Reading the mind of children in response to food advertising: a cross-sectional study of Malaysian schoolchildren’s attitudes towards food and beverages advertising on television

The global burden of non-communicable disease (NCDs) is a deep concern to the public health community especially when driven by escalating rates for overweight and obesity in children, occurring across many regions and nations as reported by a systematic analysis of obesity prevalence data from 1980 to 2013 [1]. Malaysia has the highest rates of obesity in South East Asia, with estimated prevalence rates of 22.5 % in boys and 19.1 % in girls who are less than 20 years old. This is a serious problem as NCDs such as diabetes, hypertension, fatty liver, and cardiovascular diseases of adulthood are associated with childhood obesity [2, 3]. The obesogenic environment of childhood in this context deserves attention as a modifiable risk factor. It is a combination of influences that promote obesity from all surroundings, opportunities or conditions of life [4]. Determinants of obesity are broad, and include cultural, environmental and psychological triggers, as described in the UK Foresight Report [5]. Within this matrix of determinants, the social psychology cluster inclusive of television (TV) watching and media availability is influential at the societal level. In this environment, it is well understood that TV food advertising (TVFA) is the most dominant medium to promote unhealthy foods and food choices to young viewers [6‐8].

Over the past three decades, marketing has evolved considerably in the food environment to accommodate the food industry’s definition on what is acceptable and desirable to eat [9]. Generally, food advertising portrays food advertisements as exciting and fun, and users of these products as equally appealing [10]. A systematic review on the nature, extent and effects of food marketing to children has indicated that most food advertising directed to children are those low in positive nutrients and energy-dense [11]. Techniques such as animation, story-telling, visual effects, premium offers (e.g. free toys) and product endorsements with licensed characters or movie industry tie-ins have been shown to influence children [10, 12]. It is thus observed that animation used in marketing aims to capture the attention of children by merging the fictional world of advertisements and the real world. Advertising on TV also penetrates the mind of children more easily than other static media, as they are more likely to develop a receptive memory with visual simulation generated by TV [13].

Evidence from scientific literature suggests that food marketing influences children in various ways. Qualitative surveys on children’s natural reaction when exposed to TVFA has revealed modest evidence that advertising attracts children’s attention and enhances acceptance, preference and demand for advertised products [11]. Additionally, an experimental study concluded TVFA increased children’s food consumption when they watched food advertisements and with a greater likelihood for overweight and obese children to consume energy-dense snacks compared to normal weight children [14]. Of concern, the lasting effect of early TVFA exposure leads to the development of unhealthy eating habits, mediated by perceived taste for highly advertised unhealthy food [15]. The aetiology of this pattern would be through increasing product awareness, generating positive attitudes towards junk foods, influencing children’s food preferences, and arousing cues for purchasing requests as noted in some studies [7, 16‐18].

Children’s age is a major factor in their ability to comprehend TVFA messages. Children were found capable of recognising TV commercials as early as six years old, through identifying short breaks between programmes using cues such as voice-over, jingles, pace, and editing [19, 20]. Food advertising messages may then also be reinforced through watching TV advertisements, as evidenced by parents’ observations that their children repeat an advertised product’s slogans or taglines during their daily lives [13]. It is hypothesised that children need to acquire three ascending levels of understanding before they are truly able to comprehend messages portrayed by food advertisers [21]. These include: (i) the ability to distinguish programme content from commercials; (ii) the ability to recognise the basic intention of food advertising, which is to sell or promote their products (to distinguish selling intent) and; (iii) scepticism and awareness of biased messages related to advertised food products (to distinguish persuasive intent). Children up to 12 years old are still vulnerable to food advertising and less able to be sceptical about any message content [22]. Recent scientific evidence emphasise restriction of food promotion targeting children up to 12 years of age [21, 23].

The effectiveness of TVFA directed to children can be attributed to several influencing factors. Amongst these, it is suggested that the impact of advertising message on children may differ due to sociocultural differences, but there is a gap in knowledge regarding this aspect [24]. In California, an ethnic-specific content analysis of TV channels indicated Spanish-language TV channels were dominated by fast foods (~30 %), followed by breakfast cereals and candy [25]. According to Kent et al. [26], French-speaking children in Quebec, Canada were exposed to lesser high fat, sugar, or sodium (81.0 %) food advertisements compared to English-speaking children from Ontario (89.8 %) and Quebec (96.6 %). This phenomenon warrants a need to measure the influence of food marketing based on ethnicity related to minority populations and this should be taken into account in policy development [27]. A study reported that children of Muslim cultures in the Middle East are governed by their parents in relation to moderating purchasing requests [13], whereas in Western countries ‘pestering’ behaviours are noted [7]. Gender is another influencing factor as girls are shown to be more resistant to advertising messages and persuasion compared to boys, as shown for fast food advertising [8]. The availability of TV sets within children’s bedrooms is linked to higher screen time [28], which predicts future requests for advertised food products [29]. Lastly, children’s pocket money would be another influencing factor related to the purchasing power of children for unhealthy food items [30].

Observational studies indicate that Malaysian TV food marketing is dominated by foods high in fat, refined sugars, and salt (HFSS), such as sugar sweetened beverages, unhealthy snacks, confectionery, instant noodles, biscuits and chocolate [31, 32]. These are unhealthy foods and designated as ‘non-core’ as opposed to ‘core’ foods which are healthy foods [33]. However, the impact of this type of TVFA on Malaysian children has not been studied extensively. Further, a recent multi-country study comparing TVFA patterns across Asian countries substantiated that non-core foods dominated TVFA in Malaysia, with a ratio of 7.6 non-core food advertisements for every one advertisement for core foods [34]. Given the gap in knowledge relating to the Malaysian obesogenic environment, there is a strong justification to investigate the impact of TVFA on children in Malaysia. This study aimed to provide a snapshot of children’s attitudes about TVFA of non-core foods by evaluating four induction factors and the relationship of these factors with TV viewing duration. The four induction factors include (i) recognition of advertised food products (advertisement recognition), (ii) liking the food advertisements on TV (favourite advertisement), (iii) purchase requests induced by TVFA (purchase request), and (iv) product preference generated by TVFA (product preference). These factors were drawn from a literature review [7, 16‐18] and we used the term ‘induction’ as an appropriate label for these factors. In contrast, this study also explores the relationships between potential influencing factors such as gender, age, ethnicity, body mass index and the cited four induction factors.