A scoping review of children’s and parents’ attitudes to and awareness of digital food marketing

Abstract

Digital food marketing (DFM) of unhealthy foods and beverages (high in saturated fats, sugar and salt) to children and young people influences brand recall, recognition, purchase intentions and attitudes, and increases consumption of unhealthy foods and beverages. Understanding children’s and parents’ awareness of, and attitudes toward, such marketing is crucial for developing health-promoting advocacy and policy solutions. This registered systematic scoping review synthesized literature on children’s, young people’s and parents’ attitudes and awareness of DFM. A structured search of Medline, PsycInfo, Academic Search Complete (Ebscohost), Scopus and CINAHL was conducted. Inclusion criteria were peer-reviewed studies focused on children (<18 years), young people (<24 years) or parents, published after 2000, examining attitudes or awareness of online marketing of food or non-alcoholic beverages. Data were extracted and charted in Excel. Forty studies were included for synthesis. Studies of children/young people (n = 31) show varying levels of awareness regarding DFM on social media and other digital media. While some understand social media marketing tactics, others struggle to recognize ads. Preferences lean towards influencer marketing and ‘native’ advertising styles. There is limited evidence on parents’ views (n = 9 studies), but these suggest low parental awareness of digital marketing tactics targeting children, and unclear opinions on regulation. Overall, the findings suggest a need for a versatile, trans-disciplinary research and advocacy agenda to capture the complex and rapidly evolving digital marketing landscape, enhance critical digital literacies (including power inequalities) for both children and parents, increase knowledge-sharing and advocacy, and develop regulatory policies.

INTRODUCTION

Understanding children and young people’s, and parents’ awareness of, and attitudes to, marketing of unhealthy commodities is key to developing advocacy and policy solutions that promote health. It is essential to avoid shifting responsibility for managing harmful marketing to individuals, yet creating meaningful policy addressing unhealthy food marketing, and designing evidence-informed materials to increase children’s, adolescents’ and parents’ critical digital health literacy requires engaging them in dialogue (Sykes et al., 2018). To create such dialogue, researchers need to identify awareness of media marketing issues and techniques, as well as recall and attitudes. This is particularly important for digital marketing, given that digital advertising literacy has been found to only reach adult levels in later adolescence (Zarouali et al., 2020).

Robust evidence points to the impact of digital marketing of unhealthy food and non-alcoholic beverages (i.e. high in saturated fat, salt and sugar) on children’s health and well-being via the relationship between food marketing and dietary choices and behaviours (Boyland et al., 2022). Digital food marketing is defined by the World Health Organization as, ‘Promotional activity, delivered through a digital medium that seeks to maximize impact through creative and/or analytical methods’ (WHO, 2019). Digital marketing for food and non-alcoholic beverages (henceforth digital food marketing, or DFM) seeks to leverage children’s and adolescents’ interests, preferences and developmental needs and vulnerabilities, with implications for rights to health, privacy, to participate in society, and to be free from economic exploitation (Tatlow-Golden and Garde, 2020).

Digital food marketing to children and adolescents affects responses to unhealthy food (Folkvord and van ‘t Riet, 2018; Granheim et al., 2022), with meta-analysis showing significant effects on preference, choice and eating (Boyland et al., 2022). A meta-analysis found that unhealthy food advertising increased dietary intake among children aged 2–14 years in five studies with experimental conditions for advergames (Russell et al., 2019), and that children exposed to advergames consumed an average of 53.2 kcal (95% CI: 31.5–74.9) more than children exposed to non-food advertising—enough to translate to weight gain over time if repeated regularly. This aligns with findings reporting a relationship between advergames and consumption of unhealthy food and drinks (Elliott and Truman, 2019; Coleman et al., 2022). This pattern is also seen in DFM on social media; exposure to social media marketing by influencers increased snacking on unhealthy foods and intake of unhealthy drinks (Sina et al., 2022), and promotion of unhealthy snacks by social media influencers mediated children’s decisions about food and increased consumption of unhealthy foods (McCarthy et al., 2022). The more social media consumed by children and adolescents, the more likely they are to report consuming sugar-sweetened beverages (Kucharczuk et al., 2022). User- and peer-generated social media posts have a greater impact on adolescents’ intention to purchase and consume sugary drinks, suggesting that viral marketing among/by peers may have a greater influence on behaviours than other marketing strategies (Harris et al., 2021).

The impact of some forms of DFM on children’s and adolescents’ dietary behaviours has been relatively well-documented to date, but the pace at which online marketing practices are evolving means that research frequently struggles to keep up with new developments. Digital food marketing can be paid/sponsored (the brand pays the platform and/or content creator to promote or make content, respectively), owned (the brand generates their own content for the brand-identified social media page) or earned (marketing material is shared organically by users). Any of these formats can include the use of: ‘influencers’, vloggers, celebrities and other popular personalities or personas; entertainment, humour and narrative approaches; games/advergames, or augmented reality and virtual environments; and techniques to target specific groups and tailor content to individuals based on data gathered through browsing history and other means.

Digital marketing practices and strategies, especially on social media, are becoming increasingly opaque and ambiguous as conventional analogue-era ad formats and styles have been replaced by newer formats that blur the lines still further. A key early shift to new DFM formats that obfuscate boundaries between content and marketing was so-called native advertising, where brands create paid-for content that mimics the look, sound and style of user-generated content ‘native’ to the platform, increasing attention and click rates compared to older ‘banner’ advertising styles (Einstein, 2015). Indeed, more recently, in advising on how best to increase engagement, the social media platform TikTok called on brands and advertisers to ‘stop making ads’, and instead engage with content-creators and influencers, and utilize the platforms creative and stylistic features and ‘For You’ algorithm to tailor-make marketing content that is ‘authentic’ and ‘real’ and blends into the feed seamlessly (TikTok, 2021). A further example current at the time of writing is branded hashtag challenges, where brands instigate, or capitalize on, viral challenges to encourage users to generate content that promotes their brand and/or product. Thus, the interactive character of social media marketing, and ensuing opportunities to engage with brands and their content (Montgomery and Chester, 2009), celebrities’ (Calvo-Porral et al., 2021) and influencers’ endorsements (Coates et al., 2019), and the personification of brands (Jeong et al., 2022) all contribute to a powerful tool with unparalleled reach that can be used to manipulate children's and adolescents’ dietary preferences and behaviour with very little advertiser spend.

While systematic, scoping and rapid reviews have therefore evidenced the effects of DFM on child health behaviours and outcomes (Boyland et al., 2022; Granheim et al., 2022; Kucharczuk et al., 2022), and the power of DFM to children (Elliott and Truman, 2019), much less attention has been paid to synthesizing the evidence on attitudes to and awareness of DFM among both children and parents, how these are assessed, and how they relate to one another. Parents may assume that children can distinguish between commercial and general media content, however, this is an assumption that is usually predicated on an incomplete understanding of the newer tactics and strategies of advertisers online (Loose et al., 2022). Furthermore, parents are often more pre-occupied with ‘screen time’ (time children spend on devices overall) rather than considerations of what content they are engaging with during that screen time, including exposure to commercial content and its effects (Loose et al., 2022). Yet mapping both children’s and parents’ views is crucial, as parent and child awareness is needed to form partnerships with one another, with civil society, and policymakers, and together engage in knowledge-sharing, awareness raising, and advocacy for policy change (WHO, 2019).

Thus the aim of this scoping review is to gather, summarize and critically explore the extant literature—both methods and findings—on children’s, adolescents’ and parents’ awareness of and attitudes to the marketing of unhealthy food and beverages to children and adolescents.

The research questions underpinning the review are as follows:

RQ1: What are the methods used to assess children’s, adolescents’, young people’s and parents’ attitudes towards and awareness of digital marketing of unhealthy foods and beverages?

RQ2: What are children’s, adolescents’ and young people’s awareness of and attitudes towards the digital marketing of unhealthy foods and beverages?

RQ3: What are parents’ awareness of and attitudes towards the digital marketing of unhealthy foods and beverages to children and adolescents?

METHODS

Given the exploratory nature of this research, a scoping review method was selected. Scoping reviews are useful to identify the types of evidence available on a particular topic; to identify methods addressing key questions on a particular topic; to clarify key concepts or definitions; and to identify and analyse knowledge gaps (Munn et al., 2018). As one of the key aims in this study was to investigate methods most commonly used to assess attitudes and awareness of DFM, and it was anticipated that a relatively heterogeneous sample of literature would be gathered, a scoping review was deemed most appropriate. Scoping reviews can provide a more expansive overview of a disparate body of literature, but similarly to other systematic-style review approaches, use structured systematic concept searches on trusted databases, pre-defined inclusion/exclusion criteria, a screening process and data extraction. A registered protocol for this review outlining eligibility criteria and search strategy was uploaded to the Open Science Foundation on 15 December 2022 (Muc et al., 2022). We drew on JBI guidance in drawing up the protocol and conducting the review (Peters et al., 2015).

Study context

This study was conducted as part of a larger mixed-methods, interdisciplinary project, CLICKBITE, exploring DFM and children’s rights in Ireland, applying the WHO CLICK Framework (WHO, 2019) that recommends States carry out studies that map the digital marketing system, comprehend the marketing landscape, investigate children’s actual exposure and engage in knowledge exchange with stakeholders. To realize this, CLICKBITE has investigated the food marketing landscape, carried out focus groups with children aged 7–17, as well as parents, to explore attitudes and awareness of DFM, captured children’s screen activity to measure their actual exposure to DFM, carried out interviews with advertisers and completed a policy analysis with a child rights focus.

Eligibility criteria

We included studies that focused on children, adolescents or young people, or parents of children/young people. In Ireland, the national policy framework defines children and young people up to the age of 24 years, and the World Health Organization defines youth as aged 15 to 24; hence we similarly adopted these age limits for study inclusion. We also limited inclusion to studies published after 2000, given that the early to mid-2000s is when digital advertising moved towards more targeted models and social media was in its inception (Kelly-Holmes, 2015). Other inclusion criteria stated that studies should focus on the digital marketing of food or non-alcoholic beverages to children, and be published in English, German, Spanish, Portuguese or Polish (languages spoken by the research team). Studies were excluded if they focused on non-digital food marketing, focused on DFM to adults, focused exclusively on alcoholic beverages, were social marketing studies to improve children’s nutrition, or did not describe attitudes and/or awareness. Grey literature and opinion pieces were excluded. Reviews were also excluded although their reference lists were examined for possible relevant studies. We set no limits on study design (see Muc et al., 2022, for further details).

Search strategy and abstract screening

The search strategy was structured around three core concepts: population, digital marketing and food and beverages (see Table 1 below for concept grids). We worked with an expert research librarian to develop the search strategy in Medline, which was then translated across to PsycINFO, Academic Search Complete (Ebscohost), Scopus and CINAHL. We used a combination of free text terms and database-specific thesaurus terms, so each strategy varied slightly (see Supplementary File S1 for complete Medline search strategy).

After strategy refinement, we ran searches on 29 September 2022, identifying a total of 18,863 records; we updated this search on 22 March 2024, returning an additional 1,773 records. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was used to keep track of records (see Figure 1 and Supplementary File S3 for PRISMA-ScR checklist). De-duplication was carried out in Endnote™ bibliographic software, resulting in samples of 11,953 (September 2022) and 1773 (March, 2024). These samples were exported to Rayyan™ for abstract screening. Two reviewers (M.M.D.E. and E.V. and M.M.D.E. and E.B.) independently screened abstracts in Rayyan to identify 128 and 25 records eligible for full-text screening in 2022 and 2024, respectively. Full-text screening against inclusion/exclusion criteria was carried out in Excel, with two reviewers (M.M.D.E. and E.V. and E.V. and E.B.) again independently assessing eligibility and a third (C.K. or M.T.-G.) resolving conflicts. This resulted in a total of 40 studies for data extraction.

Data charting, analysis and synthesis

Two researchers independently extracted data on 10% of the sample initially to pilot the extraction sheet and develop a consistent approach. The remaining data were extracted and charted in Excel by a single reviewer (E.V.); charted data comprised location of study, sample size and characteristics, aims/purpose, methods and key findings relevant to the research questions. During data extraction in March 2024, we also decided to extract further data on types of DFM focused on by studies, and replicated this with the studies previously identified in September 2022. Study methods were categoried and counted; these data are available in Supplementary File S2. Charted data were synthesized by tabulation, to map findings to the each of the research questions (see Tables 2–4). Key findings mapped to RQs 2 and 3 for each study were exported to a Word document for coding, and additional analysis of themes. This facilitated development of a descriptive and narrative synthesis.

RESULTS

Origin of studies

Forty studies were included in the final sample for review. All studies were conducted in middle- to high-income countries, with the majority originating in Australia (25%), EU countries (17.5%), Canada (15%) and the UK (15%) (see Figure 2).

RQ1: What are the methods used to assess children’s and parents’ attitudes towards and awareness of digital marketing of unhealthy foods and beverages?

The majority of studies (55%) adopted a quantitative approach. The most commonly used data collection methods included cross-sectional survey (40%), and focus groups or group interviews (20%). A smaller proportion (17.5%) adopted experimental designs. The majority of studies were concerned with children/adolescents or young people (77.5%), with 12.5% on parents and children combined and 10% solely on parents. Most studies focused on DFM on social media (67.5%), and just over a fifth on influencer marketing. Just under a third did not specify a type of DFM strategy. (Supplementary File S2 contains a table that provides a quantified overview of basic study characteristics, including the proportion of study designs, population and type of DFM with which the study was concerned.)

For a detailed overview of study methods and types of DFM included see Table 2, which also includes details of study aims, sample size, cohort and basic demographic information (age group and gender breakdown, where provided). Further details of study methods mapped to the specific research questions and topics are outlined in the next sections detailing the findings of RQs 2 and 3.

RQ2: What are children, adolescents and young people’s awareness of and attitudes towards the digital marketing of unhealthy foods and beverages?

Twenty-six studies were mapped on to the topic of awareness of DFM, including quantitative (n = 15), qualitative (n = 8) and mixed- or multi-method studies (n = 3). Data collection methods involved cross-sectional surveys (n = 11), focus groups (n = 4), one-to-one interviews (n = 2), digital ethnographic approaches (n = 2), screen capture (n = 1), participatory approaches using specially designed apps (n = 3), go-along interview (n = 1), experimental design (n = 1) and a diary study (n = 1). Social media platforms most commonly mentioned or focused upon in studies included YouTube (Qutteina et al., 2019; Coates et al., 2020; Molenaar et al., 2021; Pollack et al., 2021; Ares et al., 2022, 2023; Jonatan et al., 2022; van der Bend et al., 2022; Elliott et al., 2023; Evans et al., 2023; Elliott and Truman, 2024), Instagram (Qutteina et al., 2019; Lutfeali et al., 2020; Bragg et al., 2021; Molenaar et al., 2021; Ares et al., 2022; Elliott et al., 2023; Elliott and Truman, 2024) and TikTok (van der Bend et al., 2022; Elliott et al., 2023; Elliott and Truman, 2024).

Awareness of DFM

Awareness, recall and recognition

Given the design of the majority of studies, awareness of DFM was captured mostly using self-reported exposure measures (see Table 3). The study with the largest sample size (n = 9171) and reach (six countries: four higher income, USA, UK, Canada and Australia, and two middle income, Mexico and Chile) found that between 27% (UK) and 60% (Chile) of adolescents aged 10–17 years recalled being exposed to DFM, with smaller proportions reporting exposure to marketing via computer or video games (Demers-Potvin et al., 2022). Whereas participants in Mexico and Chile reported the highest rates of exposure to sugary drinks, findings were more mixed for fast food DFM across higher- and middle-income countries (see also Moradi Latreyi et al., 2020). A large Australian study had broadly comparable findings, reporting that 55% of adolescents (n = 8708) aged 12–17 remember seeing a food or drink advertisement on social media at least weekly in the past month, with 25% reporting exposure daily or almost daily (Gascoyne et al., 2021). A Canadian study similarly found that 44% of respondents between the ages of 12 and 24 (n = 2040) reported seeing ads online/internet and 40% reported seeing ads on social media sites (Hammond and Reid, 2018). Van der Bend et al. interviewed Australian adolescents aged 13–16 after their screens had been recorded while they used their regular social media apps (Van der Bend et al., 2022). Here, the screen capture method showed that a median of 6 non-core social media food posts were delivered to participants per 10 min (32% branded content; 23% paid-for ads) (see also Qutteina et al., 2022), but 60% of these participants reported noticing the social media food posts just ‘sometimes’, ‘rarely’ or ‘never’.

Adolescents showed higher recall for unhealthy food advertisements compared to healthier options or non-food ads (Baldwin et al., 2018; Murphy et al., 2020; Norman et al., 2020; Molenaar et al., 2021; van der Bend et al., 2022; Ares et al., 2023; Evans et al., 2023). Ares et al. (Ares et al., 2023) further reported exposure to a burger ad was associated with greater brand recognition compared to ads for salad or clothing, particularly among female participants, while van der Bend (van der Bend et al., 2022) reported that recall for branded food products was higher than un-branded.

Digital critical literacy

Some children/adolescents appear to have a good understanding of the purpose, function and operationalization of food marketing on YouTube by influencers and YouTube personalities (Coates et al., 2020), particularly in relation to the transactional nature of the relationship between brands and YouTube influencers (Folkvord et al., 2019). At the same time, there is also evidence of difficulty recognizing some DFM formats, with participants (n = 832) aged 13–17 in one study performing worse than chance when asked to identify Instagram ads as compared to traditional ads (Bragg et al., 2021). Two studies reported that children have variable awareness of product placement and advertising in advergames (Mehta et al., 2014; Smith et al., 2020). Qualitative findings (albeit from a decade ago) from the UK report that while children may be aware of online advertising practices such as advergames, they sometimes lack recognition of its function as a marketing exercise (Newman and Oates, 2014). There may also be a gendered aspect to digital critical literacy: one study reported that boys had more difficulty identifying persuasive marketing techniques than girls (Amson et al., 2024), while another noted that boys were more willing to try an energy drink because of product placement in video games (Yang et al., 2022).

Gender, age and ethnic differences in self-awareness of ad exposure

Some studies reported gender, age and ethnic differences in awareness of DFM. An age gradient is apparent, with older teens self-reporting exposure to a greater volume of DFM than younger adolescents (Hammond and Reid, 2018; Acton et al., 2023). Ethnic minority youth in the US report greater exposure to and engagement with DFM than their White counterparts (Fleming-Milici and Harris, 2020; Acton et al., 2023). Children from lower-income families are more likely to report being exposed to marketing of unhealthy foods than children from higher-income backgrounds (Acton et al., 2023). Acton et al. also reported that boys were more likely than girls to be exposed to marketing in video games (p < 0.001) (Acton et al., 2023). A difference in self-reports of exposure by social media platform was found in one diary study, which showed that girls were more likely to share images from Instagram and Snapchat, while boys were more likely to share images from Facebook or YouTube (Qutteina et al., 2019).

Attitudes towards DFM

Twenty-three studies were mapped to the topic of attitudes towards DFM (see Table 3 for details), including quantitative (n = 11), qualitative (n = 8) and mixed- or multi-method studies (n = 4). Data collection methods used involved experimental designs (n = 6), focus groups (n = 5), cross-sectional surveys (n = 4), one-to-one interviews (n = 4), participatory approaches using specially designed apps (n = 2), digital ethnographic approaches (n = 1) and a tagging exercise (n = 1).

Preference of advertising genre/strategy

Compared to traditional forms of advertising, children and adolescents preferred influencer marketing and the types of food advertisements featured on Instagram (Bragg et al., 2021; Molenaar et al., 2021; van der Bend et al., 2022). At least one factor driving this preference includes ‘native’ style of advertising, in which food advertisements blend seamlessly into the feed or the content being delivered (Molenaar et al., 2021; Sutinen et al., 2024)—experienced as less intrusive and disruptive than pop-ups or distinct ads and thus more compatible to scrolling and viewing content (Coates et al., 2020). Instagram-style advertising is also seen as more trendy, artistic and likeable (Bragg et al., 2021). Despite stylistic preferences for influencer marketing, attitudes were somewhat ambivalent: a significant majority of children in one study thought it was stupid and wrong for vloggers to advertise (Folkvord et al., 2019), while adolescents and young people in other studies felt it was a necessary support for content creators (Pollack et al., 2021; Sutinen et al., 2024). One UK study of 10–11 year olds found that trust was contingent on a parasocial relationship with the influencer; participants trusted the content creators they followed, but were more sceptical of those less familiar to them (Coates et al., 2020).

Opinions on and attitudes towards DFM

Key attributes of online advertising that children and adolescents identified (across a range of study designs) as appealing to youth sensibilities included formal and cultural features such as colour, humour, visual style, music, celebrity and/or influencer involvement, positive emotions, and depictions of fun and youth culture (Norman et al., 2020; Bragg et al., 2021; Molenaar et al., 2021; Ares et al., 2022; Elliott et al., 2022, 2023; van der Bend et al., 2022; Elliott and Truman, 2024). Negative attributes included perceiving ads as annoying, intrusive, repetitive or deceitful (Thaichon and Quach, 2016; Coates et al., 2020; Molenaar et al., 2021; Ares et al., 2022). Opinions on and attitudes towards DFM more broadly were similarly mixed and sometimes contradictory. Adolescents and young people characterized online advertising as tempting (Holmberg et al., 2019; Gilmour et al., 2020; Ragelienė and Grønhøj, 2021; Ares et al., 2022), humorous or entertaining (van der Bend et al., 2022; Sutinen et al., 2024), effective and persuasive (Gilmour et al., 2020), or alternatively irritating (Coates et al., 2020). Even when they found it irritating, however, engaging with online advertising had an important social function, with participants in an Australian study valuing it for helping them stay ‘on-trend’ (Thaichon and Quach, 2016). There was evidence that DFM influences young people’s perceptions of brands and individuals. After playing an advergame for a particular product, brands were rated favourably across three attitude ratings (cool, exciting and fun), while participants perceived people who use the brands associated with the advergames as being cool (36%) (Norman et al., 2020). Similarly, in an experimental study in Ireland, where participants viewed fictitious social media profile feeds, they rated peers with unhealthy food ads in their social media news feeds more positively than those with non-food ads, and rated users with healthy food ads least positively (Murphy et al., 2020).

Children, adolescents and young people’s views on resistance to and regulation of DFM

A small number of studies explored perceived resistance to DFM (Coates et al., 2020; Molenaar et al., 2021) and adolescents’ views on mitigation measures (Ares et al., 2022). Participants reported strategies in which they ‘tuned out’ the effects of DFM (Molenaar et al., 2021), or exercised self-control (Ares et al., 2022). Others engaged in concrete strategies to mitigate against DFM effects, such as using ad-blocking software (Molenaar et al., 2021), or eating healthy food while scrolling on social media or watching YouTube, to resist the hunger the ad might induce (Coates et al., 2020). Some perceived themselves to be unaffected, or less affected than others (Coates et al., 2020). For example, 80% of participants (n = 127; ages 10–13) in a Dutch study believed others would be influenced to buy, or ask parents to buy advertised products (Folkvord et al., 2019), while adolescents (ages 13–18) in Uruguay believed that younger children are more susceptible to advertising effects (Ares et al., 2022). Only two studies explored the concept of regulation of food marketing online with adolescents (Ares et al., 2022; Carters-White et al., 2022). Participants aged 12–15 in Carters-White et al.'s (Carters-White et al., 2022) study were disparaging of the idea that the industry would regulate themselves, whilst participants in Ares et al. aged 11–17 endorsed regulation to reduce DFM exposure and behaviour change communication (Ares et al., 2022).

RQ3: What are parents’ awareness of and attitudes towards the digital marketing of unhealthy foods and beverages to children and young people?

Compared to children, adolescents and young people, the evidence for parents’ attitudes and awareness of DFM appears much less developed. Nine studies in total were mapped to RQ3, with seven studies mapping to the topic of attitudes and four to awareness. Most studies were qualitative (n = 7) and used interviews (n = 4), or focus groups (n = 3). Two studies were quantitative and used a cross-sectional survey design (n = 2) employing various measures (see Table 4 for a detailed overview).

Parents’ awareness of DFM to children

Some parents may have limited awareness of the extent of children’s exposure to DFM (Mehta et al., 2014; Jonatan et al., 2022). Notably, none of the identified studies appeared to discuss ‘native’ advertising or user-generated advertising strategies. In two older studies, parents were rather more concerned about advertising on TV than digital formats (Kelly et al., 2009; Newman and Oates, 2014). In some more recent studies, parents noted that advertising was pervasive (Thaichon and Quach, 2016; Eaton et al., 2022; Jonatan et al., 2022). Participants in one study were largely accepting that marketing was ubiquitous and an integral part of consumer society (Mehta et al., 2014). For some parents, then, there was a sense of inevitability and powerlessness against large corporations advertising these unhealthy commodities (Eaton et al., 2022).

Parents’ attitudes towards DFM to children

Some parents were sceptical about advertising influencing children (Cornish, 2014; Thaichon and Quach, 2016), believing that children likely found ads repetitive, annoying and off-putting, leading to doubt that young people pay much heed to them (Cornish, 2014; Eaton et al., 2022). However, some expressed concern that DFM led to purchase requests for unhealthy foods (Thaichon and Quach, 2016; Eaton et al., 2022), which can contribute to familial conflict and parental stress (Mehta et al., 2014). Parents expressed concern at food advertisers’ strategies, including the use of celebrity culture to leverage parasocial relationships (Eaton et al., 2022), and individualized marketing on children’s personal devices, perceived to be ‘under the radar’ of parents’ supervision (Mehta et al., 2014). Ultimately for some parents, such practices led to concern that DFM may wield sufficient influence that could negatively impact their children’s health (Mehta et al., 2014). In an older study, only some parents reported that internet use was moderated/mediated but for ‘unsuitable’ or inappropriate content rather than advertising, however, others reported that their children were not allowed to use the internet unless a parent was present (Newman and Oates, 2014). Note that most of the studies cited here date from 2014 to 2016, when children’s access to internet-connected devices was substantially less than it is now.

Parents’ views on regulation and responsibility

Four parent studies focused (Carters-White et al., 2022; Nuss et al., 2024) or touched on (Mehta et al., 2014; Newman and Oates, 2014) regulation. A recent cross-sectional survey of adults, including parents, in Australia found over two-thirds (68%) supported governmental policies to regulate DFM to children online and significant disapproval (81%) of companies gathering children’s personal data for marketing (Nuss et al., 2024). Parents in Mehta et al. were ‘cynical’ of the capacity of corporations to act ethically and thus favoured governmental regulations (Mehta et al., 2014). In three studies, participants emphasized parental responsibility for protecting their children from food companies’ marketing, while expressing ambivalence and scepticism about the concept of corporate responsibility (Mehta et al., 2014; Newman and Oates, 2014; Carters-White, 2022). In those same studies, while there was acknowledgement and acceptance of the need for some regulation to protect children, advertising was also seen as a natural and inevitable necessity, businesses were seen as having a ‘right’ to market their products, and some viewed regulation as over-reach, which risked infringing on rights of individual autonomy (Mehta et al., 2014).

DISCUSSION

The aim of this review was to scope the literature on parents’, and children, adolescents and young people’s awareness of and attitudes towards DFM of unhealthy food and beverages, and to explore the methods used to carry out such studies. The findings provide a broad overview of the landscape, and highlight a number of key gaps. This section contextualizes and critically examines these findings, before discussing limitations of the study and concluding by outlining specific gaps, challenges and implications.

A need for child-centred participatory methods

Regarding methods, we found that quantitative cross-sectional designs dominate this space, although there is some indication that creative, participatory and digital ethnographic approaches are increasingly being employed. There are few qualitative studies seeking to understand children and young people’s perspectives, and none of the studies reported the involvement of children or young people as advisors or in the design or co-creation of studies. This may point to missed opportunities, as children are better positioned to advise on the ‘local context’ of digital and online spaces, and can help researchers navigate and capture the complexity of the DFM landscape, and young people’s exposure and engagement therein. For example, studies in health promotion that have adopted research methods that take as their starting point a citizen-child approach—in which children are viewed as agential subjects with rights to participate in decision-making about their lives—have yielded insightful findings into how children distinguish play/sport from physical activity/exercise, and shown how the natural and built environment can shape and constrain children’s engagement in daily physical activity (MacDougall and Gibbs, 2022). Moreover, the inclusion of children in the development of studies can have a tangible impact at policy level. For instance, child-developed indicators of hobbies and well-being generated from participatory workshops in Ireland are now routinely included in the nationally representative Health Behaviours in School-Aged Children survey, and were selected by policy-makers to help monitor implementation of the national policy framework for children and young people (0–24 years) (Kelly et al., 2021).

Child-led methods that can better help researchers understand and navigate the digital worlds of children are needed, given that the findings indicate that while both children and parents are aware of DFM, the extent of their awareness may be somewhat constrained, and they might underestimate its effects. Importantly, a study in the review combining screen capture with post-capture interviews showed that a significant proportion of DFM went un-noticed (van der Bend et al., 2022), suggesting that self-reported exposure to DFM may be underestimated and underreported, and thus awareness may be limited. As exposure to advertising on social media increases brand consideration and choice even under low attention (Santoso et al., 2020), supported by dual-process models of advertising effects that indicate impact under low-attention conditions (Nairn and Fine, 2008), this suggests researchers interested in further building the evidence-base to advocate for regulation of DFM may want to focus their efforts on study designs that circumvent reliance on self-report measures. However, self-reported attitudes and awareness remain of interest as these generate insights into families’ interpretive worlds and practices regarding food and food marketing.

Lack of focus on specific digital marketing tactics

A notable finding from the review is that while most studies focused on social media and influencer marketing, a significant proportion did not specify the precise genre or strategy of DFM. Moreover, few studies explored awareness or understanding of different marketing tactics, among either parents or children, adolescents and young people. While this highlights a gap, it is also a concern, given the apparent growth in covert and viral marketing strategies, including so-called ‘native’ marketing that mimics the look and feel of regular social media content. Industry publications regularly tout the value and effectiveness of native marketing as a means to circumvent ‘banner blindness’, and increase clicks and sales (Challinor, 2021), and it accounts for an increasing proportion of advertising spend. Native marketing approaches amounted to approximately $87.6 billion in 2022 (Yeun, 2022), and industry sources estimate projected growth to approximately $300 billion by 2031 (Business Research Insights, 2024). In a similar vein, deliberate instigation of branded hashtag challenges by unhealthy food brands is a strategy increasingly promoted to marketers by platforms as a cost-effective way to ‘spark trends and cultural movements’ (TikTok, 2024a). Reach of such strategies is extensive: one study reported the total collective views of user-generated content ranged from 12.7 million to 107.9 billion per challenge (Brooks et al., 2022). One specific such campaign on TikTok by Pepsi reportedly resulted in excess of half a million unique videos created by platform users, and over 3.1 billion video views (TikTok, 2024b). User-generated viral marketing approaches may be especially effective as adolescents trust their online peers more than companies (Harris et al., 2021). The industry shift towards native and user-generated viral marketing approaches should therefore be viewed with concern by health promoters and policy-makers alike, as the findings here suggest young people tend to favour the style and tactics used in these types of marketing strategies (Elliott and Truman, 2019), have difficulties identifying them as advertising (Harris et al., 2021), and thus may be more vulnerable to their effects.

Addressing manipulative tactics and health inequalities

The online environment has become a site of vital importance for the development of youth learning, information and identities. However, the ability of marketers to tap into platforms to exploit youth interests and desires means that DFM is becoming problematically intertwined with youth social and peer norms online (Thaichon and Quach, 2016). Lyons et al. have coined the term ‘limbic platform capitalism’ (the brain’s limbic system processes basic and powerful emotions) to describe the way in which platforms leverage algorithmic data to manipulate emotions by targeting users’ limbic pleasure centres to maximize engagement and market commodities more effectively (Lyons et al., 2023). Evidence from this review suggests that children and young people respond to DFM in precisely this way, with participants across multiple studies consistently describing food marketing as appealing to youth sensibilities through positive emotion. While acknowledging that children and young people have agency, it is also important to identify manipulative tactics that undermine their autonomy (Susser et al., 2019; Tatlow-Golden and Garde, 2020). Seeking ways to counteract such tactics is, moreover, essential to address health inequalities, as findings here indicate that DFM likely does not affect all children and young people equally. Evidence suggests boys and girls are targeted differently, while minority ethnic and lower-income children may experience greater exposure. Although most studies in this review emanated from higher-income countries, exposure data from larger multi-country studies such as Demers-Potvin et al. (Demers-Potvin et al., 2022), which included four higher-income and two middle-income countries, indicate there may be additional disparities across country lines. While precise data on exposure are difficult to glean given the reliance on self-report and the challenges of securing actual data on children’s exposure in digital media (Tatlow-Golden et al., 2021), it is nonetheless clear that DFM affects a large swathe of children and young people globally and is thus both a universal and an intersectional public health issue.

Third-person effect and implications for support for regulation and policy measures

A key and intersecting finding is that many young people and parents appear to underestimate children’s susceptibility to the persuasive effects of advertising. Many children appear to believe they can resist the effects of advertising and assume that others are more susceptible. This indicates support for the ‘third-person effect’ in relation to DFM—which Driessen et al. (Driessen et al., 2022) similarly discuss in their review of parents’ perspectives—by which individuals perceive themselves as more impervious than others to media and advertising messaging (Perloff, 1999). This has implications in terms of attitudes to regulatory regimes. While a number of studies here suggested that children and some parents are supportive of regulatory policy measures, at least some parents were ambiguous on this. Yet few studies investigated such views, so it is difficult to say with certainty what the level of support for regulation may be among parents, particularly in a context of limited awareness of the scope of and strategies employed by digital food marketers. Evidence elsewhere, however, suggests that young people support restrictions that curtail harmful commercial practices (Pitt et al., 2024). Encouragingly, there are also examples of resistance and youth advocacy. BiteBack, a youth-led UK organization, for instance, actively campaigns to end junk food advertising to young people online, and is a promising model for youth-led activism to counteract the insidious practices of food marketers online (BiteBack, 2024).

Limitations and strengths

There are several limitations as well as strengths to this review that should be noted. As we focused on peer-reviewed literature and excluded grey literature, it is possible we omitted relevant material. Most data extraction was carried out by a single reviewer, providing consistency, although dual extraction may be considered preferable. We did not carry out a risk of bias assessment on the gathered literature, as this is not a requirement of a scoping review, although it might be useful. Despite these limitations, our search strategy was robust and registered, and our methods are transparent and re-producible.

CONCLUSION: GAPS, CHALLENGES AND IMPLICATIONS

The findings of this review highlight several gaps, challenges and implications.

Self-reported exposure of children and young people to DFM is not a reliable indicator of actual exposure. Not only may children and young people have difficulty discerning commercial content and/or the intent and purpose of viral and native marketing to increase brand recognition, but also well-established theory of and evidence for dual-process models of cognitive processing demonstrate that material that is not consciously recognized and recalled also affects advertising responses (Harris et al., 2009). Screen capture measures of exposure are the only dependable method to capture the true extent of child and adolescent exposure to DFM (WHO, 2019; Tatlow-Golden et al., 2021). Additionally, creative and qualitative methods are underrepresented in the literature and would allow researchers to tease out awareness of and attitudes towards different forms of DFM, particularly native approaches, branded hashtag challenges and the many other less formal marketing methods currently being developed (Montgomery and Chester, 2009; Tatlow-Golden and Parker, 2020). Furthermore, as children and young people have insight into their lives that researchers and adults do not, it is essential that they are involved in the design and development of studies.

As industry consistently innovates advertising methods, further in-depth understanding of young people’s real-time experiences online is vital to inform the development of policy and critical digital literacy resources. Thus, as we have articulated elsewhere (WHO, 2016) as have others subsequently (e.g. Lyons et al., 2023), we need to invest in a transdisciplinary research agenda grounded in an understanding of young people’s vulnerabilities, agency and rights in this space. In a fast-paced digital environment, the slower nature of academic research and publishing can inhibit the timely sharing of knowledge compared to the pace of industry change. These elements mean that progress by researchers in this field is frequently being outpaced by the rapid shifts in the online digital environment. Researchers and research commissioners need to acknowledge this and endeavour to find innovative methods to access and assess the digital commercial environment and its encroachment on youth culture and health, and quicker, more efficient ways of disseminating and exchanging knowledge.

Digital food marketing represents a threat to children and young people’s rights including right to health, privacy and freedom from economic exploitation (Tatlow-Golden and Garde, 2020), thus the knowledge gap on both parents and, children, adolescents and young people’s views on regulation should be addressed urgently. Despite political and policy systems not always prioritizing children’s views, children and young people have expertise in their digital worlds and they can and should play a role in decision-making, such that critical digital literacy efforts should extend to understanding the questions of structure and power that determine the marketing content served to them that seeks to influence their behaviours (Sykes et al., 2013; Crondahl and Eklund Karlsson, 2016; Paasche-Orlow et al., 2018; Pangrazio and Selwyn, 2018). Framing of the problem as a child rights issue may help to persuade States of the need, and indeed their obligation under the UN Convention on the Rights of the Child, to act decisively to protect the health and well-being of all children from the marketing of harmful products.

ACKNOWLEDGEMENTS

Many thanks to Ms Rosie Dunne, expert research librarian at the University of Galway for her advice and guidance. Thanks also to staff and students at the Health Promotion Research Centre, University of Galway.

FUNDING

This study was funded by a grant from Safefood (04-2021).

CONFLICT OF INTEREST

Prof. Tatlow-Golden receives consultancy fees from UNICEF and the World Health Organization for research into children, young people and food marketing. All other authors have no conflicts of interest to report.

DATA AVAILABILITY

No new data were generated or analysed in support of this research.

ETHICAL APPROVAL

No ethical approval was required for this study.

References