed to the nearest second, and simply subdivided as a food/drink advert or a non food/drink advert. Adverts for food and/or drink products were further categorised into one of the following four subgroups, according to the sugar/acid content of the product shown:

Group 1: adverts promoting products with a high sugar content, such as confectionery, sugared cereals, cakes and biscuits

Group 2: adverts promoting products with a high acid content such as low-calorie or sugar free soft drinks

Group 3: adverts promoting products with a high sugar and high acid content such as fruit-flavoured yoghurts, carbonated or fruit-flavoured drinks

Group 4: adverts promoting products with low/no sugar and acid content such as fruit, vegetables, cereals (with no added sugar), meat and dairy products (with no added sugar).

One investigator (VP) categorised all the adverts according to the above criteria. In order to determine intra-operator agreement, 10% of the total number of adverts were re-analysed one week later and were re-categorised into the four subgroups. The level of agreement between the initial and the repeat assessment was determined using Kappa's coefficient of agreement, where 0.0 indicates no agreement and 1.0 indicates total agreement. Repeatability for the categorisation of adverts according to their sugar and/or acid content was found to be excellent, with a kappa coefficient of 1.0.

A total of 984 advertisements were transmitted during the two-month period, which accounted for 15.8% (six hours and 48 minutes) of the total programming time. On average, 24 advertisements were shown per hour of children's television broadcasting which equated to 9.48 minutes each hour.

The majority of adverts shown (62.5%, 642) related to non food/drink products. Most of these promoted toys, which accounted for 35.9% (353) of all adverts shown. Interestingly, throughout the 41 hours of recording, there was only one advertisement for an oral hygiene product. Food and/or drink advertisements accounted for just over one third of the total adverts seen (34.8%, 342). The mean broadcast time for each advert was 24 seconds (SD 9.47, range 7-82), and there was no significant difference in the duration of each advert according to the product category (p>0.05, ANOVA).

Of the 342 food and/or drink advertisements shown, 95.3% (326) were for products with a high sugar and/or acid content. Significantly fewer adverts (4.7%, 16) were for low sugar/acid products (p<0.001, x2 = 280.99, chi-squared test). Table 1 gives a more specific breakdown of the food/drink adverts shown according to their sugar and/or acid content. It can be seen that products with a high sugar content were the most frequently broadcast (56.4% of food/drink adverts). Within this subgroup, the most common adverts were for breakfast cereals with added sugar (26.3%) and confectionery products (23.7%). The next largest subgroup of adverts was for products high in both acid and sugar (38.6% of food/drink adverts) with advertisements for soft drinks (non carbonated types) featuring prominently (18.1%).

Table 1 Frequency of food and drink advertisements according to sugar and/or acid content of product
Full size table

Only 4.7% of advertisements promoted food/drink products that were deemed to have no/low sugar and acid content. Within this subgroup, adverts for dairy products (mainly cheeses) were the most common, accounting for 2.9% of all food advertisements. Breakfast cereals with no added sugar were also advertised (0.6%), as well as hot drinks such as tea and coffee (0.6%) and convenience foods (0.6%). No items of fresh fruit or vegetables, milk or water were advertised during the period under investigation.

Is there cause for concern?

The finding that food and drink advertising represented a large proportion of adverts shown during children's television programming is consistent with findings of previous British studies.1,12,13 However, the present study identified a higher transmission rate of adverts (24 per hour) than has been reported previously.12 Furthermore, advertisements accounted for 9.48 minutes of each broadcast hour, which would appear to contravene current UK advertising regulations. These state that advertising on terrestrial channels should be limited to a maximum daily average of 7.0-7.5 minutes per hour.14

The vast majority (95.3%) of food and drink adverts shown during the study period promoted products that could be detrimental to oral health as they contained high levels of sugar and/or acid. Equally concerning was the total absence of advertisements for non-cariogenic/non-erosive items such as fruit, vegetables, milk or plain water. This, however, is a feature common to children's television advertising in a number of different countries.1,5,15 Recently, Chestnutt and Ashraf13 sought to compare the proportion of adverts promoting foodstuff potentially detrimental to oral health during children's and primetime television. They found that, during children's television, 73.4% of advertising time was devoted to foods potentially harmful to teeth, as compared to only 18.6% of advertising time during primetime television. They concluded that children were being bombarded with commercials for sugar rich products.

These findings would appear to directly contravene the Code of Advertising Standards and Practice published by the Independent Television Commission (ITC) in 200214 These state that 'advertisements must not encourage or condone damaging oral health care practices. For instance, advertisements must not encourage frequent consumption throughout the day, particularly of potentially cariogenic products such as those containing sugar.' The ITC ceased to exist in 2003, and its duties have since been assumed by Ofcom (the Office of Communications). The ITC's policy document on advertising has now been adopted by Ofcom. Interestingly, this communications sector regulator is currently undertaking research into the impact of food promotion on children, the findings of which may influence future advertising standards.

It would be difficult to prove that television advertising has a direct effect on oral health, given the multifactorial nature of dental caries and erosion. However, advertising may strongly influence children's food preferences. A number of studies have shown that the time spent viewing television directly correlates with the purchase and consumption of food advertised on television.3,16,17 Positive correlations have also been found between children's television viewing, bad eating habits and incorrect knowledge about nutritional principles.18,19 Interestingly, the prevalence of obesity in American children has been found to increase by 2% for each additional hour of television watched.20

The extent and nature of advertising aimed at children has also become of great concern to parents, many of whom report that children 'pester' them to buy products advertised on television.1,19,21 Indeed McLellan2 states that marketing philosophies now aim to 'teach kids to influence their parents' purchases'. 'Pester-power' has become the advertiser's dream and the parent's nightmare! A recent UK poll found that 57% of parents wanted food advertising banned during children' television.10

It is evident that there is increasing public and professional concern regarding the potential effects of food advertising on the present and future health of British children. The prominent campaign group, Sustain (the alliance for better food and farming) recommend that adverts for unhealthy foods are prohibited during periods when large numbers of young children are likely to be viewing. However, a total ban on advertising to children (which is the case in Sweden and Norway) would be difficult to implement in this country as advertising creates substantial revenue for broadcasting companies. A more reasonable approach would be to ensure that adverts for potentially unhealthy healthy food and drink products are limited, and ideally should carry a health warning! Advertising healthy alternatives should also be encouraged.

Television advertising is, however, only one way in which manufacturers are able to influence children's behaviour in terms of dietary habits and preferences. Children are now being targeted using 'viral marketing' and 'underground communication'. It was recently reported that Kellogg's Real Fruit Winder Campaign reached 60% of children with clever PR and web activity before even commencing television advertising.8 It is clear that powerful marketing strategies are being developed to control the eating habits of children on a global scale.