TABLE 1.
Descriptive Summary of the Included Experimental Studies
| Author, Year, Country | Sample Description | Design | Advertising Exposure | Comparison or Control | Outcome | Relevant Results |
|---|---|---|---|---|---|---|
| An,50 2019, South Korea | n = 556, age range = 7–11, mean age = NS | Experimental (school), between-subject | 3 images of advergame play with HFSS food exposure (Caffé Bene, a national coffee chain, with branded food products = ice cream, sandwiches, bagels, and drinks) | Grade level (age proxy- second and third grade versus fourth and fifth grade) | Ad recognition, skeptical attitudes to advertising | Grade level (age) was a significantly associated to ad recognition and skeptical attitudes, with lower grades (2nd and third) less likely to recognize the advergame as advertising and less likely to have skeptical attitudes, than higher grades (4th and fifth). |
| Carter,40, 2011, Australia | n = 594, age range = 4–12, mean age = NS | Experimental (school), between-subject | TV advert for HFSS food brand (McDonald’s) | Age (years) | Selling intent, persuasive intent | All 3 measures of understanding increased significantly with age. Understanding of selling intent was greater than understanding of persuasive intent, which was still only 40% in 11–12 y olds. |
| Castonguay,41 2015a,a United States, [Study 2] | n = 68, age range = 5–11, mean age = NS | Experimental (NS), between-subject | 3 TV advert conditions: HFSS cereal (Frosted Flakes); TV Network; computer game. All 30 s adverts placed within 5-min cartoon | Age (5–6 vs 10–11) | Recognition of juxtaposed beliefs | Recognition was significantly greater in older children (10–11 y) compared with younger children (5–6 y). |
| Castonguay,51 2015b,a United States | n = 136, age range = 5–11, mean age = NS | Experimental (research laboratory), within-subject, random assignment | 3 TV advert conditions: HFSS cereal (Frosted Flakes); TV network; computer game. All 30 s adverts placed within 5-min cartoon | Age (5–6 vs 10–11) | Product attitude | Younger children in physical activity condition had significantly greater product attitudes than younger without physical activity and both older children groups. The overall difference between combined younger and older groups was not tested. |
| Dias and Agante,42 2011, Portugal | n = 231, age range = 7–8, mean age = NS | Experimental (school), between-subject, random assignment | Advergame for HFSS products (ice cream, potato chips, cookies, soda, pizza, lollipop, hamburger + chocolate mousse), 5-min play in groups of 1–4 | Noncommercial game with healthy products (fruit, vegetables, milk, bread) | Food liking, nutritional knowledge | Children exposed to the advergame had significantly higher preference for the HFSS products compared with those exposed to the non-commercial game. No impact on nutritional knowledge. |
| Dixon,43 2017, Australia | n = 904, age range = 5–9, mean age = 7 | Experimental (school), between-subject, random assignment | TV adverts for HFSS food (McDonald’s) shown after a 30-s movie trailer with movie tie in premium for (1) unhealthy meals (2) healthy meals or (3) both | Neutral TV advert (leisure activity) | Meal preference, product perceptions | Significantly higher preference for healthier meal if only healthy meals had movie tie in premium compared with other conditions. Significantly more positive perceptions when the healthier meals had movie tie in premium, compared with having none. |
| Duke,54 2016,b United States | n = 3665, age range = 13–17, mean age = NS | Experimental (online), between-subject, random assignment | 4×TV adverts for e-cigarettes (3 × 60-s and 1 × 30-s) | No advert | E-cigarette attitudes | Significantly more positive e-cigarette attitudes in the treatment condition compared with control. |
| Farrelly,55 2015,b United States | n = 3665, age range = 13–17, mean age = NS | Experimental (online), between-subject, random assignment | 4×TV adverts for e-cigarettes (3 × 60-s and 1 × 30-s) | No advert | Perceived benefits of e-cigarettes | TV ads positively and significantly impacted on e-cigarette beliefs compared with control. |
| Harris,44 2018, United States | n = 138, age range = 7–11, mean age = 9.4 | Experimental (research center), between-subject, random assignment | TV adverts for HFSS food (Ribena drink, Kellogg’s choc snack bar, McVitie’s biscuits) with a healthy message (health halo) or nonhealth message or healthy products (milk, pistachios, cheesestrings) | Age (7–9 vs 10–11) | Perceived risks and benefits | Age was not a predictor. Health halo advert condition perceived nutrient poor products as significantly healthier than the other 2 conditions. |
| Hudders and Cauberghe, 45 2018, Belgium | n = 180 age range = 7–12, mean age = 8.69 | Experimental (school), between-subject | TV advert (90-s) for Wii within a movie excerpt (4-min cartoon, Alvin and the Chipmunks: The Squeakquel) | Age (7–9 vs 10–12) | Identification of commercial content, advertising, literacy brand attitude (interaction only) | Identification of commercial content and advertising literacy was significantly greater in older children compared with younger children. Found advertising literacy was not significantly related to brand attitude. |
| Kim,56 2017, United States | n = 802, age range = 13–17, mean age = NS | Experimental (online), between-subject, random assignment | 3 x TV adverts for e-cigarettes from a pool of 14 (30-s to 2-min) | 3×neutral TV adverts (bottled water) from a pool of 7 (30-s to 2-min) | Perceived risks and benefits | In never-smokers only, perceived risk of cigarettes was significantly lower in intervention compared with control. |
| Lapierre,46 2015, United States | n = 79, age range = 6–9, mean age = 7.7 | Experimental (Camp, afterschool center), between-subject | 3 × 30-s TV adverts (2 for toys and 1 for HFSS cereal- HoneyNut Cheerios) | Age (years) | Persuasive intent, selling intent | Age was not a significant predictor of understanding measures. Understanding of selling intent was significantly higher than persuasive intent. |
| Matthes and Naderer,61 2015, Austria | n = 121, age range = 6–14, mean age = NS | Experimental (school), between subject, random assignment | Product placement for HFSS food (UTZ Cheese Balls) within 7-min movie excerpt (cartoon, Alvin and the Chipmunks) with moderate or high frequency product placement | No advert control, age (years) | Brand attitude, product attitude | No effect of placements on brand or product attitudes, compared with control. Brand attitude decreased with age. |
| Naderer,62 2016, Austria | n = 109, age range = 8–13, mean age = 10.76 | Experimental (school), between-subject, random assignment | Advergame (Visa branded Monopoly), approximately 30 min play time | Unbranded game (Monopoly), approximately 30 min play time, age (years) | Brand attitude | Brand attitude was significantly higher in the advergame condition compared with no advert control. Age was not a significant predictor. |
| Naderer,74 2018, Austria | n = 363, age range = 6–15, mean age = 10.55 | Experimental (school), between-subject, random assignment | Product placement of HFSS product (M&Ms) in movie (7-min clip of Smurfs) with static placement (shown in background) or character product involvement (interacts with the product) | Control, 7-min clip of Smurfs with no product placement | Brand evaluation | No difference in brand evaluation between the placement conditions or no advert control. |
| Neyens,63 2017, United Kingdom | n = 940, age range = 6–14, mean age = 9.8 | Experimental (school), between-subject, random assignment | Advergame for HFSS food (Kellogg’s Coco-Pops, 10-min play time) OR TV advert for HFSS food (Kellogg’s Coco-Pops, 19-s embedded within 10-min TV clip for youth series) | No advert control, age (years) | Persuasion knowledge, brand attitude, brand preference | Persuasion knowledge was significantly higher for the TV ad versus advergame. Children who played the advergame reported significantly more positive brand attitudes compared with children who had watched the TV ad and children in the no advertising exposure control group. Age was significantly positively related to persuasion knowledge and negatively related to brand attitude. |
| Owen,47 2013, United Kingdom | n = 134, age range = 6–10, mean age = NS | Experimental (school), between- subject | Shown 2/5 following HFSS adverts: (1) brand placement in movie (Dr Pepper in Spiderman), (2) TV sponsorship (Cadbury chocolates in Coronation Street), (3) product licensing (Shrek on Nestlé cereal), (4) advergame (McDonald’s Web site), (5) in-game product placement (Red Bull energy drink on PlayStation 2 game) | Age (6–7 vs 9–10) | Understanding of advertising | Understanding of advertising was significantly higher among older children compared with younger. Understanding of TV advertising was significantly greater than non-traditional advertising in all children. |
| Padon,57 2018, United States | n = 417, age range = 13–17, mean age = 15 | Experimental (online), between-subject, random assignment | 4 x TV adverts for e-cigarettes either low or high youth appeal (each less than 30 s) | 4×neutral TV adverts (food or drink) | Product attitude, product beliefs | Positive product beliefs increased significantly in low youth appeal ads compared with control, high youth appeals increased positive product beliefs, but it was not significant. |
| Panic,53 2013, Belgium, [Study 2] | n = 128, age range = 7–10, mean age = 8 | Experimental (school), between-subject, random assignment | Advergame for HFSS food (Lay’s crisps, 2-min play) | Noncommercial game (healthy food- fruit and vegetables) | Persuasion knowledge | No significant differences in persuasion knowledge between the commercial and non-commercial advergames. |
| Petrescu,64 2017, United States | n = 411, age range = 11–16, mean age = 13.09 | Experimental (home), between-subject, random assignment | 10×printed advert for e-cigarettes either glamourized or associated with health | No advert control | Appeal of smoking or e-cigarettes, prevalence estimates, perceived attributes of smoking, perceived harms of smoking | Significantly increased estimation in prevalence of e-cigarette use in glamour condition compared with control and health condition. In both experimental conditions perceived danger and harm of occasional smoking were rated lower than control. |
| Rifon,48 2014, United States | n = 376, age range = 5–10, mean age = 7.3 | Experimental (test site), between-subject, random assignment | Advergame for HFSS food (Honey O’s cereal) that children played or watched (designed to mimic tv ad) and with brand integrated in game or shown in background (play time determined by child) | Unbranded game, age (5–7 vs 8–10) | Persuasion knowledge, brand attitude, perceived healthiness, taste expectations | Persuasion knowledge increased with age, playing exposure and brand integration. Integrated brand conditions had increased taste expectations, perceived healthiness, but this was moderated by play and age. Treatment conditions had significantly more positive taste expectations in treatment compared with control. |
| Royne,38 2017, United States | n = 64, age range = 6–11, mean age = NS | Experimental (research facility), between-subject, random assignment | Product placement for cola, juice or milk embedded in TV cartoon (SpongeBob SquarePants, 15-min clip) | No product placement control (same 15-min TV clip | Product liking, perceived healthiness | For “likes juice” outcome, all treatments conditions had significantly higher results than control. For the “perceived healthiness of juice” outcome the milk and cola conditions were significantly greater than control. No other results were significant. |
| Sharma,65 2015, India | n = 1050, age range = 10–17, mean age = NS | Experimental (NS), between-subject, random assignment | Printed advert for HFSS food (biscuit) OR mobile handset with picture, caricature or product information | Age (10–12 vs 13–17) | Brand attitude | Teenagers had significantly lower brand attitude toward biscuits in the model's picture and product information settings compared with tweenagers. |
| Smith,52 2020, Australia | n = 156, age range = 7–12, mean age = | Experimental (university), between-subject, random assignment | 3 advert conditions for HFSS product (unfamiliar confectionery): (1) banner advertisement, (2) advergame (4-min play time), (3) rewarded video advertisement | Control group with no advertising | Brand perception, awareness of advertising | Across groups there were no significant differences between pr- and postgame ratings of taste or fun. Awareness of advertising was highest in rewarded video advertising condition 80% (only significant finding) then, advergame condition 60%, compared with just 31% of participants in the banner advertisement condition. |
| Tarabashkina, 66 2016,c Australia | n = 354, age range = 7–13, mean age = NS | Experimental (agricultural event), between-subject, random assignment | Pop-up advert for HFSS food (biscuit) within a 10-min internet exposure | Neutral pop-up advert (toy) within a 10-min internet exposure, age (7–8 vs 9–10 vs 11–12 vs 13) | Selling intent, persuasive intent, product evaluation, nutritional knowledge | No differences in cluster membership based on age, including selling and persuasive intent, product evaluation and nutritional knowledge. A trend toward choosing the advertised product was seen in the experimental group compared with control but was not significant. |
| Tarabashkina, 67 2018a,c Australia | n = 326, age range = 8–13, mean age = NS | Experimental (agricultural event), between-subject | Poster advert on a bus stop for a fictitious HFSS food product (burger) | Age (8–9 vs 10–11 vs 12–13) | Informative intention, product liking intention, attention capturing intention, persuasion attribution of the advertisement | There were no significant differences in any perceived advertising intention variables by age group. |
| Tarabashkina, 68 2018b,c Australia | n = 175, age range = 7–13, mean age = NS | Experimental (agricultural event), between-subject | Online pop-up advert for HFSS food (cookie) shown 3 times during a 10-min internet search session (2nd, fifth and eighth minute) | Age (7–8 vs 9–10 vs 11–13) | Perceived informative intent, perceived affective intent, persuasive intent, product preference, product taste, product healthiness | There were no significant differences in any of the variables by age group, except for product healthiness which the oldest age group rated as significantly lower compared with the youngest age group. Higher persuasive intent understanding led to decreased favorable food preference and lower healthiness evaluation. |
| Te'eni-Harari, 69 2014, Israel | n = 252, age range = 4–15, mean age = 9.45 (3.24) | Experimental (school), between-subject | TV advert for 4 fictitious products named “ZOZO” HFSS food (hot dog), phone, book, or toothpaste (each 20-s) | Age (4–7 vs 8–11 vs 12–15) | Brand attitude | Age had a significantly negative effect on brand attitude. |
| Uribe and Fuentes-García,70 2015,d Chile | n = 483, age range = 9–15, mean age = NS | Experimental (school), between-subject, random assignment | 3 advert conditions for HFSS brand (McDonald’s) embedded in movie clip (Richie Rich, 45-min): (1) product placement (2 scenes), (2) 2 x TV adverts, (3) 1×product placement and 1 x TV advert | No advert or product placement, same 45-min film (Richie Rich) Age (9 vs 12 vs 15) |
Brand attitude | There were no significant differences in brand attitude between any of the treatment or age groups. |
| Uribe and Fuentes-García, 75 2020,d Chile | n = 376, age range = 9–15, mean age = 12 | Experimental (school), between-subject, random assignment | Product placement for HFSS product (McDonald’s) embedded in movie clip (Richie Rich, 45-min, 2 scenes) | Age (9 vs 12 vs 15) | Recognition of the commercial nature of the message, brand preference | Recognition of advertising significantly increased as the age of the children increased (9 vs 12 vs 15). Brand preference significantly decreased as age of the children increased (9 vs 12 vs 15). |
| van Berlo,58 2017,e Netherlands | n = 73, age range = 13–18, mean age = 15.48 | Experimental (school), between-subject, random assignment | Advergame (making pizzas) with an unknown or well-known pizza brand | Unbranded game (making pizzas) | Advertising wisdom, brand attitude | No significant differences in brand attitude between the conditions. |
| van Berlo,59 2020,e Netherlands | n = 98, age range = 13–18, mean age = 14.95 | Experimental (school), between-subject, random assignment | 4-min advergame play with HFSS food (making pizza): familiar brand (Domino’s) and unfamiliar brand (Nonna’s pizza) | 4-min game play with HFSS food (making pizza) with no brand logo | Recognition of commercial intent, brand attitude (unfamiliar and familiar brand) | Recognition of commercial intent in the familiar brand condition was significantly greater than game without a brand. No difference in recognition between familiar or unfamiliar brands or unfamiliar brand and no brand condition. There were no differences in brand attitude toward the familiar or unfamiliar brands between any of the conditions. |
| van Reijmersdal, 71 2010, Netherlands | n = 2453, age range = 10–17, mean age = 12.68 | Experimental (online, at home), between-subject, random assignment | Advergame play (“GoSupermodel”) with product placement (Dutch bank) time determined by child | No game play control or noncommercial game play (time determined by child) | Brand image | Brand image results were significantly greater in the advergame play condition. |
| van Reijmersdal, 76 2020, Netherlands | n = 406, age range = 12–16, mean age = 14 | Experimental (school), between-subject, random assignment | YouTube video with well-known YouTuber sponsored by HFSS product (Fanta) | Age (12–14 vs 15–16) | Recognition of sponsored content as advertising, understanding persuasive intent | In the no disclosure group, 12–14 y olds had significantly higher recognition of sponsored content as being advertising compared with 15–16-y-olds. No significant difference between age groups for understanding persuasive intent. |
| Vasiljevic,72 2018, United Kingdom | n = 1449, age range = 11–16, mean age = NS | Experimental (school), between-subject, random assignment | 10×printed glamorous e-cigarette advert | Neutral advert (nonsmoking related) | Perceived harm of occasional and regular use, prevalence estimates of e-cigarettes and cigarettes | Children exposed to glamorous e-cigarette adverts perceived the harms of occasional smoking of 1 or 2 tobacco cigarettes to be lower than those in the control group. No significant differences between the experimental conditions for perceived harm of or prevalence estimates for e-cigarettes or cigarettes. |
| Verhellen,73 2014, Belgium | n = 125, age range = 11–14, mean age = 11.98 | Experimental (school), between-subject, random assignment | 4 advert conditions for HFSS food (Ola popsicles): (1) traditional TV ad, (2) trailer, (3) advergame, (4) trailer + advergame | No advert control | Persuasion knowledge, brand attitude | No significant differences in brand attitude or persuasion knowledge between the experimental conditions. Children without persuasion knowledge developed a significantly more positive attitude toward the brand than children with persuasion knowledge. |
| Vogel,60 2020, US | n = 135, age range = 13–18, mean age = 15.3 | Experimental (online), between-subject, random assignment | Instagram advert posts for e-cigarettes with heavy e-cigarette content (3 e-cigarette posts and 3 unrelated posts) or light e-cigarette content (1 e-cigarette posts and 5 unrelated posts) | No advert control, shown peer generated posts for e-cigarettes with heavy or light e-cigarette content | Attitudes about using e-cigarettes, risk perceptions of e-cigarettes | Participants in advert source condition had significantly greater positive attitudes toward e cigarettes, compared with peer generated source. No difference in perceived risks between sources conditions. No difference in perceived risks between e-cig conditions. |
| Waiguny,49 2014, Austria, [Study 1] | n = 51, age range = 8–10, mean age = NS | Experimental (school), between-subject, random assignment | 2 advert conditions for HFSS food (Nesquik Duo, cereal): (1) advergame (7:24-min play time), (2) TV advert (30-s) | Age (year) | Persuasion knowledge, identification of commercial content | No effect of age on the measure of persuasion knowledge or identification of commercial content. Greater identification of commercial content in TV advert compared with advergame. |
| Waiguny,49 2014, Austria, [Study 2] | n = 149, age range = 7–10, mean age = NS | Experimental (school), between-subject | Advergame for HFSS food (Nesquik Duo, cereal, 10-min play time), | No advert control | Persuasion knowledge, identification of commercial content, brand beliefs, brand reference | Advergame exposure significantly positively influenced children’s brand beliefs and preferences, compared with control. Difference in persuasion knowledge between the conditions was not separately assessed. Identification of commercial content was generally higher with a higher level of persuasion knowledge but was negatively overridden by presence in the game. |
NS, not stated.
a
Half of the sample may be reported in both.
b
Same sample but reporting of different outcomes.
c
May be the same participants across all 3 studies.
d
May be the same participants across the 2 studies.
e
Three out of the 4 schools may be reported in both.