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Food Marketing to Children and Youth: Threat or Opportunity? 6 Public Policy Issues in Food and Beverage Marketing to Children and Youth* INTRODUCTION Public policies at the federal, state, and local levels are central to the promotion, protection, and enhancement of the diets and health of U.S. children and youth. Public policy and activities that shape dietary guidance, nutrition education, food labeling, regulation of food marketing, food services, and food production and distribution, are all important determinants of the nutritional environments of children and youth. This chapter begins with an overview of education and information-related policies, including dietary guidelines, nutrition education programs and campaigns, and food labeling to guide healthful choices for children, youth, and their families. It then reviews several of the policies related to the role of schools in children’s diets, and follows with the description of the experience to date with social marketing campaigns to improve health-related behaviors. The chapter devotes substantial attention to legal considerations in regulation of advertising and marketing, including the constitutional protection of commercial free speech in the United States. The chapter also examines other potential legislative actions that may create industry incentives or support agricultural subsidies to produce and market more healthful foods, as well as taxation to reduce the demand for less healthful foods. The chapter con- * Endnotes for Chapter 6 can be found on page 478–480 in Appendix G.
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Food Marketing to Children and Youth: Threat or Opportunity? cludes with a review of the international policy environment for policies relevant to food and beverage marketing to children and youth. EDUCATION AND INFORMATION PROGRAMS AND POLICIES Numerous education and information programs and policies are sponsored by government at every level and in many venues. At the federal level, these efforts are anchored in the principles set out in the Dietary Guidelines for Americans, previously introduced in Chapter 2. This section describes several nutrition education and promotion efforts offered through the U.S. Department of Agriculture (USDA), Department of Education, and the Department of Health and Human Services (DHHS). It also describes federal nutrition labeling policies designed to facilitate healthful food choices at the point of purchase. Dietary Guidelines for Americans and MyPyramid The policy touchstones for federal education and information programs on nutrition are the Dietary Guidelines for Americans and its graphic representation, MyPyramid. Jointly developed by the DHHS and USDA, the Guidelines were designed to move federal nutrition policy to a more explicit focus on chronic disease prevention. They are now legislatively mandated, revised every 5 years, and draw from the recommendations of a nonfederal Dietary Guidelines Advisory Committee, constituted to review the most current scientific evidence and medical knowledge. The sixth edition of the Dietary Guidelines for Americans was released in 2005 and provide specific recommendations for physical activity, consumption of food groups, fats, carbohydrates, sodium and potassium, alcoholic beverages, and food safety (DHHS and USDA, 2005). Described in Chapter 2, the Dietary Guidelines provide the basis for the educational components of all 15 federal nutrition programs administered by the USDA. The USDA introduced the Food Guide Pyramid in 1992, in cooperation with the DHHS, as a graphic representation of selected Dietary Guidelines to help consumers better understand and select a balanced diet that promoted health and prevented chronic diseases. In 2005, the USDA took an additional step to personalize the guidance through an interactive food guidance system, MyPyramid, released to replace the existing Food Guide Pyramid (USDA, 2005f). MyPyramid offers recommendations tailored to the age and needs of the individual. This initiative includes an online educational tool to obtain information on an individual’s diet quality, related nutrition messages, and links to nutrition information (USDA, 2005f). A child-friendly version of MyPyramid was released to reach children ages 6–11 years with targeted messages about the importance of healthful eating
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Food Marketing to Children and Youth: Threat or Opportunity? and physical activity, and an interactive computer game to apply these messages (USDA, 2005e; Chapter 2). MyPyramid is described in more detail in Chapter 2. Federal Nutrition Education and Promotion Programs A number of federal programs include important efforts to educate consumers of various ages about improving nutritional practices. Many target children, youth, or their care providers about the importance of a nutritionally balanced diet and regular physical activity. They can be found in agencies ranging from the DHHS and USDA, to the Departments of Education, Defense, and Interior. Some examples are described here. The federal government’s largest nutrition education work is sponsored by the USDA, which embeds education throughout its various food programs, and overall, devoted approximately $715 million to nutrition education and promotion in FY2005 (personal communication, Sid Clemens, Office of Budget and Program Analysis, USDA, November 1, 2005). The USDA Center for Nutrition Policy and Promotion is the focal point for leadership within the USDA on nutrition policy and dietary guidance in programs throughout the agency. The USDA administers 15 nutrition assistance programs that totaled $46 billion in 2004, including the Food Stamp Program (FSP), the Special Supplemental Program for Women, Infants, and Children (WIC), and the Child Nutrition Programs (USDA, 2005i). All have nutrition education components. For example, the WIC program, serving 8 million participants, provides both individualized and group nutrition education. Many state WIC agencies include nutrition education classes, fact sheets, newsletters, individual counseling guides, and lesson plans for schools (IOM, 2005c). The FSP also offers a nutrition education component through selected states, although it operates on a smaller scale and reaches fewer low-income audiences than the WIC program. The activities of the Food Stamp Nutrition Education Program vary by state and provide practical nutrition information to low-income families and children. Some of these programs are developed and implemented in cooperative relationships between local FSP and state land-grant universities or nonprofit organizations (USDA, 2005d). The USDA Expanded Food and Nutrition Education Program (EFNEP) works collaboratively with county services and other local agencies to reach low-income families, children, and youth (Cooperative State Research, Education, and Extension Service, 2005). Additionally, the USDA Food and Nutrition Service has developed the Eat Smart, Play Hard™ Campaign that provides practical suggestions based on the Dietary Guidelines for Americans to motivate children and their care providers to eat healthful foods and be physically active every day (USDA, 2005a).
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Food Marketing to Children and Youth: Threat or Opportunity? There are several federal partnerships that promote nutrition and healthful diets. In 2004, the USDA Food and Nutrition Service partnered with the Department of Education to launch the HealthierUS School Challenge that encourages schools and parents to promote healthful lifestyles for children. The school challenge is an extension of the DHHS-coordinated Steps to a HealthierUS initiative, and is designed to build upon and expand the USDA Team Nutrition program that provides schools with nutrition education materials for children and families; technical assistance for school food service directors, managers, and staff; and materials to build community-based support for healthful eating and physical activity. The initiative also enhances the USDA’s effort to improve the nutritional quality of school food service through the School Meals Initiative that establishes nutritional requirements for federally reimbursed school meals (USDA, 2004a). The national Steps to a HealthierUS initiative focuses on lowering the incidence of obesity and type 2 diabetes in disproportionately affected at-risk populations, especially African Americans, Hispanics/Latinos, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders (DHHS, 2005e). As a component of this initiative, the DHHS partnered with the Ad Council to create Small Step (DHHS, 2005c) and Small Step Kids! (DHHS, 2005d), which target parents, teens, and children and include public service announcements (PSAs), a public relations campaign, a health care provider’s toolkit, and consumer materials. The child-targeted component includes games and activities, television advertisements, and links to other materials. The DHHS Centers for Disease Control and Prevention (CDC), through its Division of Nutrition and Physical Activity (DNPA), currently sponsors the national 5 a Day for Better Health program (previously administered by the National Cancer Institute [NCI]) (DHHS, NIH, NCI, 2005), which encourages consumers to eat a variety of fruits and vegetables every day (CDC, 2005a). The DNPA also sponsors the national Powerful Bones, Powerful Girls™ Campaign to promote awareness of bone health (CDC, 2005e), and the national Youth Media Campaign, VERB™, a social marketing effort to encourage tweens, ages 9–13 years, to be physically active every day (CDC, 2005g). In 2005, CDC created a National Center for Health Marketing to provide national leadership in health marketing science and its application for public health improvement (CDC, 2005b). Also in the DHHS, the National Institute of Child Health and Human Development (NICHD) sponsors the Milk Matters Calcium Education Campaign targeted to tweens and teens ages 11–15 years to promote the daily consumption of low-fat or fat-free milk along with calcium-rich foods (NIH, 2005a). Other institutes of the National Institutes of Health (NIH) also partner with national organizations and local communities in the national education initiative, We Can! (Ways to Enhance Children’s Activity
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Food Marketing to Children and Youth: Threat or Opportunity? & Nutrition), which is a collaboration among four institutes: the National Heart, Lung, Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the NICHD; and the NCI. We Can! is designed to prevent obesity in children and tweens, ages 8–13 years, by providing resources and community-based programs to parents, caregivers, children, and youth that encourage healthful dietary choices, increasing physical activity, and reducing sedentary behaviors (NIH, 2005b). Other nutrition-related education programs at the DHHS include work of the Surgeon General and of the Head Start program. The Surgeon General has launched an initiative called, Children and Healthy Choices—50 Schools in 50 States, taking him to at least one school in each of the 50 states, the District of Columbia, and Puerto Rico to discuss the benefits of healthy choices with school-aged students, including the importance of a nutritious diet and regular physical activity (DHHS, 2005b). In addition, through the Administration for Children and Families, the Head Start program grantees deliver a range of services related to comprehensive nutrition and nutrition education that foster healthy development and school readiness in low-income preschool children, ages 3–5 years, across the nation (DHHS, 2005a). Nutrition Labeling An important means of conveying nutrition information—and of educating about nutrition—is the food label itself. Both the USDA and DHHS have responsibilities for food labeling, but most of the food supply is overseen by the DHHS’s Food and Drug Administration (FDA). Information on the food label is intended to enable consumers to compare products and make informed choices about foods and beverages that best meet their nutritional needs. Standards for the implementation of the labeling guidelines were established by the Nutrition Labeling and Education Act of 1990 (NLEA) (P.L. 101–535, 1990), which mandated that labeling information should be communicated so that consumers could readily observe and comprehend such information and understand its relative significance in the context of a total daily diet (FDA, 1993). The NLEA requires nutritional information to be displayed on nearly all packaged foods as to serving size, the number of servings per container, the total number of calories derived from any source and derived from fat, and the amount of total fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, dietary fiber, total protein, vitamins A, C, E, and iron per serving (21 U.S.C. 343(q)(1)(A)-(E), 2004). Full serve and quick serve restaurants are currently exempt from the general nutritional labeling standards and requirements of the NLEA (FDA, 1993; 21 U.S.C 343 (q)(5)(A)(i), 2004). However, they are required to meet
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Food Marketing to Children and Youth: Threat or Opportunity? some nutritional labeling requirements if they identify an item on their menu as “healthy” (Food Labeling Rule, 21 C.F.R. § 101.65, 2004). The Nutrition Facts panel was developed to provide a set of consistently formatted information items that are displayed on food product labels to help consumers better understand how various foods could be integrated into a healthful diet (IOM, 2005a). Additionally, the NLEA mandates the FDA to enforce food manufacturers’ compliance with established guidelines for nutrient and health claims on a product package indicating that a relationship exists between a food and a protection from a disease or health-related condition (IOM, 2003). The FDA’s Calories Count campaign is an example of an initiative to encourage better industry use of the food label for nutrition education to consumers. In addition to the Calories Count campaign, the FDA is proposing to target the prominence of calories on the product label, address the issue of serving size for products that can be reasonably consumed at one time, update the reference amounts to reflect those that are customarily consumed, and examine approaches for recommending smaller portion sizes. These changes derive from extensive stakeholder consultation and consumer research that are intended to help consumers to purchase foods that may be integrated into a healthful diet and to highlight the importance of total calorie intake as a prime factor of concern (FDA, 2005c). Research conducted by the FDA and the Food Marketing Institute has shown that about half of U.S. adult consumers use food labels when purchasing a food item for the first time (FMI, 1993, 2001), in particular to assess whether a product is high or low in a nutrient, especially fat, and to determine total calories (IOM, 2003). On the other hand, there is little evidence that the information on food labels, at least as currently structured, has a significant impact overall on eating or food purchasing behaviors (Wansink and Huckabee, 2005; Chapter 3). There are ample prospects for enhancing the utility of the label information as a guide to healthier food choices, including choices made by and for children and youth. In its report on preventing childhood obesity, the Institute of Medicine (IOM) recommended that the FDA and other groups conduct consumer research on the use of the nutrition label, on restaurant menu labeling, and on how to revise the Nutrition Facts panel to better design and display the total calorie content for products such as vending machine items, single-serve snack foods, and ready-to-eat (RTE) foods that are typically consumed at one eating occasion (FDA, 2005a,b; IOM, 2005a). The importance of integrating and improving strategies for using the food label as an educational tool is underscored by the recent food company initiatives described in Chapter 4 to use proprietary logos or icons that communicate the nutritional qualities of their branded products. While representing an important step to draw attention to more nutritious prod-
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Food Marketing to Children and Youth: Threat or Opportunity? ucts, the array of categories, icons, and other graphics, as well as the different standards employed by these companies may introduce some confusion, particularly for young consumers, thereby raising the need for developing and regulating standard and consistent approaches. The FDA has not yet fully explored its potential role for providing leadership and expertise to food companies in order to develop and enforce an industrywide rating system and graphic representation on food labels that is appealing to children and youth to convey the nutritional quality of foods and beverages. Finding: A number of positive steps have been taken by the Food and Drug Administration to improve food and beverage labeling as a means of conveying helpful information to enable healthier choices, including exploration of ways to expand the provision of such information on menus and packaging in quick serve and full serve family restaurants. Still, the reach and effectiveness of such efforts—by FDA, industry, and the two together—are far short of what they could or should be to provide children, youth, and their parents with the information they need, using consistent standards and graphics that are easily understood and engaging. NUTRITION IN SCHOOLS Schools present an important means of reaching the nation’s children and youth with programs and approaches for healthier diets. School-based interventions seek to provide the more than 50 million elementary and secondary students in the United States with nutrition education, healthy food services, food environments that support healthy choices, and family involvement for healthier lives. The CDC’s Division of Adolescent and School Health collaborates with the Department of Education, the USDA, and other federal and state agencies to provide leadership on school health and environments, including nutrition education (with the CDC DNPA) and the nutrition environment of schools. Nutrition Education in Schools A beginning point for addressing nutrition in schools is the way it is engaged in the curriculum. A comprehensive survey conducted by the Department of Education among 1,000 school principals in a nationally representative sample of U.S. public elementary, secondary, and high schools showed that nearly all public schools provide nutrition education in the curriculum, primarily concentrated in the health curriculum (84 percent), science classes (72 percent), and school health programs (68 percent) (NCES, 1996). The topics covered in more than 90 percent of all schools surveyed included the relationship between diet and health, identi-
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Food Marketing to Children and Youth: Threat or Opportunity? fying and selecting healthful foods, nutrients and their food sources, the Dietary Guidelines for Americans, and the Food Guide Pyramid. The survey found that 97 percent of schools reported receiving nutrition materials for lesson plans from at least one source outside of the school, most often from a professional or trade association (87 percent) and the food industry (86 percent). Of the materials from sources outside the school, schools reported the highest classroom usage for those received from the food industry or commodity groups, professional or trade associations, the USDA, and state education agencies. The survey also found that the school curriculum focused primarily on increasing students’ knowledge about nutrition, with less emphasis on influencing students’ motivation, attitudes, and eating behaviors (NCES, 1996). Although this survey showed that school-based nutrition education has been an active area, the quality of the nutritional messages received by students had not been evaluated (NCES, 1996). One evaluation found that behavior change in students is more likely if a comprehensive approach to nutrition education provides messages by multiple persons through a variety of communication channels, including the classroom, school cafeteria, home, and community (USDA, 2004b). Building on this insight, the Child Nutrition and WIC Reauthorization Act of 2004 (P.L. 108–265), requires school districts participating in the National School Lunch Program (NSLP) or School Breakfast Program (SBP) to establish a local school wellness policy by 2006 (USDA, 2004c,d). USDA’s Team Nutrition has developed implementation guidance that emphasizes overall goals designed to promote student wellness for nutrition education, physical activity, and other school-based activities; nutrition guidelines for all foods available on every school campus during the school day; guidelines for reimbursable school meals that are no less restrictive than regulations and guidance issued by the USDA Secretary under the Child Nutrition Act; designation of a responsible person to ensure that school meals meet the local school wellness policy criteria; and broadly involving key stakeholders in the development of the school wellness policy (USDA, 2004c). Media Literacy in Schools Education in media literacy is another type of school-based educational initiative with potential to help improve the diets of children and youth. Media literacy refers to the ability of children and youth to develop an informed and critical understanding of the nature, technique, and impact of what they see, hear, and read in print, broadcast, and electronic media including books, newspapers, magazines, television, radio, movies, music, advertising, video games, the Internet, and emerging technologies. The goals of media literacy education are to (1) assist students to be critical media
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Food Marketing to Children and Youth: Threat or Opportunity? consumers, (2) enhance their media experiences, (3) reduce the potential adverse effects of media, and (4) promote potential benefits of media use (Brown, 2001; Buckingham, 2005; KFF, 2003). One of the challenges to developing a program of media literacy education lies in its timing across the kindergarten through 12 spectrum, as a result of the fact that most children ages 8 years and younger do not effectively comprehend the persuasive intent of marketing messages, and most children ages 4 years and younger cannot consistently discern between television advertising and informational content—hence training in the use of those powers of discernment requires that students have reached a certain developmental stage (Chapter 5). The first large-scale experimental study measuring the acquisition of media literacy skills in the United States found that incorporating an analysis of media messages into the school curriculum could enhance the development of media literacy skills (Hobbs and Frost, 2003; KFF, 2003). On the other hand, since no national media literacy campaign has yet been implemented through a school-wide curriculum in the United States, systematic evaluations are not currently available to assess the effectiveness of a broad program of media literacy education, including whether media literacy skills learned in the classroom might transfer to media exposure outside the school setting. Additionally, there is a need to incorporate skills that move beyond the critical evaluation of television programming into emerging forms of media such as the Internet and mobile marketing; viral marketing; product placement across print, broadcast, electronic media and music; and marketing venues such as schools (Chapter 4). School Food Services Ensuring that school food services, including what is offered in school cafeterias, reflect sound nutrition principles, is key. These services are designed and implemented at the school district level, but many fall within the purview of the federal Child Nutrition Programs. The Child Nutrition Programs, which include the NSLP, SBP, Child and Adult Care Food Program (CACFP), and the Summer Food Programs, target low-income children enrolled in public and nonprofit private schools, child-care institutions, and summer recreation programs (Chapter 3). The NSLP is intended to provide nutritionally balanced, reduced-cost or free meals to nearly 29 million children enrolled in public and nonprivate schools every school day (USDA, 2005b). Nearly half (49 percent) of the school lunches served through the NSLP are provided free to students and another 10 percent are provided at a reduced price (USDA, 2005i). The program also provides reimbursements for snacks given to children in after-school educational and enrichment programs.
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Food Marketing to Children and Youth: Threat or Opportunity? Participating school districts, independent schools, and institutions receive cash subsidies and donated commodities from the USDA in exchange for serving reduced-cost or free lunches to eligible children that adhere to the guidelines of the NSLP (7 C.F.R. § 210.10, 2005): no more than 30 percent of calories from fat, no more than 10 percent from saturated fat. Federal regulations also require that school lunches provide one-third of the Recommended Daily Allowance (RDA) for protein, calcium, iron, vitamin A, vitamin C, and calories. While the lunches at participating schools must satisfy these federal requirements, local school authorities have discretion to choose what specific foods are served and how they are prepared (USDA, 2005b). A U.S. General Accountability Office report found that dietary fat accounted for 34 percent of calories in the lunches served in the NSLP during the 1998–1999 school year. Although this represents a 4 percent decline from 1991–1992, it still exceeds the USDA-mandated 30 percent (GAO, 2003). The SBP has similar nutritional requirements as the NSLP. In addition to the limits on calories that must be obtained from fat, the SBP must provide children with one-fourth of the RDA for protein, calcium, iron, vitamin A, vitamin C, and calories (USDA, 2005c). The CACFP is a federal nutrition program providing meals and snacks to low-income children in child-care centers, Head Start programs, family child-care homes, and after-school programs. Child- and adult-care providers who participate in CACFP are reimbursed at fixed rates for each meal and snack served. The USDA has established minimum requirements for the meals and snacks offered by participating child-care providers, but they are not required to meet specific nutrient-based standards such as those required for the NSLP and SBP (USDA, 2002a; Chapter 3). USDA has also developed the Child Nutrition Labeling Program (CNLP) which is a voluntary technical assistance program designed to assist schools and institutions participating in the NSLP, SBP, and the CACFP by determining the contribution a commercial product makes toward the meal pattern requirements (USDA, 2005g). The CNLP requires an evaluation of product formulation of those products sold and used in these programs, and in order to carry the Child Nutrition label, it must be produced under federal inspection by the USDA (USDA, 2005g,h). Promoting Fruits and Vegetables in Schools Increasing the availability of fruits and vegetables to children in schools has been a priority and an important means of improving the quality of foods served in the federal nutrition assistance programs. Several pilot programs have been developed at the school, district, state, and federal level to explore strategies to increase fruit and vegetable consumption among students in schools. The 2002 Farm Bill provided $6 million for the Fruit
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Food Marketing to Children and Youth: Threat or Opportunity? and Vegetable Pilot Program to distribute fresh and dried fruits and fresh vegetables to elementary and secondary school children in four states and one Indian reservation (Branaman, 2003; ERS, 2002). One hundred schools in four states (e.g., Indiana, Iowa, Michigan, and Ohio) and seven schools in New Mexico’s Zuni Indian Tribal Organization participated in the pilot during the 2002–2003 school year (Buzby et al., 2003). The participating schools could choose when and how to distribute the fresh produce to students, but the program requested that the fruits and vegetables be made available to students outside the regular school meal periods. Quantitative outcome data were not collected, but a qualitative process evaluation suggested satisfaction in many schools and food service staff (Buzby et al., 2003). The recent Child Nutrition and WIC Reauthorization Act expanded the program to four more states and two additional Indian reservations (Committee on Education and the Workforce, 2004; Chapter 3). The Department of Defense’s Fresh Produce Program has been working with schools in several states to provide fresh fruits and vegetables for the school meal programs. Schools have also begun to incorporate produce from school gardens (Morris and Zidenberg-Cherr, 2002), school salad bars (USDA, 2002b), and farmers’ markets (Azuma and Fisher, 2001) into the school meals programs in an effort to increase student participation and specifically to increase their fruit and vegetable consumption. Evaluations of these programs are essential to assess the effects of these changes on students’ dietary behaviors. Competitive Foods in Schools School food services, and special fruit and vegetable programs are not the only food and beverage products available to students. Recent attention has been drawn to other sources of “competitive” foods that are often high calorie and low nutrient and viewed as potentially displacing more healthful foods. Competitive foods include items sold through snack shops, student stores, vending machines, a la carte lines, and school fundraisers. The sale of competitive foods in schools is often used to support academic or other types of programs. Public schools that are under financial pressure are more likely to make competitive foods available to their students through exclusive “pouring rights” contracts and snack food sales (Anderson and Butcher, 2005). Competitive foods are widely available in schools and generate substantial revenues, especially for middle and high schools throughout the United States (GAO, 2005). In 2003–2004, an estimated 30 percent of high schools generating the most revenue from competitive foods raised more than $125,000 per school (GAO, 2005; Chapter 3). An analysis of a sample of schools in 27 states and 11 large urban areas found that the 80 to 90 percent of secondary schools allowed
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Food Marketing to Children and Youth: Threat or Opportunity? the type of products that are available and marketed in America’s schools and other venues. However, a variety of legislative initiatives pertaining to the availability, marketing, and sales of competitive foods and beverages in schools have been enacted or proposed at the state, district, and local levels. Social marketing applies commercial marketing concepts and techniques to promote voluntary behavior change in specific groups or target audiences based on their socio-demographic, behavioral, and psychological characteristics. Evidence for the effectiveness of social marketing programs to promote healthful behaviors is promising but mixed. A central challenge to large-scale social marketing efforts is discerning their impact. Social marketing programs that have had positive results had higher funding, been sustained, been shaped by formative research, used an integrated marketing approach, and had ongoing monitoring and evaluation. Like other dimensions of commerce, advertising and marketing is subject to regulation, including marketing that reaches children. Due to the prominence and complexity of this matter, the chapter presents a detailed analysis of the related issues, precedents, and considerations. The committee agreed that there was potential benefit from children’s advertising closely aligned with healthful diets, and if an emphasis on the advertising of healthful foods and beverages could not be accomplished voluntarily, Congress should consider and, most felt*, enact legislation mandating the shift on both broadcast and cable television. The customary deliberations of the legislative process would afford the opportunity for further assessment of the execution and implications of such a shift. Other potential policy approaches that have been suggested are reviewed, including creating industry incentives and support for agricultural subsidies to produce and market more healthful foods, as well as to reduce the demand for less healthful foods. The rising concern about obesity in children and youth globally has led to public health responses in many countries that have developed regulatory and voluntary advertising and marketing guidelines. Similarly, several international organizations, including the World Health Organization, have developed related policies. * JHB excepted, based on his belief that the level of quantitative evidence on the salutary impact of more balanced television advertising on children’s dietary patterns, in combination with a reported decline in the role of television advertising in the overall marketing of foods to children, would be insufficient for such a requirement to overcome the constitutional protection of freedom of speech.
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