Radical Fashion as A Clear Break from The Old Designs Summary summarize the readingput on important information Health & Place 29 (2014) 124–131 Contents l

Radical Fashion as A Clear Break from The Old Designs Summary summarize the readingput on important information Health & Place 29 (2014) 124–131
Contents lists available at ScienceDirect
Health & Place
journal homepage: www.elsevier.com/locate/healthplace
Racial/ethnic and income disparities in child and adolescent exposure
to food and beverage television ads across the U.S. media markets$
Lisa M. Powell a,n, Roy Wada b, Shiriki K. Kumanyika c
a
Health Policy and Administration, School of Public Health and Institute for Health Research and Policy, University of Illinois at Chicago, USA
Institute for Health Research and Policy, University of Illinois at Chicago, USA
c
Perelman School of Medicine, University of Pennsylvania, USA
b
art ic l e i nf o
a b s t r a c t
Article history:
Received 12 November 2013
Received in revised form
13 June 2014
Accepted 21 June 2014
Available online 1 August 2014
Obesity prevalence and related health burdens are greater among U.S. racial/ethnic minority and lowincome populations. Targeted advertising may contribute to disparities. Designated market area (DMA)
spot television ratings were used to assess geographic differences in child/adolescent exposure to foodrelated advertisements based on DMA-level racial/ethnic and income characteristics. Controlling for
unobserved DMA-level factors and time trends, child/adolescent exposure to food-related ads, particularly for sugar-sweetened beverages and fast-food restaurants, was significantly higher in areas with
higher proportions of black children/adolescents and lower-income households. Geographically targeted
TV ads are important to consider when assessing obesity-promoting influences in black and low-income
neighborhoods.
& 2014 Elsevier Ltd. All rights reserved.
Keywords:
Television advertising
Racial/ethnic disparities
Income disparities
Media markets
1. Background
In 2009–2010, nearly 17% of U.S. children ages 2–19 were
classified as obese (Ogden et al., 2012). The data indicated that
obesity prevalence was 24.3% among non-Hispanic black children
and 21.2% among Hispanic children, compared to 14% among nonHispanic white children (Ogden et al., 2012). Evidence also shows
obesity prevalence is greater among children and adolescents
living in lower-income households (Ogden et al., 2010). Marketing
of foods and beverages that are unhealthy (i.e. high in saturated
fat, sugar and/or sodium) to children and adolescents has received
particular attention from researchers, public health advocates, and
regulatory agencies as a probable contributor to the increased prevalence of childhood obesity (Federal Trade Commission, Centers for
Disease Control and Prevention 2011; Kraak et al., 2011; Cheyne et al.,
☆
This study was supported by the Robert Wood Johnson Foundation (RWJF)
through grants to the African American Collaborative Obesity Research Network
and to the Bridging the Gap program at the University of Illinois at Chicago and by
the National Cancer Institute (NCI) award number R01CA138456. The manuscript’s
contents are solely the responsibility of the authors and do not necessarily
represent the official view of the RWJF, the NCI or the National Institutes of Health.
The authors thank Dr. Sonya A. Grier for her helpful comments on an earlier version
of the paper. The authors have no conflicts of interests for this manuscript.
n
Correspondence to: University of Illinois at Chicago, Institute of Health Research
and Policy, M/C 275, 1747 W. Roosevelt Road, Chicago IL 60608, USA. Tel.: þ 1 312
413 8468; fax: þ1 312 355 2801.
E-mail address: powelll@uic.edu (L.M. Powell).
http://dx.doi.org/10.1016/j.healthplace.2014.06.006
1353-8292/& 2014 Elsevier Ltd. All rights reserved.
2013; Powell et al., 2011; Federal Trade Commission, 2012; Institute of
Medicine, 2006; Center for Science in the Public Interest, 2010).
Exposure to food-related television advertising is associated with
children’s purchase requests, consumption patterns and adiposity
(Chou et al., 2008; Institute of Medicine, 2006; Andreyeva et al., 2011).
Nutritional content studies show that despite industry pledges
to promote only healthy products, relatively little progress has
been made; the vast majority of television advertisements seen by
or directed at children consist of unhealthy foods and beverages
that are high in saturated fat, sugar or sodium (Harris et al., 2010;
Harris et al., 2011; Harris et al., 2012; Powell et al., 2011; Kunkel
et al., 2009; Powell et al., 2013). Exposure to television ads for
foods increased between 2009 and 2011 among children ages 2–5
and 6–11 years, offsetting previous declines for children, while
teens’ exposure further increased and steepened its upward trend
(Powell et al., 2013).
“Targeted marketing” refers to the common marketing strategy
of directing products and product promotions to groups of consumers or ‘segments’ with common demographic or other relevant
characteristics based on their presumed likelihood of buying the
product (Kotler, 1975). Targeted product advertising may involve
placing relatively more advertisements in channels that reach the
population segment of interest, resulting in higher exposure, as
well as tailoring the content of advertisements to be particularly
salient for the targeted group; these strategies are often used in
combination and concern about such marketing practices arises
when relatively unhealthy products are being promoted to the
L.M. Powell et al. / Health & Place 29 (2014) 124–131
targeted group (Grier and Kumanyika, 2010; Grier and Lassiter,
2013). The Federal Trade Commission reported that 48 food and
beverage companies spent $1.8 billion on youth-targeted marketing in 2009, of which $632.7 (35.4%) was on television, the largest
single medium through which products are marketed to youths
(Federal Trade Commission, 2012).
Targeted marketing of food and beverages that are high in fat or
sugar based on race/ethnicity has been documented in studies of
exposure to national TV advertisements as well as the content of
those ads (Grier and Kumanyika, 2008; Harris et al., 2010; Harris
et al., 2011; Powell et al., 2010) and may contribute to or
perpetuate the higher than average risks of obesity among black
and Hispanic children. The disproportionate exposure of black and
Hispanic youths to targeted television advertising is compounded
by the fact that on average they are more likely to have TVs in their
bedrooms and watch television an hour or more longer per day
compared to their white peers (Rideout et al., 2010; Rideout et al.,
2011). Of similar concern, low- to mid-socioeconomic status (SES)
based on parents’ education level is correlated with youths’ viewing more TV (greater than 30 additional minutes) than their highSES counterparts (Rideout et al., 2010). Further, a number of
studies with multivariate analyses suggest independent associations of race/ethnicity and SES with children’s and adolescents’ TV
viewing time (Gorely et al., 2004; Hoyos Cillero and Jago, 2010).
Television advertising can be targeted at local as well as
national levels, increasing exposure among certain segments of
the population; these two levels may be complementary or
mutually reinforcing. Although national television ads can be
targeted based on a given population’s relative viewership of
certain programming, advertising directed to local geographic
areas can vary according to specific demographic characteristics
such as racial/ethnic composition through placement of ads
(referred to as “spot ads”) in local media markets known as
“designated market areas” (DMAs) (Gold, 2005). DMA media
market data, including data with information about racial/ethnic
characteristics of the area population, are made available to
marketers for use in targeting ad placement and for other business
purposes (The Nielsen Company, 2013).
To understand the patterns of geographically-based food and
beverage product television advertisements seen by children and
adolescents, we linked Nielsen DMA-level spot television ratings
data for children aged 2–11 and adolescents aged 12–17 from
2003–2007 to DMA-level Census data on racial, ethnic and SES
characteristics across DMAs. Controlling for unobserved media
market-level factors and time trends, we assessed exposure
according to the racial/ethnic composition of residents in DMAs
and according to DMA-level median household income.
2. Methods
2.1. Advertising measures
Local spot food and beverage television ratings data reflecting
the numbers of ads seen were licensed from Nielsen Media
Research (NMR) for English language stations. Ratings were
obtained for each year from 2003–2007 for the largest 129 DMAs
in the United States. Nielsen’s DMAs regions are geographic areas
used when measuring local television viewing. DMAs vary in size,
generally covering several counties, with some describing commonly recognized metropolitan areas. Nielsen tracks commercials
either as full-disclosure markets (FDMs), which track all television
advertising in the area, or automated discovery markets (ADMs),
which do not track commercials until they have appeared in a
FDM (Szczypka et al., 2003). Therefore, we examined the 88 DMAs
that had been tracked as FDMs.
125
The NMR advertising data are based on individual ratings of
television programs, obtained by monitoring household audiences
across DMAs. Ratings are measured in units of Targeted Ratings
Points (TRPs) for specific subgroups of the population within
households, which we obtained for children aged 2–11 years and
adolescents aged 12–17 years. An ad with 100 TRPs in the year, for
example, is estimated to have been seen an average of one time by
100 percent of the given subgroup population in households with
televisions in that DMA during that year. We used the ratings data
to derive exposure measured as the weekly number of television
ads seen, on average, by children and adolescents in a given DMA.
2.2. Food product categories
TRPs were aggregated at the brand level and then categorized
across food product categories using NMR product classification
codes that define its product categories based on definitions used
by the Publishers Information Bureau (PIB) (Publishers
Information Bureau, 2006). Food-related products were categorized into seven mutually exclusive categories, as reported elsewhere (Powell et al., 2007): cereal, sweets, snacks, beverages,
other food products, fast-food restaurants and full-service restaurants. Several subcategories of beverages were examined including
sugar-sweetened versus non-sugar-sweetened beverages and regular versus diet soda. The sugar-sweetened beverage (SSB) category was defined as including soda, fruit drinks, bottled water
with added sugar, isotonic drinks (sports drinks), and other sugarsweetened drinks. This beverage sub-category was created using a
combination of PIB product classification codes and brand-specific
nutrition information in order to correctly identify relevant
products (Powell et al., 2011).
2.3. Demographic and socioeconomic information
We examined the association of racial/ethnic composition
using four race/ethnicity categories: non-Hispanic white (white–
reference category), non-Hispanic black (black), Hispanic, and
non-Hispanic non-white/black (other race) (consisting mostly of
non-Hispanic American Indians and Asians). The information on
the percentage of children ages 2–11 and adolescents ages 12–17
in each of the four race/ethnicity categories was calculated using
estimated population counts by age, year and county obtained
from the 1990–2011 Bridged-Race Population Estimates produced
by the U.S. Census Bureau in collaboration with the National
Center for Health Statistics (United States Department of Health
and Human Services, Centers for Disease Control and Prevention,
National Center for Health Statistics, 2013). The total population
for each DMA was added up for each age category (for ages 2–11
and 12–17) within each racial/ethnic group. The racial/ethnicity
distribution of children or adolescents in each DMA was then
calculated by dividing the respective racial/ethnic estimated
population total for all available counties in each DMA by the total
population for the two age categories in that DMA. Information on
median household income and population was obtained by county
and year from the Small Area Income and Poverty Estimates by the
U.S. Census (U.S.Census Bureau, 2013).
Because the Nielsen ratings data were measured at the DMA
level, the demographic and socioeconomic information was
summed for all counties within each DMA for which public
information was available. Of the original 88 FDM DMAs in our
sample, we were unable to obtain demographic information for
one of the DMAs (Bakersfield) whose only county was split with
another DMA. Additionally, small rural counties without public
information on population or median household income were
excluded. We also excluded 21 counties that were split across
DMA borders. The resulting reduction in the representative
126
L.M. Powell et al. / Health & Place 29 (2014) 124–131
population sample size in the DMAs was relatively small. The 87
FDM DMAs examined in this study represented 80% of U.S.
population.
2.4. Analysis
Multivariate analyses were undertaken to assess DMA-level
differences in children’s and adolescents’ exposure to local spot
food and beverage product television advertising based on the
racial/ethnic and socioeconomic makeup of the DMA. An empirical
model of children’s and adolescents’ exposure to local spot food
and beverage product television adverting of the following form
was estimated:
EXP mt ¼ β0 þ β1 BLK mt þ β2 HISmt þ β3 OTH mt þ β4 HHINC mt þ μm þ γ t þ εmt
ð1Þ
where the outcome measure, EXPmt , indicates the number of
local food and beverage product ads seen per week in DMA m at
time t for total food and beverages, and by the product and
beverage sub-product categories defined above. BLKmt, HISmt, and
OTHmt represent the proportion of children/adolescents in the
DMA that are black, Hispanic and of other race, respectively.
Whites were the omitted race/ethnicity category. HHINCmt measures the median household income in DMA m at time t. β are
conformable vectors of parameters to be estimated. μm is a vector
of DMA fixed effects included to account for unobserved DMA
media market-level heterogeneity and γt is a vector of year fixed
effects to account for time trends. εist is a standard residual term.
For selected parameter estimates, we tested whether estimated
exposure was significantly higher for unhealthy product categories
compared to healthier counterpart categories (i.e. whether the
estimated association with a higher proportion of black children/
adolescents or lower median household income in DMAs was
significantly higher for fast-food restaurant versus full-service
restaurants, SSBs versus non-SSBs, or regular soda versus diet
soda). Robust standard errors were computed and adjusted for
clustering at the DMA level. STATA v 12.1 was used for all analyses.
In addition to reporting coefficient estimates from our regression
estimates, we also reported elasticity measures which express the
findings in a common metric in terms of the percentage change in
advertising exposure that would result from one percent change in
a given independent variable.
We undertook sensitivity analyses in our empirical estimation
by including the 41 additional DMAs available only as ADMs
(which increased the coverage to approximately 90% from 80% of
the U.S. population in 2004 when using FDM). Using the ADM
sample did not significantly alter our findings. Consistent with the
literature we, therefore, report only results using the FDMs which
track all commercials.
3. Results
Table 1 shows that black and Hispanic children and adolescents
together comprised slightly more than one-third of the populations in
these age groups; median household income was approximately
$50,000 in the media markets studied. Children and adolescents in
these media markets saw, on average, 21.1 and 32.9 food and beverage
television local spot advertisements per week that aired in the DMAs
in 2003–2007. These local spot ads represented 22.7% and 33.6% of
total (local spot plus national) television food and beverage ads seen
by children aged 2–11 and 12–17 in those 87 DMAs. Adolescents saw
more ads than children did in every product category, particularly for
fast-food restaurant ads.
Of the seven main food-related categories, fast-food restaurant
ads were the most prevalent local spot ads seen both in absolute
and relative terms of total exposure by product type (7.0 ads per
week for children aged 2–11 years and 12.1 per week for
adolescents aged 12–17 years, representing 37.6% and 44.3% of
total fast-food ads seen by children and adolescents in those
markets). Children and adolescents saw 2.8 and 4.5 local spot
beverage ads per week, of which the majority, 2.0 and 3.2 ads per
week, respectively, were for SSBs. Exposure to local spot ads for
cereal was 1.9 and 2.1 ads per week among children and adolescents, respectively, which was relatively low compared to cereal
ads seen that were aired nationally (exposure from local spot ads
made up 10.7% and 22.0% of total cereal ad exposure for the
respective age groups).
The results from the multivariate regression analyses (based
on Eq. (1)) are presented in Table 2. On average, children’s and
adolescents’ exposure to local spot food and beverage ads was
significantly higher in DMAs that had higher percentages of black
children and adolescents and significantly lower in DMAs with
higher median household incomes. Each percentage point increase
in the proportion of child/adolescent black population was associated with 2.2 and 2.9 additional food and beverage ads seen, on
average, per week by children and adolescents, respectively. In
elasticity terms, a 10% increase in the proportion of the child and
adolescent population that was black was associated with 16.4% and
14.2% higher respective exposure to food-related advertising. For
each $1000 increase in DMA-level median household income,
children and adolescents saw, on average, 0.7 and 1.2 fewer local
spot food-related advertisements per week. That is, a 10% increase
in local area median household income was associated with 17.4%
and 18.3% fewer ads seen by children and adolescents, respectively.
By food-related categories, the results show that DMAs with
higher proportions of black population were associated with greater
exposure to ads in all food categories except full-service restaurant
ads seen by children. Larger than average associations between the
prevalence of child/adolescent black population in the DMA were
found for sweets, beverage, snack and fast-food restaurant product
categories for children (respective elasticities of 2.2, 1.8, 1.8 and
1.7 compared to 1.6 for all food-related products) and beverages and
sweets for adolescents (respective elasticities of 1.9 and 1.8 compared
to 1.4 for all food-related products). Higher DMA-level median
household income was particularly associated with lower exposure
to ads for cereal, snacks, sweets and beverages for both children
(respective elasticities of 4.4, 3.4, 2.3, and 1.9) and adolescents (respective elasticities of 3.5, 3.0, 2.6, and 2.4). There
was no association between children’s or adolescents’ exposure to
local spot food and beverage television advertisements and the
percentage child/adolescent population that was Hispanic for any of
the non-restaurant food or beverage categories.
Across restaurant types, the association between the proportion of the child/adolescent black population and advertisement
exposure for children was significant for fast-food restaurants
(elasticity of 1.7) but not for full-service restaurant ads, and among
adolescents the association was larger for fast-food restaurant ads
compared to full-service restaurants ads (elasticity of 1.4 versus
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