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能量密集型食品。快餐店（FF）和高糖早餐麦片（SBC）占幼儿广告支出和曝光率的最大部分。由于年龄小，学龄前儿童可能非常容易受到食品营销的影响。目的：本研究的主要目的是确定FF和SBC的儿童导向营销对学龄前儿童的饮食摄入量和BMI的影响。此外，我们将研究交叉促销搭售（CPTI）的额外影响，以及种族/民族是否会调节这种关联。使用定性的方法，我们将确定相关的因素，父母购买FF和SBC，可以通过政策和家庭层面的干预措施进行修改。方法：我们将进行纵向调查的800个亲子配对招募从四个不同民族的东北城市。调查将在15个月内进行10次评估。基线和最终调查将亲自进行。八项临时调查将通过iPod touch自行管理。学龄前儿童的饮食摄入量将通过重复7天的FF和SBC消费回忆和4个24小时的饮食回忆与父母作为代理进行评估。身高和体重将被客观测量。儿童对FF和SBC儿童导向营销的接触将通过三个来源来衡量：在前6名学龄前电视网络上播放的电视广告，在票房最高的青年电影中的产品植入，以及在连锁快餐店和位于四个集水区的大型超市的购买点促销活动的现场观察。将通过定期监测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广告采样时间框架相对应，并远程更新，以包括有关新发布的电影和CPTI的提示。将通过将家长调查答复与这三个食品营销来源的内容分析相结合来确定总体暴露情况。将使用纵向统计分析，允许饮食摄入量的变化作为儿童定向营销的随时间变化的暴露量的函数。在线焦点小组和电话访谈将与有目的的父母样本进行，根据他们的孩子接触食品营销和消费FF和SBC。重要性：这是第一个大规模的基于人群的研究，客观地测量学龄前儿童的食品营销暴露的多种来源，并评估其对饮食和BMI的影响。必须进行严格的研究，量化针对儿童的食品营销的影响，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症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.