Impact of Food Marketing and Cross-Promotions on Preschoolers' Dietary Intake

背景：食品公司每年花费近20亿美元用于针对儿童的营销，其中大部分用于推广高脂肪、高能量的食品。餐厅快餐（FF）和高糖早餐麦片（SBC）在幼儿中的广告支出和曝光率最高。由于学龄前儿童年龄小，他们很容易受到食品营销的影响。目的：本研究的主要目的是确定以儿童为导向的FF和SBC营销对学龄前儿童饮食摄入和BMI的影响。此外，我们将研究交叉推广搭配（CPTIs）的额外影响，以及种族/民族是否会缓和这种关联。使用定性方法，我们将确定与父母购买FF和SBC相关的因素，这些因素可以通过政策和家庭层面的干预来改变。方法：对东北4个民族多元城市的800对亲子进行纵向调查。调查将在15个月内进行10次评估。基线调查和最终调查将亲自进行。八项中期调查将通过iPod touch进行自我管理。通过重复7天的FF和SBC摄入量召回和以家长为代理的4次24小时膳食召回来评估学龄前儿童的膳食摄入量。身高和体重将被客观地测量。儿童接触FF和SBC的儿童导向营销将通过三个渠道进行衡量：在前6个学前电视网络播出的电视广告，在票房最高的青少年级电影中的植入广告，以及在四个集水区的连锁快餐店和大型超市现场观察购买点促销。通过定期监测FF网站和超市评估来评估cpti。iPod touch调查将预先编程，以确保调查时间与电视商业采样时间框架相对应，并远程更新，包括新发布的电影和cpti的提示。总体暴露将通过结合家长调查回应和这三个食品营销来源的内容分析来确定。将采用纵向统计分析，考虑到饮食摄入量随时间变化而变化的对儿童定向营销的影响。在线焦点小组和电话访谈将根据孩子接触食品营销和消费FF和SBC的情况，对有目的的父母样本进行选择。意义：这是第一个以人群为基础的大型研究，客观地测量学龄前儿童食品营销暴露的多种来源，并评估其对饮食和体重指数的影响。必须进行严格的研究，量化以儿童为导向的食品营销的影响，以便为有效的政策提供信息，并促进负责任的食品营销做法。这项研究的结果将对预防儿童肥胖具有重要的公共卫生意义。

DESCRIPTION (provided by applicant): Background: Food companies spend nearly $2 billion each year on child-directed marketing, the majority of which is used to promote high-fat energy-dense foods. Restaurant fast foods (FF) and high sugar breakfast cereals (SBC) account for the greatest advertising expenditures and exposure among young children. Because of their young age, preschool children are potentially highly susceptible to food marketing. Aims: The primary goal of this study is to determine the impact of child-directed marketing of FF and SBC on preschool children's dietary intake and BMI. Additionally, we will examine the added impact of cross- promotional tie-ins (CPTIs) and whether race/ethnicity moderates this association. Using qualitative methods, we will identify factors related to parental purchases of FF and SBC that may be modified through policy and family-level interventions. Methods: We will conduct a longitudinal survey of 800 parent-child dyads recruited from four ethnically diverse Northeast cities. The survey will include 10 assessments over a 15-month period. The baseline and final surveys will be administered in-person. Eight interim surveys will be self-administered through an iPod touch. Preschoolers' dietary intake will be assessed through repeated 7-day recalls of FF and SBC consumption and four 24-hour dietary recalls with parents as a proxy. Height and weight will be objectively measured. Children's exposure to child-directed marketing of FF and SBC will be measured through three sources: TV commercials aired on the top 6 preschool TV networks, product placements in the top box-office youth-rated movies, and onsite observations of point-of-purchase promotions at chain fast food restaurants and large supermarkets located in the four catchment areas. CPTIs will be assessed through regular monitoring of FF websites and supermarket assessments. The iPod touch surveys will be pre-programmed to ensure the survey timing corresponds to TV commercial sampling timeframes, and remotely updated to include prompts about newly released movies and CPTIs. Overall exposure will be determined by combining parent survey responses with content analyses of these three sources of food marketing. Longitudinal statistical analyses that allow for changes in dietary intake as a function of time-varying exposure to child-directed marketing will be used. Online focus groups and telephone interviews will be conducted with a purposeful sample of parents, selected based on their children's exposure to food marketing and consumption of FF and SBC. Significance: This is the first large population-based study to objectively measure multiple sources of food marketing exposure among preschoolers' and evaluate its impact on diet and BMI. Rigorous research quantifying the impact of child-directed food marketing is imperative to inform effective policy and promote responsible food marketing practices. Findings from this study will have important public health implications for preventing obesity in children.