Health and Nutrient Content Claims in Food Advertisements on Hispanic and Mainstream Prime-time Television

RESEARCH ARTICLE

Health and Nutrient Content Claims in Food Advertisements on Hispanic and Mainstream Prime-time Television Jodie Abbatangelo-Gray, ScD, MS, MA1; Carol Byrd-Bredbenner, PhD, RD2; S. Bryn Austin, ScD3 ABSTRACT Objective: Characterize frequency and type of health and nutrient content claims in prime-time weeknight Spanish- and English-language television advertisements from programs shown in 2003 with a high viewership by women aged 18 to 35 years. Design: Comparative content analysis design was used to analyze 95 hours of Spanish-language and 72 hours of English-language television programs (netting 269 and 543 food ads, respectively). Main Outcome Measures: A content analysis instrument was used to gather information on explicit health and nutrient content claims: nutrition information only; diet-disease; structurefunction; processed food health outcome; good for one’s health; health care provider endorsement. Analysis: Chi-square statistics detected statistically significant differences between the groups. Results: Compared to English-language television, Spanish-language television aired significantly more food advertisements containing nutrition information and health, processed food/health, and good for one’s health claims. Samples did not differ in the rate of diet/disease, structure/function, or health care provider endorsement claims. Conclusions and Implications: Findings indicate that Spanish-language television advertisements provide viewers with significantly more nutrition information than English-language network advertisements. Potential links between the deteriorating health status of Hispanics acculturating into US mainstream culture and their exposure to the less nutrition-based messaging found in English-language television should be explored. Key Words: content analysis, health claims, nutrient content claims, television, Hispanic (J Nutr Educ Behav. 2008;40:348-354)

INTRODUCTION Obesity is a growing epidemic of considerable public health significance. In the United States, the burden of obesity and its associated risks for chronic disease are felt most among lower socioeconomic status (SES) populations.1-3 According to the National Institutes of Health, women have an increas1

Ogilvy & Mather, New York, New York Nutritional Sciences Department, Rutgers University, New Brunswick, New Jersey 3 Department of Society, Human Development, and Health, Harvard School of Public Health, Division of Adolescent and Young Adult Medicine, Children’s Hospital Boston, Massachusetts Funding for this paper was provided in part by the Department of Nutrition at the Harvard School of Public Health, the National Cancer Institute, the American Association of University Women, and the Leadership Education in Adolescent Health Project grant T71 MC 00009-16 from HRSA/Maternal and Child Health Bureau. 2

Address for correspondence: Jodie Abbatangelo-Gray, 267 W 89th St, 6D, New York, NY 10024; Phone: (212) 600-1481; E-mail: [email protected]

©2008 SOCIETY FOR NUTRITION EDUCATION doi: 10.1016/j.jneb.2008.01.003

ing rate of obesity and diabetes4 compared to men,5 and Hispanics are more likely than non-Hispanic whites of the same age group to report being in fair or poor health.6 Furthermore, Hispanics have lower levels of nutrition knowledge than non-Hispanic whites in the United States.7-9 In the United States, “the now well-documented ‘epidemiologic paradox’ ” describes how longer residency in the United States among Hispanics is associated with increasingly adverse risk factors and poorer health, particularly among the second- and third-plus-generations, compared to first-generation immigrants.10 The more healthful profile of recent immigrants tends to deteriorate and eventually approximate that of the mainstream population, particularly in terms of diet and obesity,11,12 as acculturation increases over time.2,10,13-19 Note that the term “Hispanic” used throughout this paper refers to descendents of Latin American and Spanish-speaking Caribbean territories who are living in the United States with varying degrees of acculturation.

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Hindin et al posit that television remains one of the most powerful sources of communication, despite the introduction of other technological innovations such as the Internet.20 According to the latest American Dietetic Association national public opinion survey, Nutrition and You: Trends 2002, 72% of consumers named television as their main source of nutrition information (a dramatic increase from 48% in 2000), followed by magazines (58%), newspapers (33%), and family and friends (17%).21 Furthermore, the importance of television as a nutrition information source is higher among less educated populations.22 Recent Roper data also indicate that Americans regard television as a trusted source of information for both their personal general health as well as nutrition.23 In the United States, the average adult female watches about 4.5 hours of television per day,24,25 and her Hispanic counterpart views, on average, an additional 1.5 hours.26 Although television is a primary source of health and nutrition information for many Americans, little recent research has examined food advertising during prime-time television viewing hours in the mainstream (English) media market, and almost no such research has examined the Hispanic media market. The goal of this paper is to characterize the frequency and type of health and nutrient content claims embedded in food advertisements broadcast on Spanish and English-language prime-time network television programming that had a high viewership of women aged 18 to 35 years. Two theories of information acquisition inform this study. According to Social Cognitive Theory, behaviors can be learned through observation,27 and Cultivation Theory suggests that people who are heavy users of television are likely to be more influenced by content than individuals who watch less television.28 Given the heavy media consumption by young women in the United States within both the Hispanic and mainstream populations,25,29 it is reasonable to speculate that television food advertising may affect dietary choices.

METHODS Data Collection Television programming samples were collected in Atlanta, Georgia and Boston, Massachusetts during the second-quarter advertising period of 2003 (Hispanic: April 21st to May 30th; mainstream: April 21st to May 21st). Prime-time (7:00 PM11:00 PM) television programs that ranked highest by Nielsen Media Research among women aged 18 to 35 years were selected for both advertising samples. The advertising sampling period for each program encompassed the 2 minutes immediately preceding the introduction of the program through the closing credits following the program. In total, 95 hours of prime-time weekday programming were sampled from the largest Hispanic network in the United States, Univision, and 72 hours of programming were sampled from 6 major mainstream networks (CBS,

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NBC, ABC, FOX, WB, and UPN) for the English-language sample. Owing to the longer format of Hispanic programs (60 minutes vs 30 to 60 minutes for mainstream prime-time programs) and the daily serial airing schedule of Spanishlanguage soap operas (called “telenovelas”), 7 different Hispanic programs were analyzed compared to 19 different programs shown weekly on the mainstream networks. These programs were recorded each time they aired during the sampling period. TV Guide on-line (www.tvguide.com) was accessed daily to confirm programming times and stations for each night’s sample. To track sample capture, each day the videotape from the previous night’s recording was reviewed and programs were logged by date, time, day of week, and network. All nonprogram spots (ie, advertisements, public service announcements, promotions for upcoming television programs, news, weather and sports briefs, and any other segments that were not part of a scheduled television program), program introductions, and program credits were extracted from the original source videotapes to create the final tape. The study reported here examined food advertisements, which were defined as a commercial advertisement featuring a food, beverage, or nutritional supplement that is meant to be ingested directly or have its flavors extracted by chewing (eg, gum).

Instrument The content analysis instrument used in this study was based on instruments from previous studies.30,31 Preliminary versions of the instrument were reviewed by a panel of 5 experts to ensure that operational definitions were clear and the full range of conceptual domains were captured and refined. The pretest sample included food ads that were not part of the final study sample. The final instrument included 2 main sections: basic information about the advertisement (eg, length, product advertised) and explicit health and nutrient content claims. For research purposes, we used health claim message categories that are more specific and nuanced than those defined by the Food and Drug Administration (FDA). Specific health claims included: nutritioninformation– only claims (eg, low in fat, contains folic acid, contains a specific nutrient or nutrients, but does not link nutrients to a disease or a bodily function); diet-disease claims that linked a whole food item (ie, unprocessed or minimally processed food) or specific nutrient to a disease (eg, folic acid prevents birth defects); structure-function claims that linked a whole food item or specific nutrient to a functional or structural aspect of the body (eg, vitamin C supports the immune system); and processed food health outcome claims that linked a highly processed, branded food with a diet-disease or structure/function health outcome. Two additional general health claims that were not mutually exclusive of specific health claims included: (1) “good for one’s health,” which used terms like wholesome,

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part of a nutritious breakfast, or a good source of a particular nutrient; and (2) a “health care provider endorsement,” which featured a medical professional(s) or statement(s) that suggested the advertised product is recommended by a medical professional. Nutrient content claims included: inclusionary statements (ie, food items contained a specific nutrient, grain, fruit, or were “pure” and/or “natural”); and exclusionary statements (ie, food items minimized or eliminated a nutrient, caffeine, or were “lean,” “thin,” and/or “slim”). Two trained researchers used the study instrument to analyze the content of the food advertisements sampled. The first researcher was a native English speaker fluent in Spanish; the second was a native Spanish speaker fluent in English. Prior to data collection, the researchers reviewed the instrument and all operational definitions to ensure congruity in conceptual understanding and coding protocol. A detailed coding booklet, which included all definitions and directions for filling out each item on the questionnaire, was created and used to train the coders. The trained researchers independently coded the same 15 food ads, and they then discussed coding results to assess clarity of the instrument and consensus of interpretation. To establish intrarater reliability, both researchers independently coded 10 ads and then recoded the same advertisements 4 weeks later. Cohen’s ␬ statistic was calculated to determine the interrater reliability.32 For the final sample, the one researcher coded all food advertisements. A second researcher independently coded nearly two thirds (61%) of all unique Hispanic-television food advertisements and 30% of all unique mainstream advertisements.

Statistical Analysis Food advertisements were the unit of analysis in this study. All health and nutrient-content claims were coded dichot-

omously (ie, the advertisement either contained or did not contain the claim). Descriptive statistics were calculated to describe the claims made in food advertising. Chi-square tests assessed whether the types of claims on Hispanic television were significantly different from those on mainstream television. The statistical software package SPSS 12.0 (SPSS, Inc. Chicago, Ill, 2002) was used in all analyses.

RESULTS The capture rate for the television program sample was 90% for the Hispanic sample and 92% for the mainstream. These rates were less than 100% because of occasional recording equipment failures and/or unannounced changes in the television programming schedule. Test results indicate a high degree of both intra- and interrater reliability. Intrarater reliabilities yielded a ␬ statistic of 1.0 and 100% agreement for the health-related advertising appeal and nutrient content sections of the coding instrument. For those same sections, interrater reliabilities yielded ␬ statistics ranging from 0.87 to 0.98. The final Hispanic broadcast sample included 2556 nonprogram spots, and the mainstream sample 3168 nonprogram spots. Food advertisements accounted for 11% (n ⫽ 269) of all nonprogram spots on Hispanic television, compared to 17% (n ⫽ 543) of nonprogram spots on mainstream networks. Sample size calculations were estimated during the initial stages of this research using the EpiInfo 3.3.1 software package (EpiInfo, Inc., Centers for Disease Control and Prevention, Atlanta, Ga, 2003). The total sample size of 812 food advertisements achieved in this study far exceeds this minimum estimated requirement (n ⫽ 411) to detect a difference between samples of at least 10% (␣ ⫽ .05, power ⫽ 0.80). In both samples, food advertisements were 15, 30, or 60 seconds in length, with approximately two-thirds being 30

Table 1. Food Advertisement Types on Mainstream (n ⫽ 543) and Hispanic (n ⫽ 269) Prime-time Television

Mainstream Type of Advertisement Primary product advertised* Food Beverage Both Vendor category Restaurant Nonrestaurant Restaurant type Fast-food Casual dining

Hispanic

N

%

N

%

325 177 18

62.5 34.0 3.5

140 116 8

53.0 43.9 3.0

209 334

38.5 61.5

71 198

26.4 73.6

153 56

73.2 26.8

62 9

87.3 12.7

Chisquare Statistic 7.339

P value ⬍ .05

11.650

⬍ .001

5.926 ⬍ .05

*Based on subsample of mainstream (n ⫽ 520) and Hispanic (n ⫽ 264); ads that do not feature a primary food item have been excluded. N indicates number of advertisements in category; %, percentage of total food ads for the primary product advertised.

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Table 2. Health Claims Made in Food Advertisements Broadcast on Mainstream (n ⫽ 543) and Hispanic (n ⫽ 269) Prime-time Television

Mainstream Health Claim Total health claims Nutrient information only Diet-disease Structure-function Processed food health outcome Good for one’s health Health care provider endorsement

N* 39 1 7 10 11 34 13

%* 7.2 0.2 1.3 1.8 2.0 6.3 2.4

Hispanic N 67 33 3 3 16 39 3

% 24.9 12.3 1.1 1.1 5.9 14.5 1.1

Chisquare Statistic 49.792 65.469 0.045 0.602 8.609 14.916 1.523

P Value ⬍ .001 ⬍ .001 NS NS ⬍ .01 ⬍ .001 NS

*N indicates number of advertisements in category; %, percentage of total food ads that contained the health claim; NS, not significant.

seconds long. Advertisement length did not differ significantly between Hispanic and mainstream television. As can be seen in Table 1, the proportion of all advertisements that were for food in the Hispanic sample was significantly (P ⬍ .05) lower than the mainstream sample. Table 1 also reveals that beverage advertisements were significantly more frequent on Hispanic television than on mainstream television. Food advertisements that focused on restaurants were significantly more frequent on mainstream networks than on the Hispanic network. When examined by restaurant type (fast-food vs casual dining), fast-food restaurant chains were advertised significantly more often in the Hispanic sample than the mainstream sample. A review of Table 2 indicates that 25% of the Hispanic food advertisements made health claims compared to only 7% of mainstream food advertisements. Compared to the mainstream sample, the Hispanic sample included significantly more health claims overall, particularly “good for one’s health” claims (14.5% vs 6.3%) and nutrition information-only claims (12.3% vs 0.2%). However, the samples did not differ in the rate at which diet/disease claims, structure/function claims, or health care provider endorsement claims were used. Overall, the Hispanic network aired more than 2.5 times as many advertisements containing inclusionary nutrient content claims, compared to the mainstream networks (see Table 3). Hispanic advertisements included significantly more claims for vitamin, mineral, fruit, and pure/ natural claims than did mainstream advertisements. Few or no advertisements in either sample made protein, fiber, grain, or unsaturated fat inclusionary claims. Exclusionary claims were more common in mainstream than Hispanic television advertisements, though the difference was not statistically significant (Table 3). The most commonly used exclusionary claim in both samples was “light.” The only statistically significant difference in exclusionary claims was for “low calories.” Although none of the Hispanic network advertisements made this claim, 4% of mainstream ads did. Finally, the Spanish-language media environment was more than twice as likely to use celebrity-endorsed ad

appeals versus English-language spots (20.8% vs 9.9%, P ⬍ .001).

DISCUSSION The overall findings from this study corroborate those of previous content analyses conducted with mainstream television.33-35 In particular, health and nutrition claims are infrequently used in food advertisements, more nutrient content claims than health claims are made, and among health claims, fewer diet-disease and structure-function claims are made in comparison to general “good for you” health claims.30,33,35 Similar findings also have been reported for African American programming.34 Furthermore, given the level of credibility that celebrity endorsements potentially imbue,36-39 particularly when combined with the already highly influential medium of television, celebrity-endorsed items are perhaps more likely to be consumed than items advertised without celebrity endorsement.36-40 This finding is significant given that celebrity spokespersons were used often in both samples, particularly in Hispanic ads. The findings of this study suggest that Hispanic network television advertisers are significantly more likely to use health and nutrition claims than advertisers on mainstream network television. If this advertising approach is based on consumer market research, 1 possible interpretation is that advertisers believe the Spanish-speaking population in the United States may place greater importance on the health and nutrition qualities of food than non-Spanish speakers. Another possible interpretation is that advertisers are aware that Hispanics may be more susceptible to the influence of such information and/or have high levels of trust in television,29,41,42 perhaps because of lower education levels,43,44 and thus, may be more susceptible to nutrition messaging. Regardless of marketing rationale, it is interesting to note that in many respects, less acculturated Hispanics eat a more healthful diet than non-Hispanic whites.3,12,45,46 However, their diets begin to deteriorate as they become

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Table 3. Nutrient Content Claims in Food Advertisements on Mainstream (n ⫽ 543) and Hispanic (n ⫽ 269) Prime-time Television

Mainstream Nutrient Content Claim Total advertisements making inclusionary claim Vitamins Minerals Protein Fiber Grain type mentioned Whole grain referenced Mono- or polyunsaturated fat Fruit Pure/natural Other Total advertisements making exclusionary claims Low-calorie Low-fat Fat type specified Cholesterol Sugar Sodium Caffeine Alcohol Additives Carbohydrates Lean, thin, slim Light

N* 77 18 11 3 0 3 3 0 17 30 10 68 21 4 0 3 7 0 0 0 0 7 11 29

%* 14.2 3.3 2.0 0.6 0 0.6 14.3 0 3.1 5.5 1.8 12.5 3.9 0.7 0 0.6 1.3 0 0 0 0 1.3 2.0 5.3

Hispanic N 100 41 31 7 4 0 0 0 44 35 1 22 0 3 0 6 0 0 0 0 0 0 4 13

% 37.2 15.2 11.5 2.6 1.5 0 0 0 16.4 13.0 0.4 8.2 0 1.1 0 2.2 0 0 0 0 0 0 1.5 4.8

Chisquare Statistic 55.796 37.975 33.088 6.213 8.114 1.492 NA NA 45.290 13.69 2.908 3.445 10.680 0.302 4.621 3.498 NA NA NA NA 3.498 0.288 0.095

P Value ⬍ .001 ⬍ .001 ⬍ .001 ⬍ .05 ⬍ .05 NS NA NA ⬍ .001 ⬍ .001 NS NS ⬍ .001 NS NA NS NS NA NA NA NA NS NS NS

*N indicates number of advertisements in category; %, percentage of total food ads that contained the health claim; NS, not significant; NA, not available.

more acculturated.2,10,13-19 Thus, the authors of this paper suggest there may be a link between television exposure and this trend in deteriorating diet. A potential explanation why more highly acculturated Hispanics eat a less healthful diet than less acculturated Hispanics is that they watch less Spanish-language television than their less acculturated counterparts,47,48 and therefore they are less exposed to the greater frequency of protective, nutrition-related information conveyed by Spanish-language television. The impact of the frequency with which nutritionrelated claims were used is important to consider, because various studies support the notion that consumer knowledge rises when exposed to diet/disease advertising messages.49-52 Even though these types of campaigns are not known to significantly narrow the knowledge gap, research has demonstrated that television advertising campaigns can raise awareness about health issues, particularly among marginalized segments of the population.53 Indeed, a number of studies support the notion that television can affect numerous behaviors ranging from violence to diet to sexual activity.28,54-56 According to Social Cognitive Theory, behaviors can be learned through observation,27 and repeated exposure to a stimuli like food advertisements can produce responses within an individual.57,58 Similarly, Culti-

vation Theory posits that television creates or “cultivates” beliefs and expectations about the “real” world, and that people who are heavy users of television are likely to be more influenced by content than individuals who watch less, especially regarding topics with which the viewer has little firsthand experience.28 Given the heavy television use among young women in the United States within both the Hispanic and mainstream populations,25,28,29 it is reasonable to speculate that television food advertising may affect dietary choices. Although it is likely unreasonable to expect that food advertising content alone will lead to a sustained state of changed dietary intake, even the very limited nutrition information that can be communicated in a 30-second food advertisement may benefit marginalized populations. Future research should investigate whether the shift from watching Hispanic television to English-language television as acculturation occurs, and the concomitant level of exposure to nutrition-related claims seen and heard in both advertising environments, contributes to the decline in diet quality among well-acculturated Hispanics in the United States. A potential limitation of this study is that sampling was conducted during a single time period. However, this method is comparable to those used in other content analyses, and results were consistent with previous studies.59 A

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second limitation is that the researcher who coded 100% of the Hispanic and mainstream sample is not a native Spanish speaker. As a result, it is possible that she may have misinterpreted some Spanish-language idioms and innuendo. This threat to internal validity was minimized by having a native Spanish speaker dual-code 61% of all Hispanic advertisements; this rate of dual-coding is much higher than the standard among leading content analyses, which is 20%.60 The strong interrater reliabilities for the Hispanic study sample suggest that instances of misinterpretation were rare.

IMPLICATIONS FOR RESEARCH AND PRACTICE The findings of this study provide an update on the use of health and nutrient-content claims on prime-time mainstream network television food advertising, and perhaps more importantly, provide one of the first-ever analyses of food advertisements on Hispanic television in the United States. Previous research indicates that health and nutrient-content claims in advertising have the potential to revolutionize food product innovation50,52 and increase nutrition knowledge for people of all socioeconomic levels,61 however, as the research presented here indicates, neither mainstream nor Hispanic television food advertisements used this strategy to any great extent. Television is a primary source of health and nutrition information for many Americans,20-23 thus including nutrition and health claims in food advertisements could be an effective way to communicate key health concepts to viewers. For these claims to be accepted by the public, the FDA, the federal agency that regulates nutrition and health claims, and the Federal Trade Commission, which regulates advertising, should better communicate how they work to protect consumers from fraudulent claims. Although food advertisers are not in the business of public health, advertisers’ goals and the goals of public health are not exclusive. A step that may encourage advertisers to use health claims more frequently in television advertising would be to streamline and simplify the required wording that must accompany these claims to make their use feasible in a 30-second advertisement. That food advertisements broadcast on Spanishlanguage television are more likely to use health claims compared to the mainstream media market is an intriguing finding of this study. Potential links between exposure to English-language television advertising and the deteriorating health status of Hispanics as they become more acculturated into the mainstream US culture should be explored. Future studies also should examine the relationship between food advertising and related shifts in dietary behaviors among both Hispanics and non-Hispanics living in the United States. Ongoing studies of the ways that foods are portrayed and advertised are needed to understand the ever-shifting media environment and its effect on nutrition and health.

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ACKNOWLEDGEMENTS Funding for this paper was provided in part by the Department of Nutrition at the Harvard School of Public Health, the National Cancer Institute, the American Association of University Women, and the Leadership Education in Adolescent Health Project grant T71 MC 00009-16 from HRSA/Maternal and Child Health Bureau.We would like to acknowledge Alina Flores, MA, for her dedicated work as a reviewer and a second coder; Taren Daily and family for their assistance in recording the programs analyzed in this program; Walter Willett, MD, PhD, for his intellectual and financial support of this project in its initial stages; and finally the National Cancer Institute and American Association of University Women, which supported J. Abbatangelo-Gray through to the completion of this research. S.B. Austin was supported by the Leadership Education in Adolescent Health Project grant T71 MC 00009-16 from HRSA/Maternal and Child Health Bureau.

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