Table 1 Studies included in the review. Summary and main findings

Ueda et al., 2012 [28], India

Experimental

LOW

Children (3–13 years old).

To evaluate exposure to advertising of less healthy food and its association with eating behaviors and BMI

Brand logo recognition: 30 to 80%. Capacity for logo recognition increased with age and socio-economic status. Adjusting by these variables and gender, logo recognition was associated to higher BMI and nutritional knowledge, but not with preferences towards less healthy foods or purchase requests. No significant differences were found between genders.

Chernin, 2008 [29] USA

Experimental

LOW

Children (5–10 years old).

To examine the influence of two advertisements (breakfast cereal, juice powder) on food product preferences

Exposure to food advertising increased children’s preference for the advertised products. This influence was stronger among boys than among girls, although both genders were depicted in the advertisements.

Tarabashkina et al., 2016 [30] Australia

Experimental

MEDIUM

Children and adolescents (7–13 years old).

To assess the role of product evaluations, nutritional knowledge and awareness of persuasive intent on food choices among children and adolescents

When participants showed little nutritional knowledge and low awareness of persuasive intent behind advertising and believed the advertised product to be healthy, they were more likely to choose the advertised product. No significant differences were found by gender and age in the control and experimental groups.

Norman et al., 2018 [31] Australia

Experimental

MEDIUM

Children and adolescents (7–12 years old).

To evaluate the impact of advertising (TV and online gaming platforms) on the amount of food consumed among children and adolescents

Children exposed to food ads in TV and online gaming platforms ate more food while snacking, compared to the group exposed only to non-food ads in TV. There were no significant differences or interactions by age, gender, brand recognition, and household weekly income.

Anderson et al., 2015 [32] Canada

Experimental

LOW

Children and adolescents (9–14 years old)

To evaluate the influence of food ads in TV on the energy intake

Girls with excess weight showed a higher increase of their energy intake compared to girls with normal weight and boys, suggesting higher vulnerability to food advertising. Girls exposed to food ads were more likely to find the TV show acceptable, compared to girls that viewed non-food ads. Among boys, TV show acceptability was not influenced by the product type advertised.

Velazquez and Pasch, 2014 [33] USA

Experimental

LOW

Children and adolescents (8–15 years old).

To assess the relationship between attention to unhealthy food ads and food preferences and choices

The amount of time and frequency of exposure to unhealthy foods was significantly associated to preferences for unhealthy foods. This association was not affected by sex, age or BMI.

Keller et al.,2012 [34] USA

Study 1:

LOW

Children (4–6 years old).

To determine if the presence of a familiar brand affects test-meal intake

Energy intake increased by ~ 41 kcal in children with excess weight when presented with branded food items than when offered unbranded foods (i.e. in unmarked, plain white containers). In contrast, children with normal weight consumed ~ 45 kcal less when presented with branded foods, compared to the unbranded condition. There was no significant difference between boys and girls.

Experimental

Study 2: Experimental

LOW

Children (7–9 years old).

To determine if the presence of a familiar fast-food brand affects test-meal intake

The boys’ energy intake was similar in the presence of fast-food branded/unbranded food items. In turn, girls consumed ~ 100 kcal more when the items were accompanied by a fast-food brand.

Anschutz et al., 2009 [35] Netherlands

Experimental

LOW

Children (8–12 years old)

To evaluate the effects of TV food ads on concurrent non-advertised sweet snack food intake

Boys who viewed food ads presented higher snack intake than boys exposed to neutral (non-food) ads. In turn, snack intake was slightly lower among girls when they viewed food ads than when the viewed neutral ads.

Dixon et al., 2014 [36] Australia

Experimental

LOW

Pre-adolescent children (average: 11 years old).

To evaluate responses to promotional elements -nutrient content claims, sports celebrity endorsements

and premium offers- in food packaging

Children were more likely to choose energy-dense, nutrient-poor food products when their packs showed nutrient claims (both genders) or sports celebrities (only boys), compared to control conditions (no promotions).

Hobin et al., 2012 [37] Canada

Experimental

LOW

Children (6–12 years old)

To determine if children make healthier food choices if toy premiums are only offered with healthier fast-food meals

Children were more likely to choose healthier meals when toy premiums were only offered with meals that met nutritional criteria. This effect was stronger among boys than among girls.

Ogle et al., 2017 [38] USA

Experimental

LOW

Children (6–9 years old)

To determine if adding licensed cartoon characters to healthy food/beverages packaging can increase attention to and preference for these products

Children paid more attention to products with characters and preferred less-healthy products, although they preferred products without characters over 60% of the time. Age, sex, and the specific cartoon character were significant influences on product choice, with characters being preferred by younger boys.

Adams and Geuens, 2007 [39] Belgium

Experimental

LOW

Adolescents (15 years old)

To examine responses to healthy and unhealthy slogans in ads for food products perceived as healthy or unhealthy

Although no significant main effects were found for the healthfulness of the slogan or the product, there was a significant interaction effect. More significantly positive responses and increased purchase intent were elicited when the healthfulness of the slogan and the perceived healthfulness of the product were consistent. Adolescents that were highly concerned about health responded more positively towards healthy slogans. No significant differences were found between genders.

Harris et al., 2018 [40] USA

Experimental

LOW

Children (7–11 years old).

To evaluate the effects of health messages in child-directed advertising for unhealthy food products

Children’s perception of healthfulness of unhealthy products increased when associated to nutrition and/or physical activity messages. No significant differences were found between genders.

Gines Geraldo and Machado Pinto e Silva, 2012 [41] Brazil

Experimental

LOW

Children (6–10 years old)

To describe visual memory of the packaging of snacks and filled cookies in relation to nutritional status, school grade and gender

Both genders exhibited similar memory levels for colors depicted in the packaging of both products. Girls remembered imagery and characters depicted on the packaging better than boys. Nutritional status was not a significant influence on visual memory of pack features.

Anschutz et al., 2010 [42] Netherlands

Experimental

LOW

Children (8–12 years old)

To assess the effect of viewing adult-directed advertising (energy-dense, “light” products, and non-food products) on concurrent snack intake and possible moderating effects of maternal behaviors.

Food intake decreased significantly with age and increased with hunger and liking of the test food products. Children who received maternal encouragement to be thin ate more when exposed to food ads (vs. non-food ads), while children that did not receive such encouragement ate more when exposed to non-food ads. No significant main effect was found for ad types (energy-dense food, “light” food, non-food) or gender.

Castonguay and Bakir, 2018 [43] USA

Experimental

LOW

Children 5 to 11 years old

To analyze gender differences in nutritional understanding, intentions to engage in physical activity and responses to an advertisement for a unhealthy food product with and without imagery of children practicing sports

Compared to girls, boys that viewed an ad portraying physical activity were more likely to believe that eating the advertised food (sugar-coated cereal) would make them stronger, compared to girls and to boys who viewed an ad without such images.

Descriptive, cross-sectional. Content analysis

HIGH

N/A

To analyze the content of food ads aired during children-directed TV shows.

Most ads shown during children-directed TV shows exclusively male characters, while 18.8% of ads featured female characters exclusively, and 6.7% featured males and females. Healthy food products were associated to girls, while healthy activities were predominantly associated to boys.

Childs and Maher, 2003 [44] USA

Descriptive, cross-sectional. Content analysis

HIGH

N/A

To examine the use of gender in children-directed TV food ads.

There was overrepresentation of male voices and characters portrayed in the ads, indicating that a gender bias towards male audiences exists in food advertising to children.

Skatrud-Mickelson et al., 2012 [45] USA

Descriptive, cross-sectional. Content analysis

HIGH

N/A

To estimate exposure of children to food brand impressions in top-grossing movies.

Exposure to food brand impressions varied among boys and girls depending on age and movie MPAA ratings. Girls were more exposed to brand impressions from G/PG-rated movies, while boys were more exposed from PG-13/R-rated movies.

Harrison, 2006 [46] USA

Descriptive, cross-sectional. Content analysis

HIGH

N/A

To analyze food advertising content in children-directed TV, comparing ads portraying Black and non-Black characters.

Male characters were overrepresented in both the ads that featured Black characters and those who did not.

Olivares et al.,2011 [47] Chile

Quantitative. Descriptive, cross-sectional.

MEDIUM

Children (8–13 aos)

To explore attitudes towards food ads among school children.

65% of participants expressed a liking for trying new foods and beverages promoted in TV ads. No significant differences were found between genders.

Cornwell et al., 2014 [48] USA

Quantitative. Descriptive, cross-sectional.

MEDIUM

Children (3–6 years old)

To evaluate associations between BMI and knowledge of brands of food products high in fats, salt and sugar among children

Knowledge of packaged and fast food brands was found to be a predictive factor of BMI among children. No significant differences were found by age and gender, nor according to hours spent watching TV.

Klepp et al., 2007 [49] Austria, Iceland, Portugal, Norway, Belgium, Denmark, Spain, Netherlands, Sweden

Quantitative. Descriptive, cross-sectional.

HIGH

Children (average: 11 years old)

To investigate associations between exposure to food ads in TV and reported fruit and vegetable intake among children from nine European countries.

Most children reported higher exposure to ads for unhealthy food than for fruit and vegetables, but boys reported spending slightly more time watching TV than girls. Exposure to ads for healthy foods was positively associated with reported fruit and vegetable intake.

Baldwin et al., 2018 [50] Australia

Quantitative. Descriptive, cross-sectional.

LOW

Children and adolescents (10–16 years old)

To examine associations between internet and social media behavior and unhealthy food intake

Exposure to advertising was associated with a higher intake of the advertised products. No significant differences were found between genders.

Bhawra et al.,2018 [51] Canada

Quantitative. Descriptive, cross-sectional.

MEDIUM

Adolescents and young adults (16–30 aos)

To assess support to food policies among youth in Canada.

Young women expressed stronger support than men for nutrition symbols and warnings school policies, zoning restrictions on advertising, marketing bans and maximum salt limits.

Kumar et al., 2015 [52] USA

Quantitative. Descriptive, cross-sectional.

MEDIUM

Adolescents (12–17 years old)

To analyze exposure to ads for sugar-sweetened beverages

Between 42 and 54% of the participants reported exposure to these advertisements more than once a day. Significant differences were found by age, ethnic group and parents’ educational level, as well as gender. Boys reported more frequent exposure to sugary sport beverage ads than girls.

Adachi-Mejia et al., 2011 [53] USA

Quantitative. Descriptive, cross-sectional.

MEDIUM

Children (10–13 years old)

To explore the relationship between weight status and receptivity to food advertising among adolescents.

Having a favorite ad was the chosen indicator of receptivity. Boys who reported having a favorite ad were more likely to mention an ad for beer, while girls were more likely to mention an ad for candy/sweets as their favorite.

Buijzen et al., 2008 [54] Netherlands

Quantitative. Descriptive, cross-sectional.

LOW

Children (4–12 years old)

To analyze associations between exposure to food advertising and consumption of advertised brands, advertised energy-dense food product categories and food products in general

Exposure to food advertising was significantly associated to consumption of advertised brands and energy-dense food product categories. Intra-family consumption-related communication was found to moderate the relations between advertising and food consumption. No significant differences were found by age, gender, and time spent watching TV.

Grunseit et al., 2012 [55] Australia

Quantitative. Descriptive, cross-sectional.

LOW

N/A

To examine a) opinions regarding the role of athletes in the promotion of physical activity and obesity prevention, b) attitudes towards the promotion of unhealthy food products in sports and c) health-related behaviors among young Australian athletes.

Most participants agreed that athletes should be positive role models for active lifestyles. Women tended to agree more with the proposition than men. There were also significant differences in the percentages of women that were opposed to advertising of alcohol and unhealthy food in sports and endorsement by professional athletes, compared to men.

Olivares-Cortes et al., 2017 [56] Chile

Quantitative. Descriptive, cross-sectional.

HIGH

N/A

To explore attitudes and opinions about a new front-of-pack nutrition labeling system among school-children with diverse nutritional status and socioeconomic level

Most children reported liking to be informed about the nutritional value of food products and many expressed that they would stop buying products with nutrient warning signs. There were significant differences by nutritional status and socioeconomic level, but gender was not a significant influence.

Bezbaruah and Brunt, 2012 [57] USA

Quantitative. Descriptive, cross-sectional.

LOW

Children (9–11 years old)

To determine the influence of cartoon characters in fruit and vegetable preferences

The children reported that their fruit/vegetable preferences were determined by flavor and nutritional value. There were no significant differences between genders.

Vila-López and Kuster-Boluda, 2016 [58] Spain

Quantitative. Descriptive, cross-sectional.

HIGH

Adolescents (14–17 years old)

To explore gender differences in the association between perception of food packaging cues and health motivations and weight control

Girls were more concerned about weight control and health and paid more attention to informative cues on food packaging when motivated to control weight, compared to boys. Visual cues were not relevant for both genders.

Marquis et al., 2005 [59] Canada

Quantitative. Descriptive, cross-sectional.

LOW

Children (10 years old)

To evaluate the association between eating while watching TV and food-related behaviors

Eating while watching TV was found to be significantly associated to unhealthier food choices. Significant correlations were found between the frequency of eating while watching TV, the importance given to a food’s appearance and children’s requests for advertised foods, but only among boys.

Kaur and Vohra, 2013 [60] India

Quantitative. Descriptive, cross-sectional.

MEDIUM

Children (4–11 years old)

To analyze the effectiveness of in-store food promotion strategies targeting children.

Free gifts highlighted on packaging, assortment of foods, and placement of packaged foods in shelf locations directly accessible to children were found to be among the most effective in-store promotional strategies. Food requests were more strongly affected by these influences among boys than among girls.

Vohra and Soni, 2015 [61] India

Quantitative. Descriptive, cross-sectional.

LOW

Children (4–11 years old)

To identify the variables that predict shopping behavior in retail stores among children.

Retail shopping behavior in children is influenced by food promotions in stores, the frequency with which the child accompanies their mothers to the store, the age of the parents and maternal educational level. There was no significant difference among genders.

Busse and Díaz, 2016 [62] Peru

Quali-quantitative Descriptive, cross-sectional

HIGH

Children (7–11 years old)

To explore habits regarding TV and food behaviors among Peruvian children.

Boys and girls reported different preferences in TV shows, suggesting differences in exposure to food-related TV content. Some girls demonstrated awareness of the persuasive intent in TV ads, while others did not. In contrast, all boys were aware of the persuasive intent in advertising.

Bunting et al., 2013 [63] New Zealand

Qualitative. Descriptive, cross-sectional

MEDIUM

Adolescents and young adults (16–21, 22–28 and 29–35 years old)

To evaluate perceptions and knowledge about energy drinks

Participants expressed awareness regarding the marketing of different energy drinks as predominantly “feminine” or “masculine” and the resulting manipulation of consumer choices by the food industry.

Elliott, 2009 [64] Canada

Qualitative. Descriptive, cross-sectional

MEDIUM

Children fromgrades 1 to 6

To analyze differences in attitudes and responses of boys and girls towards “fun food” marketing techniques.

Girls were more likely to choose products based on color preferences and aesthetic appeal, while boys were more interested in the interactive features of the products.