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Exposure to Child-Directed TV Advertising and Preschoolers’ Intake of Advertised Cereals

  • Jennifer A. Emond
    Correspondence
    Address correspondence to: Jennifer A. Emond, PhD, Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hinman Box 7920, One Medical Center Drive, Lebanon NH 03756.
    Affiliations
    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
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  • Meghan R. Longacre
    Affiliations
    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
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  • Keith M. Drake
    Affiliations
    The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire

    Greylock McKinnon Associates, Cambridge, Massachusetts
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  • Linda J. Titus
    Affiliations
    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
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  • Kristy Hendricks
    Affiliations
    Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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  • Todd MacKenzie
    Affiliations
    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
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  • Jennifer L. Harris
    Affiliations
    Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, Connecticut
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  • Jennifer E. Carroll
    Affiliations
    Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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  • Lauren P. Cleveland
    Affiliations
    Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, Massachusetts
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  • Gail Langeloh
    Affiliations
    Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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  • Madeline A. Dalton
    Affiliations
    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
    Search for articles by this author
Published:December 17, 2018DOI:https://doi.org/10.1016/j.amepre.2018.09.015

      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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