Social Science & Medicine 116 (2014) 223e224
Contents lists available at ScienceDirect
Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed
Commentary
Response to: Counter-advertising to combat unhealthy food marketing will not be enough. Commentary on “Can counteradvertising reduce pre-adolescent children's susceptibility to front-of-package promotions on unhealthy foods? Experimental research” Helen Dixon a, *, Maree Scully a, Bridget Kelly b, Kathy Chapman c, Melanie Wakefield a a
Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia School of Health and Society, University of Wollongong, New South Wales, Australia c Cancer Council New South Wales, New South Wales, Australia b
a r t i c l e i n f o Article history: Received 24 June 2014 Accepted 28 June 2014 Available online 30 June 2014 Keywords: Counter-advertising Nutrition Experiment Children
Roberto's commentary on our paper (Dixon et al., 2014a) in this issue of Social Science and Medicine provides helpful contextual information concerning the plethora of marketing for unhealthy foods to which children are exposed. The commentary discusses potential strategies to address concerns about child-targeted food marketing, including industry self-regulation, policies mandating reductions in child-targeted marketing, and finally counteradvertising strategies to help children defend against food marketing. Our study was concerned with exploring the usefulness of the latter approach, and the results showed that counter-ads provided most children with some defence against front-of-package promotions (FOPPs) (nutrient content claims and sports celebrity endorsements) on unhealthy foods. Roberto identified a potential limitation of our analyses, in that we did not control for multiple comparisons. To address this suggestion, we have subsequently reassessed the significance of the main effects using the Bonferroni correction to account for
DOI of original article: http://dx.doi.org/10.1016/j.socscimed.2014.02.031. * Corresponding author. E-mail address: [email protected] (H. Dixon). http://dx.doi.org/10.1016/j.socscimed.2014.06.050 0277-9536/© 2014 Elsevier Ltd. All rights reserved.
undertaking multiple statistical tests [p < 0.0021 (0.05 divided by 24 tests)]. Under this scenario, observed differences between children in the control condition and children who saw the counter-ads and understood them persist (see Table 3, Dixon et al., 2014a). The majority of children understood the counter-ads, and the counterads led these children to rate the FOPPs as less believable and rate unhealthy products bearing FOPPs as less healthy compared to children who did not view counter-ads. However, for the group of children who misunderstood the counter-ads, application of the more stringent p-value meant the one previously reported significant difference with children in the control group (extent to which FOPP was perceived as meaningful) was no longer statistically significant. While the overall pattern of means on the various response variables for the control group relative to the ‘misunderstood’ group in Table 3 implies that children who misunderstood counter-ads generally appraised products bearing FOPPs more favorably, none of these differences were statistically significant. Thus, the results of statistical testing indicate that those children who misunderstood the counter-ads were no worse or better off than those who did not view any counter-ads. Application of the more stringent criterion for statistical significance still indicated that the counter-ads performed more favorably for children who
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H. Dixon et al. / Social Science & Medicine 116 (2014) 223e224
understood them than for children who did not, in terms of perceptions of the healthiness of unhealthy products with FOPPs but not for the more specific reactions to the FOPPs. Overall, the results still draw attention to the need to rigorously pre-test any child-targeted counter-advertisements for potential misunderstanding and any positive, negative and null effects before investing in them as campaigns. Our study tested the utility of counter-ads with older children (grades 5 and 6). Given we found grade 5 children were more likely to misunderstand the counterads than grade 6 children, it would be especially important to assess understanding of counter-ads among children with more immature cognitive abilities (e.g. early primary school grades). If significant negative effects of counter-ads relative to no counterads were found for this group, caution in using counter-ads with children across a range of ages would be advisable. Conversely, if positive effects and no negative effects were found, then the utility of using counter-ads with children of varying cognitive maturity may be supported, depending on the absolute extent that they may protect children from unhealthy food marketing. As Roberto notes, there are a range of policy options to restrict the impact of food marketing on children, and it would be inadvisable that counteradvertising campaigns detract from other policy responses, such as regulating marketing content. Roberto suggested that more research is needed to explore whether counter-advertisements might be useful for adults. Our paper testing counter-ads with children cited another recent study by our research team which tested the utility of counteradvertisements in making parents less susceptible to the influence of food promotions (Dixon et al., in press). Using a comparable experimental design, 1269 parents of children aged 5e12 years participated in the study. The results revealed that compared to parents who saw a control advertisement, parents who saw a counter-advertisement perceived unhealthy products featuring FOPPs as less healthy, expressed weaker intentions for buying such products, and were more likely to read the nutrition facts panel before nominating their product choices. Parents who saw a counter-ad also perceived consumers of unhealthy products featuring FOPPs as less intelligent, and rated the FOPPs themselves as less trustworthy, less credible and more misleading than parents who saw a control ad. These differences between the counteradvertising and control conditions were all statistically significant after applying the Bonferroni correction (p < 0.0018).
It should be noted that at best, the counter-ads succeeded in making parents and children more skeptical of the FOPPs and critical of the nutrition content of unhealthy products. However, this brief exposure to the counter-ads did not lead to measurable reductions in the most pertinent consumer response measure: product choice. Conversely, our other experimental studies comparing parent's and children's responses to FOPPs versus no FOPPs (i.e. simulating a ban on FOPPs), did find significant effects on both parent's and children's product choices (Dixon et al., 2014b, 2011). Viewed together, this evidence suggests that regulating against such FOPPs would yield more tangible gains in terms of promoting healthier food choices than counter-advertising alone. In conclusion, the results of our research with children and especially parents indicates that counter-advertising may help to reduce the negative influence of unhealthy food marketing and improve the accuracy of consumer's evaluations of the healthiness of promoted food products. However, counter-advertisements alone are unlikely to improve food intakes and curb the obesity epidemic. We concur with Roberto that while counter-advertising may assist in combatting unhealthy food marketing, a range of complementary strategies would need to be implemented simultaneously to promote meaningful improvements in children's diets. Funding This research was funded by the Bupa Health Foundation & Cancer Council Victoria. References Dixon, H., Scully, M., Kelly, B., Chapman, K., Wakefield, M., 2014a. Can counteradvertising reduce pre-adolescent children's susceptibility to front-of-package promotions on unhealthy foods?: Experimental research. Soc. Sci. Med. Dixon, H., Scully, M., Niven, P., Kelly, B., Chapman, K., Donovan, R., et al., 2014b. Effects of nutrient content claims, sports celebrity endorsements and premium offers on pre-adolescent children's food preferences: experimental research. Pediatr. Obes. 9, e47ee57. Dixon, H., Scully, M., Kelly, B., Donovan, R., Chapman, K., Wakefield, M Counteradvertising may reduce parent's susceptibility to nutrient content claims and sports celebrity endorsements on unhealthy foods. J. Nutr. Educ. Behav. (in press). Dixon, H., Scully, M., Wakefield, M., Kelly, B., Chapman, K., Donovan, R, 2011. Parent's responses to nutrient claims and sports celebrity endorsements on energydense and nutrient-poor foods: an experimental study. Public Health Nutr. 14, 1071e1079.
Contents lists available at ScienceDirect
Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed
Commentary
Response to: Counter-advertising to combat unhealthy food marketing will not be enough. Commentary on “Can counteradvertising reduce pre-adolescent children's susceptibility to front-of-package promotions on unhealthy foods? Experimental research” Helen Dixon a, *, Maree Scully a, Bridget Kelly b, Kathy Chapman c, Melanie Wakefield a a
Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia School of Health and Society, University of Wollongong, New South Wales, Australia c Cancer Council New South Wales, New South Wales, Australia b
a r t i c l e i n f o Article history: Received 24 June 2014 Accepted 28 June 2014 Available online 30 June 2014 Keywords: Counter-advertising Nutrition Experiment Children
Roberto's commentary on our paper (Dixon et al., 2014a) in this issue of Social Science and Medicine provides helpful contextual information concerning the plethora of marketing for unhealthy foods to which children are exposed. The commentary discusses potential strategies to address concerns about child-targeted food marketing, including industry self-regulation, policies mandating reductions in child-targeted marketing, and finally counteradvertising strategies to help children defend against food marketing. Our study was concerned with exploring the usefulness of the latter approach, and the results showed that counter-ads provided most children with some defence against front-of-package promotions (FOPPs) (nutrient content claims and sports celebrity endorsements) on unhealthy foods. Roberto identified a potential limitation of our analyses, in that we did not control for multiple comparisons. To address this suggestion, we have subsequently reassessed the significance of the main effects using the Bonferroni correction to account for
DOI of original article: http://dx.doi.org/10.1016/j.socscimed.2014.02.031. * Corresponding author. E-mail address: [email protected] (H. Dixon). http://dx.doi.org/10.1016/j.socscimed.2014.06.050 0277-9536/© 2014 Elsevier Ltd. All rights reserved.
undertaking multiple statistical tests [p < 0.0021 (0.05 divided by 24 tests)]. Under this scenario, observed differences between children in the control condition and children who saw the counter-ads and understood them persist (see Table 3, Dixon et al., 2014a). The majority of children understood the counter-ads, and the counterads led these children to rate the FOPPs as less believable and rate unhealthy products bearing FOPPs as less healthy compared to children who did not view counter-ads. However, for the group of children who misunderstood the counter-ads, application of the more stringent p-value meant the one previously reported significant difference with children in the control group (extent to which FOPP was perceived as meaningful) was no longer statistically significant. While the overall pattern of means on the various response variables for the control group relative to the ‘misunderstood’ group in Table 3 implies that children who misunderstood counter-ads generally appraised products bearing FOPPs more favorably, none of these differences were statistically significant. Thus, the results of statistical testing indicate that those children who misunderstood the counter-ads were no worse or better off than those who did not view any counter-ads. Application of the more stringent criterion for statistical significance still indicated that the counter-ads performed more favorably for children who
224
H. Dixon et al. / Social Science & Medicine 116 (2014) 223e224
understood them than for children who did not, in terms of perceptions of the healthiness of unhealthy products with FOPPs but not for the more specific reactions to the FOPPs. Overall, the results still draw attention to the need to rigorously pre-test any child-targeted counter-advertisements for potential misunderstanding and any positive, negative and null effects before investing in them as campaigns. Our study tested the utility of counter-ads with older children (grades 5 and 6). Given we found grade 5 children were more likely to misunderstand the counterads than grade 6 children, it would be especially important to assess understanding of counter-ads among children with more immature cognitive abilities (e.g. early primary school grades). If significant negative effects of counter-ads relative to no counterads were found for this group, caution in using counter-ads with children across a range of ages would be advisable. Conversely, if positive effects and no negative effects were found, then the utility of using counter-ads with children of varying cognitive maturity may be supported, depending on the absolute extent that they may protect children from unhealthy food marketing. As Roberto notes, there are a range of policy options to restrict the impact of food marketing on children, and it would be inadvisable that counteradvertising campaigns detract from other policy responses, such as regulating marketing content. Roberto suggested that more research is needed to explore whether counter-advertisements might be useful for adults. Our paper testing counter-ads with children cited another recent study by our research team which tested the utility of counteradvertisements in making parents less susceptible to the influence of food promotions (Dixon et al., in press). Using a comparable experimental design, 1269 parents of children aged 5e12 years participated in the study. The results revealed that compared to parents who saw a control advertisement, parents who saw a counter-advertisement perceived unhealthy products featuring FOPPs as less healthy, expressed weaker intentions for buying such products, and were more likely to read the nutrition facts panel before nominating their product choices. Parents who saw a counter-ad also perceived consumers of unhealthy products featuring FOPPs as less intelligent, and rated the FOPPs themselves as less trustworthy, less credible and more misleading than parents who saw a control ad. These differences between the counteradvertising and control conditions were all statistically significant after applying the Bonferroni correction (p < 0.0018).
It should be noted that at best, the counter-ads succeeded in making parents and children more skeptical of the FOPPs and critical of the nutrition content of unhealthy products. However, this brief exposure to the counter-ads did not lead to measurable reductions in the most pertinent consumer response measure: product choice. Conversely, our other experimental studies comparing parent's and children's responses to FOPPs versus no FOPPs (i.e. simulating a ban on FOPPs), did find significant effects on both parent's and children's product choices (Dixon et al., 2014b, 2011). Viewed together, this evidence suggests that regulating against such FOPPs would yield more tangible gains in terms of promoting healthier food choices than counter-advertising alone. In conclusion, the results of our research with children and especially parents indicates that counter-advertising may help to reduce the negative influence of unhealthy food marketing and improve the accuracy of consumer's evaluations of the healthiness of promoted food products. However, counter-advertisements alone are unlikely to improve food intakes and curb the obesity epidemic. We concur with Roberto that while counter-advertising may assist in combatting unhealthy food marketing, a range of complementary strategies would need to be implemented simultaneously to promote meaningful improvements in children's diets. Funding This research was funded by the Bupa Health Foundation & Cancer Council Victoria. References Dixon, H., Scully, M., Kelly, B., Chapman, K., Wakefield, M., 2014a. Can counteradvertising reduce pre-adolescent children's susceptibility to front-of-package promotions on unhealthy foods?: Experimental research. Soc. Sci. Med. Dixon, H., Scully, M., Niven, P., Kelly, B., Chapman, K., Donovan, R., et al., 2014b. Effects of nutrient content claims, sports celebrity endorsements and premium offers on pre-adolescent children's food preferences: experimental research. Pediatr. Obes. 9, e47ee57. Dixon, H., Scully, M., Kelly, B., Donovan, R., Chapman, K., Wakefield, M Counteradvertising may reduce parent's susceptibility to nutrient content claims and sports celebrity endorsements on unhealthy foods. J. Nutr. Educ. Behav. (in press). Dixon, H., Scully, M., Wakefield, M., Kelly, B., Chapman, K., Donovan, R, 2011. Parent's responses to nutrient claims and sports celebrity endorsements on energydense and nutrient-poor foods: an experimental study. Public Health Nutr. 14, 1071e1079.
