National Academy of Science/ Institute of Medicine Committee: October 2005 – December, 2006

1. National Academy of Science/Institute of Medicine Committee:October 2005 – December, 2006

2. Trends: Children’s Obesity

3. How much per year is spent on food & beverage marketing directed to children & youth? $500 million $1 billion $5 billion $10 billion Food Marketing Quiz

4. At what age can children differentiate advertising from program content on television? 2 years 4 years 6 years 8 years At what age do children understand the persuasive intent of advertising? 4 years 6 years 8 years 10 years Food Marketing Quiz

5. Growth in New Food Products Targeted to U.S. Children and Youth 1994 to 2004 New products targeted to total market New products targeted to children & youth Source: Williams J. 2005b. Product Proliferation Analysis for New Food and Beverage Products Targeted to Children, 1994–2004. University of Texas at Austin Working Paper.

6. Tobacco Surgeon General’s Report -1964 Labels and Warnings – within weeks TV & Radio Advertising – Banned by Law in 1970 1971 FTC (Sweets and Cavities) Rules proposed to ban ads for children <8 Congress intervenes to hold back FTC CARU formed 1974 1990s Alarming rise in Obesity Policy History

7. - Congress asks CDC to study Food Marketing and Children’s Diets - CDC commissions National Academy of Science/Institute of Medicine - IOM Committee Formed - Committee Works Tirelessly (for FREE!) - Press Release - Book in Print - $2,000,000,000 lawsuit - Policy? E.g., Law, Monitoring body, etc.?? Committee Timeline 2004 Spring Summer Fall 2005 Winter Spring Summer Fall 2006 Winter Spring Summer Fall 2007 2008

8. Comprehensive evidence based review of what is known about: The causal influence of food and beverage marketing on the diets and diet-related health outcomes of children and youth Main Committee Charge

9. 15 Committee members 2 - ½ time IOM staff members 4 (2 ½ day) Meetings Subgroups: Diet Marketing Ecological Model Evidence Review Public Policy 6 months – almost weekly conference calls Committee Work

10. Systematic Evidence Review • explicit criteria for study inclusion • explicit criteria for study relevance, ratings, etc. • replicable

11. Study Inclusion • Only Peer-reviewed, published research • English • Any country • Any date • Only original research, no review articles • Only research that reports a quantitative relationship between a variable involving marketing, and a variable involving either a pre-cursor to diet, diet, or diet-related health

12. Dimensions for Study Evaluation: • Sample size, year published, population studied • Cause variable, effect variable • Research Method • Statistically significant association between cause variable and effect variable? • Strength of evidence for causation (Causal Inference Validity) • Quality of Measures • Generalizability (Ecological Validity)

13. Diet -- -Related Diet Health Outcomes Short- - TermConsumption Adiposity, Other Usual Dietary Intake Moderators Age, SES, Gender, Race/Ethnicity Causal Framework Used for the Systematic Evidence Review Marketing Mediators/Precursors Food & Beverage Product, Place, Preferences, Beliefs, Price, Promotion Purchase Requests

14. Cause Variable, Effect Variable • Cause variable, e.g.: • TV ad exposure • Product Placement in Film • Print Ad exposure • Radio Ad exposure • Effect variable, e.g.,: • Food Preferences • Food Purchase requests • Short-term consumption • Adiposity

15. Research Method • CS (cross-sectional) • Exp (randomized trial) • Exp-N (natural experiment) • L-Pnl (longitudinal study – panel) • L-Trnd (longitudinal study – trend)

16. Statistical Significance Cause _||_ Effect | Measured Covariates E.g., in a regression BMI = 21.7 + .52*TVhours/day - .64*Mother’s Education P-value = .0074

17. Strength of Evidence for Causation • Experimental studies • Observational studies

18. Strength of Evidence for Causation:Experimental studies • Randomized Assignment of Treatment • High Quality Measures • If dropout - not associated with treatment

19. Causeset _||_ Effect Causeset _||_ Effect Causeset _||_ Effect Strength of Evidence for Causation:Experimental studies Evidence: Causeset _||_ Effect

20. Strength of Evidence for Causation:Observational studies • Quality Measures • All potential confounders measured (well) and appropriately controlled for statistically, • Reverse causation can be eliminated, perhaps by time-order

21. Cause _||_ Effect | Measured Confounders Cause _||_ Effect | Measured Confounders Cause _||_ Effect | Measured Confounders Cause _||_ Effect | Measured Confounders Evidence: Cause _||_ Effect | Measured Confounders Strength of Evidence for Causation:Observational studies

22. Strength of Evidence for Causation:Observational studies Cause _||_ Effect | Measured Confounders Good Evidence for causation if: • All confounders measured well • Effect not prior to cause

23. Measurement • Validity – measure directly and accurately measures what it is intended to measure • Reliability – same measurement technique applied repeatedly, yields same outcome • Precision – fineness vs. coarseness of measure

24. Ecological Validity Generalizability: Similarity of observational conditions to real-life. E.g., - after-school lab study vs. survey

25. Results • Tabular Overview of Evidence Base • Marketing  Precursors • Marketing  Diet • Marketing  Health

26. Example Results: Summary

27. Example Results: Summary

28. Results • Tabular Overview of Evidence Base • Marketing  Precursors • Marketing  Diet • Marketing  Health

29. Results: Pre-cursors • Precursors: • Preferences • Food Purchase Requests • Beliefs about Food

30. Results: TV Ads and Food Preferences

31. TV Ads and Purchase Requests • (Young 2-5): Strong evidence for causation • (OC 6-11) Moderate evidencefor causation • (Teens 12-18) Weak/Insufficient for causation

32. Results: Summary of Pre-cursors

33. Results • Tabular Overview of Evidence Base • Marketing  Precursors • Marketing  Diet • Marketing  Health

34. Results: Short-term Consumption • (Young 2-5): Strong evidence for causation • (OC 6-11) Strong evidence for causation • (Teens 12-18) No evidence

35. Results: Usual Dietary Consumption • (Young 2-5): Moderate evidence for causation • (OC 6-11) Weak evidence for causation • (Teens 12-18) Weak/Insufficient against causation • (not including French, et al., study on vending machine price

36. Results • Tabular Overview of Evidence Base • Marketing  Precursors • Marketing  Diet • Marketing  Health

37. Marketing  Health

38. Results: Summary • TV Ads  Precursors (esp. for young children) • TV Ads  Short-term consumption (esp. for YC) • TV Ads  Usual Diet (???) • Moderate evidence for YC • Weak for OC • Weak against for teens • Marketing  Health (???) • TV Ads _||_ Obesity : strong evidence • TV Ads  Obesity: insufficient evidence

39. Results • ONLY TV Ads studied – marketing much broader • Only effects of ads for high-calorie, low nutrition foods studied • Effects of ads for healthy foods – virtually unstudied!

40. Lawsuit Center for Science in the Public Interest (CSPI) vs. Viacom, Kellog Charge: Unfair and deceptive advertising and marketing to children under 8 Request: $1 billion each

41. J. Michael McGinnis(Chair), Institute of Medicine Daniel Anderson, University of Massachusetts, Amherst J. Howard Beales III, George Washington University David Britt, Sesame Workshop (retired) Sandra Calvert, Georgetown University Keith Darcy, Ethics Officer Association Aimee Dorr, University of California, Los Angeles Lloyd Kolbe, University of Indiana Dale Kunkel, University of Arizona Paul Kurnit, Kurnit Communications & KidShop Robert Post, Yale Law School Richard Scheines, Carnegie Mellon University Frances Seligson, Pennsylvania State University Mary Story, University of Minnesota, Minneapolis Ellen Wartella, University of California, Riverside Jerome Williams, University of Texas, Austin Co-study Directors: Jennifer Gootman and Vivica Kraak Committee on Food Marketing and the Diets of Children and Youth

42. For more information. . . Read about the project and download fact sheets at: www.iom.edu The book is available at: www.nap.edu Download the executive summary free . . .