Topic: Unhealthy Food & Beverage Marketing

Strategy Profile: Reducing Exposure to Unhealthy Food and Beverage Advertising

Posted on September 15, 2023

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Reducing exposure to unhealthy food and beverage advertising is a strategy to eliminate the tax deductibility of television advertising costs for nutritionally poor foods and beverages advertised to children and adolescents ages 2-19.

What population benefits?

All youth and adolescents between the ages of 2 and 19.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce exposure to unhealthy food and beverage advertising on television and, in turn, promote healthy weight.

What activities and resources are needed?

Activities Resources Who Leads?
Process tax statements and conduct audits • Time for the state tax administrator to process tax statements and conduct audits State tax administrator
Prepare tax statements and participate in audits • Time for a private company tax accountant to prepare tax statements and participate in audits Private company tax accountant

FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/chi.2021.0016.

Suggested Citation

CHOICES Strategy Profile: Reducing Exposure to Unhealthy Food and Beverage Advertising. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Strategy Profile: Home Visits to Reduce TV Time

Posted on September 15, 2023

Mom and daughter meeting with counselor at home, while daughter is looking at a handheld screen

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Home visits to reduce TV time is a program to disseminate a screen time managing device to families through a home visiting program to reduce screen time among children ages 4-7.

What population benefits?

Children ages 4-7 with BMI >75th percentile who receive home visits.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce child daily television time which can help improve dietary intake and, in turn, promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Coordinate the training rollout • Time for the director to coordinate the trainings Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program
Train community health workers who would implement the program • Time for community health workers to receive trainings
• Travel costs
• Material costs		 Home Visiting Program Coordinator
Train registered nurses about referring children to home visits to reduce screen time • Time for registered nurses to receive trainings
• Travel costs		 Home Visiting Program Coordinator
Purchase program materials • TV control device cost
• Posters cost
• Incentives for children cost		 Home Visiting Programs
Coordinate patient referrals and provide counseling during home visits • Time for registered nurses to recruit and refer patients
• Time for community health workers to implement		 Community health center registered nurses & community health workers
Strategy Modification

Some state and local health agencies added to this strategy by teaching about parental controls on other screen devices (e.g., tablets, smart phones, etc.). This could help parents limit all types of screen time for their children, not just on the television. This would require additional training and materials for families.

FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/chi.2021.0016.

Selected CHOICES research brief including cost-effectiveness metrics:

Carter S, Bovenzi M, Sabir M, Bolton AA, Reiner JR, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Home Visits to Reduce Screen Time {Issue Brief}. Boston Public Health Commission, Boston, MA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2023. Available at: https://choicesproject.org/publications/brief-home-visits-screen-time

Suggested Citation

CHOICES Strategy Profile: Home Visits to Reduce TV Time. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Brief: Home Visits to Reduce Screen Time in Boston, MA

Posted on May 31, 2022

Mom and daughter meeting with counselor at home, while daughter is looking at a handheld screen

The information in this brief is intended only to provide educational information.

A version of this brief was published in May 2022. This brief was updated in February 2023 to reflect revised projections for Boston’s population. 

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to reduce the amount of screen time viewed at home by young children in Boston, MA. Community health workers would provide counseling and resources on strategies to limit children’s screen time to children and families who participate in home visiting programs.

The Issue

In 2017, three in 10 first graders in Boston had overweight or obesity.1 Access to healthy foods, beverages, and opportunities to participate in regular physical activity are key priorities for communities in supporting children growing up at a healthy weight. However, not all families have access to the same resources.

Limiting children’s screen time is also a high priority for communities.2 Food companies use television to market unhealthy foods and drinks to children, which can increase children’s food intake and their risk for excess weight gain.3 Moreover, food companies have disproportionately marketed fast food and sugary drinks to Black and Hispanic youth4 and children from lower income households watch more screen media than their peers,5 putting them at greater risk for unfavorable health outcomes.

Helping families manage screen time can promote a healthy weight and advance health equity. Home visiting programs engage community health workers to improve health behaviors and reduce the risk of chronic diseases for families with children. Home visiting programs specifically support children who are exposed to conditions that could negatively impact their health.6

About the Home Visits to Reduce Screen Time Strategy

This strategy supports the Boston Public Health Commission’s goal of preventing obesity and chronic disease using a health equity lens while also building and maintaining partnerships with home visiting programs across Boston. Through professional development trainings opportunities, community health workers would learn ways to support families and children in limiting their screen time. During a home visit, community health workers would share the importance of appropriate screen time limits and provide strategies and tools for families to use, including a screen time management device. Integrating this strategy through existing home visiting programs could help more children manage their screen time and grow up at a healthy weight.7

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2030) of implementing the home visits to limit screen time strategy with the costs and outcomes associated with not implementing the program.

Implementing the home visits to reduce screen time strategy is an investment in the future. By the end of 2030:
If home visits to reduce screen time was implemented in Boston, then by the end of 2030: 3,320 children would be reached over 10 years, 60 cases of childhood obesity would be prevented in 2030, each child would view 1.8 fewer hours of screen time each day, and $44,600 in health care costs would be saved over 10 years.

Conclusions and Implications

Incorporating counseling and providing resources to limit screen time through existing home visiting programs could reach 3,320 children ages 4-7. Over 10 years, we project that children whose families participated in the program would watch nearly two fewer hours of screen time per day, on average. This strategy could also prevent 60 cases of childhood obesity in 2030, saving $44,600 in health care costs related to excess weight over 10 years. It would cost $540 per child.

Community health workers play an important role in building healthier communities and promoting health equity. By training and equipping 119 community health workers annually by ensuring that everyone has access to what they need to grow up healthy and strong, this strategy could help reach those families and children that may be at higher risk of having or developing obesity. Children in households with low income could see greater health benefits from this strategy.7

In addition to promoting healthy weight, this strategy may also benefit children in other ways. Too much screen time can negatively impact children’s sleep and social wellbeing.8 Providing children and their families with strategies to move away from their screens allows for more time for developmentally appropriate activities like reading and active play. Strategies families can use to limit online video viewing and mobile device use may be particularly important as screen time from these sources has increased dramatically in recent years.5

Working with community health workers in Boston’s existing home visiting programs will help families build a foundation for overall health and wellbeing. These preventive strategies play a critical role in helping children establish healthy habits early on in life. 

References

  1. School Health Services, Dept of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. School Health Services, Dept of Public Health; 2020. Accessed Feb 22, 2022. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017

  2. Healthy People 2030: Building a healthier future for all. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. Accessed Feb 4, 2022. https://health.gov/healthypeople

  3. Russell SJ, Croker H, Viner RM. The effect of screen advertising on children’s dietary intake: A systematic review and meta-analysis. Obes Rev. 2019;20(4):554-568. doi:10.1111/obr.12812

  4. UConn Rudd Center for Food Policy & Obesity. Fast Food Advertising: Billions in spending, continued high exposure by youth. 2021. Fast Food Fact, UConn Rudd Center for Food Policy & Obesity. https://www.fastfoodmarketing.org/media/FACTS%20Summary%20FINAL%206.15.pdf   

  5. Rideout V, Robb MB. The Common Sense Census: Media Use by Kids Age Zero to Eight. 2020. Common Sense Census. https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-kids-age-zero-to-eight-2020 

  6. Duffee JH, Mendelsohn AL, Kuo AA, Legano LA, Earls MF. Early Childhood Home Visiting. Pediatrics. Sep 2017;140(3). doi:10.1542/peds.2017-2150 

  7. Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. Mar 2008;162(3):239-45. doi:10.1001/archpediatrics.2007.45 

  8. Tremblay MS, LeBlanc AG, Kho ME, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. Sep 21 2011;8:98. doi:10.1186/1479-5868-8-98

Suggested Citation:

Carter S, Bovenzi M, Sabir M, Bolton AA, Reiner JR, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Home Visits to Reduce Screen Time {Issue Brief}. Boston Public Health Commission, Boston, MA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2023. For more information, please visit www.choicesproject.org

A version of this brief was published in May 2022. This brief was updated in February 2023 to reflect revised projections for Boston’s population. 

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

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Brief: Reducing Screen Time in Early Child Care Settings in Boston, MA

Posted on September 20, 2021

Teacher playing with kids

The information in this brief is intended only to provide educational information.

Versions of this brief were published in September 2021 and January 2023. The January 2023 update was to reflect revised projections for Boston’s population. This brief was updated again in October 2023 to more accurately represent the model period.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to reduce screen time in early child care settings in Boston. This strategy provides voluntary training to early child care educators and resources to families to limit noneducational television time at child care and home.

The Issue

Every child should have opportunities to grow up at a healthy weight. Too much screen time in early childhood is linked to overweight and obesity, as it reduces opportunities for children to be active and advertisement exposure can lead children to eat and drink more unhealthy foods.1 The American Academy of Pediatrics recommends limiting screen time to one hour of quality programming per day in child care and at home for children over 2 years old.2 Less than half of children ages 2-5 met this guideline.3

Limiting screen time at child care and home would support children’s healthy growth. In 2017, about three in 10 first graders in Boston had overweight or obesity.4 Reducing young children’s screen time will ensure more children grow up at a healthy weight and enter school ready to learn.

About the Strategy to Reduce Screen Time in Early Child Care Settings

This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators, offering ongoing support and technical assistance, and providing parents with educational materials that may lead to reducing screen time in young children.5,6 Helping educators to implement practices shown to be effective in reducing television time can help the children in Boston’s early education and care settings engage in fewer minutes of screen time.

NOTE: The data that informed these estimates were collected after the program closures prompted by the COVID-19 pandemic. As programs reopen and demand continues to increase, this strategy could reach more children.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of implementing a strategy to reduce screen time in Boston early child care settings with the costs and outcomes associated with not implementing the strategy over 10 years (2020-2029).

Implementing a strategy to reduce screen time in early child care settings is an investment in the future. By the end of 2029:

18,200 children would be reached over 10 years; 125 cases of childhood obesity would be prevented in 2029; this strategy would cost $16 per child to implement; children reached by this strategy would experience 33 fewer minutes of screen time per child per day

Conclusions and Implications

If the strategy were implemented, we estimate that over 10 years, 18,200 children ages 3-5 would attend programs that support reducing screen time (based on the number of programs open during the COVID-19 pandemic). This strategy would prevent 125 cases of obesity in 2029 alone, saving $138,000 in obesity-related health care costs over 10 years. The average annual cost to implement this strategy would be $161 per program, or $16 per child.

Expanding training opportunities for early child care educators will also help support quality care. Ensuring access to quality care is essential for families and employers.7 In the initial training series, this strategy would provide additional skills training and professional development for 1,380 educators and more opportunities to reduce screen time in 570 (100%) child care programs serving 3-5 year olds.

Besides promoting a healthy weight, viewing less screen time benefits children in other ways. Too much screen use is associated with less sleep and can negatively impact social well-being.1 We estimate that, on average, each child attending a program implementing the strategy would view 33 fewer minutes of screen time per day. This allows more time for developmentally appropriate play activities, helping to form a strong foundation for overall well-being. 

This strategy would train and provide technical assistance to early childhood educators on reducing screen time. As programs reopen post-pandemic and demand for child care continues to increase, the strategy could reach even more children. This strategy would enable early child care programs in Boston to support healthy growth because every child deserves a healthy start. 

References

  1. Li C, Cheng G, Sha T, Cheng W, Yan Y. The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review. International Journal of Environmental Research and Public Health. 2020;17(19):7324. 

  2. COUNCIL ON COMMUNICATIONS AND MEDIA. Media and Young Minds. Pediatrics. 2016;138(5):e20162591. 

  3. Healthy People 2030. Increase the proportion of children aged 2 to 5 who get no more than 1 hour of screen time a day – PA-13. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. Accessed July 20, 2021. https://health.gov/healthypeople/objectives-and-data/browse-objectives/physical-activity/increase-proportion-children-aged-2-5-years-who-get-no-more-1-hour-screen-time-day-pa-13/data 

  4. School Health Services, Dept of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. School Health Services, Dept of Public Health; 2020. Accessed July 23, 2021. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017

  5. Mendoza JA, Baranowski T, Jaramillo S, et al. Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. American Journal of Preventive Medicine. 2016;50(5):584-592. 

  6. Dennison BA, Russo TJ, Burdick PA, Jenkins PL. An intervention to reduce television viewing by preschool children. Archives of Pediatrics and Adolescent Medicine. 2004;158(2):170-176. 

  7. Campbell F, Patil P, McSwain K. Boston’s Child-Care Supply Crisis: What a Pandemic Reveals. November 2020. https://www.bostonopportunityagenda.org/-/media/boa/early-ed-census-2020-pt-1-202011.pdf

Suggested Citation:

Bovenzi M, Carter S, Sabir M, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Boston, MA: Reducing Screen Time in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023. For more information, please visit www.choicesproject.org

Versions of this brief were published in September 2021 and January 2023. The January 2023 update was to reflect revised projections for Boston’s population. This brief was updated again in October 2023 to more accurately represent the model period.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

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Three Interventions That Reduce Childhood Obesity Are Projected to Save More Than They Cost to Implement

Posted on December 1, 2015

A CHOICES paper identifying cost-effective nutrition interventions with broad population reach highlights the importance of primary prevention for policy makers aiming to reduce childhood obesity.

Gortmaker SL, Claire Wang Y, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three Interventions That Reduce Childhood Obesity Are Projected to Save More Than They Cost to Implement. Health Aff, 34, no. 11 (2015):1304-1311.

Graph of impact of interventions outlined in article

Reused with permission from Project HOPE/Health Affairs. The published article is archived and available online at www.healthaffairs.org.

The United States will not be able to treat its way out of the obesity epidemic with current clinical practice. Instead, reversing the tide of obesity will require expanded investment in primary prevention, focusing on a combination of interventions with broad population reach, proven individual effectiveness, and low cost of implementation.

This study is the first of its kind to estimate the cost effectiveness of a wide variety of nutrition interventions high on the obesity policy agenda—documenting their potential reach, comparative effectiveness, implementation cost, and cost-effectiveness. Researchers identified three interventions that would more than pay for themselves by reducing healthcare costs related to obesity: an excise tax on sugar-sweetened beverages; elimination of the tax subsidy for advertising unhealthy food to children; and nutrition standards for food and drinks sold in schools outside of school meals. Implemented nationally, these interventions would prevent 576,000, 129,100, and 345,000 cases of childhood obesity, respectively, in 2025. The projected net savings to society in obesity-related health care costs for each dollar spent would be $30.78, $32.53, and $4.56, respectively.

Additional interventions modeled include restaurant menu calorie labeling, increased access to adolescent bariatric surgery, improved early care and education, and nutrition standards for school meals. The study points out that the improvements in nutrition standards for both school meals and foods and beverages sold outside of meals through current Smart Snacks in School regulation make the Healthy, Hunger-Free Kids Act of 2010 one of the most important national obesity prevention policy achievements in recent decades.

Though researchers analyzed interventions separately, no strategy on its own would be sufficient to reverse the obesity epidemic. The study also emphasizes the importance of obesity prevention that spans across multiple settings throughout the life course. While childhood interventions are necessary to reduce obesity during the early years of life and ensure that children enter into adulthood at a healthy weight, it is critical that environments spanning the life course continue to support healthy eating and drinking behaviors.

“Policy makers looking to reverse the childhood obesity epidemic and reduce long-term obesity prevalence need to focus on implementing cost-effective preventive interventions that reach a large percentage of our nation’s children,” says lead investigator of the CHOICES Project, Dr. Steve Gortmaker, who also serves as a Professor of the Practice of Health Sociology and the Director of the Prevention Research Center on Nutrition and Physical Activity at the Harvard T.H. Chan School of Public Health.

The study notes that interventions affecting both children and adults are particularly attractive, since near-term health care cost savings can be achieved by reducing adult obesity, while laying the ground work for long-term cost savings by reducing childhood obesity. The sugar-sweetened beverage excise tax, for example, would save $14.2 billion in net costs over the course of the decade, primarily due to reductions in adult health care costs.

Interventions that can achieve near-term health cost savings among adults and reduce childhood obesity offer policy makers an opportunity to make long-term investments in children’s health while generating short-term returns.

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BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth

Posted on July 31, 2015

CHOICES research found that eliminating the tax subsidy of TV advertising costs for unhealthy food and beverages advertised to children and adolescents could be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

Sonneville KR, Long MW, Ward ZJ, Resch SC, Wang YC, Pomeranz JL, Moodie ML, Carter R, Sacks G, Swinburn BA, Gortmaker SL. BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth. Am J Prev Med. 2015 Jul;49(1):124-34. doi: 10.1016/j.amepre.2015.02.026.

Every year, children in the US are exposed to thousands of food-related TV advertisements, most of which promote nutritionally poor foods and drinks. Despite changes in media consumption, TV remains the predominant platform to reach youth, and the advertising industry knows it. Food marketers spend millions of dollars on youth-directed television each year, and these advertising expenditures are currently treated by the US government as an ordinary business expense. In 2009, for example, the food and beverage industry received a tax subsidy of nearly $80 million for the $633 million spent on TV advertising to children.

With factors such as the US Constitution’s protection of marketing as commercial speech and the government’s reluctance to regulate even minimal restrictions on advertising, eliminating or amending the tax deduction available to food companies for the costs of advertising to children has been proposed.

Children crowded around an iPad“By changing the tax treatment of advertising expenses, the food industry will have less incentive to advertise unhealthy foods and drinks to kids,” says lead author Kendrin Sonneville, ScD, RD, Director of Nutrition Training in the Division of Adolescent Medicine at Boston Children’s Hospital.

The study intervention involved the elimination of this tax subsidy, applying to television programming watched on traditional TV and to television advertising aired during children’s programming, reaching nearly 74 million youth between the ages of two to 19. By using a simulation model, the researchers estimated that the intervention would reduce an aggregate 2.13 million BMI units in the population, costing $1.16 per BMI unit reduced. Over a 10-year period, the intervention would result in $352 million in healthcare cost savings and gain 4,538 quality-adjusted life years (QALYs).

While the effects of the intervention may be small at the individual level, such a policy could have substantial impact on healthcare expenditure at the population level. Although the policy would likely be met with opposition from the food industry, eliminating the tax subsidy of advertising expenses would also generate tax revenue and is likely to receive strong public support. The study provides important information for a feasible approach to reducing children’s advertising exposure.

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