EAL

NGHC: Childhood Nutrition and Advertising (2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

The aim of this study was to assess whether children perceive food to taste better if it has a label of an entertainment brand compared to the original packaging.

Inclusion Criteria:

Students from three pre-schools in the greater Reykjavik area were chosen
Children ages 3.5 to six years
Written informed consent was signed by the parents of the subjects.

Exclusion Criteria:

Children younger than 3.5 years or older than six years of age
Children not in chosen pre-school classes.

Description of Study Protocol:

Recruitment

Three pre-schools in the greater Reykjavik area were chosen.

Design

Randomized cross-over trial
Children tasted food wrapped in original packaging or with a entertainment brand wrapper
- LazyTown is an Icelandic children's television program with a focus on healthy lifestyle.
Children rated their preference for taste of the food
Social background questionnaire was completed by the parents.

Blinding Used

One research assistant sat behind a screen and could not see the child, but his arms could reach around the screen to introduce the products tested
Another research assistant was placed behind the child.

Intervention

Five pairs of identical food and beverages were introduced one at a time
Healthy food and beverages from various food groups were chosen
The children were asked to point out the LazyTown food and then the child was asked to taste the two samples in random order
The blinded research assistant asked the child if the foods tasted the same, or point to the one that tastes best
The research assistant behind the child then recorded the answers.

Statistical Analysis

Preference was coded
- +1 for preference of LazyTown food
- Zero for no preference
- -1 for preference for the original food.
An average preference score was calculated for each subject by adding up the answers
Correlation between taste preference and parent's attitudes and social background was calculated.

Data Collection Summary:

Timing of Measurements

Children completed the taste preference study and parent's completed the social background and attitude questionnaire at separate times.

Dependent Variables

Taste preference for sample in original wrapper or in branded wrapper.

Independent Variables

Five separate foods were provided in original wrapper and in LazyTown wrapper.

Control Variables

Family social background
- Mother and father's education
- Marital status
- Number of siblings living in the subjects household.
Parent's attitude toward LazyTown brand and marketing of healthy food.

Description of Actual Data Sample:

Initial N: 66 children
Attrition (final N): 66 children
Age: 3.5 to six years
Ethnicity: Not stated.

Other Relevant Demographics

Mother's education
- Secondary school (less than 11 years): Four (7.8%)
- Gymnasium (13 to 14 years): 16 (31.4%)
- University level (more than 15 years): 31 (60.8%).
Father's education
- Secondary school (less than 11 years): Three (6.8%)
- Gymnasium (13 to 14 years): 19 (43.2%)
- University level (more than 15 years): 22 (50.0%).
Marital status
- Married or partnership: 44 (86.3%)
- Not in a relationship: Seven (13.7%).
Number of siblings living in the subject's household
- One: Seven (13.5%)
- Two: 44 (84.6%)
- Three: One (1.9%).
Average age of mother: 36.2 years (±5.3 years)
Average age of father: 37.3 years (±6.1 years).

Location

Reykjavik, Iceland.

Summary of Results:

Key Findings

Taste preferences (N=66)

Sample	Preference for Sample in Original Wrappings		Taste the Same or No Answer		Preference for Sample in LazyTown Wrappings
Sample	N	Percentage	N	Percentage	N	Percentage
Water	3	4.5	45	68.2	18	27.3
Bread	5	7.8	32	50.0	27	42.2
Fruit Juice	4	6.3	36	56.3	24	37.4
Yogurt	3	4.8	43	68.3	17	27.0
Carrots	2	3.1	35	54.7	27	42.2

Two children did not want to taste the bread, juice and carrots and one child did not want to taste the yogurt. Their answers were coded as zero when calculating the preference score:

Mean preference score was 0.29 (±0.32)
Median: 0.20
95% CI: 0.21, 0.38.

Attitudes towards LazyTown: Parents of pre-school children (N=66)

		N	Percentage
Attitude towards LazyTown	Very positive	21	41.2
	Rather positive	23	45.1
	Neither positive nor negative	5	9.8
	Rather negative	2	3.9
	Very negative	0	0.0
Attitude towards marketing of healthy food for children using the LazyTown brand	Very positive	19	37.3
	Rather positive	16	31.4
	Neither positive nor negative	14	27.4
	Rather negative	2	3.9
	Very negative	0	0.0

All of the parents involved knew LazyTown
90% of the children did own some products related to LazyTown: Clothes, shoes, books, DVDs, costumes, etc.
98% of the parents claimed that their children watched or listened to LazyTown entertainment
- Radio, television or DVD
- Average duration of 1.1 hour per week (±1.1 hour per week).

Taste preference was not related to parent's education, marital status, the number of siblings or attitudes towards LazyTown.

Author Conclusion:

Between 27% and 42% of children preferred the taste of the food with the branded (LazyTown) wrapper
It might be suggested that popular brands could be useful to promote healthy eating among young children along with other actions.

Funding Source:

Government:

The Icelandic Centre for Research

Industry:

LazyTown, Myllan, Mjolka, Hollt & Gott, Froosh provided food or labels

Food Company:

Reviewer Comments:

About 50% to 60% of the parents involved had a university degree, compared with about 38% in the general population in the greater Reykjavik area.

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?	Yes
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)	N/A
	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?	N/A
	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?		Yes
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	Yes
	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.)	Yes
	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?	N/A
	6.6.	Were extra or unplanned treatments described?	Yes
	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)?	Yes
	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