TABLE 2.
Study characteristics of studies included in the systematic review researching the influence of unhealthy food and beverage marketing through social media and advergaming on diet‐related outcomes in children
| Experimental studies | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| First author (year of publication) | Study design | Participants | Country | Marketing medium | Food or beverage type | Marketing exposure/intervention | Control | Main outcome | Main result |
| Agante (2019) 62 | Non‐randomized controlled trial |
N = 104 Age range = 6–9 Mean age = not reported |
Portugal | Advergaming | Pringles (potato crisps) |
Experimental group 1: playing advergame on day 1, questionnaire on day 1 and a week later Experimental group 2: playing advergame 5 days in a row, questionnaire on days 1 and 5 |
Questionnaire without exposure to advergame | Brand and product category choice: after immediate exposure, 1 week after exposure and after repeated exposure |
Both brand (Pringles: 58.6% vs. 20.6%, p < 0.001) and product (crisps: 34.3% vs. 11.5%, p = 0.046) were chosen more often after immediate exposure, when compared with control. One week after exposure, brand (63.9% vs. 20.6%, p = 0.001) and product (38.9% vs. 11.8%, p = 0.034) were still chosen more often in the first experimental group when compared with control. After repeated exposure, only brand was significantly chosen more often when compared with control (85.3% vs. 52.9%, p = 0.015). |
| Coates (2019) 28 | RCT |
N = 176 Age range = 9–11 Mean age = 10.5 ± 0.7 |
United Kingdom | Social media (YouTube influencers on Instagram) | Unhealthy snacks (jelly candy and chocolate buttons) | Mock Instagram profiles of two popular YouTube vloggers promoting unhealthy snacks |
Mock Instagram profiles of two popular YouTube vloggers promoting healthy snacks (carrots and grapes) or non‐food items |
Overall energy intake (kcal) and unhealthy snack intake |
Exposure to unhealthy Instagram profiles led to 26% more kcal intake vs. non‐food condition (448.3 vs. 357.1 kcal, p = 0.001) and 15% more kcal intake vs. healthy Instagram condition (448.3 vs. 388.96 kcal, p = 0.05). Exposure to unhealthy Instagram profiles led to 32% more unhealthy snack intake vs. non‐food condition (384.83 vs. 292.24 kcal, p = 0.001) and 20% more vs. healthy condition (384.83 vs. 319.51 kcal, p = 0.03). There was no statistically significant difference in energy and unhealthy snack intake between the non‐food condition and healthy Instagram condition. |
| Coates (2019) 63 | RCT |
N = 151 Age range = 9–11 Mean age = 10.32 ± 0.6 |
United Kingdom | Social media (YouTube vlogs) | McVitie's (chocolate digestive cookies) | Influencer marketing of McVitie's cookies, with or without an advertising disclosure | Influencer marketing of a non‐food item | Cookie intake in kcal (McVitie's brand or alternative) |
Children who viewed vlogs with a disclosure had a 12% higher overall snack intake than children exposed to non‐food marketing, F(2, 144) = 4.28, 0.016, ηp2 = 0.06. Children exposed to vlogs with a disclosure consumed 41% more marketed snack kcals than children exposed to non‐food marketing (214.40 vs. 149.61 kcal, p = 0.002). |
| Dias (2011) 64 | RCT |
N = 231 Age range = 7–8 Mean age = not reported |
Portugal | Advergaming | Healthy and unhealthy snacks |
Advergame including unhealthy snack marketing, followed by a questionnaire |
Advergame including healthy snack marketing, followed by a questionnaire | Healthy snack selection (0–6 snacks) |
70% of children exposed to the advergame including healthy snack marketing chose ≥3 healthy snacks. 63% of the children exposed to the advergame including unhealthy snack marketing chose ≥3 unhealthy snacks. 4.3% of children from the advergame including unhealthy snack marketing chose 6 healthy snacks vs. 15.5% of children from the advergame including healthy snack marketing (p < 0.001). |
| Esmaeilpour (2018) 65 | RCT a |
N = 330 Age range = 6–11 Mean age = not reported |
Iran | Advergaming | Healthy and unhealthy food | Healthy/unhealthy advertising × high/low entertaining media (5‐min advergame/2 min of TV) | Unhealthy food choice frequency |
Children exposed to unhealthy foods (through advergaming and TV) significantly chose more unhealthy foods than the children exposed to healthy foods (M = 2.899 vs. M = 2.146, p < 0.001). Exposure to unhealthy foods through advergaming led to choosing more unhealthy foods than exposure through TV (M = 3.5 vs. M = 2.298, p = 0.003). |
|
| Folkvord (2013) 29 | RCT |
N = 270 Age range = 8–10 Mean age = 8.9 ± 0.8 |
The Netherlands |
Advergaming |
Energy‐dense snacks and fruit | Advergame promoting energy‐dense snacks, fruits or non‐food | No advergaming | Caloric intake of energy‐dense snacks and fruit |
Children exposed to both food advergames ate significantly more than the non‐food group and the control condition (202 and 183 kcal vs. 130 and 106 kcal, p < 0.01). The children from the food advergame groups also ate significantly more energy‐dense snacks than the children from the control group (170 and 150 kcal vs. 80 kcal, p < 0.01). When analyzing apple intake alone (instead of total fruit intake), the children from the energy‐dense condition ate significantly more apples than the non‐food and control conditions (p < 0.05). |
| Folkvord (2014) 66 | RCT b |
N = 261 Age range = 7–10 Mean age = 7.7 ± 0.7 |
The Netherlands | Advergaming | Energy‐dense snacks | Advergame promoting energy‐dense snacks | Advergame promoting non‐food items | Caloric intake (kcal) | Children in the energy‐dense condition ate significantly more kcal compared to the non‐food condition, 156.3 vs. 101.3 kcal, F(1, 252) = 18.541, p < 0.01. |
| Folkvord (2015) 67 | RCT c |
N = 92 Age range = 7–10 Mean age = 8.4 ± 1.1 |
The Netherlands | Advergaming | Energy‐dense snacks | Advergame promoting energy‐dense snacks | Advergame promoting non‐food items | Caloric intake (kcal) | Children who played the advergame promoting energy‐dense snacks ate significantly more than children who played the advergame promoting non‐food products (178.0 vs. 132.9 kcal, p < 0.05). |
| Folkvord (2016) 68 | RCT d |
N = 133 Age range = 7–10 Mean age = 8.9 ± 1.0 |
The Netherlands | Advergaming | Energy‐dense snacks | Advergame promoting energy‐dense snacks | Advergame promoting non‐food items | Caloric intake (kcal) | The main effect of type of advergame on intake (kcal) was not significant, F(1, 129) = 0.10, p = 0.75. |
| Folkvord (2017) 69 | RCT |
N = 562 Dutch: N = 211 Age range = 6–11 Mean age = 9.0 ± 1.18 Spanish: N = 351 Age range = 6–12 Mean age = 8.9 ± 1.68 |
The Netherlands and Spain | Advergaming | Energy‐dense snacks | Advergame promoting energy‐dense snacks, with and without protective message | Advergame promoting non‐food items, with and without protective message | Caloric intake (kcal) |
The type of advergame influenced total snack intake among Dutch children, F(1, 103) = 9.847, p = 0.001, but not among Spanish children, F(1, 170) = 0.061, p = 0.417. Dutch children from the unhealthy advergame group ate significantly more energy‐dense snacks than children from the non‐food advergame group (182.43 vs. 90.27 kcal, p = 0.001). The type of advergame only influenced the total snack intake among Spanish children in the age category of 9–12 (p = 0.012), where the energy‐dense advergame led to higher intake than the non‐food advergame (specific numbers not reported). The interaction effect of type of advergame*protective message was not significant on total snack intake among Dutch children, F(1, 120) = 1.556, p = 0.107, or Spanish children, F(1, 346) = 0.439, p = 0.254. |
| Folkvord (2020) 70 | RCT |
N = 132 Age range = 13–16 Mean age = 14.1 ± 0.96 |
The Netherlands | Social media (Instagram) | Red pepper and energy‐dense snacks | Instagram post promoting red peppers | Instagram post promoting energy‐dense snacks or non‐food items | Vegetable intake | There was no significant main effect of type of Instagram post on vegetable intake (p > 0.05). There was also no significant effect of condition on the consumption of individual vegetable types (p > 0.05 and BF10 = 0.095). |
| Hang (2008) 71 | RCT e |
N = 71 Age range = 5–6 Mean age = not reported |
China | Advergaming | 7Up (soft drink) | Advergame promoting 7Up | Advergame without product placement | Beverage choice | 56% of the children in the experimental group chose 7Up vs. 29% of the control group (chi‐square = 5.296, p < 0.05) |
| Harris (2012) 72 | RCT |
N = 149 Age range = 7–8 and 9–12 Mean age = 9.4 |
United States of America | Advergaming | Sweet snacks, fruit and vegetables | Advergame promoting unhealthy foods | Advergame promoting healthy foods or non‐food items | Intake (in grams) of healthy, somewhat unhealthy and very unhealthy snacks |
Children in the healthy condition consumed more healthy food compared to children in the unhealthy condition (86.2 vs. 57.7 g, p = 0.02). Children in the unhealthy condition consumed the most unhealthy foods and children from the healthy condition the least (31.9 vs. 20.5 g, p = 0.03). Children in the control condition consumed amounts of healthy and unhealthy food that fell between the other conditions, but the differences were not significant (p > 0.05). There was no significant effect of condition on moderately healthy food consumed (p = 0.58). |
| Hernandez (2010) 73 | One‐group pre‐post test |
N = 128 Age range = 10–15 Mean age = not reported |
Mexico | Advergaming | Unhealthy snacks |
Advergame 1: Ritz Bits sandwiches, Chips Ahoy!, Oreo and Fun fruits, with corporate snack brand Nabisco. Advergame 2: X‐treme Jello, Chips Ahoy!, and Oreo with corporate snack brand name Jello. |
Snack choice | 65.6% of the adolescents selected the snack placed on the advergames, while 34.4% selected other brands. | |
| Mallinckrodt (2007) 74 | Non‐randomized controlled trial |
N = 294 Age range = 5–8 Mean age = not reported |
Australia | Advergaming | Froot Loops (cereal) | Advergame promoting Froot Loops | No advergame | Intentions to request brand |
The exposure was not significantly associated with brand requests (p = 0.54). |
| Neyens (2017) 75 | RCT |
N = 940 Age range = 6–14 Mean age = 9.8 ± 2.4 |
Belgium | Advergaming | Kellogg's Coco‐Pops (sugared breakfast cereal) trough advergame or TV | Advergame or watching TV commercial promoting Kellogg's Coco‐Pops | No advertising | Pester intent (4‐point Likert scale from no intent to intent) | There was a significant association between advertising format and pester intent (p = 0.044). Pester intent was significantly higher in the advergame group, compared to the TV group (M = 2.9 vs. M = 2.7, p = 0.014), but not compared with the control group (M = 2.83, p = 0.363). |
| Pempek (2009) 76 | RCT |
N = 30 Age range = 9–10 Mean age = 9.5 ± 0.9 |
United States of America | Advergaming | Unhealthy or healthy snacks and beverages | Advergame promoting unhealthy snacks and beverages | Advergame promoting healthier snacks and beverages | (Un)healthy snack and beverage selection (summary score 0–2 of snacks chosen) | Children in the healthy advergame condition selected more healthy snacks than those in the unhealthy condition, M = 1.4 vs. M = 0.2, F(2, 24) = 6.23, p = 0.007. |
| Putnam (2018) 77 | RCT f |
N = 132 Age range = 4–5 Mean age = 4.8 ± 0.48 |
United States of America | Advergaming | Unhealthy snacks or healthy snacks | Advergame promoting healthy or unhealthy snacks | Advergame without snacks | Snack and beverage selection (healthy/unhealthy) | The treatment conditions did not have a significant effect on snack consumption when compared with the control group, and the two treatment groups did not significantly differ from each other either (chi‐square = 2.11, p = 0.35). |
| Rifon (2014) 78 | RCT |
N = 276 Age range = 5–10 Mean age = 7.3 |
United States of America | Advergaming | Froot Loops (cereal) |
Advert exposure type: integrated, background or no advertising (control) × Exposure interaction: playing the advergame or watching a video of the advergame |
Purchase requests (scale 0–5: definitely no to definitely yes) |
There was a significant effect of exposure type and interaction with the game on purchase requests (p = 0.037). For the play condition, the background advertising led to the greatest purchase request and the control to the least. The integrated advertising was most effective on purchase requests in the watch group, followed by the control group. Overall, the watch group had greater purchase intentions than the play group. |
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Shefali (2015) 61 |
One‐group pre‐ post‐test g |
N = 15 Age range = 5–8 Mean age = not reported |
India | Advergaming | Kentucky Fried Chicken (Fried chicken) | Advergame promoting fried chicken | Purchase request intention and product choice |
When asked, 60% of the children wanted to eat the product after the game. The KFC brand was also preferred for consumption over other brands. When asked after playing the game, 60% of the children said they would ask their parents to buy KFC. Fifteen minutes later, when asked which food they would like to order, most of the children preferred other fast food brands. |
|
| Smith (2020) 79 | RCT |
N = 156 Age range = 7–12 Mean age = 8.7 ± 1.5 |
Australia | Advergaming | Gummy confectionery | Banner advertising, advergame or rewarded video advertising promoting gummy confectionery | Game without advertising | Brand choice and snack consumption (grams and kcal) |
Children from the experimental conditions chose the advertised brand more often than the control condition, but only children from the rewarded video condition chose the brand significantly more often (64.1% vs. 19.5%, p < 0.002). Condition did not influence overall energy intake measured in grams, F(3, 155) = 0.351, p = 0.78, or calories, F(3, 155) = 0.861, p = 0.46. |
| Waiguny (2014) 80 | Non‐randomized controlled trial |
N = 149 Age range = 7–10 Mean age = not reported |
Austria | Advergaming | Nesquik (instant cocoa) | Advergame promoting instant cocoa | No advergame | Pester intentions (PI) and pester behavior (PB): 0 coded as no preference, PI or PB and 1 is coded as preference, PI or PB. |
PI was higher amongst children in the experimental condition than in the control group (0.55 vs. 0.08, F = 35.431, p < 0.001). PB also significantly differed per condition: PB was 0.41 in the advergame group and 0.15 in the control group (F = 10.518, p = 0.001). |
| Observational studies | ||||||||
|---|---|---|---|---|---|---|---|---|
| First author and year of publication | Study design | Participants | Setting | Marketing medium | Food or beverage type | Method | Main outcome | Main result |
| Baldwin (2018) 81 | Cross‐sectional survey |
N = 417 Age range = 10–16 Mean age = not reported |
Australia | Social media (Facebook and YouTube) | 7 types of unhealthy foods and 5 types of unhealthy beverages | Survey on online food brand engagement | Weekly unhealthy food and beverage consumption scores (0–7 and 0–5) |
Watching food and beverage brand videos on YouTube was significantly associated with higher intake scores for food (Bfood = 0.46, p = 0.015), beverages (Bdrink = 0.34, p = 0.009) and combined (Bcombined = 0.80, p = 0.003) than for children who did not watch videos. There were no significant associations between unhealthy scores and any of the Facebook or other social media behaviors found. |
| Folkvord (2016) 82 | Cohort follow‐up after RCT |
N = 218 Age range = 10–12 Mean age = 11.13 |
The Netherlands | Advergaming | Energy‐dense snacks or fruit | Choice of energy‐dense snacks or fruit after an advergame featuring energy‐dense snacks or fruit, or after no game two years prior | Weight status (BMI) two years (T2) after advergame‐induced food intake (T1) |
Energy‐dense snack intake at T1 was not related to BMI at T2. Apple intake at T1 was associated with BMI in T2 in the energy‐dense advergame group (B = −0.33, p = 0.01), but not when adjusted for baseline BMI. |
| Qualitative studies | ||||||||
|---|---|---|---|---|---|---|---|---|
| First author and year of publication | Study design | Participants | Setting | Marketing medium | Food or beverage type | Marketing exposure/intervention | Main outcome | Main result |
| Coates (2020) 83 | Focus groups |
N = 24 (n = 4 per focus group) Age range = 10–11 Mean age = not reported |
United Kingdom | Social media (YouTube vlog) | Nutella (chocolate spread) | Vlog containing Nutella marketing segment |
Behaviors influenced by HFSS marketing |
YouTuber videos are often consulted to inform future purchase decisions. Some children thought that influencer marketing is likely effective because viewers will wish to imitate the YouTuber's behavior. Many children believed they were affected by exposure to the influencer marketing campaign for Nutella. Some children displayed conscious motivation to resist the effects of marketing. However, the ability to resist the effect is questionable. |
| Thaichon (2016) 84 | Semi‐structured interviews |
N = 30 Age range = 11–16 Mean age = not reported |
Australia | Social media | Fast food | Snapshots of fast food marketing in social networking sites | Intentions to eat unhealthy food | The children stated that appealing pictures create positive perceptions of fast food consumption, which influences willingness to try advertised food. They also said that they tend to change their eating habits after repeatedly being exposed to social network advertisements. |
Abbreviations: BMI, body mass index; kcal, kilocalories; RCT, randomized controlled trial.
The influence of health knowledge activation (other main factor researched in study, but not of interest in this review).
The influence of impulsivity (other main factor researched in study, but not of interest in this review).
The influence of attentional bias (other main factor researched in study, but not of interest in this review).
The influence of a go/no‐go task to modify implicit approach reactions (other main factor researched in study, but not of interest in this review).
The influence of mood (other main factor researched in study, but not of interest in this review).
The influence of character awareness (other main factor researched in study, but not of interest in this review).
The authors of this article state that the study design is qualitative. However, an experiment has been conducted. This study was included as an experimental study in this review.