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. 2023 Feb 24;10(3):442. doi: 10.3390/children10030442

Table 1.

Results of studies examining the association between nutrition-related messages through advertising, video games, and social media and nutritional choices and obesity/overweight/body fat in adolescents.

Authors Country Study Design Way of Study Performance Participants, Sample Size Methods Main Findings
Cervi et al., 2017 [20] USA Cross-sectional Electronically 1080 teenagers aged 14 to 17; 48.5% boys and 51.5% girls Each parent and adolescent completed two online surveys on diet-, physical activity-, and cancer prevention-related behaviors. A questionnaire related to the consumption of drinks (sugary, soft, energy, sports drinks) was completed and information related to the sensitivity of teenagers to advertisements (autonomous motivation, controlled motivation, barriers, self-efficacy, knowledge) was collected. BMI was self-reported. High advertisement sensitivity was associated with greater consumption of SSBs. Adolescents with high vulnerability to advertising were more likely to consume at least one SSB daily. Non-Hispanic black adolescents were more likely to be exposed to advertisements and more likely to consume at least one SSB daily compared to their non-Hispanic white peers. However, no significant associations were found between being overweight or obese and consumption or advertisement sensitivity. No significant associations were found between BMI and sensitivity/vulnerability to advertising or BMI and daily consumption of SSBs.
Powell et al., 2017 [21] USA Longitudinal, 2-year, cross-sectional The study was based on television ratings (data from NMR) linked to the ECLS-K cohort (1998–1999) and the U.S. NHANES (2003–2004). 414 children and adolescents with an onset age of 8 to 11 years of ae; 48.3% girls and 51.7% boys Information on the frequency of fast-food, soft drink, sport drink, and fruit drink consumption in the previous seven days and the hours of TV watching per week was collected through relevant questions. BMI was measured by specialized personnel. In addition, the DXA method was used. As for NMR’s advertising data, these were based on individual TV program ratings. Scores were measured in TRP units; monthly TRPs were aggregated to the brand level and then categorized across food categories using an NMR product classification code that specified the product category. Exposure to advertisements for soft drinks and sugary drinks was significantly associated with higher frequency of their consumption among young people, even after controlling for unobserved heterogeneity. The association between fast-food advertising and its consumption was not confirmed after controlling for unobserved heterogeneity. Exposure to cereal advertising was significantly associated with young adolescents’ BMI percentile rank, but exposure to fast-food and soft drink advertising was not. The obesity results revealed that children’s exposure to cereal advertising correlated with body fat percentage. The same was true of fast-food advertising. In contrast, exposure to SSB advertising was marginally significantly associated with body fat percentage.
Baldwin et al., 2018 [22] Australia Cross-sectional About 7600 parents who were members of a group of a market research firm (McNair Ingenuity) were contacted by e-mail. 417 children and adolescents aged 10 to 16 years of age; 196 boys and 221 girls Filling out a questionnaire on consumption of unhealthy foods and drinks, internet and social media use, (Facebook; YouTube) and interactions therein with different commercial food and beverage companies (”liking”, sharing, entering sponsored contests). Certain online and social media behaviors were linked to higher consumption of unhealthy foods and drinks. Watching commercial content on YouTube and self-reported exposure to online food advertising were significantly associated with higher consumption of unhealthy foods and/or beverages after adjusting for demographic factors. Children who bought food online were also significantly more likely to have unhealthy eating choices.
Trude et al., 2018 [23] USA Randomized controlled trial Home environment 509 children and adolescents aged 9 to 15 years of age; 227 boys and 282 girls The intervention was divided into three phases, each lasting two months: (1) healthier drinks, (2) healthier snacks, and (3) healthier cooking methods. Social media (Facebook, Instagram, and Twitter) was used to integrate all levels of research. Recipes, news, and activities related to healthy drinks and snacks were featured daily. During each phase, guardians received a text message 3–5 times per week regarding healthy eating behavior. Study participants were not required to attend any training sessions; they were only invited to follow social media and subscribe to the messaging program (intervention group). The CIQ and BKFFQ were used, and young people’s food purchasing habits (pre-intervention and 6 to 12 months post-intervention) were measured. Youths in the intervention group increased their purchases of healthier foods and beverages, which were 1.4 times more per week than those of youths in the comparison group. After the intervention, there was a 3.5% reduction in calories from sweets for the middle-adolescence participants in the intervention group compared to the control group. No effect on SSB consumption was observed.
Gesualdo and Yanovitzky, 2019 [24] USA Qualitative National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating study; electronically 1657 adolescents aged 12 to 17 years of age; 50% girls The independent variable in all analyses was the adolescent’s susceptibility to advertising influence. The susceptibility score for each participant was obtained by averaging their responses to three items (wanting to try, thinking the advertised products will taste good, trusting the advertised messages). The dependent variables were self-reported SSB preference and SSB consumption during the previous week. The relationship between advertising susceptibility and consumption of SSBs was mainly initiated by the perceived use of SSBs by their peers. In other words, advertising-vulnerable adolescents were more likely to report a preference for SSBs if advertising led them to perceive that their peers consumed these SSBs regularly.
Qutteina et al., 2019 [25] Belgium Qualitative and quantitative Electronically 21 teenagers aged 12 to 18 years of age; 11 boys and 10 girls Diary study with a one-week data collection period. Participants were trained to take screenshots of any food-related images (images of food, brand logos, restaurants, etc.) received and/or associated with social media. Participants were asked about the social media platform the image was found on and whether they were actively looking for the shared image or whether they inadvertently encountered it. Social media usage questions were also asked. All participants reported high use of social media (at least three social media accounts, with some reporting up to six social media accounts). Girls were more likely to share images of food from Instagram and Snapchat. On the other hand, boys were more likely to share images of food on YouTube and Facebook. Despite more boys participating in the study, boys only shared 27% of the images. Social media focused on the consumption of non-core foods in large portions and was promoted equally by peers, marketers, and influencers.
Thomas et al., 2019 [26] UK Cross-sectional Online 3348 adolescents aged 11 to 19 years of age; 49% girls and 51% boys Deprivation was assessed by region with the IMD. Participants reported their consumption behaviors of HFSS products and healthy products such as fruit and vegetables, as well as the hours spent watching both commercial and non-commercial television services on both weekdays and weekends. Adolescents from poor neighborhoods were more likely to consume a range of HFSS/high-fat foods and reported increased exposure to advertising for these foods.
Critchlow et al., 2020 [27] UK Cross-sectional Electronically; online 3348 adolescents aged 11 to 19 years of age; 48% boys and 52% girls Participants were shown two advertisements for HFSS food brands: (1) a fast-food brand and (2) a confectionery brand (for sweets) that were both affordable to teenagers. Data on sex, age, ethnicity, region of residence, IMD, and self-reported BMI were collected. Participants were asked to what extent each advert influenced their choice in terms of making the product attractive, healthy, or a choice for them. Adolescents reacted positively to the two HFSS food advertisements. This included positive perceptions of branding (e.g., perceived popularity and appeal) and advert design (e.g., fun and age group appeal), as well as behavioral impact (e.g., temptation to try). Positive reactions had key associations with age (younger teenagers were more likely to report that both adverts would appeal to their age group and be tempted to try the promoted brands) and, to a lesser extent, BMI. Girls were more likely than boys to react positively to most parameters studied for both adverts.
Fleming-Milici and Harris, 2020 [28] USA Cross-sectional Electronically 1564 adolescents aged 13 to 17 years of age; 46.9% boys and 53.1% girls Participants reported their engagement with food and beverage brands on social media (“liking”, sharing, following brands), TV, or other screen time based on YRBSS questions (2018). Widespread engagement with food and beverage brands on social media was shown among teenagers. Greater odds of engagement in high versus moderate television viewing was noted across all food categories, suggesting a greater influence of television and a possible dose–response relationship. High use of another screen format predicted teenagers’ engagement with fast-food and snack brands only.
Gearhardt et al., 2020 [29] USA Cross-sectional Laboratory 171 male and female adolescents aged 13 to 16 years of age fMRI neuroimaging, rating preference for advertisements (approximately 15 s in randomized order) typically seen by teenagers (unhealthy fast food, healthier fast food, phone), and eating a meal at a simulated fast-food restaurant. The primary outcome variable was food intake in the simulated fast-food restaurant. Fast-food advertisements could result in greater food intake in adolescents through activation of neurobiological systems related to reward, memory, processing, and visual attention.
Murphy et al., 2020 [30] Ireland Two experimental studies Schools; computer-based 151 adolescents aged 13 to 17 years of age. First study: 72 teenagers aged 13 to 14 years of age (45 girls, 27 boys). Second study: 79 teenagers aged 13 to 17 (49 girls and 30 boys). Adolescents were requested to view the feeds of Facebook users of a similar age. They were presented with 36 profiles in random order. While viewing each profile feed, participants answered questions regarding the likelihood of sharing the posts they saw, questions about their use of digital media, and questions about their knowledge of brands, among others. At the end, participants were asked to list all the brands they remembered seeing while viewing their Facebook feeds. A Tobii-T60 eye-tracking monitor was also used in the second study. Adolescents responded significantly more positively to unhealthy food advertising compared to non-food and healthy food advertising. In terms of recall, recall for unhealthy food brands was almost five times higher than for healthy food brands and almost twice as high as for non-food brands. In addition, adolescents recognized many unhealthy food brands and did so at about twice the rate of healthy food and non-food brands.
Smit et al., 2020 [31] The Netherlands Longitudinal, 2-year Schools 453 adolescents with an initial age of 8 to 12 years; 52.5% girls and 48.8% boys Data were obtained from the MyMovez project. Participants received the “Wearable Lab”. For seven consecutive calendar days, adolescents received daily questionnaires assessing video viewing frequency and unhealthy eating behaviors (i.e., consumption of SSBs and unhealthy snacks) through the device. Frequency of watching vlogs influenced their consumption of unhealthy drinks two years later. The analyses did not demonstrate significant relationships with the consumption of unhealthy snacks.
Bragg et al., 2021 [32] USA Randomized controlled trial Electronically 832 adolescents aged 13 to 17 years of age; 51.2% boys and 48.8% girls Teenagers saw eight pairs of unhealthy food and drink adverts presented in random order. The teens then answered questions pertaining to how much they liked the image and how tasty they thought the featured product might be. Food advertisements on Instagram were particularly attractive to teenagers compared to traditional food adverts, indicating that the visual appearance of adverts and context exert a strong influence on teenagers’ perceptions and choices.
Dikmen et al., 2021 [33] Turkey Cross-sectional Schools 2699 teenagers aged 11 to 16 years of age; 1380 boys and 1319 girls Adolescents were administered a questionnaire on television viewing habits and their tendency to purchase food and beverages under the influence of television advertisements. Girls were more influenced by television advertisements and tended to buy the advertised foods more than boys. A total of 69.6% of teenagers said they were influenced by food advertisements, and 66.4% of them bought those foods. The preferred products were cakes, cookies, chocolate, sweet and savory snacks, and soft drinks.
Fernández-Escobar et al., 2021 [34] Spain Randomized controlled trial Schools 857 adolescents aged 11 to 14 years of age The intervention consisted of watching a video of a 5 min cartoon with two commercial breaks, each of which included two advertisements promoting unhealthy food and drinks with health promotion messages from HAVISA at the bottom of the commercial.
Afterwards, students were presented healthy and unhealthy foods and were asked to freely choose a product. A questionnaire measured the effect of the intervention, attitudes, and the intention to consume the advertised products.
Participants exposed to unhealthy food advertising showed a high desire and intention to consume the advertised food, and the majority (about 7 in 10) chose unhealthy processed snacks over fruit or nuts. No differences were observed regarding the desire to perform physical activity or the perceived importance of a healthy diet and physical activity. This suggested that the health promotion messages used by HAVISA had little or no effectiveness in changing health-related behaviors or attitudes following this brief adolescent intervention.
Gascoyne et al., 2021 [35] Australia Cross-sectional Schools 8708 adolescents aged 12 to 17 years of age; 52.6% girls and 47.6% boys Students were asked to report how often in the past month they had seen an advert for a food or beverage product on social media, about related posts, and about how often they were consuming unhealthy foods or drinks. Exposure to food and beverage advertising on social media was associated with high intake of unhealthy beverages, while engagement in such marketing was associated with high intake of unhealthy food and beverages. The strongest associations were seen among students who reported liking and sharing food or beverage content daily or almost daily.
Qutteina et al., 2022 [36] Belgium Cross-sectional Schools 1002 adolescents aged 11 to 19 years of age; 58% girls and 42% boys The effect of exposure to food messages was measured through thirty-five items that explored the extent to which the participant saw core and non-core food messages on social media. Participants reported the extent to which they saw food messages posted by friends or other influencers and celebrities, as well as messages posted by companies. Food intake was measured using the Flemish Food Frequency Questionnaire. Adolescents who reported higher exposure to social media posts related to non-core/unhealthy foods were significantly more likely to also report higher consumption of them.
Harris et al., 2022 [37] USA Cross-sectional Electronically 1566 adolescents aged 13 to 17 years of age; 46.9% boys and 53.1% girls The survey included questions about television viewing, attitudes towards advertising, brand popularity, and consumption of unhealthy and healthy foods. The study also assessed teenagers’ engagement with brands on social media. Participants were asked to rate eight brands representing a range of different product types most advertised to 12–17-year-olds. Adolescents showed a high level of preference for targeted advertising of company brands, as well as frequent consumption of these advertised products;
exposure to television commercials for unhealthy products was associated with the consumption of unhealthy foods and beverages.
Ares et al., 2022 [38] Uruguay Qualitative Two private secondary schools and a public health facility 209 adolescents, aged 12 to 18 years of age; 56% girls and 44% boys Adolescents were divided into small groups consisting of 2–7 participants, who were adolescents of the same age (±1 year). A total of five researchers with previous experience in qualitative research conducted the interviews. An interview guide was used, which included questions on five main topics: social media use, exposure to digital marketing in general, and digital food marketing in particular, perceptions of digital food marketing, the perceived impact of digital marketing on food choice, and strategies to reduce the influence of digital marketing on adolescent dietary choices. The group interviews, lasting between 10 and 35 min, were recorded and then transcribed. Participants reported seeing advertisements for a wide range of products and services. All teens reported seeing food adverts on social media or websites. The most frequently reported adverts pertained to fast-food restaurants from both large chains and small businesses. Participants recalled seeing influencers promoting food and beverages on YouTube, TikTok, and Instagram. Energy drinks, fast-food e-restaurants, soft drinks, and fortified water were the most frequent product categories. Most participants described the impact of digital marketing on actual purchase or consumption as little or non-existent. Some participants reported consuming fast food and soft drinks but did not recognize the influence of digital marketing on their decisions to do so. However, others acknowledged that advertisements they see on social media and websites influence their choices and described specific situations where they bought or consumed the advertised food or drink.

BKFFQ: Block Kids 2004 Food Frequency Questionnaire; BMI: body mass index; CIQ: Child Impact Questionnaire; ECLS-K: Early Childhood Longitudinal Study—Kindergarten; HAVISA: Hábitos de Vida Saludables en la Población Española; HFSS: high in fat, salt, and sugar; IMD: Index of Multiple Deprivation; NHANES: National Health and Nutrition Examination Survey; NMR: Nielsen Media Research; SSBs: sugar-sweetened beverages; TRP: target rating point; YRBSS: Youth Risk Behavior Surveillance System.