NGHC: Childhood Nutrition and Advertising (2013)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To experimentally investigate the influence of licensed characters on children's subjective rating of a food product and whether children's taste preferences are affected by packaging cues regarding the product's nutritional value.

Inclusion Criteria:

Children between the ages of four and six who visited a grocery store with their parent or legal guardian in a large northeastern city during study times in December 2007.

Exclusion Criteria:

Children with nut or wheat gluten allergies.

Description of Study Protocol:

Recruitment

Adult patrons arriving to a grocery store with children were approached for potential consent of child's participation in the study.

Design

  • Two x two between-subjects with four conditions:
    • Healthy cereal name
    • Sugary cereal name
    • Character present
    • Character absent
  • Randomization of assigned condition was achieved through selection of a poker chip from a bag for each participant
  • Parent or guardian of participants completed a survey of participant characteristics including adult education level and television use in the home.

Intervention

Subjects were shown cereal boxes according to assigned group and asked to taste a sample of the cereal and provide their opinion. 

Statistical Analysis

SPSS statistical software, version 15 (SPSS Inc, Chicago, Illinois) including:

  • Frequency tables
  • Mean differences via univariate analysis of covariance and then univariate of analysis of variance with a two (character present or absent) x two (Healthy Bits or Sugar Bits) factorial design
  • Tukey significant difference post hoc test (P<0.05).
Data Collection Summary:

Timing of Measurements

All measurements were recorded from a one-time presentation of exposure items.

Dependent Variables

  • Cereal tasted a sample of the cereal and provide their opinion
  • Children rated the cereal’s taste on a five-point smiley face scale (one = really do not like; five = really like).

Independent Variables

  • Character present on box
  • Character absent on box
  • "Healthy" Bits
  • "Sugar" Bits.

Control Variables

  • Sex
  • Age
  • All subjects received the same cereal and payment for participation in the study
  • Boxes were designed to be exactly the same other than the studied facts of characters present or not and healthy or sugar title representation.
Description of Actual Data Sample:
  • Initial N: 84 children
  • Attrition (final N): 81 children (36 male, 42 female, two no response)
  • Age: All participants were between four and six years; mean age, 5.56 years. 

Other Relevant Demographics: Parent/Guardian Highest Educational Level (Female, Male)

No high school diploma 11 (14%) 13 (16%)
High school or GED 20 (25%) 21 (26%)
Some college or associate degree 24 (30%) 21 (26%)
Four-year college degree 16 (20%) 10 (12%)
Graduate degree 5 (6%) 5 (6%)
No reply or don't know 4 (5%) 10 (13%)

Anthropometrics

Groups were similar.

Location

Large northeastern city, otherwise not specified except authors affiliated with the University of Pennsylvania, Philadelphia.

Summary of Results:

Key Findings

  • Significant effect of character present on subjective report of taste (P=0.01) 
  • Cereal name had a significant effect on reported taste (P=0.04) 
  • There was also significant interaction between characters and titles (P=0.04). 

Other Findings

  • Almost all children liked the cereal, but those who saw a popular character on the box liked it more (mean, 4.70±0.86) than those who viewed a box without a character (4.16±1.24)
  • "Healthy" Bits was liked more (mean, 4.65±0.84) than "Sugar" Bits (4.22±1.27)
  • Children who received the Sugar Bits with no character on box liked the cereal significantly less than children in other categories. Those receiving Healthy Bits did not show significant difference in liking based on character. Sugar Bits were liked more with character on box than without.
Author Conclusion:
  • The use of popular characters on food products positively affects children's subjective assessment of taste
  • The name of the cereal also affects children's subjective assessment of taste; however, not in the direction expected
  • Children responded positively to words that promoted health possibly due to messages encouraging healthier eating habits resonating with young children.
Funding Source:
University/Hospital: University of Pennsylvania, Annenburg School for Communication
Reviewer Comments:

Researchers also provided detailed information on how the cereal box was designed, prior test marketing and cereal product selection to minimize introduction of bias.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? No
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? No
  6.6. Were extra or unplanned treatments described? No
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes