Advertising is a pervasive influence on children and adolescents. Young people view more than 40 000 ads per year on television alone and increasingly are being exposed to advertising on the Internet, in magazines, and in schools. This exposure may contribute significantly to childhood and adolescent obesity, poor nutrition, and cigarette and alcohol use. Media education has been shown to be effective in mitigating some of the negative effects of advertising on children and adolescents.
Several European countries forbid or severely curtail advertising to children; in the United States, on the other hand, selling to children is simply “business as usual.”1 The average young person views more than 3000 ads per day on television (TV), on the Internet, on billboards, and in magazines.2 Increasingly, advertisers are targeting younger and younger children in an effort to establish “brand-name preference” at as early an age as possible.3 This targeting occurs because advertising is a $250 billion/year industry with 900 000 brands to sell,2 and children and adolescents are attractive consumers: teenagers spend $155 billion/year, children younger than 12 years spend another $25 billion, and both groups influence perhaps another $200 billion of their parents' spending per year.4,5 Increasingly, advertisers are seeking to find new and creative ways of targeting young consumers via the Internet, in schools, and even in bathroom stalls.1
THE EFFECTS OF ADVERTISING ON CHILDREN AND ADOLESCENTS
Research has shown that young children—younger than 8 years—are cognitively and psychologically defenseless against advertising.6–9 They do not understand the notion of intent to sell and frequently accept advertising claims at face value.10 In fact, in the late 1970s, the Federal Trade Commission (FTC) held hearings, reviewed the existing research, and came to the conclusion that it was unfair and deceptive to advertise to children younger than 6 years.11 What kept the FTC from banning such ads was that it was thought to be impractical to implement such a ban.11 However, some Western countries have done exactly that: Sweden and Norway forbid all advertising directed at children younger than 12 years, Greece bans toy advertising until after 10 pm, and Denmark and Belgium severely restrict advertising aimed at children.12
ADVERTISING IN DIFFERENT MEDIA
Children and adolescents view 400 00 ads per year on TV alone.13 This occurs despite the fact that the Children's Television Act of 1990 (Pub L No. 101–437) limits advertising on children's programming to 10.5 minutes/hour on weekends and 12 minutes/hour on weekdays. However, much of children's viewing occurs during prime time, which features nearly 16 minutes/hour of advertising.14 A 30-second ad during the Super Bowl now costs $2.3 million but reaches 80 million people.15
A 2000 FTC investigation found that violent movies, music, and video games have been intentionally marketed to children and adolescents.16 Although movie theaters have agreed not to show trailers for R-rated movies before G-rated movies in response to the release of the FTC report, children continue to see advertising for violent media in other venues. For instance, M-rated video games, which according to the gaming industry's own rating system are not recommended for children younger than 17 years, are frequently advertised in movie theaters, video game magazines, and publications with high youth readership.17 Also, movies targeted at children often prominently feature brand-name products and fast food restaurants.18 In 1997–1998, 8 alcohol companies placed products in 233 motion pictures and in 1 episode or more of 181 TV series.18
According to the Consumer's Union,19 more than 160 magazines are now targeted at children. Young people see 45% more beer ads and 27% more ads for hard liquor in teen magazines than adults do in their magazines.20 Despite the Master Settlement Agreement with the tobacco industry in 1998, tobacco advertising expenditures in 38 youth-oriented magazines amounted to $217 million in 2000.21
An increasing number of Web sites try to entice children and teenagers to make direct sales. Teenagers account for more than $1 billion in e-commerce dollars,22 and the industry spent $21.6 million on Internet banner ads alone in 2002.23 More than 100 commercial Web sites promote alcohol products.23 The content of these sites varies widely, from little more than basic brand information to chat rooms, “virtual bars,” drink recipes, games, contests, and merchandise catalogues. Many of these sites use slick promotional techniques to target young people.23,24 In 1998, the Children's Online Privacy Protection Act (Pub L No. 105–277) was passed, which mandates that commercial Web sites cannot knowingly collect information from children younger than 13 years. These sites are required to provide notice on the site to parents about their collection, use, and disclosure of children's personal information and must obtain “verifiable parental consent” before collecting, using, or disclosing this information.25
Advertisers have traditionally used techniques to which children and adolescents are more susceptible, such as product placements in movies and TV shows,26 tie-ins between movies and fast food restaurants,18 tie-ins between TV shows and toy action figures or other products,7 kids' clubs that are linked to popular shows, and celebrity endorsements.27 Cellular phones are currently being marketed to 6- to 12-year-olds, with the potential for directing specific advertisers to children and preteens. Coca-Cola reportedly paid Warner Bros. Studios $150 million for the global marketing rights to the movie “Harry Potter and the Sorcerer's Stone,”28 and nearly 20% of fast food restaurant ads now mention a toy premium in their ads.29 Certain tie-in products may be inappropriate for children (eg, action figures from the World Wrestling Federation or an action doll that mutters profanities from an R-rated Austin Powers movie).
Children's advertising protections will need to be updated for digital TV, which will be in place before 2010. In the near future, children watching a TV program will be able to click an on-screen link and go to a Web site during the program.30 Interactive games and promotions on digital TV will have the ability to lure children away from regular programming, encouraging them to spend a long time in an environment that lacks clear separation between content and advertising. Interactive technology may also allow advertisers to collect vast amounts of information about children's viewing habits and preferences and target them on the basis of that information.31
SPECIFIC HEALTH-RELATED AREAS OF CONCERN
Tobacco manufacturers spend $30 million/day ($11.2 billion/year) on advertising and promotion.32 Exposure to tobacco advertising may be a bigger risk factor than having family members and peers who smoke33 and can even undermine the effect of strong parenting practices.34 Two unique and large longitudinal studies have found that approximately one third of all adolescent smoking can be attributed to tobacco advertising and promotions.35,36 In addition, more than 20 studies have found that children exposed to cigarette ads or promotions are more likely to become smokers themselves.37,38 Recent evidence has emerged that tobacco companies have specifically targeted teenagers as young as 13 years of age.39
Alcohol manufacturers spend $5.7 billion/year on advertising and promotion.40 Young people typically view 2000 beer and wine commercials annually,41 with most of the ads concentrated in sports programming. During prime time, only 1 alcohol ad appears every 4 hours; yet, in sports programming, the frequency increases to 2.4 ads per hour.42,43 Research has found that adolescent drinkers are more likely to have been exposed to alcohol advertising.44–50 Given that children begin making decisions about alcohol at an early age—probably during grade school50 —exposure to beer commercials represents a significant risk factor.46,50 Minority children may be at particular risk.51
“Just Say No” as a message to teenagers about drugs seems doomed to failure given that $11 billion/year is spent on cigarette advertising, $5.7 billion/year is spent on alcohol advertising, and nearly $4 billion/year is spent on prescription drug advertising.52 Drug companies now spend more than twice as much on marketing as they do on research and development. The top 10 drug companies made a total profit of $35.9 billion in 2002—more than the other 490 companies in the Fortune 500 combined.53 Is such advertising effective? A recent survey of physicians found that 92% of patients had requested an advertised drug.54,55 In addition, children and teenagers may get the message that there is a drug available to cure all ills and heal all pain, a drug for every occasion (including sexual intercourse).41
Food Advertising and Obesity
Advertisers spend more than $2.5 billion/year to promote restaurants and another $2 billion to promote food products.56 On TV, of the estimated 40 000 ads per year that young people see, half are for food, especially sugared cereals and high-calorie snacks.29,57 Healthy foods are advertised less than 3% of the time; children rarely see a food advertisement for broccoli.58 Increasingly, fast food conglomerates are using toy tie-ins with major children's motion pictures to try to attract young people.59 Nearly 20% of fast food ads now mention a toy premium in their commercials.29 Several studies document that young children request more junk food (defined as foods with high-caloric density but very low nutrient density) after viewing commercials.60–63 In 1 study, the amount of TV viewed per week correlated with requests for specific foods and with caloric intake.61 At the same time, advertising healthy foods has been shown to increase wholesome eating in children as young as 3 to 6 years of age.64
Sex in Advertising
Sex is used in commercials to sell everything from beer to shampoo to cars.65 New research is showing that teenagers' exposure to sexual content in the media may be responsible for earlier onset of sexual intercourse or other sexual activities.66,67 What is increasingly apparent is the discrepancy between the abundance of advertising of products for erectile dysfunction (ED) (between January and October, 2004, drug companies spent $343 million advertising Viagra, Levitra, and Cialis)68 and the lack of advertising for birth control products or emergency contraceptives on the major TV networks. This is despite the fact that 2 national polls have found that a majority of Americans favor the advertising of birth control on TV.69,70 Ads for ED drugs give children and teens inappropriate messages about sex and sexuality at a time when they are not being taught well in school sex education programs.71,72 Research has definitively found that giving teenagers increased access to birth control through advertising does not make them sexually active at a younger age.73–80
ADVERTISING IN SCHOOLS
Advertisers have slowly but steadily infiltrated school systems around the country. The “3 Rs” have now become the “4 Rs,” with the fourth R being “retail.”83,84 Ads are now appearing on school buses, in gymnasiums, on book covers, and even in bathroom stalls.85 More than 200 school districts nationwide have signed exclusive contracts with soft drink companies.86 These agreements specify the number and placement of soda-vending machines, which is ironic given that schools risk losing federal subsidies for their free breakfast and lunch programs if they serve soda in their cafeterias. In addition, there are more than 4500 Pizza Hut chains and 3000 Taco Bell chains in school cafeterias around the country.87
There is some good news, however. In May, 2006, the nation's largest beverage distributors agreed to halt nearly all sales of sodas to public schools and sell only water, unsweetened juice, and low-fat milk in elementary and middle schools. Diet sodas would be sold only in high schools.88
School advertising also appears under the guise of educational TV: Channel One. Currently available in 12 000 schools, Channel One consists of 10 minutes of current-events programming and 2 minutes of commercials. Advertisers pay $200 000 for advertising time and the opportunity to target 40% of the nation's teenagers for 30 seconds.89 According to a recent government report, Channel One now plays in 25% of the nation's middle and high schools81 and generates profits estimated at $100 million annually.89
Clearly, advertising represents “big business” in the United States and can have a significant effect on young people. Unlike free speech, commercial speech does not enjoy the same protections under the First Amendment of the Constitution.90 Advertisements can be restricted or even banned if there is a significant public health risk. Cigarette advertising and alcohol advertising would seem to fall squarely into this category, and ads for junk food could easily be restricted.91
One solution that is noncontroversial and would be easy to implement is to educate children and teenagers about the effects of advertising—media literacy. Curricula have been developed that teach young people to become critical viewers of media in all of its forms, including advertising.92–94 Media education seems to be protective in mitigating harmful effects of media, including the effects of cigarette, alcohol, and food advertising.93–96
Pediatricians should become familiar with the methods that advertisers use to target children and adolescents.
Pediatricians should only subscribe to magazines that are free of tobacco and alcohol advertisements for their waiting rooms (eg, Good Housekeeping has refused to carry tobacco ads since 1952).
Pediatricians should counsel their patients to limit total noneducational screen time to no more than 2 hours/day,97 which will limit exposure to advertising of all kinds.
Pediatricians should write letters to advertisers if they see inappropriate ads and should encourage parents to do the same (letters can be addressed to the Children's Advertising Review Unit, Council of Better Business Bureaus, 845 Third Ave, New York, NY 10022).
Pediatricians should work with community groups and local school boards to implement media education programs that teach about the effects of advertising on children and adolescents. The federal government should help underwrite the cost of establishing and disseminating such programs.
Pediatricians should work with parents, schools, community groups, and others to ban or severely curtail school-based advertising in all forms.
Pediatricians should work with parent and public health groups to:
ask Congress and the Federal Communications Commission to limit commercial advertising on children's programming to no more than 5 to 6 minutes/hour, which would decrease the current amount by 50%;
ask Congress to implement a ban on cigarette and tobacco advertising in all media, including banners and logos in sports arenas;
ask Congress to restrict alcohol advertising to what is known as “tombstone advertising,” in which only the product is shown, not cartoon characters or attractive women;
ask Congress to implement a ban on junk-food advertising during programming that is viewed predominantly by young children;
ask Congress to increase funding for public TV—the sole source of high-quality, educational, noncommercial programming for children;
advocate for confining ads for ED drugs to after 10 pm. The American Academy of Pediatrics has always strongly endorsed the advertising of birth control on TV. There is now considerable evidence that birth control advertising could lower teen pregnancy rates even further while having no impact on rates of teen sexual activity.79 However, when birth control advertising is so rare on prime time TV, it makes no sense to allow ED drug advertising that may confuse children and teens about human sexuality and make sexual activity seem like a recreational sport.
ask Congress and the Federal Communications Commission to prohibit interactive advertising to children in digital TV; and
ask Congress to convene a national task force on advertising under the auspices of the Institute of Medicine, the National Institutes of Health, or the FTC. This task force would discuss the nature of the current problem and the current research and would propose solutions toward limiting children's exposure to unhealthy advertising, including the funding of future research. The task force would include representatives from the toy industry, the fast food industry, and the advertising community, as well as pediatricians, child psychiatrists and psychologists, and public health advocates.
Pediatricians, together with the American Academy of Pediatrics Media Resource Team, should work with the entertainment industry to ensure that the advertising of violent media to children does not occur, that product placements in movies and TV do not occur, that the dissemination and enforcement of the individual industries' own rating systems is facilitated, and that advertising for contraceptives is more widely disseminated on network TV.
COMMITTEE ON COMMUNICATIONS, 2006–2007
Donald L. Shifrin, MD, Chairperson
Ari Brown, MD
Bernard P. Dreyer, MD
Kenneth R. Ginsburg, MD, MSEd
Regina M. Milteer, MD
Kathleen G. Nelson, MD
Deborah Ann Mulligan, MD
Michael Brody, MD
American Academy of Child and Adolescent Psychiatry
Brian Wilcox, PhD
American Psychological Association
*Victor C. Strasburger, MD
AAP Section on Media
All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.