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Food advertising on British children's television: a content analysis and experimental study with nine-year olds.

OBJECTIVES: The nature and significance of food advertising during children's television was examined in two studies: a content analysis of advertising (Study 1) and an investigation of the impact of food adverts on the self-perception of overweight children (Study 2). PARTICIPANTS: Study 1 monitored 91 h of children's broadcasting on four terrestrial and satellite stations in the UK. In Study 2, 103 children aged 9.75 y viewed two videotaped cartoons containing either food or non-food product advertisements. MEASURES: Study 1 used a detailed record of advertisement style and content. Study 2 included a self-report measure of current state, and measures of self-esteem, dietary restraint, body weight and height. RESULTS: Half of the 828 adverts were for food products, 60% of which were for breakfast cereals and confectionery/ snacks. Food advertisements used significantly more animation, stories, humour and the promotion of fun/happiness/mood alteration. In Study 2, significant interactions between advertisement type and overweight were observed on ratings of perceived health and appetite for sweets. CONCLUSION: While small changes are apparent, advertisements during children's television are still dominated by those for foods of questionable nutritional value, in a manner designed to engage attention and emotional response. That overweight children appeared more influenced by their personal enhancement message, suggests the value of further work identifying who is most influenced and by what features of advertising.

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Direct-to-consumer prescription drug advertising and the public.

OBJECTIVE: Drug manufacturers are intensely promoting their products directly to consumers, but the impact has not been widely studied. Consumers' awareness and understanding of, attitudes toward, and susceptibility to direct-to-consumer (DTC) drug advertising were examined. DESIGN: Random-digit dialing telephone survey with a random household member selection procedure (completion and response rates, 58% and 69%, respectively). SETTING: Respondents were interviewed while they were at their residences. PARTICIPANTS: Complete data were obtained from 329 adults in Sacramento County, California. MEASUREMENTS AND MAIN RESULTS: Outcome measures included awareness of advertisements for 10 selected drugs, misconceptions about DTC advertising, attitudes toward DTC ads, and behavioral responses to such promotions. The influence of demographic characteristics, health status, attitudes, beliefs, and media exposure on awareness and behaviors was examined. On average, respondents were aware of advertisements for 3.7 of the 10 drugs; awareness varied from 8% for Buspar (buspirone) to 72% for Claritin (loratadine). Awareness was associated with prescription drug use, media exposure, positive attitudes toward DTC advertising, poorer health, and insurance status. Substantial misconceptions were revealed; e.g., 43% thought that only "completely safe" drugs could be advertised. Direct-to-consumer advertisements had led one third of respondents to ask their physicians for drug information and one fifth to request a prescription. CONCLUSIONS: Direct-to-consumer advertisements are reaching the public, but selectively so, and affecting their behaviors. Implications for public policy are examined.

Adult↗

Current trends in cigarette advertising and marketing.

Because the nation's health is so greatly influenced by cigarette smoking, this report examines current trends in cigarette advertising and marketing. According to the Federal Trade Commission, total cigarette advertising and promotional expenditures reached $2.1 billion in 1984. From 1974 through 1984, total expenditures increased approximately sevenfold, or threefold after adjustment according to the consumer price index. In 1985, cigarette advertising expenditures accounted for 22.3 percent, 7.1 percent, and 0.8 percent of total advertising expenditures in outdoor media, magazines, and newspapers, respectively. When all products and services were ranked according to national advertising expenditures, cigarettes were first in the outdoor media, second in magazines, and third in newspapers. The proportion of total cigarette advertising and promotional expenditures devoted to promotional activities has increased steadily, from 25.5 percent in 1975 to 47.6 percent in 1984. The proportion of expenditures for cigarettes yielding 15 mg or less of "tar" has increased substantially and has consistently exceeded the domestic market share of these cigarettes. The fastest growing markets are discounted cigarettes and brands containing 25 cigarettes per pack. Several advertising campaigns have targeted women, minorities, and blue-collar workers. The study of these marketing trends should assist health officials in identifying and predicting patterns of cigarette use and in developing health promotion programs that counteract the influence of advertising by incorporating similar, effective techniques.

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Tobacco counter-advertising: a review of the literature and a conceptual model for understanding effects.

The tobacco counter-advertising literature is reviewed as it relates to basic process questions concerning what makes counter-advertisements effective. Limitations in addressing (a) counter-advertisement content and the psychological mediators targeted, (b) counter-advertisement style and the affective reactions targeted, (c) prior smoking experience, and (d) other audience factors are enumerated. A theoretical model based on alcohol advertising research is presented to address those limitations. The model addresses the practical research question of predicting when tobacco counter-advertising will work by examining the independent influence of each of these enumerated factors, as well as how these factors operate in concert, qualifying each other. The model also addresses the process question of explaining how counter-advertising works by identifying affective and cognitive processes as mediators. By understanding the processes that underlie the qualified findings, one can better advise the designers of tobacco counter-advertisements how to be more effective.

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How adolescent girls interpret weight-loss advertising.

While they demonstrate some ability to critically analyze the more obvious forms of deceptive weight-loss advertising, many girls do not recognize how advertising evokes emotional responses or how visual and narrative techniques are used to increase identification in weight-loss advertising. This study examined how girls aged 9-17 years interpreted magazine advertising, television (TV) advertising and infomercials for weight-loss products in order to determine whether deceptive advertising techniques were recognized and to assess pre-existing media-literacy skills. A total of 42 participants were interviewed in seven geographic regions of the United States. In groups of three, participants were shown seven print and TV advertisements (ads) for weight-loss products and asked to share their interpretations of each ad. Common factors in girls' interpretation of weight-loss advertising included responding to texts emotionally by identifying with characters; comparing and contrasting persuasive messages with real-life experiences with family members; using prior knowledge about nutrition management and recognizing obvious deceptive claims like 'rapid' or 'permanent' weight loss. Girls were less able to demonstrate skills including recognizing persuasive construction strategies including message purpose, target audience and subtext and awareness of economic factors including financial motives, credibility enhancement and branding.

Adolescent↗

Attitudes toward physician advertising among rural consumers.

The issue of whether physicians should advertise their services has been the subject of much debate among health policymakers. This study reports data from a survey of rural residents in Illinois regarding attitudes toward physician advertising and reasons for opposition or support of the practice. The results indicate neither strong opposition nor strong support for physician advertising. While those who are opposed are largely nonspecific regarding their reasons, those in favor primarily expect that it will aid in the selection of a physician. However, few respondents indicate a predisposition to shop for a physician. Although the major concern about physician advertising is a danger of false advertising by some physicians, it appears that the respondents are not trusting of advertising in general rather than of advertising by physicians in particular. These findings suggest that regardless of its potential advantages, physician advertising may be relatively ineffective because consumers may be inattentive, unresponsive, or distrusting .

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The influence of advertising on tobacco consumption: some problems with Chetwynd et al.'s analysis.

In a recent study of the relationship between cigarette advertising and the aggregate consumption of cigarettes in New Zealand between 1973 and 1985, Chetwynd et al. (1988) argue that quarterly data suggest that advertising affects overall consumption of cigarettes with an elasticity of +0.07. In addition, they argue that advertising has a 'carry over' effect of about four quarters on current consumption. These results are potentially important for two reasons. Although the evidence is mixed, the conventional view is that cigarette advertising affects brand choice among smokers but not aggregate demand for cigarettes. Chetwynd et al.'s results, (hereafter, Chetwynd) contradict this traditional view. Secondly, if advertising does increase the aggregate demand for cigarettes, then a public policy banning cigarette advertising might reduce aggregate demand for cigarettes. Unfortunately, the Chetwynd, study is sufficiently flawed with conceptual and econometric problems that their inference that advertising increases cigarette demand is questionable. Certainly cigarette advertising may increase or decrease cigarette consumption. The point we wish to make is that, any inference one way or the other based on the results of Chetwynd, cannot be viewed as well-grounded in either scientific methodology or statistical principles.

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The response of New Zealand boys to corporate and sponsorship alcohol advertising on television.

A survey of a random sample of 302 New Zealand boys aged 9-14 years investigated responses to two recent television advertisements featuring alcohol companies. Alcohol product advertising is not allowed on New Zealand television but a corporate advertisement which was allowed was perceived by most of the children to be advertising beer and to be encouraging drinking. A corporate sports sponsorship advertisement had lower association with alcohol, which may have been because of children's limited understanding of the concept of sponsorship. Most of the children remembered both advertisements and many expected their peers to take notice of them. There was strong support for both advertisements being broadcast on television. Overall, the survey suggested that this television advertising was creating strong positive associations between the companies' products and significant cultural and emotional elements, thus contributing to a climate that was not supportive of alcohol education.

Adolescent↗

Evidence of a possible link between obesogenic food advertising and child overweight.

A recent review of the literature concluded that advertising of foods on television may influence children's food choices and encourage unhealthy diets, but the review acknowledged there was a lack of clear evidence in coming to this conclusion. The present paper examines ecological evidence for a link between advertising to children and the risk of overweight using data from surveys of advertising on children's television and estimates of the prevalence of overweight among children, in the USA, Australia and eight European countries. A significant association was found between the proportion of children overweight and the numbers of advertisements per hour on children's television, especially those advertisements that encourage the consumption of energy-dense, micronutrient-poor foods (r = 0.81, P < 0.005). A weaker, negative association was found between the proportion of children overweight and the number of advertisements encouraging healthier diets (r = -0.56, P < 0.10). The quantity of advertising on children's television appears to be related to the prevalence of excess body weight among children. Furthermore, the content of the advertising appears to have a specific effect. The findings justify the need for taking precautionary measures to reduce children's exposure to obesogenic marketing practices.

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Trends in market demand for internal medicine 1999 to 2004: an analysis of physician job advertisements.

BACKGROUND: The health care marketplace has changed substantially since the last assessment of demand for internal medicine physicians in 1996. METHODS: We reviewed internal medicine employment advertisements published in 4 major medical journals between 1996 and 2004. The number of positions, specialty, and other practice characteristics (e.g., location) were collected from each advertisement. RESULTS: Four thousand two hundred twenty-four advertisements posted 4,992 positions. Of these positions, jobs in the Northeast (31% of positions) or single specialty groups (36.8% of positions) were most common. The relative proportion of advertisements for nephrologists declined (P < .001), while the relative proportions of advertisements for critical care specialists (0.5% in 1996 to 1.7% in 2004, P = .004) and hospitalists (1.0% in 1996 to 12.1% in 2004, P < .001) increased. Advertisements for outpatient-based generalist positions (i.e., Primary Care and Internal Medicine) declined (-2.7% relative annual change, 95% confidence interval [95% CI] -4.1%, -1.2%) between 1996 and 2004, a decrease largely due to a substantial decline in advertisements noted between 1996 and 1998. However, over the entire time period, the combined proportion of advertisements for all generalists (hospitalists and outpatient-based generalists) did not change (0.5% relative annual change, 95% CI -0.8% to 2.0%). CONCLUSIONS: Since 1996, demand for the majority of medical subspecialties has remained constant while relative demand has decreased for primary care and increased for hospitalists and critical care. Increase in demand for generalist-trained hospitalists appears to have offset falling demand for outpatient generalists.

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Content of advertisements for junior doctors: is there sufficient detail?

OBJECTIVE: To determine whether employers follow BMA guidelines on advertisements when advertising for junior doctors. DESIGN: Survey of advertisements for junior doctors in the BMJ's classified advertisements supplement from 12 March to 14 May 1994. SUBJECTS: 300 advertisements for substantive posts for junior doctors. OUTCOME MEASURES: Compliance with BMA guidelines, compared by grade, specialty, and employer (trust or regional health authority); observation of any useful information not included in the guidelines. RESULTS: Only eight advertisements included all the recommended information. Amount of information given was related to grade, specialty, or employer in only one respect: advertisements for basic trainees were more likely than those for higher specialist trainees to include information on pay and hours of work (P < 0.001). CONCLUSION: Advertisements for junior doctors in the BMJ do not comply with BMA guidelines and often contain little useful information for potential applicants.

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Continuous tracking of the Australian National Tobacco Campaign: advertising effects on recall, recognition, cognitions, and behaviour.

OBJECTIVES: To relate Australian National Tobacco Campaign advertising to outcome measures such as smokers' awareness of and reaction to the campaign, and indicators of interest in smoking cessation. DESIGN: Continuous tracking was used to survey random cross sectional samples of the target audience via telephone interviews. Baseline measures were collected preceding each advertising phase, whereafter subjects were interviewed on a weekly basis for the entire period of each phase. Changes in outcomes could thus be inferred on a weekly basis allowing variations in advertising intensity to be monitored for effect. Three phases were evaluated variously in Melbourne, Sydney, and Adelaide. SUBJECTS: A total of 9033 subjects aged 18-40 years were interviewed. Age and sex of the sample were evenly distributed. RESULTS: In general, it was found that the greater the media weight, the greater the recall and recognition mediated by the message of the advertisement and the creative execution-advertisements with a clear figure ground executional format appeared more memorable than those without, and health effects advertisements were more memorable than those encouraging calls to a quitline. The relationship between various communication effects and media weight was limited by the confounding of prior activities in two of the phases. CONCLUSIONS: Advertisements with clear figure ground executional formats and those illustrating health effects of smoking have high memorability. Future campaigns that are continuously tracked are recommended to systematically vary media weight, flighting schedules, and advertisement type, so as to maximise information about these variables and their interactions.

Adolescent↗

Emotions for sale: cigarette advertising and women's psychosocial needs.

OBJECTIVE: To explore messages of psychosocial needs satisfaction in cigarette advertising targeting women and implications for tobacco control policy. METHODS: Analysis of internal tobacco industry documents and public advertising collections. RESULTS: Tobacco industry market research attempted to identify the psychosocial needs of different groups of women, and cigarette advertising campaigns for brands that women smoke explicitly aimed to position cigarettes as capable of satisfying these needs. Such positioning can be accomplished with advertising that downplays or excludes smoking imagery. As women's needs change with age and over time, advertisements were developed to reflect the needs encountered at different stages in women's lives. Cigarette brands for younger women stressed female camaraderie, self confidence, freedom, and independence; cigarette brands for older women addressed needs for pleasure, relaxation, social acceptability, and escape from daily stresses. CONCLUSIONS: Psychosocial needs satisfaction can be communicated without reference to cigarettes or smoking. This may explain why partial advertising bans are ineffective and comprehensive bans on all forms of tobacco marketing are effective. Counter-advertising should attempt to expose and undermine the needs satisfaction messages of cigarette advertising campaigns directed at women.

Adult↗

The tobacco industry's code of advertising in the United States: myth and reality.

The major American tobacco companies developed and agreed to abide by the Cigarette Advertising Code in 1964. The stated aims of the code were to prohibit advertising directed at young people, to prohibit advertising that used fraudulent health claims, and to assure compliance with the code's provisions through the establishment of an administrative arm and enforcement mechanism to prescreen and monitor all cigarette advertising. In the 32 years since the Cigarette Advertising Code's adoption, the tobacco industry has used the existence of this code and its revisions and promises of self-regulation in accordance with this code as evidence that it promotes tobacco use only in a responsible manner. The code has served as the basis of the industry's efforts to avoid further local, state, and federal regulatory oversight of its marketing activities. A historical review of cigarette advertising since 1964 indicates that the voluntary code's major provisions have been regularly violated in the spirit and the letter. The administrative and enforcement provisions of the original Cigarette Advertising Code were quietly dismantled soon after the voluntary code's adoption and were completely omitted from the revised code in 1990. The historical evidence indicates that self-regulation of cigarette advertising and promotion by the tobacco industry has been repeatedly given trials and has not worked.

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Cigarette advertising on taxicabs in Boston, Massachusetts (USA).

OBJECTIVE: To examine the frequency of tobacco advertisements on taxicabs within Boston, Massachusetts (USA). DESIGN: At seven locations throughout Boston, an observer counted all taxicabs over 30-minute periods in December 1995. MAIN OUTCOME MEASURES: Confirmed sightings of taxicabs with cigarette advertisements were recorded with information collected on the cigarette brand and taxicab company. RESULTS: A total of 314 taxicabs were observed over 210 minutes of observation time, including 127 (40.4%) with cigarette advertisements. Taxicabs with cigarette advertisements were seen once every 1.65 minutes on average, with Marlboro as the most frequently advertised brand (69 of 127 advertisements, 54.3%). Less affluent locations were serviced by greater proportions of taxicabs carrying cigarette advertisements compared with more affluent locations (odds ratio = 2.08, 95% confidence interval = 1.18-3.68). CONCLUSIONS: Taxicabs represent a major form of exposure to cigarette advertising in Boston.

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Exposure of black youths to cigarette advertising in magazines.

OBJECTIVE: To estimate the potential exposure of black adolescents to brand specific advertising in magazines. DESIGN: A probit regression analysis was conducted of pooled 1990 and 1994 data on brand specific advertising in 36 popular US magazines to examine the relationship between the presence or absence of advertising in each magazine for each of 12 cigarette brands, and the proportion of each magazine's youth (ages 12-17 years) readers who were black. MAIN OUTCOME MEASURES: The presence or absence of advertising in each magazine in 1990 and 1994, for each of 12 cigarette brands. RESULTS: After controlling for total magazine readership and the percentage of young adult, Hispanic, and female readers, black youth cigarette brands (those whose market share among black youths exceeded their overall market share) were more likely than other brands to advertise in magazines with a higher percentage of black youth readers. Holding all other variables constant at their sample means, the probability of a non-black youth brand advertising in a magazine decreased over the observed range of percentage black youth readership from 0.65 (95% confidence interval (CI) 0.55 to 0.75) for magazines with 5% black youth readers to 0.33 (95% CI 0.00 to 0.69) for magazines with 91% black youth readers. In contrast, the probability of a black youth brand advertising in a magazine increased from 0.40 (95% CI 0.17 to 0.62) at 5% black youth readership to 1.00 (95% CI 0.97 to 1.00) at 91% black youth readership. CONCLUSIONS: Black youths are more likely than white youths to be exposed to magazine advertising by cigarette brands popular among black adolescents.

Adolescent↗

Can anti-smoking television advertising affect smoking behaviour? controlled trial of the Health Education Authority for England's anti-smoking TV campaign.

OBJECTIVES: To evaluate the effectiveness of the Health Education Authority for England's anti-smoking television advertising campaign in motivating smokers to give up and preventing relapse in those who had already given up. DESIGN: A prospective, controlled trial was conducted in four TV regions in central and northern England. One region received no intervention (controls), two regions received TV anti-smoking advertising (TV media), and one region received TV anti-smoking advertising plus locally organised anti-tobacco campaigning (TV media + LTCN). The TV advertisements were screened in two phases over 18 months; during the first phase the intensity of the advertising was varied between TV regions. 5468 men and women (2997 smokers, 2471 ex-smokers) were selected by two stage random sampling and interviewed before the intervention, of whom 3610 were re-interviewed six months later, after the first phase of the campaign. Only those interviewed at six months were followed to the main end point at 18 months when 2381 subjects were re-interviewed. MAIN OUTCOME MEASURES: Self reports of cigarette smoking at the 18 month follow up were compared between the three levels of intervention. Odds ratios for intervention effects were adjusted for pre-intervention predictors of outcome and pooled for smokers and ex-smokers using meta-analytic methods. RESULTS: After 18 months, 9. 8% of successfully re-interviewed smokers had stopped and 4.3% of ex-smokers had relapsed. The pooled adjusted odds ratio for not smoking in the TV media only condition compared to controls was 1.53 (95% confidence intervals (CI) 1.02 to 2.29, p = 0.04), and for TV media + LTCN versus controls, 1.67 (95% CI 1.0 to 2.8, p = 0.05). There was no evidence of an extra effect of the local tobacco control network when combined with TV media (odds ratio 1.15, 95% CI 0.74 to 1.78, p = 0.55). The was also no evidence of any intervention effects after the first phase of the TV media campaign, including no effect of varying the intensity of the advertising during this initial phase. Applying these results to a typical population where 28% smoke and 28% are ex-smokers, and where there would be an equal number of quitters and relapsers over an 18 month period without the campaign, suggests that the campaign would reduce smoking prevalence by about 1.2%. CONCLUSIONS: The Health Education Authority for England's anti-smoking TV campaign was effective in reducing smoking prevalence through encouraging smokers to stop and helping prevent relapse in those who had already stopped. The lack of an effect after the first phase of the campaign indicates that if advertising at this intensity is to have an impact, a prolonged campaign is necessary. These results support the UK governments' recent decision to fund similar campaigns, and suggests that anti-smoking TV advertising should be undertaken routinely as an essential component of any population smoking reduction strategy. Reducing smoking prevalence would make a substantial contribution to achieving the UK government's target of preventing 300 000 cancer and heart disease deaths over the next 10 years.

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Excessive and disproportionate advertising in peer-reviewed journals.

The International Committee of Medical Journal Editors (ICMJE) has outlined ethical guidelines concerning the advertising practices of peer-reviewed journals that briefly discuss issues of excessive and disproportionate advertising. The authors evaluated these guidelines using quantitative data, assessing the types and frequencies of advertising in 2001 print issues of NEJM and JAMA, two principal members of ICMJE. Advertising ratios (ratio of advertisements to editorial content) were near unity in NEJM and 0.30 in JAMA, compared with reported ratios of 0.15 among low-circulation specialty science journals and 0.80 among high-circulation consumer magazines. In both journals, five corporations placed more than 50% of all display advertisements. The findings suggest a dissonance between the ethical guidelines and the de facto advertising practices of arguably the two most important member journals of the ICMJE. There is a need to define and apply standards for excessive and disproportionate advertising.

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