Child-directed marketing strategies

This study describes the observed CDM strategies and the nutritional composition of packaged RTE breakfast cereals sold at major South African retailers in 2019. CDM was present on 95 % of breakfast cereals analysed with direct CDM strategies, that is, those strategies directed primarily at the child him/herself rather than the adult parent or caretaker, present on the majority (69 %) of packaged breakfast cereals.

Elsewhere, CDM prevalence on breakfast cereals is lower in Guatemala at 50·9 %^{(Reference Soo, Letona and Chacon32)}, in Chile at 35·7 %^{(Reference Stoltze, Reyes and Smith13)} and in USA at 31 %^{(Reference Song, Halvorsen and Harley33)}. The pervasiveness of CDM in SA and Guatemala is aligned with evidence that points to more aggressive marketing strategies used by multinational companies in low- and middle-income countries resulting in more rapid rising consumption of unhealthy foods than has occurred previously in high-income countries^{(Reference Stuckler, Mckee and Ebrahim34)}. Chile has introduced effective regulations to restrict CDM^{(Reference Stoltze, Reyes and Smith13)}, and this explains their lower prevalence of CDM.

Just under half (41·2 %) of the products in this study with CDM made use of multiple CDM strategies. Products with multiple direct CDM strategies had a higher sugar and Na content. This is similar to another study that found when more on-package marketing techniques are featured on a product, the product has a lower nutritional quality^{(Reference Aerts and Smits35)}.

Illustrations as a strategy was the most predominantly (95 %) used on-package CDM, of which animal illustration (16·7 %), object illustration (12·2 %) and imaginary creature illustration (2·7 %) were the direct CDM illustrations strategies used. Among visual marketing tactics, illustrations in general have been shown to negatively influence children’s choice of food products towards non-core foods^{(Reference Hallez, Qutteina and Raedschelders36)}. Cues of emotional consumption appeal (13·1 %) pertaining to enjoyment, pleasure and creating a positive mood was the most used consumption appeal type noticed.

Character strategies which were defined as personified animals, objects or imaginary creatures in this study were present on 10·8 % of breakfast cereals. This strategy was less prevalent on South African breakfast cereals when compared to Guatemala (31 %)^{(Reference Soo, Letona and Chacon32)}, Belgium (18·8 %)^{(Reference Vermote, Bonnewyn and Matthys37)}, Chile (29·7 %)^{(Reference Stoltze, Reyes and Smith13)} and Argentina (29 %)^{(Reference Allemandi, Castronuovo and Tiscornia24)}. Although SA does not have regulations on marketing, the SA National Department of Health’s draft R429⁽³⁸⁾ of 2014 recommends that images directed at children and the inclusion of toys should not be used to advertise foods containing nutrients of concern above nutrient cut-off points, and this may account for the low use of character strategies. Character strategy in this study relates to cartoon characters or promotional characters as referred to in several studies. The use of characters on products is shown to increase purchase request from children^{(Reference Connor39)}. Characters make packaged foods more appealing to children, while health and nutritional claims reassure the parent in their choice to purchase these items for their children^{(Reference Elliott17)}. A Mexican study found that claims were displayed more frequently in less healthy cereals as classified by the United Kingdom Nutrient Profiling Model (UKNPM)^{(Reference Nieto, Rincon-Gallardo Patiño and Tolentino-Mayo40)}.The use of characters and media branding could be a strategy to positively influence children’s food preferences towards fruits and vegetables^{(Reference Kraak and Story41)}.

Fantasy strategy defined as a display of fantastical or magical effects was found on 8·6 % of breakfast cereals. Role models (7·7 %) constituting of non-youth (7·2 %) which are adult role models and youth who looked like a child younger than 13 years of age (3·2 %) were observed. This was slightly lower than role models observed in Chile (9·52 %)^{(Reference Stoltze, Reyes and Smith13)}. Family (5 %) reference to image or text about family situations was also observed.

None of the breakfast cereals sold in SA made any reference to toys or cross-promotions which contrasts with Chile with 6 % toy reference and 3·6 % cross-promotions. The draft R429⁽³⁸⁾ proposing prohibition on the use of toys to promote foods high in nutrients of concern may account for the absence of toys in breakfast cereals packaging. This is encouraging as the use of gifts, toys and cross-promotions as marketing techniques have been shown to influence purchase decisions^{(Reference Stoltze, Reyes and Smith13)}.

Health and nutitional claims

South African breakfast cereals have a high prevalence of health and nutritional claims. UK and Argentina show a lower prevalence of health claims but a higher prevalence of nutritional claims when compared to SA^{(Reference Allemandi, Castronuovo and Tiscornia24)}.

Front-of-package nutritional claims on children’s cereals are potentially misleading, especially when placed on products with a high amount of nutrients of concern^{(Reference Harris, Thompson and Schwartz42)}. Food marketing is likely to directly address parents to promote foods for children’s consumption^{(Reference Hebden, King and Kelly43)} leading to an increased consumption of breakfast cereals high in nutrients of concern. Portion recommendations have been shown to influence parent’s purchase choice the most^{(Reference Russell, Burke and Waller22)}. Visual cues such as nature images are also shown to influence parents’ purchase choice^{(Reference Russell, Burke and Waller22)}.

Dietary patterns need to change, and an environment should be created that encourages the increased intake of nutritious and traditional foods while reducing the intake of packaged unhealthy foods. This requires regulation of the food industry to curb harmful CDM which entices children towards unhealthier choices^{(Reference Hawkes, Smith and Jewell44)}.

Statistically significant differences were noted in four nutrients: protein, fibre, total sugar and total carbohydates. In breakfast cereals with direct CDM, the protein and fibre content was significantly lower than in breakfast cereals without direct CDM. This finding was similar to studies in New Zealand^{(Reference Devi, Eyles and Rayner29)}, Australia^{(Reference Chun, Louie and Dunford23)} and the USA^{(Reference Schwartz, Vartanian and Wharton30)}. RTE breakfast cereals in SA with a higher dose of direct CDM (using three or more direct CDM strategies) had significantly lower amounts of energy when compared those with less than three direct CDM strategies. This is in contrast to finding in New Zealand and Australia where ‘cereals for kids’ had a marginally higher energy density when compared to other breakfast cereals^{(Reference Chun, Louie and Dunford23,Reference Devi, Eyles and Rayner29)} .

The mean total sugar content was significantly higher in breakfast cereals with CDM compared to those without CDM. Similarly, significantly high sugar content was found in breakfast cereals with CDM in New Zealand^{(Reference Devi, Eyles and Rayner29)}, Australia^{(Reference Chun, Louie and Dunford23)}, Guatemala^{(Reference Soo, Letona and Chacon32)} and the USA^{(Reference Schwartz, Vartanian and Wharton30)}. Foods high in sugar have a negative impact on children’s nutrition preferences, purchase behaviour, consumption patterns and diet-related health^{(Reference Kelly, Vandevijvere and Ng12)}, and excessive consumption has been linked to adverse health outcomes, such as dental caries, CVD and metabolic disorders.

There was no significant differences noted in the Na content of breakfast cereals with direct CDM when compared to those without direct CDM, which was similar to Guatemala^{(Reference Soo, Letona and Chacon32)} but different to New Zealand^{(Reference Devi, Eyles and Rayner29)} where the Na content was significantly higher. This could be a positive effect of the implementation of the South African Na regulation (R214)⁽⁴⁵⁾ which restricted breakfast cereal Na levels to below 500 mg/100 g in June 2016. Although this study was conducted in 2019, data collection was completed before the stricter Na limits (400 mg/100 g) of phase two of the R214 were implemented in SA in June 2019. Further reductions in Na levels may be likely.

It is concerning that breakfast cereals marketed to children are substantially higher in sugar, a nutrient if consumed in excess is associated with poor health outcomes and free sugar is excessively consumed by South African children^{(Reference Igumbor, Sanders and Puoane5,Reference Steyn, Nel and Malczyk46)} . Although protein content in breakfast cereals with direct CDM is low compared to those without direct CDM, adequate intake of protein among South African children^{(Reference Steyn, Nel and Malczyk46)} causes some concern. Given SA’s burden of undernutrition and stunting, adequate protein intake is important^{(Reference Abrahams, Mchiza and Steyn7)}. The lower fibre content of breakfast cereals with direct CDM is worrisome as majority of South African children from 1 to 9 years of age have a very low fibre intake^{(Reference Steyn, Nel and Malczyk46)} and fibre intake is linked with good health outcomes^{(Reference Wentzel-Viljoen, Lee and Laubscher47)} and shown to reduce elevated cholesterol, blood pressure and obesity risk among adolescents^{(Reference Fulgoni, Brauchla and Fleige48)}. Fibre intake is linked to the prevention of non-communicable diseases and improved immunity^{(Reference Wentzel-Viljoen, Lee and Laubscher47)}. This study finds the nutritional content of breakfast cereals marketed to children to be unhealthier than those not targeted to children and yet more than 95 % of all breakfast cereals carry a health or nutritional claim. This is misleading to parents who may assume, due to on-package marketing, that these products are healthy and fit for children’s consumption and thereby influence their purchase decision^{(Reference Kovic, Noel and Ungemack15,Reference Russell, Burke and Waller22)} .

Although any one single food cannot necessarily be identified as the cause of obesity, but rather the overall dietary intake, the proliferation of products as well as increased consumption of these products high in nutrients such as sugar and saturated fat are likely to contribute to obesity unless the consumption of these items is accompanied by a reduction in overall energy, sugar and saturated fat from other food products.

Regulations

Given the excessive use of marketing techniques and high sugar content of breakfast cereals found in this study, implementing restrictions on the marketing of unhealthy packaged breakfast cereals is important. The Advertising Standards Authority (ASA) initiated the South African Marketing to Children pledge in 2008 which was signed by members of the major food corporations in 2009. This volunatry pledge is the only form of regulation that exists in SA as an industry self-regulation effort and remains ineffective. The pledge violation by Coco-Cola Beverages South Africa (CCBSA) not to advertise or sell SSB around school premises is a clear indicator of the ineffectiveness of self-regulation^{(Reference Erzse, Christofides and Stacey49)}. Neither the current draft R429 nor the draft Department of Communications and Digital Technology Audio- and Audio-Visual Content Services Policy Framework (AAVCS) white paper are adequate to curb unhealthy food marketing to children⁽⁵⁰⁾. R429 could be strengthened by regulating CDM on packaging, among various forms of media and the internet. AAVCS could expand on food-related maketing to children rather than promoting industry self-regulation.

Chile has one of the highest obesity rates worldwide and introduced their marketing to children regulation in 2016^{(Reference Kelly, Vandevijvere and Ng12)} and within 7 months of regulation implementation there was a significant reduction in CDM in products with high levels of nutrients of concern and calories^{(Reference Stoltze, Reyes and Smith13)}.

Recommendations

CDM is known to influence purchase choices and has been linked to increased intake of unhealthy foods^{(Reference Kelly, Vandevijvere and Ng12)}, and thus the presence of CDM strategies on South African breakfast cereals is cause for concern. CDM strategies such as illustrations could be utilised on healthier breakfast cereals to attract children to healthier choices^{(Reference Hallez, Qutteina and Raedschelders36)}. Based on the results of this study, it is advisable to consider government-led, mandatory regulations restricting CDM of pre-packaged breakfast cereals and other pre-packaged foodstuffs typically high in sugar, saturated fat and Na and implementing front-of-pack labels that could increase the awareness of the ‘high-in’ nutrients of concern on breakfast cereals.

Further research is required on the pester power of children and the influences on parents to purchase breakfast cereals and other packaged food products with undesirable nutrient profiles when it contains CDM, in SA. Differentiation in pester power between younger children and adolescents may also be beneficial. The prevalence and benefit of CDM on fresh produce and packaged foods without excessive amounts of nutrients of concern should be explored.

Limitations

Data were collected from large, established supermarket chains, and hence CDM on breakfast cereal products informally imported and sold in stores in ethnic enclaves around SA (Indian enclave, Somalian enclave and Chinese enclave to name a few) was not captured. Another potential limitation is the exclusion of specific brands if they are sold exclusively in a province other than the Western Cape. The lack of adequate photographic evidence of the back of packs and sides of packs limited the study to the FoP.