Food marketing to children in Canada: a settings-based scoping review on exposure, power and impact

Rachel Prowse, BSc, RD

https://doi.org/10.24095/hpcdp.37.9.03

This article has been peer reviewed.

Author reference:

School of Public Health, University of Alberta, Edmonton, Alberta, Canada

Correspondence: Rachel Prowse, School of Public Health, University of Alberta, 4-347 Edmonton Clinic Health Academy, 11405 – 87 Avenue NW, Edmonton, AB  T6G 1C9; Email: prowse@ualberta.ca

Abstract

Introduction: Food marketing impacts children’s food knowledge, behaviours and health. Current regulations in Canada focus on restricting promotional aspects of food marketing with little-to-no consideration of the places where children experience food. Understanding food marketing in children’s everyday settings is necessary to protect children. This scoping review describes the current literature on food marketing to children in Canada by setting.

Methods: The author searched databases for Canadian research on children’s exposure to food marketing, and the power and impact of food marketing to children (2-17 years) across settings, and on how current regulations may mediate the effect of food marketing on children. Peer-reviewed studies in English, published between 2000 and 2016, were included.

Results: Twenty-five studies documented children’s exposure to food marketing and its power and/or impact on them in homes (via television, or online) (n = 12), public schools (n = 1), grocery stores (n = 8), fast food restaurants (n = 2), and in general (n = 2). Research trends suggest that unhealthy foods are targeted at children using multiple promotional techniques that overlap across settings. Several research gaps exist in this area, leading to an incomplete, and potentially underestimated, picture of food marketing to children in Canada. Available evidence suggests that current Canadian approaches have not reduced children’s exposure to or the power of food marketing in these settings, with the exception of some positive influences from Quebec’s statutory regulations.

Conclusion: The settings where children eat, buy or learn about food expose them to powerful, often unhealthy food marketing. The current evidence suggests that “place” may be an important marketing component to be included in public policy in order to broadly protect children from unhealthy food marketing. Organizations and communities can engage in settings-based health promotion interventions by developing their own marketing policies that address the promotion and place of unhealthy food and beverages.

Keywords: food marketing, childhood obesity, public health 

Highlights

  • Children’s everyday settings are important places to restrict unhealthy food marketing.
  • Research in Canada shows that children (2-17 years) are exposed to food marketing in homes, schools and supermarkets; however, overall exposure is likely underestimated.
  • Powerful marketing techniques are often used in promoting less healthy foods to children.
  • Multiple exposures to the marketing of unhealthy foods in various settings may adversely shape children’s food culture.
  • Current evidence suggests that actions by governments and communities that address all components of marketing (product, place, promotion and price) will more effectively protect children from powerful, unhealthy food marketing in their everyday settings, however more research is needed.

Introduction

Children’s development takes place in their everyday settings.Footnote 1  The places where children live, learn and play are critical factors in determining their current and future health.Footnote 2  In fact, the Ottawa Charter for Health Promotion emphasizes the importance of everyday settings in preventing disease.Footnote 3  To this end, the World Health Organization recommends that the places where children gather be free from unhealthy food and beverage marketing.Footnote 4  “Place” is also a critical factor for marketers, as it is one of the four components of marketing known as the “four Ps” (4Ps): product, promotion, place and price. Corporations strategically mix the 4Ps to reach their target audience effectively and influence attitudes and behaviours.Footnote 5

Food marketing impacts children’s food knowledge, preferences, behaviours and health.Footnote 6  Factors that promote a poor diet are of concern since, according to Statistics Canada, one-quarter of the calories eaten by Canadians aged 4 to 18 years are from “other foods” (e.g. foods to be limited according to Canada’s Food Guide), including soft drinks, fruit drinks, chocolate and chips.Footnote 7  More than half of children in Canada consume fewer than five servings of vegetables and fruit per day.Footnote 8  The impact of food marketing on children’s food preferences and behaviours depends on their exposure to and the power of the marketing messages, where exposure is defined as “the reach and frequency of the marketing message,” and power is “the creative content, design and execution of the marketing message.”Footnote 9 ,p.11

There are three main mechanisms by which food marketing to children is currently “controlled” in Canada (Table 1): (1) Quebec statutory regulation [Quebec’s Consumer Protection Act (QCPA)Footnote 10]; (2) food industry voluntary self-regulation [Canadian Children’s Food and Beverage Advertising Initiative (CAI)Footnote 11]; and (3) broadcast industry self-regulation (The Broadcast Code for Advertising to Children12). Additionally, in 2016, the Canadian Health Minister announced forthcoming federal statutory regulations on food marketing.Footnote 13  School food policies may also regulate food marketing to children; however, current provincial and territorial policies tend to focus on food provision and are limited and inconsistent in their address of food marketing (Table 1).

Table 1. Types of regulatory control of food marketing to children in Canada
Regulatory control Year introduced Location Type Restriction on food marketing (product) Marketing channels and techniques covered (promotion)
Quebec Consumer Protection Act (QCPA)Footnote 10 1980 Quebec Statutory No commercial marketing to children under 13 years.Table 1 - Footnote a Television
Radio
Print media
Internet
Mobile phones
Signs
Other promotional items
Canadian Children’s Food and Beverage Advertising Initiative (CAI)Footnote 15 2007 All of Canada (except Quebec) Voluntary self-regulation of food industry Committed companies agree not to advertise to children under 12 years at all, or only to advertise “better-for-you” foods, as defined by a uniform nutrition criteria developed by the food industry.Footnote 19 Television
Radio
Print media
Internet
Mobile phones
Video games
Movies
Elementary schools
Select marketing techniques (licensed characters, movie cross-promotions, celebrities, product placement)
The Broadcast Code for Advertising to ChildrenFootnote 12 of the Canadian Code of Advertising StandardsFootnote 20 2004; 2007 All of Canada (except Quebec) Self-regulation of broadcast media Advertising to children under 12 years should not discourage a healthy lifestyle or adherence to Canada’s Food Guide; advertising should not show excessive amounts of food being consumed or in general. Television
Radio
Print media
Internet
Billboards
Proposed regulations on food marketing to childrenFootnote 17 Forthcoming Not disclosed Statutory Possible restrictions of unhealthy food marketing for select age groups (to be determined). Possible restriction of select marketing channels, techniques, and settings (to be determined).
Provincial/territorial school food policiesTable 1 - Footnote b 2008 British ColumbiaFootnote 21 Footnote 22 Mandatory adoption of nutrition guidelines in public schools Discourages unhealthy food marketing. Posters
Coupons
Branded equipment
2010 OntarioFootnote 23 Mandatory adoption of nutrition guidelines in public schools Does not restrict food marketing. Not applicable
2005 New BrunswickFootnote 24 Footnote 25 Mandatory adoption of nutrition guidelines in public schools Recommends healthy food marketing and discourages unhealthy food marketingTable 1 - Footnote c Rewards
Incentives
Vending machine promotions
Fundraising
2006 Nova ScotiaFootnote 26 Mandatory adoption of nutrition guidelines in public schools Recommends healthy food marketing.Table 1 - Footnote c Table 1 - Footnote d Advertising (non-specific)
Fundraising
Rewards
2011 Prince Edward IslandFootnote 27 Mandatory adoption of nutrition guidelines in public schools Restricts unhealthy food marketing.Table 1 - Footnote c Table 1 - Footnote d Advertising (non-specific)
2009 SaskatchewanFootnote 28 Footnote 29 Voluntary nutrition guidelines for mandatory school board food policies Recommends healthy food marketing. Rewards
Fundraising
2009 ManitobaFootnote 30 Footnote 31 Voluntary nutrition guidelines for mandatory public school food policies Recommends healthy food marketing.Table 1 - Footnote c Table 1 - Footnote d “Daily special” promotions
2008 AlbertaFootnote 25 Voluntary nutrition guidelines Recommends healthy food marketing. Posters
2007 QuebecFootnote 79 Voluntary nutrition guidelines Recommends healthy food marketing. Fundraising
2009 Newfoundland & LabradorFootnote 32 Voluntary nutrition guidelines Does not restrict food marketing. Not applicable
2008 YukonFootnote 33 Voluntary nutrition guidelines Discourages unhealthy food marketing. Rewards
Incentives
Fundraising

Current and proposed regulations may control both exposure to and power of food marketing to children by restricting the amount and the use of persuasive promotional techniques (discussed in the Results section of this article). Unfortunately, place, a key component of marketers’ strategiesFootnote 5  and of health promotion interventions,Footnote 14  is poorly considered in current approaches, with the exception of the CAI restricting some marketing in elementary schools.Footnote 15 Footnote * It is reasonable to expect that regulations that ignore this key component of marketing will not generate maximal impact on children’s exposure to or the power of food marketing. Place is often misinterpreted as the location of marketing messages, which is in fact a component of promotion.Footnote 16  A more accurate definition of place, from a marketing perspective, is the location where behaviours are performed or related goods and services are acquired.Footnote 5  In the context of food marketing, place may represent where we eat, purchase or learn about food.

Notably, the settings in which children are marketed to are a policy consideration of proposed regulations in Canada;Footnote 17  however, no research has explored what these settings are. It is critical to understand food marketing in the context in which children experience it in order to form effective policies. Using a settings-based approach,Footnote 18  this review aims to explore the places where children may be exposed to food marketing by reviewing (1) the extent of their exposure to and the power of food marketing by setting; (2) the influence of statutory (QCPA) and voluntary (CAI) regulations on exposure and power;Footnote **  and (3) the impact of food marketing on the attitudes, perceptions and behaviours of Canadian children.

Methods

The author systematically searched eight health, psychology and business databases (Table 2) identified by a research librarian for research on the exposure to and power of food marketing to children in Canada, its impact and the influence of regulations in July 2015 and updated the search in September 2016. All references were imported into an online reference manager. The author selected articles based on a priori inclusion criteria (Table 2) through systematic title, abstract and full-text screening (Figure 1). After title and abstract reviewing, three Canadian researchers with expertise in the topic area were consulted to identify missing research and confirm comprehensiveness of search results. The researchers provided 21 new items, but only fourFootnote 34-37  met the inclusion criteria (Figure 1).  This scoping review was limited to peer-reviewed, English-language studies using Canadian data. Two French-language articlesFootnote 38 Footnote 39 were excluded, as no expert fluent in French was able to review them. The author reviewed all studies and extracted the data.

Table 2. Scoping review of food marketing to children in Canada: systematic search criteria and process
Inclusion criteria English language
Canadian data
Published between January 2000 and September 2016
Original research
Evidence on exposure to, power of and/or impact of food marketing to children (aged 2–17 years), or the influence of Canadian food marketing regulations
Evidence on exposure, power and regulation must identify the setting
Evidence on impact must clearly identify the setting, or study the collective impact of food marketing across settings
Exclusion criteria Grey literature
Evidence on infants and toddlers (less than age 2 years)
Evidence on parents only
Commentaries on policy interventions
Search string (food OR beverage OR diet OR nutrition [TIAB]), AND (marketing OR advertis*[TIAB]), AND (child* OR youth OR teen OR adolescen*[TIAB]), AND (Canad*[TIAB]).
Databases searched ABI/INFORM Complete, CBCA Complete, CINAHL, MEDLINE, ProQuest Dissertation and Theses, PsycINFO, Scopus, Web of Science Core

Figure 1 - Flow chart of systematic search strategy

Figure 1 - Text Equivalent

The author systematically searched eight health, psychology and business data¬bases identified by a research librarian for research on the exposure to and power of food marketing to children in Canada, its impact and the influence of regulations in July 2015 and updated the search in September 2016. As the figure shows, 257 records were initially identified. All references were imported into an online reference manager. The author selected articles based on a priori inclusion criteria through systematic title, abstract and full-text screening. After title and abstract reviewing, three Canadian researchers with expertise in the topic area were consulted to identify missing research and confirm comprehensiveness of search results. The researchers pro¬vided 21 new items, but only four met the inclusion criteria. This scoping review was limited to peer-reviewed, English-language studies using Canadian data. Two French-language arti¬cles were excluded, as no expert fluent in French was able to review them. The author reviewed all studies and extracted the data. In the end, 25 articles met the inclusion cri¬teria.

Results

Twenty-five articles met the inclusion criteria (Figure 1). The literature available examined the exposure to, power of or impact of food marketing to children in Canada in general,Footnote 36 Footnote 40 on television,Footnote 34 Footnote 41-48 online,Footnote 49-51  in public schools,Footnote 52  on product packaging in grocery storesFootnote 35 Footnote 37 Footnote 53-58 and in fast food restaurantsFootnote 59 Footnote 60 (Table 3). The majority of articles were based on cross-sectional studies (n = 14).Footnote 34 Footnote 37 Footnote 42-45 Footnote 49-56 Two articles reviewed the impact of the QCPAFootnote 43 Footnote 44 and four reviewed that of the CAIFootnote 45-47 Footnote 56 on exposure to and power of food marketing. Table 4 provides a summary of the influence of regulations on exposure and power by setting. Nine studies explored how food marketing impacted food attitudes, preferences and behaviours—three using experimental,Footnote 48 Footnote 59 Footnote 60 one using cross-sectionalFootnote 49  and five using qualitative methods.Footnote 35 Footnote 36 Footnote 40 Footnote 57 Footnote 58

Table 3. Synthesis of Canadian, English-language literature on exposure to and the power and impact of food marketing to children in Canada, and the influence of the QCPA and the CAI
Author Setting Population; location Design Purpose Data Collection Period Overview of methods Key outcome measures Key results
Kelly et al., 2010Footnote 34 Home: TV Children’s TV; Alberta, Ontario Cross-sectional Identify frequency, nutritional quality and persuasive techniques used in food advertising on children’s TV channels in 11 countries Oct. 2007–Mar. 2008 Recorded all ads on 3 most popular children’s TV channels for 2 weekdays and 2 weekend days from 6:00–22:00. Food ads were coded for promotional techniques and nutritional quality (core, noncore or miscellaneous). χ2 tests compared country-level differences. Number and rate of food advertising;
proportion of food ads by program type, product type and nutritional quality;
proportion of food ads with persuasive techniques
In Canada, one-fifth of ads were for food, the second-most advertised product. (E)
Overall, food advertising was 4–7 ads/hr/channel and was higher on weekends.
80% of ads were for noncore foods.  Fast food most commonly advertised. (E)
Canada had one of the lowest proportions of food ads with premium offers (0–4%) but had the second-highest proportion of food ads with promotional characters (33–36%), of which almost all were for noncore foods. (P
Adams et al., 2009Footnote 42 Home: TV General TV; Ontario, Quebec Cross-sectional Compare frequency, nutritional quality of food advertising on children’s TV in Canada and the UK prior to introduction of UK regulations  30 Oct., 2006–5 Nov., 2006 Recorded all ads on 4 free viewing channels (24h/d). Ads were coded as “of particular appeal to (OPAT) children” Footnote 42 p.658 if >20% of viewing population were children. UK Food Standards Agency definition used to identify “less healthy” food ads. Fisher exact tests used to compare OPAT children and non-OPAT children groups. Number and rate of food ads;
proportion of food ads OPAT children;
nutritional quality of food ads
In Canada, 2315 food ads were identified from 4 channels over 7 days. (E)
7% of ads were OPAT children (defined as 2–17 years in Canada). (P)
66% of food ads were for “less healthy” foods. (E)
No significant differences between proportion of “less healthy” food ads that were OPAT children compared to ads not OPAT children in Canada (p = .15). (P)
No significant differences in product type advertised between OPAT-children ads and non-OPAT-children ads were found in Canada, except for sweets and candy, which were advertised less often to children. (P)
Adams, et al., 2009Footnote 41 Home: TV General TV; Ontario, Quebec Longitudinal Compare frequency, nutritional quality of food ads on prime time TV from 1991–2006 in Canada and the UK  26 Oct., 1991-1 Nov., 1991; 30 Oct., 2006 – 5 Nov., 2006 Recorded ads on 5 and 4 free channels in 1991 and 2006, respectively, from 19:00–22:59. Food ads were coded for food type and promotional technique. “TV diets” were generated by summing one serving of each food advertised and were compared to reported diets from national surveys. χ2 tests compared outcomes within and across countries. Number and rate of food ads;
product type and nutritional quality of food ads 
No change in rate of TV food advertising from 1991–2006 (5/h) in Canada. (E)
Fast food product and restaurant ads significantly increased five-fold in Canada and were the most commonly advertised items at 29.5% and 15.6% of food ads. Fruits, vegetables and juices significantly decreased from 8% of ads to 2% in Canada. (E)
TV diets from 1991 and 2006 were similar, but 2006 had less energy from alcohol. The 1991 and 2006 TV diets contained less fibre and energy from protein than reported intakes. The 2006 TV diet had greater levels of energy from sugar and higher sodium levels than reported intakes in 2006. (E)
Potvin Kent et al., 2011Footnote 43   Home: TV TV viewed by English- and French-speaking children aged 10–12 yrs; Ontario, Quebec Cross-sectional Compare frequency of food marketing on children’s preferred TV in two Canadian provinces 26 Mar. 2009–1 Apr. 2009 Recorded 90 hours of TV watched from 6:00–0:00 by 428 children over one week. Ads were coded by day/time, program type, station, ad type/length, food type and target audience. χ2 tests compared differences between French-speaking children in Quebec, English-speaking children in Quebec and English-speaking children in Ontario. Number and rate of food ads; 
characteristics of ads by station, channel and time;
type of food advertised; 
type of promotion used
Neither the number of food ads nor the rate of TV food advertising (3–5/h) differed significantly between groups (p < .06). (IR-E)
More food ads targeted preschoolers (p < .001), children (p < .001) and teenagers (p < .03) in the English-speaking groups compared to the French-speaking group. (IR-P)
More ads were for snacks/candy and grain products in English-speaking groups compared to the French-speaking group. (IR-E)
Significantly more persuasive marketing techniques (fun appeal, characters/celebrities, contests) were seen by English-speaking groups compared to French-speaking group. (IR-P)
Potvin Kent et al., 2012Footnote 44 Home: TV TV viewed by English- and French-speaking children aged 10–12 yrs; Ontario, Quebec Cross-sectional Compare nutritional quality of foods advertised on children’s preferred TV in two Canadian provinces 26 Mar., 2009–1 Apr., 2009 Recorded 90 hours of TV watched from 6:00–0:00 by 428 children over 1 week. Nutritional quality of foods advertised was assessed by a 100 g reference size and classified as high in fats, sugar or sodium and/or low in fibre, and identified as “less healthy” using the UK Food Standards Agency definition. One-way ANOVA with post hoc tests compared group differences.Footnote 43   Mean nutrients per 100 g advertised; 
percentage energy from energy, fats, carbohydrates;
proportion of high-sugar/fat/salt, low-fibre food ads;
proportion of “less healthy” food ads
English- and French-language food ads significantly differed in macronutrient content: French higher in total fat, saturated fat, trans fat; lower in carbohydrates, sugar, energy than English groups (p < .001). (IR-E)
Statistically significantly more English ads were for “less healthy” (68.3-68.9%) foods than French ads (60.6%) (p < .001).(IR-E)
Potvin Kent et al., 2011Footnote 45 Home: TV TV viewed by English- and French-speaking children aged 10–12 yrs; Ontario, Quebec Cross-sectional Compare presence of food marketing to children on children’s preferred TV by companies committed and not committed to CAI  26 Mar., 2009–1 Apr., 2009 Recorded 99.5 hours of TV watched from 6:00–0:00 by 272 children over 1 week. Ads were coded by food type, use of media characters and whether the ad was from a CAI or non-CAI company. Nutritional quality was assessed by 100 g reference size, and using the UK Food Standards Agency definition for “less healthy” foods. χ2 tests and t tests compared differences between CAI and non-CAI ads. Number of food promotions;
type of food products promoted;
proportion of use of media characters;
proportion of “less healthy” products  
24% (n = 418) of all ads recorded were for foods or beverages. (E)
Food companies committed to CAI provided 63% of all ads recorded. (IR-E)
Ads by CAI companies had significantly more energy, fats, sugar and sodium (p < .001). (E)
Significantly more ads by CAI companies were considered “less healthy” than non-CAI companies (p = .001). (IR-E)
CAI ads used media characters more often (p < .001) and were significantly more likely to promote “less healthy” products with media characters (p < .001) than non-CAI. (IR-P)
Potvin Kent et al., 2014Footnote 46 Home: TV Children’s specialty TV; British Columbia, Ontario Longitudinal Compare frequency, nutritional quality of food marketing on children’s TV from 2006–2011 by companies committed and not committed to voluntary industry regulation (CAI) May 2006; May 2011 4 weeks of food ads for 11 food categories aired from 6:00–0:00 on two children’s specialty channels were purchased from Nielsen Media Research for two time periods. Ads were coded for target audience, use of persuasive marketing techniques and food company commitment to the CAI in 2011. Nutritional content was assessed by 100 g reference size, and using the UK Food Standards Agency definition for “less healthy” foods. t tests compared mean group differences. Mean nutrient content;
proportion “less healthy”;
proportion targeting children, teens and adults;
proportion using persuasive marketing techniques 
Proportion of food ads by CAI companies decreased by 24% and that of non-CAI companies increased by 76% from 2006 to 2011. (IR-E)
No change in proportion of CAI ads considered “less healthy” (p = .235). (IR-E)
Significant decrease in proportion of non-CAI ads considered “less healthy” (p < .001). (IR-E)
Increased targeting of “less healthy” ads to children and teens by CAI companies in 2011 over 2006. (IR-P)
Increased use of fun appeals and characters by CIA companies in 2011 over 2006. (IR-P)
Potvin Kent & Wanless, 2014Footnote 47 Home: TV Children’s specialty TV and general TV viewed by children aged 2–11 yrs; British Columbia, Ontario Longitudinal Compare changes in children’s exposure to food marketing on TV between 2006 and 2011 May 2006; May 2009; May 2011  4 weeks of food ads for 11 food categories aired between 6:00-0:00 on 27 channels (2 children specialty channels and 25 general channels) were purchased from Nielsen Media Research for three time periods. Children’s exposure levels to food ads were estimated and compared across time periods. Number and rate of food ads;
children’s overall average exposure to food advertising 
Number and rate of food ads increased between 2006 and 2011. (IR-E)
There was a decrease in food ads on children’s channels (5%) but a 44%–45% increase on general channels between 2006 and 2011. (IR-E)
Overall exposure increased by 6%–17% between 2006 and 2009. (IR-E)
Children’s exposure to candy and cereal ads was mostly from children’s specialty channels but ads for chocolate, juice, diet soft drinks and fast food came from general TV. (IR-E)
Hudson & Elliott, 2013Footnote 48 Home: TV Children aged 7–12 yrs; Canada Experimental Assess the impact of TV product placement on snack behaviour in children Not stated 225 children were randomly assigned to view a 20-min children’s TV program with healthy, unhealthy, or no product placement. After viewing, children recalled brands, sponsors or advertising messages in the program, and chose a food and beverage from a set selection. Questionnaires were used to record children’s experiences of the show. Logistic regression tested the predictive ability of multiple variables, including recall of product placement, on snack behaviour.  Recall of product placement;
immediate choice of food and beverage;
impact of other variables on relationship between product placement and behaviour (TV viewing habits, how much children liked the TV program and products) 
Children were unaware of product placement as a marketing technique. (I)
Children (especially aged 10–12 yrs) who viewed an unhealthy product placement in a TV program had better recall of products. (I )
There was a modest but mixed impact on snack choice immediately after viewing. Pepsi or Coke and Fruit Gushers were most popular regardless of the experimental group, which may be due to children selecting “treats” during the experiment. (I)
Strongest predictors of snack choice were whether the child liked the product packaging, and whether the product looked fun or “yummy.”Footnote 4848,p.193 (I)
Brady et al., 2010Footnote 50 Home: online Websites of CAI companies with marketing targeted at children aged 6-12 yrs; Canada Cross-sectional Compare marketing to children on the websites of CAI companies Not stated 24 websites of CAI companies were identified and evaluated for 379 items related to the presence and type of online marketing techniques. Five marketing objectives were evaluated: target market appeal, increased engagement, increased awareness of the brand and websites, increased brand engagement, and influencing children’s brand preferences and consumption norms. Proportion of websites targeting children,
number of marketing objectives,
techniques and strategies observed on websites
83% of websites targeted children under age 12 yrs. (P)
Websites commonly encouraged prolonged engagement through free memberships (63%), high-score leader boards (50%) and game rewards (46%). Interaction with product/brand was promoted though “advergames,” music, sounds, animation and buttons (88%). (P)
Half encouraged sharing brand or website with friends. The majority of websites had material that could be downloaded by children for use in their everyday lives, such as screensavers, wallpaper, placemats and growth charts. (P)
Foods advertised were similar to those advertised on TV and were inconsistent with Canada’s Food Guide. (E)
One-third provided nutrient information, 21% claimed health benefits and 42% promoted physical activity. (P)
Potvin Kent et al., 2013Footnote 51 Home: online Restaurant websites; Canada Cross-sectional Compare content of English-Canadian and French-Canadian food company websites, and websites by CAI and non-CAI companies Spring 2010 77 English-Canadian and 70 French-Canadian restaurant websites, identified from food ads on children’s preferred TV,44 were analyzed for child-directed content. Websites with child content were coded for marketing features, child protection features and health promotion messages. χ2 and t tests compared group differences between English and French websites, and between CAI and non-CAI websites. Frequency of marketing techniques,
child protection features,
and healthy living messages
Frequency of child-directed content was not statistically different between French and English sites (p < .640), nor between CAI and non-CAI websites (p < .877). (IR-P)
No significant difference in the proportion of marketing to children or online marketing techniques between English- and French-Canadian food company websites, nor between CAI and non-CAI company websites. (IR-P)
French websites had more healthy living messages but this was not statistically significant. (IR-P)
Non-CAI companies used no child-protective features while 14.3%–28.6% of CAI companies did. CAI companies were also more likely to promote healthy living. (IR-P)
Brady et al., 2008Footnote 49 Home: online Children aged 7–13 yrs; Canada Cross-sectional Explore children’s awareness and use of online food marketing features and its impact on food requests Jul. 2007–Aug. 2007 A convenience sample of 83 children at a summer day camp was recruited and completed an interview and questionnaire on the awareness and engagement with online marketing and relationships with requesting foods. Prevalence of engagement with online marketing,
prevalence of requests, purchases of food advertised online
Significantly fewer children (68%) believed there was food marketing on the internet compared to TV (99%) (p < .001). (I)
Over one-third visited food company websites advertised on TV or on product packaging (I)
13% shared these websites with friends.(I)
35% wanted to try a food advertised online and 21% requested or purchased the product. (I)
Soft drinks, chocolate and candy were the top foods children wanted to try. (I)
Velazquez et al., 2015Footnote 52 School Public schools; British Columbia Cross-sectional Identify frequency and type of food marketing in public schools in Vancouver Nov. 2012–Apr. 2013 Observational audit of food promotions in common areas of 23 public schools. Promotions were coded by location, size, advertised product/brand, ad purpose, marketing techniques, and healthfulness as per provincial nutrition guidelines. χ2 and Fisher exact tests compared school group differences. Number of food promotions;
frequency of product type advertised, presence of marketing type, and provincial nutrition category 
87% of schools contained food marketing (median 17/school, range 0–57/school), with more in secondary schools than elementary (p < .01). (E)
60% of promotions were located in schools’ hallways. (E)
55% of schools promoted “prohibited” foods and beverages according to the provincial guidelines. Only 13% of promotions were nutrition education. (E)
Products and brands were promoted in 18% and 26% of promotions, respectively; characters and premium offers were rare (3% and 4% of promotions, respectively) (P)
Berry & McMullen, 2008Footnote 53 Grocery store Breakfast cereals at eye level of children aged 8 yrs or younger in Canadian supermarkets; Ontario  Cross-sectional Explore associations between marketing techniques and nutritional quality of breakfast cereals Mar. 2005–Nov. 2005 Recorded breakfast cereals in a representative sample of 15 grocery stores that were 0–48 inches off ground. Product packaging was coded for marketing features. Nutritional content and ingredients were recorded. Multivariate regression using marketing features as predictors and nutritional content as outcomes was used to determine whether the cereal aisle is “health-protective” or “health-exploitive”53,p.333 Frequency of marketing features (spokes-characters, colours, child-orientation, reachable by child, oversized box);
sugar, whole grain and trans fat content;
relationship between features and nutrition
2755 cereal boxes identified at children’s height. (E)
Spokes-characters, colourful packaging, and child-oriented incentives were found on 34%, 48% and 35% breakfast cereal shelf space, respectively. (P)
17% of cereals were in child-themed colours and/or shapes (P)
Cereals with these marketing techniques were also significantly higher in sugar, refined grain and/or trans fat. (P)
Boxes that could be reached by children had mixed results on nutritional content (no difference in sugar, but more likely to have whole grain and less trans fat). (P)
Elliott, 2008Footnote 54 Grocery store Regular (non-junk) foods targeted to children in Canadian supermarkets; location not provided Cross-sectional Assess the nutritional quality of foods marketed to children in Canadian grocery stores Dec. 2005 367 foods targeted to children (“fun foods” 54,p.359) were purchased from Loblaws Superstore and coded for 36 variables related to the food type and packaging marketing features (graphics, nutrition claims). “Poor nutritional quality” products were identified using US Center for Science in the Public Interest benchmarks. χ2, phi and Cramer’s V tests assessed group differences. Frequency of food types by nutritional quality;
frequency of marketing techniques;
differences by groups (food type, nutrient quality, presence of marketing technique)
Dry goods (cereal, crackers, cookies, granola bars, etc.) were the most common “fun foods” (61%). Vegetables and fruit were only 1% of the “fun foods”. (E)
89% of “fun foods” were high in fat, sugar, or sodium. Acceptable cut-offs for sugar content were most frequently violated, at 70% of products. Total fat and sodium cut-offs were violated in 23% and 17% of products. (E,P)
Products high in fat, sugar or sodium were significantly more likely to have a front-of-pack nutrition claim (p < .001) (P)
Elliott, 2012Footnote 55 Grocery store Regular (non-junk) foods targeted to children in Canadian supermarkets; Alberta Cross-sectional Identify regular grocery foods marketed to children in Canadian grocery stores 2009 354 foods targeted to children (“fun foods” 55,p.305) were purchased from The Real Canadian Superstore and Safeway and coded for 37 variables related to food type, packaging marketing features, target audience and nutritional quality. χ2, phi and Cramer’s V tests assessed group differences. Frequency of child-targeting product packaging and relationships between food types, packaging characteristics, target audience, nutritional quality The majority of “fun foods” were dry goods (64%), only 1% were fruits or vegetables. (E)
Parents were targeted on 55% of products. (P)
Marketing techniques included: colours, shapes, cartoons, highlighting “fun food,”Footnote 55,p.305 nutrition claims, small portion sizes and convenient packaging. (P)
Table 4. Summary of influence of current regulation in Canada on exposure to and power of food marketing to children by setting
Setting Influence of QCPA Influence of CAI
ExposureTable 4 - Footnote a to food marketing overall ExposureTable 4 - Footnote a to unhealthy food marketing PowerTable 4 - Footnote b ExposureTable 4 - Footnote a to food marketing overall ExposureTable 4 - Footnote a to unhealthy food marketing PowerTable 4 - Footnote b
Home (TV) No influence Positive influence Positive influence Negative influence No influence Negative influence
Home (online) No influence No influence
School
Supermarket No influence

Exposure to and power of food marketing to children in Canada

Exposure to food marketing in the home: television

Six articles reviewed exposure to television food marketing.Footnote 34 Footnote 41-45 In these studies, exposure was measured by the proportion of all television advertisements that were for food (overall and unhealthy) and the rate of food advertisements per hour per channel.

One-fifth of advertisements recorded on three popular children’s channels in Canada between 2007 and 2008 were for food (unpublished data by Kelly et al.Footnote 34). Potvin Kent et al. studied the top 30 hours of television watched by ten to 12 year old children in Ontario and Quebec in 2009, which included general and children’s channels, and found that 24% to 27% of the advertisements children watched were for food.Footnote 43

The studies reported varying rates of food advertising, from three to seven advertisements per hour per channelFootnote 34 Footnote 41 Footnote 47 (unpublished data by Kelly et al.Footnote 34). This variability may be related to differences in study methods, including heterogeneity in the number and type of channels recorded, times and number of days recorded and location and dates of data collection.

Exposure to unhealthy food television advertisements was evaluated by determining the proportion of advertised foods that were high in energy, fat, sugar or salt.Footnote 34 Footnote 42 Footnote 44 According to Kelly et al., 80% of food advertisements on children’s channels were for “noncore foods” that were high in fat, sodium or energy.Footnote 34  Using the UK’s Nutrient Profiling system, Adams et al.Footnote 42  found that 66% of all food advertisements on general television in Canada were “less healthy.” Potvin Kent et al.Footnote 44  found that 88% of food advertisements watched by children in Canada were “less healthy” using the same nutrient profiling system.  

Influence of regulation on exposure. Potvin Kent et al. researched the impact of statutory regulation in 2009Footnote 43  and voluntary industry regulation in 2011Footnote 46  in Canada and found that neither were associated with reduced children’s exposure to television food marketing. Specifically, French-speaking children in Quebec and English-speaking children in Quebec and Ontario were found to be exposed to the same rate of food advertisements per hour per channel.Footnote 43  Potvin Kent and WanlessFootnote 47  estimated that children’s overall exposure to television food advertising increased by 6% in Vancouver and 17% in Toronto between 2006 and 2011, since the introduction of the CAI. Although food advertisements on children’s television from CAI companies decreased by 24% between 2006 and 2011, the same kind of advertisements by non-CAI companies increased by 76%.Footnote 46

Small improvements in the nutritional quality of the advertised foods were associated with the QCPAFootnote 43  but not the CAI.Footnote 46  Significantly fewer advertisements watched by children were found on French-language television in Quebec for “less healthy” foods than on English-language television in Ontario;Footnote 44  however, 81% of the former were still “less healthy.” On the other hand, there was no significant change in the proportion of “less healthy” foods advertised by CAI companies between 2006 and 2011.Footnote 46

Power of food marketing in the home: television

The power of food marketing is evaluated by the prevalence of child targeting in food advertisements and the use of powerful promotional techniques. On general television (from 7:00 p.m.–11:00 p.m.), 7% of food advertisements were of particular appeal to children (aged 2–17 years) in 2006.Footnote 42  On television watched by French-speaking children (10-12 years) in Quebec in 2009, only 30% of food advertisements were targeted at children, compared to 76% and 65% of advertisements watched by English-speaking children (10-12 years) in Quebec and Ontario, respectively.Footnote 43  In 2011, approximately one-quarter of food advertisements by CAI and non-CAI companies on children’s specialty channels targeted children and teens.Footnote 46

A variety of marketing techniques were used in television food advertisements, including premiums (such as giveaways, vouchers), promotional characters, fun and health appealsFootnote 34 Footnote 46. Foods advertised with these powerful techniques were often unhealthy.Footnote 34 Footnote 46  For example, Kelly et al.Footnote 34  found that almost 100% of televised food advertisements that used promotional characters on children’s channels in 2007 and 2008 in Canada were for “non-core” foods, compared to only 80% overall.

Influence of regulation on power. Small improvements in the power of food advertisements were found to be associated with the QCPAFootnote 43  but not the CAI.Footnote 46  In 2009, the QCPA was associated with fewer food advertisements targeted at French-speaking children in Quebec, but did not prove to fully protect all children in Quebec since English-speaking children view television originating outside Quebec which is not restricted by Quebec’s law.Footnote 43  Overall, there was no change in the prevalence of targeting children in food advertisements by CAI or non-CAI companies between 2006 and 2011.Footnote 46  In fact, there is some evidence that it has worsened, since more unhealthy food advertisements targeted children in 2011 than 2006.Footnote 46  For example, between 2006 and 2011 the use of fun and licensed characters to advertise “less healthy” products increased by 38% and 234% by CAI companies, respectively.Footnote 46

Exposure to food marketing in the home: online

Online food marketing in Canada was captured by two studies evaluating marketing to children on food company websites.Footnote 50 Footnote 51 This evidence does not assess the multitude of emerging electronic marketing techniques used to target children, including viral marketing (online word-of-mouth by consumers), social networking and direct marketing by e-mail.Footnote 4  The author found no studies that assessed these techniques in Canada. Studies from other countries may be informative, since Canadians can access international websites; however, that was beyond the scope of this review. The two included studies focussed on documenting the powerful characteristics of food company websites and were not designed to measure exposure—for example, the proportion of websites visited by children with food marketing. Thus, the available evidence does not reveal children’s exposure to food marketing online, or the impact of regulation on the degree of exposure.

Power of food marketing in the home: online

In 2010, Potvin Kent et al.Footnote 51  reviewed websites tied to food or beverages advertised on television watched by ten to 12 year old children to evaluate the impact of the QCPA and the CAI. Of 148 websites, approximately one-third were child-directed, which was defined as having “child-oriented marketing features such as spokes-characters, cartoons, contests, activities, or games directed at children; and [using] simple vocabulary easily understood by children.”Footnote 51 ,p.801 In a separate evaluation of only CAI company websites, 83% contained marketing directed at children under 12 years of age.Footnote 50

Multiple techniques urged children to engage with the food marketing on CAI websites:Footnote 50

  • memberships, incentives and leaderboards for repeated and prolonged use of online media;
  • “advergames,” music, animation and e-buttons to interact with the product or brand;
  • electronic word-of-mouth techniques to share brand or website information; and
  • downloadable features (computer wallpaper, growth charts, shopping lists, board games) to embed brands into children’s daily lives.

Influence of regulation on power. No statistical differences in the power of food marketing (e.g., whether or not they targeted children, the type or frequency of promotional techniques used) were found between French- and English-language websites, nor between CAI and non-CAI websites in 2010.Footnote 51

Exposure to food marketing in schools

With only one study on marketing in schools conducted in the last decade,Footnote 52  evidence is lacking in this setting. Velazquez et al.Footnote 52  examined the extent of commercial and non-commercial (made by the school or students) food promotions in a representative sample of 23 Vancouver public schools in the 2012/13 school year. Through observation, Velazquez et al.Footnote 52  found that 87% of schools displayed food promotions. Schools had a median of 17 promotions (range = 0–57). Secondary schools had more advertising than elementary schools.Footnote 52

Velazquez et al.Footnote 52  used British Columbia’s school nutrition guidelinesFootnote 21  to assess the healthfulness of observed food and beverage promotions. Over half of schools promoted foods or beverages prohibited by the provincial guidelines.Footnote 52  Almost one-quarter of all promotions were for “Choose Least Often” or “Not Recommended” items.Footnote 52  On the other hand, 80% of the schools had promotions for “Choose Most Often” items, which made up 45% of all promotions.

Influence of regulation on exposure. No studies have evaluated the impact of the QCPA or the CAI on exposure to food marketing in schools. The lower levels of food marketing in elementary schools documented by Velazquez et al.,Footnote 52  a setting partially covered by the CAI, may reflect the influence of the CAI; however, this finding more likely reflects the fact that secondary schools have more food services (vending machines and concessions) than elementary schoolsFootnote 52  and thus more food promotion.

Power of food marketing in schools

Velazquez et al.Footnote 52  found that observable food promotions in schools often involved specific products or brands, and rarely used animated characters, celebrities or premium offers. The rare use of these powerful techniques may be related to the finding that half of promotions recorded were noncommercial promotions created by the students or the school.Footnote 52

Influence of regulation on power. Not documented.

Exposure to food marketing in supermarkets

Two studies documented the proportion of products that targeted children through product packaging. From 15 randomly audited grocery stores in Ontario, Berry and McMullen found 2755 cereal boxes at child height (defined as 48 inches from the ground, which takes into account the eye level of a child sitting in a shopping cart as well as standing or walking).Footnote 53  Up to half of breakfast cereal shelf space at child height contained cereal boxes with at least one child-directed feature (described in the “Power of food marketing in supermarkets” section of this article). From the University of Toronto’s Food Label Information Program database, which contains over 10 000 packaged food products collected between 2010 and 2011, Murray found that 415 (4%) targeted children, defined as depicting fun or play, or using cartoons or child-like fonts.Footnote 56  One other studyFootnote 55  identified products that were targeted to children only, without collecting a total product denominator. In two supermarkets in Alberta, Elliott found over 350 everyday foods (not junk foods) that targeted children, defined as being designed for children, or displaying cartoons, cross-merchandising, unusual shapes, colours, tastes, or games on its packaging.Footnote 55  The estimates of exposure in these three studies are not complete; true exposure may be underestimated, since none of the studies explored food marketing in checkout areas, store display, or other features of grocery stores.

Overall, most foods marketed to children in supermarkets were high in sugar, fat or sodiumFootnote 54  and/or low in desirable nutrients.Footnote 56  Almost one-quarter of foods marketed to children were labelled “better for you” according to the CAI definition; however, two-thirds of the “better for you” foods were still high in sugar, fat or sodium.Footnote 37  A significantly greater proportion of some food categories (snacks, beverages, cereals, crackers, pudding and combination dishes not measurable by a cup, such as pizza) were considered “less healthy” according to the UK’s Nutrient Profiling system when they were marketed to children compared to when they were not marketed to children.Footnote 56  ElliottFootnote 55  and MurrayFootnote 56  both found that 1% or less of foods marketed to children were vegetables or fruits.

Influence of regulation on exposure. Neither the QCPA nor the CAI explicitly applies to product packaging. No research exists on the impact of the QCPA on product packaging. The impact of the CAI on the overall exposure to product packaging targeted at children is not documented; however, Murray found that the CAI did not impact the nutritional quality of foods marketed to children through product packaging.Footnote 56

Power of food marketing in supermarkets

The majority of grocery store products Elliott reviewed had “fun” features on product packaging, including cartoons and cartoonish fonts.Footnote 54  Murray found that unusual flavours, shapes and colours, characters and graphics or lettering were the most commonly used marketing techniques on products targeting children.Footnote 56  In an analysis of breakfast cereals boxes, 48% had child-oriented colours, 35% had incentives or premium offers and 34% had spokes-characters.Footnote 53

Similar to research on television food advertisements, powerful marketing techniques on product packaging were associated with poor quality foods.Footnote 53 Footnote 54In particular, breakfast cereals were more likely to be higher in sugar if their packaging targeted children.Footnote 53  As well, over two-thirds of non-junk, high-sugar products had a nutrition claim, compared to only half of “healthier” products.Footnote 54  Berry and McMullen suggested that the marketing landscape in the cereal aisle in Canada is “health-exploitive,”Footnote 53 ,p.334 meaning that it uses child-directed marketing techniques on less healthy products, encouraging their consumption.

Influence of regulation on power. Not documented.

Impact of food marketing on children in Canada

The evidence of a causal impact of food marketing on children’s food attitudes, preferences and behaviours is compelling and has been discussed elsewhere.Footnote 6 Footnote 61 Footnote 62 Although limited, Canadian studies provide local insight into how children in Canada are impacted by food marketing. Experimental and qualitative studies in Canada have shown that television product placement,Footnote 48  online advertising,Footnote 49  product packaging,Footnote 35 Footnote 57 Footnote 58 Footnote 60 and toy premiumsFootnote 59  can impact Canadian children’s attitudes, preferences, and behaviours.

Hudson and ElliottFootnote 48  found that although only 17% of children (7-12 years) were aware of product placement, children who viewed a television program with unhealthy product placements (vs. no product placement or healthy product placement) were most likely to recall the advertised products. Almost one-quarter of children aged 7 to 13 years said they purchased or requested a food advertised online (most commonly soft drinks, chocolate and candy).Footnote 49

Researchers used focus groups of children aged 5 to 12 years to assess children’s preferences, perceptions and interpretations of packaged foods.Footnote 35 Footnote 57 Footnote 58 Preferences were commonly influenced by packaging that used themes of fun and was esthetically pleasing or interactive.Footnote 57  When asked to identify healthy products, children created their own, often inaccurate, rationales based on colours,Footnote 57  nutrition or organic claims,Footnote 35 Footnote 57 ingredient listsFootnote 35 Footnote 57 and sometimes nutrition facts tables.Footnote 35 Footnote 57 Results from focus groups with 225 children across Canada revealed that marketing features (colours, words, pictures, spokes-characters and front-of-pack claims) were more regularly used than nutrition facts and ingredient lists in evaluating the healthfulness of packaged foods.Footnote 58

Elliot et al.Footnote 60  investigated whether six to 11 year old children’s taste preferences differed based on food packaging design. When compared to food in plain packaging, children preferred the food in McDonald’s packaging; however, this preference was not maintained when food in McDonald’s packaging was compared to colourful or Starbucks packaging. Exploring a method of healthy food promotion, Hobin et al.Footnote 59  assessed the impact of toy premiums on meal choice. Children (aged 6–12 years) who were offered toy premiums with healthy options only (vs. healthy and unhealthy options) were over three times as likely to select the healthy meal.Footnote 59

Finally, evidence from qualitative studies that were not setting-specific show that Canadian children have homogeneous attitudes towards food,Footnote 36 Footnote 40 suggesting that cumulative exposures to food marketing may have a greater impact on children’s food culture than a single exposure in a study. Focus groups conducted in Alberta, Ontario and New Brunswick with children aged 6 to 11 years showed that children distinguished between food for themselves and for others.Footnote 40  They reported that “kids’ food” is junk food, sugary, associated with cartoons, comes in fun shapes or colours and is something you can play with or eat with your hands.Footnote 40 ,p.133 These symbolic features identified by children mimic the powerful techniques listed in this review and used by the food industry to market to children. Conversely, children saw adult food as plain, unprocessed, healthy, responsible food, and not for them.40 As well, adolescents (aged 12-14 years) personify food in a consistent manner across Canada:36 broccoli is “shy, unpopular, and boring,”Footnote 36 ,p.87 and milk is “athletic”Footnote 36 ,p.87 (except for older boys). They see junk food, on the other hand, as a “party person” who is “funny and fun to hang around with.”Footnote 36 ,p.87 Children’s food attitudes may have been socially constructed by commercial food marketing, or the lack thereof, and may partly explain why the children’s diets do not align with Canada’s Food Guide.

Discussion

This scoping review found evidence of multiple exposures to food marketing to children in different settings—at home, at school and in supermarkets. With the exception of television and product packaging, the evidence base is limited. Fast food restaurants represent another setting where food marketing would be expected, but only the impact of promotional techniques used in fast food restaurantsFootnote 59 Footnote 60 has been studied in Canada. International research has documented food marketing in other settings (restaurants,Footnote 63  sports centresFootnote 64  and outsideFootnote 65 ) and thus, this review likely underestimates Canadian children’s exposure. Foods high in energy, fat, sugar and salt were commonly marketed in all settings, which is consistent with findings from other research.Footnote 6  Children were often targeted with powerful promotional techniques that were multiple and varied, and overlapped across settings; food marketers have an arsenal of marketing tools.

With the exception of limited positive influences of the statutory regulation in Quebec on television food advertising, current evidence suggests that statutory and self-regulations in Canada have not improved either children’s exposure to or the power of food marketing; however more research is needed to understand regulations’ impact across settings. Dhar and Baylis estimated that the QCPA has positively impacted population health by reducing weekly household fast food consumption in French-speaking, but not English-speaking, households with children in Quebec since English-speaking households may view non-Quebec food marketing not covered under the QCPA.Footnote 66  Although the influence of regulation in schools has not been measured, a 2004 survey of all Canadian public schools found that prevalence of commercial (food and non-food) advertising was lower in Quebec than the rest of Canada.Footnote 67  Quebec’s statutory regulation, a rights-based approach to child health,Footnote 4  may better influence the settings and context in which children live, compared to industry self-regulation.

The evidence synthesis presented here shows that food attitudes, preferences and behaviours of Canadian children are impacted by exposures to food marketing in a single setting. More important, however, may be the uniformity of food attitudes among Canadian children, which is suggestive of a nonspecific, collective impact of food marketing exposure over time and across place. As children become increasingly immersed in marketing throughout their lives, and as promotional techniques and channels integrate and overlap more often,Footnote 68  it is reasonable to ask whether exposures to unhealthy food marketing have a greater cumulative impactFootnote 61  than when viewed separately by promotion type.

The body of evidence presented in this scoping review must be considered within the daily life of an average Canadian child, who watches two to three hours of television,Footnote 69  uses the computer or plays video games for one to two hours,Footnote 69  sits in school for five to six hoursFootnote 70  and whose family shops for groceries almost every second day.Footnote 71  In that light, it becomes more obvious that children in Canada (with the exception of some in Quebec) are at risk of exposure to an astounding volume of powerful food marketing. Furthermore, the settings where food marketing occur that the author has identified in this review are common places for children to eat, buy or learn about food.

The study of Vancouver schools may suggest that children’s exposure to unhealthy food marketing is less frequent and the marketing is less powerful in schools than in other settings, since only one-quarter of foods advertised were unhealthy and powerful promotional techniques were rare.Footnote 52  This finding may be noteworthy, as it may signify that settings-based policies, such as British Columbia’s mandatory school food policy with food marketing recommendations,Footnote 21 Footnote 22 are more comprehensive and efficient than traditional promotion-focussed regulations. The latter may not reach the extensive food-related commercialization in Canadian public schools previously reported,Footnote 67  including exclusive agreements with Coca-Cola and Pepsi, incentive programs (Campbell’s Labels for Education) and sponsored educational materials (Pizza Hut’s “Book it”, Mr. Christie’s “Smart Cookie”). Unfortunately, the limited research precludes conclusions about the state of marketing in schools, especially since variability in school food policies likely contributes to different food marketing environments in schools across Canada.

Experts have recommended strong, comprehensive statutory regulations with independent monitoring and compliance penalties to effectively reduce children’s exposure to powerful unhealthy food marketing.Footnote 72 Footnote 73 Nevertheless, those planning interventions must consider how multiple exposures to food marketing interact and socially construct food attitudes and behaviours in children’s everyday settings. The tendency for regulations to focus on the promotional aspects of food marketingFootnote 74  without considering the settings where children eat, buy or learn about food may increase the risk of policies that inadequately intercept marketers’ plans to reach children. Settings as a component in the proposed Canadian food marketing regulationsFootnote 17  is valuable if the regulations consider settings not as just promotional marketing channels, but as the places where behaviours are performed or related goods and services are acquiredFootnote 5  – where children eat, buy and learn about food.

Implications for policy and research

A comprehensive approach to restricting unhealthy food marketing to children that addresses product, promotion, place and price may require action by policy makers, industry and communities.

In the United States, Palaskhappa et al. found that lower childhood obesity prevalence was associated with strong laws regulating the sale of unhealthy foods (OR = 0.68, 95% CI:0.48–0.96) and food advertising in schools (OR = 0.63, 95% CI:0.46–0.86), compared to states with no laws.Footnote 75  Furthermore, states with multiple strong school food laws (two or more) compared to states with no laws had reduced risk of obesity in elementary schools and of overweight in middle schools.Footnote 75  The success of this kind of regulation demonstrates that government policy regulating the food industry, if it follows research-based recommendations,Footnote 73  can be paired with local settings-based initiatives to prohibit unhealthy food marketing in the places where children live, learn and play, such as schools and recreation facilities. The places where we eat, buy and learn about food are critical points of intervention for health promotion, just as they are critical targets for the food industry.

The goal of marketing restrictions should be to improve children’s everyday lives, not just limit the marketing channels used to reach them. Solely focussing on the promotional aspects of food marketing may allow marketers continued access to children by simply switching from one marketing technique to another. The increase in new media marketing techniques and decrease in television marketing observed in the United States after the introduction of industry self-regulationFootnote 68  may be evidence of such a consequence. The sectors that disseminate food marketing (schools, media, retailers, sports organizations, etc.) are key actors in supporting food marketing restrictions.Footnote 9

Using the broadcast industry’s code as an example of sector-based action,Footnote 12  organizations and communities can take the lead in place-based interventions by developing their own marketing or sponsorship policies that address the promotion, place and pricing of unhealthy food and beverages. Setting-based health promotion helps to shift the focus from an individualistic risk-factor approach to one that appreciates the complexity of interconnecting environmental and individual factors influencing health.Footnote 14  Whole-system approaches, a feature of settings-based interventions, with actions by government, industry and communities may impact culture more widely than traditional reductionist approaches that view issues linearly with single causes and outcomes.Footnote 14  For example, school food polices, which may include multiple aspects of marketing (see Table 1), can be expanded to comprehensively address all 4Ps. In addition to proposed marketing regulations, policy makers may also consider adopting additional supporting interventions that target broader aspects of marketers’ 4Ps, such as product availability through industry reformulation, or food pricing via taxes and subsidies, in a whole-system intervention to reduce the impact of food marketing. A 4Ps policy strategy may help address unhealthy food marketing in situations where it is not applicable or feasible to introduce a settings-based policy, such as in the business sector.

Further research is needed to fully examine children’s exposure to and the power and impact of food marketing within the settings of children’s everyday lives and consider the influence of all 4Ps. Specifically, more research is needed on how settings, such as schools, recreation centres, daycares, retailers and other spaces, can be targeted when creating policy to protect children from unhealthy food marketing. More research is also needed on children older than 12 years and population subgroups (e.g. by income or ethnicity) to completely understand the state of food marketing to children in Canada and its impact.

Strengths and limitations

The settings-based approachFootnote 18  used to conduct this review diverges from the usual siloed media/promotion perspective and provides fresh insight into children’s exposure to food marketing, its power and its impact on their lives. By critiquing the literature through the 4Ps marketing lens, this review bridges the population health and business disciplines and provides a novel perspective on population health interventions and research on food marketing to children.

Restricted to peer-reviewed, English-language research in Canada, however, the findings in this review may underestimate children’s exposure to and the power of food marketing in Canada. The limited search strategy may have excluded studies that cursorily measured food marketing to children as a part of broader study objectives irrelevant to this review. With only 23 studies (mostly cross-sectional) published over the last decade, the temporal aspects of marketing are not well documented. Due to the mix of study designs, the quality of studies was not evaluated.

Conclusion

Creating environments that support healthy diets for children is a priority in Canada as a strategy to reduce the prevalence of childhood obesity.Footnote 76  However, food marketing in the settings where children eat, buy and learn about food encourages “fun” junk foods inconsistent with healthy diets. The findings from this scoping review suggests that statutory and voluntary regulations are not adequately protecting Canadian children from exposure to powerful unhealthy food marketing. Complementary actions from government, industry and communities, such as strong, enforced, and monitored statutory regulations and broadened school food policies, may be needed to address the multifaceted nature of powerful food marketing. With almost seven million children under 18 yearsFootnote 77  in Canada and 400 000 new births every year,Footnote 78  protecting the places where children live, learn and play from unhealthy food marketing constitutes one of the strategies needed to help reverse the tide of childhood obesity in Canada.

Acknowledgements

Stipend support to Rachel Prowse was provided by the Heart and Stroke Foundation of Canada and the CIHR Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (PICDP Program) (Grant #53893); the CIHR Doctoral Award – Frederick Banting and Charles Best Canada Graduate Scholarship; and the Women and Children’s Health Research Institute Graduate Studentship, supported by the Stollery Children’s Hospital Foundation. Rachel Prowse would also like to extend appreciation to the PICDP Program for the experiential learning opportunity to collaborate with a third party agency to develop the review objectives. The author would like to thank Dr. Kim Raine for her editorial assistance.

Conflicts of interest

Rachel Prowse has no financial relationships that may pose a conflict of interest.

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