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. 2024 Aug 22;7(8):e2429671. doi: 10.1001/jamanetworkopen.2024.29671

Trends in Children’s Exposure to Food and Beverage Advertising on Television

Lisa M Powell 1,✉, Julien Leider 2, Rebecca M Schermbeck 2, Aline Vandenbroeck 1, Jennifer L Harris 3
PMCID: PMC11342137  PMID: 39172450

Key Points

Question

How has children’s exposure to food-related advertising on television, including for products high in nutrients to limit, changed following changes to the voluntary industry self-regulatory Children’s Food and Beverage Advertising Initiative?

Findings

This repeated cross-sectional study found that, from 2013 to 2022, advertisements seen declined by 77.6% for children aged 2 to 5 years and by 78.5% for those aged 6 to 11 years, but both age groups continued to see more than 1000 advertisements per year, and the majority of food and beverage products seen were unhealthy.

Meaning

These findings show that children’s exposure to food-related advertisements on television remains high, suggesting the need for government regulations based on time of day.

This cross-sectional study examines changes in children’s exposure to food-related television advertising after changes in the voluntary industry self-regulatory Children’s Food and Beverage Advertising Initiative standards.

Abstract

Importance

Reducing children’s exposure to advertisements promoting unhealthy foods and beverages has been recognized by the World Health Organization as a key strategy to improve children’s diets and reduce childhood obesity.

Objective

To examine changes in children’s exposure to food-related (food, beverage, and restaurant) television advertising, including for products high in nutrients to limit (NTL; ie, saturated fat, trans fat, total sugars, and sodium) based on federal Interagency Working Group guidelines, following changes in the voluntary industry self-regulatory Children’s Food and Beverage Advertising Initiative (CFBAI).

Design, Setting, and Participants

This repeated cross-sectional study used US television ratings data on advertising exposure from The Nielsen Company for 2013, 2014, 2015, 2018, and 2022. Food and beverage product advertisements were assessed for nutritional content. Participants included 2- to 5-year-old and 6-to 11-year-old children. Data analysis was performed from July 2023 to January 2024.

Exposure

Changes in CFBAI standards in 2014 and 2020.

Main Outcomes and Measures

The primary outcome was the number of food-related advertisements seen per year and percentage of food and beverage product advertisements high in NTL, on all programming and children’s programming (defined as ≥35% child audience share).

Results

From 2013 to 2022, total advertisements seen per year declined by 77.6% (from 4611 to 1035) for 2- to 5-year-olds and by 78.5% (from 4860 to 1046) for 6- to 11-year-olds. Advertisements seen on children’s programming decreased by 95.1% (from 1703 to 84 per year) for 2- to 5-year-olds and by 97.0% (from 1745 to 52 per year) for 6- to 11-year-olds. The percentages of advertisements for products high in NTL decreased from 2013 to 2022 but were still high: 68.9% for all programming and 63.9% for children’s programming for 2- to 5-year-olds, and 68.4% for all programming and 60.6% for children’s programming for 6- to 11-year-olds. The majority (51%-52%) of CFBAI-member food and beverage advertisements on children’s programming remained high in NTL. Black children saw more food-related television advertisements than White children (58% more for 2- to 5-year-olds and 72% more for 6- to 11-year-olds); however, the percentage of advertisements for food and beverage products high in NTL seen was similar by race.

Conclusions and Relevance

In this repeated cross-sectional study of children’s exposure to food-related television advertisements, exposure via children’s programming decreased substantially. However, most advertisements seen were still for unhealthy products, and exposure from all programming remained substantial. Findings of more than 90% of advertising exposure not from children’s programming and more than 1000 food-related advertisements seen per year suggest the need for government regulations based on time of day rather than programming.

Introduction

Reducing children’s exposure to advertisements that promote unhealthy foods and beverages is a key global strategy to improve children’s diets and reduce childhood obesity. Accordingly, the World Health Organization (WHO) has called for government-mandated policies to restrict marketing of unhealthy food to children.1 However, few countries have enacted such policies, and industry has responded to public health concerns by introducing self-regulatory initiatives focused primarily on television advertising directed to children younger than 12 or 13 years.2,3 Furthermore, worldwide reviews have found limited improvements in children’s exposure to advertising of nutritionally poor products associated with food industry self-regulation.4,5

The US voluntary industry self-regulatory Children’s Food and Beverage Advertising Initiative (CFBAI) was introduced in 2006. Companies pledged to advertise only better-for-you products (using individual company-defined nutrition criteria) in child-directed programming.6 Yet following implementation, in 2009, children aged 2 to 11 years continued to view more than 4000 food-related advertisements per year.7,8 Moreover, nearly all (84%) food and beverage (FB) products in television advertisements viewed by children promoted products high in saturated fat, trans fat, total sugars, and/or sodium, including 98% of CFBAI-company advertisements viewed on children’s programming.9 Furthermore, the majority of food-related television advertisements seen by children appeared during programming that did not qualify as child-directed according to CFBAI definitions (ie, ≥35% audience share of children aged 2-11 years).8,9,10

In 2014, the CFBAI introduced uniform nutrition criteria with limits on calories, saturated fat, sodium and total sugars that varied by product category, with further revisions in 2020.11 It also updated its definition of child-directed programming to child-audience share of 30% or higher.12 Nonetheless, more recent evaluations found that foods and beverages advertised to children on television, including in child-directed programming, continued to be nutritionally poor.10,13,14,15

In addition, although previous evaluations have demonstrated reductions in children’s exposure to food-related television advertising since 2009, these reductions were largely attributed to declines in the amount of time that children spend watching traditional television (ie, commercial broadcast and cable channels).10,14,16,17 For example, from 2013 to 2016, the number of food-related TV advertisements viewed by children aged 2 to 5 and 6 to 11 years declined by 13% for both age groups, whereas TV viewing declined by 15% for preschoolers aged 2 to 5 years and by 20% for children aged 6 to 11 years over this time period.10

Evaluations have also identified limitations in CFBAI protections for more vulnerable children. Although most CFBAI companies promise not to advertise to children younger than 6 years, young children (aged 2-5 years) viewed only 5% to 7% fewer total food-related TV advertisements compared with somewhat older children (aged 6-11 years) in 2016, including on children’s television channels.10 CFBAI pledges also fail to recognize the disproportionate impact of higher exposure to unhealthy food advertising by children from minoritized racial or ethnic groups and of lower socioeconomic status owing to greater screen usage.18,19,20,21 In addition, evidence shows that Black children see disproportionately more food advertisements, even after taking into consideration differences in amount of time spent watching television.19 For example, Black children (aged 2-5 and 6-11 years) viewed at least 80% more food-related TV advertisements than White children in 2017, which was higher than differences in time spent watching TV (46% more and 72% more, respectively).19

Given changes in CFBAI program requirements, changes in television viewing patterns and ongoing racial differences in children’s exposure to advertising, it is important to continue to evaluate trends and the status of US children’s exposure to food-related television advertising. This study uses television ratings data to provide a comprehensive examination of exposure to food-related television advertising among children (aged 2-5 and 6-11 years) from 2013 to 2022.

Methods

Data

This repeated cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.22 This study did not require institutional review board approval or informed consent because no individual participant data were used, in accordance with 45 CFR §46. Changes in exposure to food-related television advertisements following the introduction (2014) and revision (2020) of CFBAI category-specific uniform nutrition standards were assessed using television ratings data for 2013, 2014, 2015, 2018, and 2022 licensed from The Nielsen Company. Nielsen data are based on a national sample of television-equipped households in the US (average of 41 000 households). Sampling frames for housing units are obtained from Census data and used to select housing units from which households are sampled. Household-level and person-level data are weighted by Nielsen to ensure a match between the sample and known population totals using iterative proportional fitting (ie, to provide projections for all US television households). Self-reported race is collected from sampled households as part of periodic personal interviews conducted by Nielsen.

The Nielsen Company provided television program ratings data aggregated across households for advertisements shown for each product on each program and channel. Separate ratings data were obtained for children aged 2 to 5 and 6 to 11 years, including by race. The television ratings measure the percentage of children (among households with televisions) who saw a program or advertisement. The ratings data in this study covered exposure from broadcast network, cable network, and syndicated television advertising, as well as spot television advertising shown only to local broadcast markets, from all programming (regardless of audience composition) and from children’s programming (defined as programming with ≥35% child-audience [aged 2-11 years] share), excluding Spanish-language programming. Spot television advertising was not available by race. Sensitivity analyses assessed exposure from programming with different child-audience shares (30%, 25%, and 20%).

Food Categories and Nutritional Content Classification

Food-related products were categorized into 7 categories: beverages, cereal, snacks, sweets, other foods (eg, fruits, vegetables, meats, pasta, condiments, and so forth), fast-food restaurants (ie, Nielsen’s quick-service restaurant classification), and full-service restaurants (non–quick-service restaurants). Nutritional content was assessed for the 5 FB (ie, nonrestaurant) product categories. Information on energy and nutritional content (grams of saturated fat, trans fat, and total sugars, and milligrams of sodium) for advertised FB products was determined from the following sources: manufacturer’s website, product nutrition facts panels from food labels on grocery store websites or in person, US Department of Agriculture (USDA) Food Data Central (formerly known as the USDA Nutrient Database), or the Minnesota Nutrient Data System. Across years, we were unable to obtain nutritional information on less than 9% of the FB advertising seen by children because they were either a nonspecific FB product (eg, Dairy Association or general food company) or nutritional content was not available from our aforementioned sources.

The nutritional content of each FB product was assessed according to nutrition guidelines developed by the Federal Trade Commission, Centers for Disease Control and Prevention, Food and Drug Administration, and USDA to identify FBs that should not be marketed to children (Interagency Working Group [IWG] guidelines).23 Advertised FB products were categorized as either an individual or a main dish and/or meal item and were assessed for nutrients to limit (NTL) based on IWG principle B for recommended limits on saturated fat, trans fat, total sugars, and sodium. Measures were generated to indicate whether each FB product was high in each and any recommended NTL. Individual items were classified as high in saturated fat if the item contained more than 1 g per reference amount customarily consumed (RACC) or more than 15% of total calories came from saturated fats. Meals and/or main dishes were considered high in saturated fat if they contained more than 1 g of saturated fat per 100 g of the item or more than 10% of total calories from saturated fats. Milk, whole eggs, and nuts were exempted from the saturated fat guidelines. All products were limited to less than 0.5 g of trans fat per RACC for individual items or labeled serving size for meals and/or main dishes. The IWG recommended that added sugars be limited to 13 g per RACC for individual items or labeled serving size for meals and/or main dishes. However, because nutrition facts panels did not list added sugars before 2020, plain or flavored milk products and yogurt were allowed an additional 12.5 g and 16 g of sugar, for a total of 25.5 g and 29 g of total sugars, respectively, to account for naturally occurring sugars in these products. In addition, fruits and 100% fruit and/or vegetable juices were exempt from the total sugars limit. Finally, a food item was considered high in sodium if it contained more than 210 mg per RACC for individual items or 450 mg per labeled serving size for meals and/or main dishes. For foods with a small RACC (≤30 g per the Federal Register24,25,26,27), recommendations refer to the amount per 50 g of food. RACCs for the general food supply were used for all products except baby or toddler products, which used RACCs for infants and children aged 1 to 3 years.

Statistical Analysis

Analyses included changes in children’s (aged 2-5 and 6-11 years including by race for White and Black children) annual exposure to food-related television advertisements on all and child-directed programming and by CFBAI-company membership and food, beverage and restaurant category. Analyses also examined changes in the proportion of FB product advertisements seen for products that exceeded recommended guidelines for NTL following implementation of CFBAI revised nutrition criteria. Analyses were conducted in Stata/MP statistical software version 18.0 (StataCorp) from July 2023 to January 2024.

Results

Table 1 shows that between 2013 and 2022, children’s total exposure to food-related advertisements on all television programming decreased by 77.6%, from 4611 to 1035 advertisements per year, among 2- to 5-year-olds and by 78.5%, from 4860 to 1046 advertisements per year, among 6- to 11-year-olds. Exposure to cereal advertisements decreased the most (by 87.4% for children aged 2-5 years and by 86.8% for children aged 6-11 years), whereas exposure to fast-food restaurant advertisements decreased the least (by 63.7% for children aged 2-5 years and by 65.7% for children aged 6-11 years). Fast-food advertisements also made up the largest category (36% for children aged 2-5 years and 38% for children aged 6-11 years) of food-related advertisements seen by children in 2022. Additionally, among FB categories, sweets represented a substantial portion of exposure (24% of nonrestaurant advertisements), whereas exposure decreased the least for beverage products (by 73.5% for children aged 2-5 years and 74.5% for children aged 6-11 years). Furthermore, of beverage advertisements seen on all programming in 2022, 54.3% seen by 2- to 5-year-olds and 54.6% seen by 6- to 11-year-olds promoted sugar-sweetened beverages (data not shown).

Table 1. Children’s Exposure to Food-Related Advertisements by Age, CFBAI Membership, Product Category, and Programming Audience, 2013-2022a.

Age group and type of advertisements All audiences ≥35% Child audience
2013 2014 2015 2018 2022 Change, 2013-2022, % 2013 2014 2015 2018 2022 Change, 2013-2022, %
Children aged 2-5 y
Total No. of food-related advertisements per year 4611 4531 4041 3210 1035 −77.6 1703 1702 1358 892 84 −95.1
CFBAI companies 2727 2536 2153 1511 436 −84.0 1238 1129 836 454 24 −98.0
Non-CFBAI companies 1884 1995 1888 1699 598 −68.2 465 573 522 438 59 −87.2
Total No. of food and beverage advertisements per year 2998 2879 2510 1906 552 −81.6 1228 1181 914 627 45 −96.3
Beverages 361 332 348 374 96 −73.5 91 79 68 85 2 −97.4
Cereal 755 570 443 273 95 −87.4 583 419 315 192 14 −97.7
Snacks 339 320 265 191 59 −82.5 154 142 102 26 1 −99.4
Sweets 658 649 589 485 131 −80.1 117 117 103 141 5 −96.0
Other 885 1009 865 583 171 −80.7 283 424 327 182 24 −91.6
Total No. of restaurant advertisements per year 1613 1652 1532 1304 482 −70.1 474 521 444 265 38 −91.9
Fast-food restaurants 1036 1047 1034 904 377 −63.7 248 257 237 110 8 −96.9
CFBAI companies 334 313 267 239 58 −82.8 190 172 135 85 4 −97.7
Non-CFBAI companies 702 735 767 665 319 −54.5 58 85 101 26 3 −94.1
Full-service restaurants 577 604 498 400 106 −81.7 226 264 207 155 31 −86.5
CFBAI companies 0 0 0 0 0 NA 0 0 0 0 0 NA
Non-CFBAI companies 577 604 498 399 106 −81.7 226 264 207 155 31 −86.5
Children aged 6-11 y
Total No. of food-related advertisements per year 4860 4725 4460 3077 1046 −78.5 1745 1787 1554 941 52 −97.0
CFBAI companies 2868 2650 2462 1525 462 −83.9 1293 1199 1034 555 27 −97.9
Non-CFBAI companies 1992 2074 1998 1553 583 −70.7 452 588 520 387 25 −94.5
Total No. of food and beverage advertisements per year 3134 2972 2800 1864 564 −82.0 1271 1236 1087 698 33 −97.4
Beverages 391 366 399 355 100 −74.5 102 101 92 84 1 −99.2
Cereal 785 613 542 319 104 −86.8 604 463 406 244 15 −97.5
Snacks 376 346 302 180 61 −83.8 174 162 125 28 0 −99.9
Sweets 730 718 687 482 134 −81.6 148 163 153 169 4 −97.1
Other 852 928 871 528 165 −80.6 243 347 311 172 13 −94.7
Total No. of restaurant advertisements per year 1726 1753 1659 1213 482 −72.1 473 551 466 243 19 −96.0
Fast-food restaurants 1151 1166 1167 865 395 −65.7 278 316 286 120 7 −97.4
CFBAI companies 363 347 302 240 63 −82.6 205 196 159 95 5 −97.4
Non-CFBAI companies 788 819 865 625 332 −57.9 73 119 127 26 2 −97.5
Full-service restaurants 575 587 492 348 87 −84.9 195 235 180 123 12 −94.1
CFBAI companies 0 0 0 0 0 NA 0 0 0 0 0 NA
Non-CFBAI companies 575 587 492 348 87 −84.9 195 235 180 123 12 −94.1
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Abbreviations: CFBAI, Children’s Food and Beverage Advertising Initiative; NA, not applicable.

a

Data are licensed from The Nielsen Company. Totals may not exactly equal subtotals as a result of rounding.

Exposure to food-related advertisements on children’s programming decreased even more compared with declines on all programming, by 95.1% (from 1703 to 84 advertisements per year) for 2- to 5-year-olds and by 97.0% (from 1745 to 52 advertisements per year) for 6- to 11-year-olds. Thus, by 2022 less than 10% of children’s food-related advertisement exposure came from children’s programming (8% for children aged 2-5 years; 5% for children aged 6-11 years), compared with just over one-third in 2013. In sensitivity analyses of alternative definitions of children’s programming (eTable 1 in Supplement 1), the proportion of advertisements viewed on children’s programming remained low, even on programming with greater than or equal to 20% child audience-share (21% of advertisements for children aged 2-5 years and 18% of advertisements for children aged 6-11 years). Hence, regardless of the definition for children’s programming, by 2022, 80% to 90% of exposure came from non–children’s programming. In addition, exposure to advertisements from CFBAI member companies on children’s programming declined at a higher rate compared with nonparticipating companies. As a result, in 2022 CFBAI companies were responsible for just 29% of advertisements viewed on children’s programming by 2- to 5-year-olds and 53% of advertisements viewed by 6- to 11-year-old children, compared with 73% for 2- to 5-year-olds and 74% for 6- to 11-year-olds in 2013.

Assessing the nutritional content of products, Table 2 shows a decrease in the proportion of FB products that were high in NTL, with greater declines for advertisements on children’s programming and for CFBAI member companies. In 2013, more than 90% of CFBAI-member products in advertisements seen on children’s programming were high in NTL, compared with 51.0% (for children aged 6-11 years) and 51.5% (for children aged 2-5 years) in 2022. However, the majority of FB product advertisements seen in 2022 on all programming and children’s programming was still for products high in NTL: 68.9% for all programming and 63.9% for children’s programming of products for 2- to 5-year-olds, and 68.4% for all programming and 60.6% for children’s programming for 6- to 11-year-olds. eTable 2 in Supplement 1 shows the greatest reductions for products high in total sugars, particularly on children’s programming, where the proportion of advertisements seen for high-in-sugar products decreased from 79.5% to 38.8% for 2- to 5-year-olds and from 82.4% to 45.0% for 6- to 11-year-olds. The Figure summarizes trends in children’s exposure to food-related advertisements.

Table 2. Percentage of Food and Beverage Products in Television Advertisements Seen by Children High in Nutrients to Limit, by Age, Product Category, CFBAI Membership, and Programming Audience, 2013-2022a.

Age group and type of advertisements All audiences ≥35% Child audience
2013 2014 2015 2018 2022 2013 2014 2015 2018 2022
Children aged 2-5 y
All foods and beverages 80.4 78.6 78.0 69.9 68.9 90.2 83.0 80.7 68.4 63.9
Beverages 36.7 31.2 37.4 37.4 41.4 45.9 21.8 2.0 2.8 0.2
Cereal 86.3 86.7 74.2 47.9 38.0 97.7 98.0 84.1 54.1 31.0
Snacks 88.7 88.8 91.9 76.3 77.9 99.1 96.8 98.9 99.4 100.0
Sweets 91.1 91.6 90.0 89.8 93.3 99.6 98.7 95.9 98.4 100.0
Other 82.9 78.2 84.5 83.0 80.2 81.5 70.4 84.0 87.6 81.0
By CFBAI membership
CFBAI companies 83.6 81.1 80.4 69.5 69.5 92.0 83.9 82.4 59.2 51.5
Non-CFBAI companies 68.3 70.0 70.5 70.6 67.8 80.7 79.4 75.1 82.0 73.7
Children aged 6-11 y
All foods and beverages 82.3 81.3 78.6 70.3 68.4 93.8 89.2 81.7 69.5 60.6
Beverages 40.6 33.3 37.4 37.7 42.6 57.8 28.8 3.7 3.2 0.4
Cereal 87.4 88.4 76.2 50.4 37.3 98.2 98.4 84.5 55.2 29.8
Snacks 88.8 90.0 92.4 78.1 77.9 99.2 98.0 98.6 99.4 100.0
Sweets 91.2 91.7 90.1 90.5 93.2 99.3 98.2 96.7 98.2 100.0
Other 86.7 84.5 85.9 83.8 80.5 92.0 86.6 87.8 89.6 87.5
By CFBAI membership
CFBAI companies 85.1 83.8 80.2 69.0 68.9 94.6 89.8 81.4 60.5 51.0
Non-CFBAI companies 71.3 72.5 73.2 73.1 67.3 89.8 86.3 82.8 87.1 79.3
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Abbreviation: CFBAI, Children’s Food and Beverage Advertising Initiative.

a

Data are licensed from The Nielsen Company. It could not be determined whether certain food and beverage products were high in nutrients to limit; this affected less than 9% of food and beverage advertising seen by children aged 2 to 5 and 6 to 11 years across years. Those products are not included in the denominator of the percentages in this table. Restaurant advertising was not assessed for nutritional content and is not reflected in this table.

Figure. Children’s Exposure to Food-Related Advertisements, by Age and Programming Audience, 2013-2022.

Figure.

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Data are licensed from The Nielsen Company.

Analyses by race (Table 3) showed similar declines in food-related advertisements seen by Black compared with White children from 2013 to 2022 (for children aged 2-5 years, there were decreases of 81.4% for Black children and 78.1% for White children; for children aged 6-11 years, there were decreases of 78.3% for Black children and 79.8% for White children). However, Black children in both age groups continued to view substantially more such advertisements compared with their White peers (1380 vs 876 advertisements per year for children aged 2-5 years and 1506 vs 877 advertisements per year for children aged 6-11 years). Although the disparity in advertisements viewed by Black vs White children declined for 2- to 5-year-olds (from 85% more advertisements seen in 2013 to 58% more in 2022), it increased for 6- to 11-year-olds (60% more in 2013 vs 72% more in 2022). However, the proportion of products high in NTL was similar for advertisements seen by Black and White children in all programming and children’s programming (eTable 3 in Supplement 1). There were also racial differences in time spent watching television (25% more for children aged 2-5 years and 62% more for children aged 6-11 years for Black vs White children; television viewing data from The Nielsen Company not shown in tables).

Table 3. Children’s Exposure to Food-Related Advertisements by Race, Age, CFBAI Membership, Product Category, and Programming Audience, 2013-2022a.

Race, age group, and type of advertisement All audiences ≥35% Child audience
2013 2014 2015 2018 2022 Change, 2013-2022, % 2013 2014 2015 2018 2022 Change, 2013-2022, %
Black children
Children aged 2-5 y
Total No. of food-related advertisements per year 7406 7720 6871 5052 1380 −81.4 2436 2353 2084 1307 99 −95.9
CFBAI companies 4491 4425 3875 2549 623 −86.1 1834 1596 1351 693 36 −98.0
Non-CFBAI companies 2915 3295 2997 2503 757 −74.0 602 757 733 614 63 −89.6
Total No. of food and beverage advertisements per year 4929 5029 4426 3115 770 −84.4 1795 1663 1459 927 57 −96.8
Beverages 593 591 606 609 144 −75.7 123 112 105 121 2 −98.0
Cereal 1163 907 753 427 127 −89.1 874 604 527 294 19 −97.8
Snacks 572 566 485 323 90 −84.2 238 210 167 39 1 −99.6
Sweets 1220 1305 1168 847 185 −84.9 161 168 163 217 6 −96.1
Other 1380 1659 1414 910 225 −83.7 399 569 496 256 28 −93.1
Total No. of restaurant advertisements per year 2477 2691 2445 1936 610 −75.4 641 690 625 380 42 −93.5
Fast-food restaurants 1618 1750 1679 1368 483 −70.1 355 357 351 167 13 −96.2
Full-service restaurants 859 942 766 568 127 −85.3 286 333 275 213 29 −90.0
Children aged 6-11 y
Total No. of food-related advertisements per year 6936 7289 7259 5180 1506 −78.3 2245 2479 2246 1546 104 −95.4
CFBAI companies 4163 4219 4150 2695 704 −83.1 1670 1692 1511 914 59 −96.5
Non-CFBAI companies 2773 3070 3108 2485 802 −71.1 575 788 735 632 45 −92.1
Total No. of food and beverage advertisements per year 4576 4703 4663 3238 853 −81.4 1634 1730 1580 1140 69 −95.8
Beverages 579 583 662 616 146 −74.8 128 138 128 139 1 −99.0
Cereal 1046 907 836 527 167 −84.1 775 653 602 395 33 −95.8
Snacks 548 549 512 319 91 −83.3 228 230 184 46 0 −99.8
Sweets 1188 1265 1283 878 203 −82.9 190 229 219 277 10 −94.9
Other 1215 1399 1370 897 246 −79.8 313 481 447 282 25 −92.1
Total No. of restaurant advertisements per year 2360 2585 2596 1942 654 −72.3 611 749 666 406 35 −94.2
Fast-food restaurants 1574 1728 1828 1385 529 −66.4 364 429 406 199 17 −95.3
Full-service restaurants 786 857 768 556 125 −84.2 248 321 261 207 18 −92.7
White children
Children aged 2-5 y
Total No. of food-related advertisements per year 4010 3984 3555 2976 876 −78.1 1614 1660 1289 868 70 −95.7
CFBAI companies 2424 2295 1942 1439 379 −84.4 1171 1113 800 440 21 −98.2
Non-CFBAI companies 1586 1689 1613 1538 497 −68.6 443 548 490 428 49 −89.0
Total No. of food and beverage advertisements per year 2673 2594 2263 1836 482 −82.0 1167 1160 871 609 39 −96.6
Beverages 310 282 308 359 83 −73.2 86 73 64 83 2 −97.3
Cereal 702 546 416 269 87 −87.7 553 417 303 190 12 −97.8
Snacks 309 294 243 183 52 −83.2 147 142 99 24 1 −99.5
Sweets 551 550 507 452 118 −78.6 110 111 93 134 4 −95.9
Other 802 922 789 573 142 −82.3 272 417 312 177 20 −92.8
Total No. of restaurant advertisements per year 1336 1390 1292 1141 395 −70.5 447 501 418 259 31 −93.1
Fast-food restaurants 832 853 849 779 308 −63.0 229 242 217 105 6 −97.3
Full-service restaurants 504 537 444 362 86 −82.9 217 259 201 154 24 −88.8
Children aged 6-11 y
Total No. of food-related advertisements per year 4344 4195 3967 2775 877 −79.8 1639 1702 1476 866 38 −97.7
CFBAI companies 2611 2414 2241 1406 394 −84.9 1214 1144 985 508 20 −98.4
Non-CFBAI companies 1733 1782 1726 1369 482 −72.2 425 558 491 357 18 −95.8
Total No. of food and beverage advertisements per year 2861 2704 2549 1734 483 −83.1 1193 1180 1036 639 25 −97.9
Beverages 344 315 353 330 88 −74.4 93 93 86 76 1 −99.2
Cereal 729 577 512 297 86 −88.2 567 440 389 225 11 −98.0
Snacks 351 319 280 168 54 −84.6 164 155 121 25 0 −99.9
Sweets 641 630 607 439 120 −81.3 139 157 145 155 4 −97.4
Other 795 862 796 501 135 −83.1 231 335 296 157 9 −96.1
Total No. of restaurant advertisements per year 1484 1492 1418 1041 393 −73.5 446 522 440 226 13 −97.1
Fast-food restaurants 965 967 976 737 323 −66.5 260 297 267 111 5 −98.1
Full-service restaurants 518 525 441 304 70 −86.5 185 225 173 116 8 −95.7
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Abbreviation: CFBAI, Children’s Food and Beverage Advertising Initiative.

a

Data are licensed from The Nielsen Company. Totals may not exactly equal subtotals as a result of rounding.

Discussion

The results of this repeated cross-sectional study show that children’s exposure to food-related advertising on television decreased substantially over the last decade, from almost 5000 advertisements per year in 2013 to approximately 1000 advertisements per year in 2022. Exposure from children’s programming decreased to an even greater extent. By 2022, more than 90% of children’s exposure to food-related television advertisements occurred on non–children’s programming compared with more than a decade ago when just under one-half of exposure came from children’s programming.9 Moreover, 11 years ago CFBAI-participating companies were responsible for almost 60% of children’s exposure to food-related advertisements, compared with approximately 40% in 2022.

The nutritional content of FB product advertisements seen by children on all television following the introduction of CFBAI’s category-specific uniform nutrition criteria in 2014 improved somewhat, from 8 in 10 advertisements promoting products high in saturated fat, trans fat, total sugars and/or sodium in 2013 to just under 7 in 10 in 2022. Nonetheless, more than 50% of FB product advertisements seen on children’s programming exceeded IWG NTL nutrition guidelines, including those from CFBAI-member companies. These results reflect limitations of self-regulation that have been previously identified. For example, 85% of products that CFBAI companies indicated may be advertised to children following introduction of its 2014 uniform nutrition criteria did not meet WHO guidelines for foods that should be advertised to children.15 Following its revised criteria in 2020, overall nutrition quality of products that CFBAI companies listed as appropriate for advertising to children did improve.28 However, only 35% of these listed products were actually advertised on children’s television programming, and the advertised products were statistically significantly less nutritious than listed products that companies did not advertise directly to children.28

The data from this study also showed that Black children continued to have higher exposure to food-related television advertisements compared with White children, although the proportion of products high in NTL was similar across these races. Although a recent report19 found that disproportionate exposure to food-related advertisements by Black vs White children decreased from 2017 to 2021, the data from the present study revealed that the exposure gap increased again in 2022. Furthermore, disparities in advertisement exposure in 2022 (58% more and 72% more for Black vs White children aged 2-5 years and 6-11 years, respectively) continued to exceed differences in time spent watching television (25% more and 62% more for Black vs White children; television viewing data from The Nielsen Company not shown in tables). Therefore, government restrictions of unhealthy food advertising to children would help to address diet-related health disparities due to disproportionate exposure to unhealthy food advertising among children in minoritized racial or ethnic communities.1,29

Also importantly, the overall reduction in exposure to food-related television advertisements was likely related to substantial reductions in children’s television viewing, which have been accompanied by increases in other screen use. From 2013 to 2020, the average time that young children (aged 0-8 years) spent watching traditional television declined by more than 50%, while their total screen media use increased by 25%.20 Among somewhat older children (aged 8-12 years), total screen usage increased by 21% from 2015 to 2021, but watching on a television set increased by 11% (including streaming services) from 2019 to 2021.21 Accordingly, children’s exposure to food-related marketing is prevalent in other media, including on digital devices. For example, viewing YouTube videos is now popular with young children younger than 9 years,20,30,31 and two-thirds of popular child-influencer videos feature at least 1 food-related appearance within the video content.32 Moreover, recent international studies33,34 indicate that children are frequently exposed to food marketing in digital media and social media platforms (estimates of 1560-2461 messages per year). Similar to television, most food-related marketing messages viewed online promote nutritionally poor products, including fast food, candy, sugar-sweetened beverages, and snacks.31,32,33,34 It will be important for future US-based work to examine children’s exposure to food-related marketing, including product nutritional content, across a variety of digital media platforms.

Limitations

This study is subject to several limitations. First, because data obtained from The Nielsen Company were aggregated across their sample providing projections for US television households, we were unable to account for sampling variability and formally test statistical significance of observed changes. Second, we did not assess nutritional content for restaurant advertisements because these often did not highlight menu offerings with enough specificity to assess their nutritional content. Third, we did not examine additional ingredients of concern not captured in the IWG guidelines or CFBAI self-regulations including nonnutritive sweeteners (NNSs) and food dyes. Since the IWG guidelines were published, the American Academy of Pediatrics has recommended additional research on consumption of NNSs by children.35 For example, 52% of yogurts on the CFBAI list of products that may be advertised to children included NNSs.13 Additionally, some states are now seeking to limit food dyes in FB products because of their potential harm.36,37 Future work should monitor the extent of children’s exposure to advertising of products that include NNSs and dyes.

Conclusions

This study found a substantial reduction in children’s exposure to food-related television advertisements yet, at the same time, demonstrated continued limitations of the CFBAI in protecting children from unhealthy television food-related advertising. First, the majority of children’s exposure continues to be for nutritionally poor products, placed by companies not participating in the CFBAI and appearing on programming not covered by CFBAI pledges (ie, primarily non–children’s programming). Furthermore, although CFBAI-member companies pledge not to advertise to children younger than 6 years, young children continue to view more than 1000 food-related advertisements per year, similar to their 6- to 11-year-old counterparts. Government regulations that restrict advertising of unhealthy foods and beverages applied to programming based on time of day rather than on child-audience share would be more effective. In addition, the finding that the nutritional content of foods and beverages that continue to be advertised, including on children’s programming by CFBAI-member companies, do not meet the IWG nutrition criteria supports the WHO recommendation for government-led criteria to limit foods and beverages marketed to children.

Supplement 1.

eTable 1. Total Number of Food-Related Advertisements Seen Per Year by Age and Programming Audience, 2022

eTable 2. Percent of Food and Beverage Products in Television Advertisements Seen by Children High in Nutrients to Limit, by Age, Product Category, and Programming Audience, 2013-2022

eTable 3. Percent of Food and Beverage Products in Television Advertisements Seen by Children High in Nutrients to Limit, by Race, Age, Product Category, CFBAI Membership, and Programming Audience, 2013-2022

jamanetwopen-e2429671-s001.pdf (343KB, pdf)
Supplement 2.

Data Sharing Statement

jamanetwopen-e2429671-s002.pdf (14.1KB, pdf)

References

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eTable 1. Total Number of Food-Related Advertisements Seen Per Year by Age and Programming Audience, 2022

eTable 2. Percent of Food and Beverage Products in Television Advertisements Seen by Children High in Nutrients to Limit, by Age, Product Category, and Programming Audience, 2013-2022

eTable 3. Percent of Food and Beverage Products in Television Advertisements Seen by Children High in Nutrients to Limit, by Race, Age, Product Category, CFBAI Membership, and Programming Audience, 2013-2022

jamanetwopen-e2429671-s001.pdf (343KB, pdf)
Supplement 2.

Data Sharing Statement

jamanetwopen-e2429671-s002.pdf (14.1KB, pdf)

Articles from JAMA Network Open are provided here courtesy of American Medical Association

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