Children, Adolescents, and Advertising (RE9504)
AMERICAN ACADEMY OF PEDIATRICS

Committee on Communications

Advertising is a powerful force in American culture. It exists to sell products and services. In 1750 BC the Code of Hammurabi made it a crime, punishable by death, to sell anything to a child without first obtaining a power of attorney. In the 1990s, selling products to American children has become a standard business practice.
American children have viewed an estimated 360 000 advertisements on television before graduating from high school.[1] Additional exposures include advertisements on the radio, in print media, on public transportation, and billboards. Commercials have even entered the classroom through programs like Channel One--video equipment packaged with current events programming that contains commercials.

The principal goal of commercial children's television is to sell products to children, with food and toys being the two most frequently advertised product categories.[2] Advertisers generally use two approaches to sell their products. The traditional method places commercials in programs that are attractive to children. These commercials promote products unrelated to the program being shown. The second approach, begun in 1982, features toy action figures as the main characters of a program. Because these programs are often developed by the marketing division of toy companies to market specific toys, they are frequently referred to as "program-length commercials."

The Children's Television Act of 1990 mandates that all broadcasters carry children's educational or instructional programming as a condition for license renewal. One of the problems of the current law is that stations can cite public service announcements (PSAs) or short vignettes as evidence of compliance. These actions may fulfill the letter of the law; however, they do not fulfill its intent. In fact, good evidence exists that the Children's Television Act of 1990 is being undercut already, even in the law's first year of enactment.[3] Because programming practices can be challenged only at the time of licensure renewal, local monitoring is essential. Local monitoring is the only way to ensure that stations are complying not only with the letter of the law, but also with the INTENT of the law, which is to create a better television programming environment for children. Networks appear to be violating the law's intent by airing cartoons and claiming them as educational programming.[3]

In addition to improving the quality of programming, the Children's Television Act of 1990 also limits commercial time during children's programming to 10 1/2 minutes per hour on weekends and 12 minutes per hour on weekdays. Part of this act directs the Federal Communications Commission (FCC) to consider whether children's programs based on toys constitute program-length commercials. The FCC concluded that only those shows that include paid advertising for the toy(s) featured in the program can be classified as program-length commercials. Even though the FCC has enforced this guideline, it appears that it is too narrow and should address all program-length commercials. In addition, the Children's Television Act established the Children's Television Endowment Fund to encourage the development of new educational programming for children.

EFFECTS OF ADVERTISING ON CHILDREN

There have been numerous studies documenting that young children under 8 years of age developmentally are unable to understand the intent of advertisements and, in fact, accept advertising claims as true.[4,5] Indeed, the youngest viewers, up to age 8, cannot distinguish advertising from regular television programming.[4,5] In addition, advertisers have become adept at circumventing rules and minimizing warnings. For example, the disclaimers "some assembly required" or "when eaten as part of a complete nutritional breakfast" are spoken rapidly by the announcer or shown in small print, and are not understood by most children.[5]
Commercials broadcast during children's programs also promote foods that may have an adverse influence on children's health. Television viewing has been associated with obesity, the most prevalent nutritional disease among children in the United States.[6,7] Food commercials that are broadcast during children's programming often promote high-calorie foods which, when eaten too often, may contribute to the energy imbalance that promotes obesity.
The barrage of advertising for food and toys, especially on Saturday morning television, may also result in increased conflict between parents and their children.[4,5] The American Academy of Pediatrics believes advertising directed toward children is inherently deceptive and exploits children under age 8 years of age.

EFFECTS OF ADVERTISING ON ADOLESCENTS

Adolescents are capable of understanding the nature of advertisements. However, many of the products advertised to adolescents are harmful to their health. Nearly 90% of high school seniors have tried alcohol[8] and most tobacco abuse begins by age 16.[9] Beer, wine, and liquor companies spend over $2 billion per year on advertising and promotion. Cigarette manufacturers spend $3.25 billion per year solely on advertising.[10,11] Although the advertisers insist that their intent is to promote brand selection, an unacknowledged consequence is increased product consumption. Good data support this assertion.[4,5] In the United States, the increased per capita consumption of alcohol parallels expenditures on beer and wine advertising.[12] In the mid-1970s the per capita consumption of alcohol in Sweden decreased by 20% after all beer and wine advertising was banned. In Japan, consumption of cigarettes has increased substantially since a massive cigarette advertising campaign was begun.[13]

CIGARETTES

In the United States, tobacco consumption causes over 400000 deaths per year and contributes to more than one of every six deaths.[14,15] In 1988 alone, teenagers spent $1.26 billion on cigarettes and smokeless tobacco.[14] Approximately 2 million teenagers begin smoking cigarettes each year.[14] Despite the ban on television advertising of cigarettes, the prominent display of logos, billboards, and banners in televised sports events makes cigarette advertising on American television more prominent than ever before.[16]
In two recent studies, one-third of 3-year-old children and nearly all children older than age 6 were able to recognize the Old Joe Camel logo.[17,18] By age 6 the Camel logo is as familiar to children as Mickey Mouse.[17]
Advertising for Camel cigarettes was more effective among children and adolescents than among adults.[18] Camel's share of the illegal children's cigarette market represents sales of $476 million per year--one-third of all cigarette sales to minors.[18]

BEER AND WINE

Alcoholic beverages represent a major health risk to American youth. In 1993, 3137 young people who were 16 to 24 years of age died in alcohol-related motor vehicle crashes.[19] In addition, alcohol is involved in more than one-fourth of teenage suicides and homicides, which are the second and third leading cause of deaths for that age group.[20] Nonetheless, American children view nearly 2000 beer and wine commercials per year on television.[12] Alcohol advertising specifically targets young people by showing the supposed advantages of drinking--more friends, greater prestige, more fun, and greater sex appeal[21]--and suggesting that without alcoholic beverages teens cannot have fun or be popular.
There is compelling public health interest in protecting children and adolescents against both cigarette and alcohol advertising. Counter-advertising aimed at alcoholic beverages or cigarettes is effective but rarely seen, especially when compared with ads against marijuana and cocaine.[2]

RESPONSIBLE SEXUAL BEHAVIOR

Billions of dollars are being spent to encourage children and adolescents to buy products that are not healthy for them, with American advertising messages often including inappropriate sexual innuendos in an attempt to sell their products. Conversely, PSAs for abstinence and birth control products--which could prevent unwanted teenage pregnancies and sexually transmitted diseases including acquired immunodeficiency syndrome (AIDS), remain largely forbidden by national network television.[22] The 1985 Guttmacher report found that the United States has the highest teenage pregnancy rate in the Western world due, in part, to inadequate access to birth control products, inappropriate depictions of sexuality in American media, and inadequate sex education.[23] Guidelines for appropriate sexual content in advertising messages exist and should be followed.[24]

RECOMMENDATIONS OF THE COMMITTEE ON COMMUNICATIONS

One conclusion might be to ban advertising directed at children under age 8 and recommend that all advertising directed toward adolescents should promote health. However, the viewing audience cannot be accurately sequestered by age, and a ban would also infringe on the rights of free speech directed at older children. Therefore, the American Academy of Pediatrics recommends the following:

1. All toy-based programs (as defined by the FCC), since they truly represent commercials for products, should be regulated by the FCC.
2. There should be stricter enforcement of existing regulations that define the nature and content of educational programs. Strict and heavy fines should be imposed when such violations are proved.
3. There should be stricter limitations on the amount of advertising permitted on children's television (eg, no more than 5 to 6 commercial minutes per hour on weekday or weekend programming). This would decrease the current limits by approximately 50%.
4. There should be increased funding of the Children's Television Endowment Fund. Funds should be used to underwrite the production of high-quality, educational programming for children. This programming could be broadcast on either current public broadcasting systems or a new commercial-free public station for children. This fund should be augmented by a new 10% surcharge on advertisers who target children and adolescents.
5. There should be a ban on all tobacco and alcohol advertising in all media. This ban should include all "passive" advertising in sponsored sports events (ie, banners, logos, etc).
6. PSAs dealing with AIDS should emphasize the use of condoms as well as benefits of abstinence for adolescents. Broadcast of advertising for condoms and other birth control products should also be increased through commercial channels targeted to adolescents and young adults, including cable.
7. "Anti-drug" PSAs should receive more prominent airing during prime time hours. Drug-related counter-advertising should target cigarettes and alcohol, in addition to marijuana and cocaine.
8. Funding should be increased to continue the study of the effects of television and other media on behaviors of children and adolescents.
9. Parents must educate children to be responsible and informed consumers. A variety of resources should be developed to help parents teach children that commercials are designed to sell products. These resources should be made available to parents through schools, libraries, and pediatricians' offices. School-based curricula that teach children and adolescents media literacy should be developed and disseminated.
10. Parents, interested groups, committees of the Academy (nationally and locally), and pediatricians should monitor local television broadcasts to ensure adherence to existing limits on commercial time. There must be stronger support for strict FCC monitoring of local television stations' adherence to the Children's Television Act of 1990.

COMMITTEE ON COMMUNICATIONS, 1993 TO 1994
Steven Shelov, MD, Chairman
Miriam Bar-on, MD
Lillian Beard, MD
Marjorie Hogan, MD
H. James Holroyd, MD
Bob Prentice, MD
S. Norman Sherry, MD
Vic Strasburger, MD

REFERENCES
1. Strasburger VC. Children, adolescents, and television 1989, II; the role of pediatricians. Pediatrics. 1989;83:446-448
2. Dietz WH, Strasburger VC. Children, adolescents and television. Curr Probl Pediatr. 1991;21:8-32
3. Center for Media Education, Institute for Public Representation. A Report on Station Compliance With the Children's Television Act. Washington, DC: Georgetown University Law Center; 1992
4. Atkin CK. Television advertising and socialization to consumer roles. In: Pearl D, Bouthilet L, Lazar J, eds. Television and Behavior: Ten Years of Scientific Progress and Implications for the Eighties. Rockville, MD: National Institute of Mental Health; 1982:191-200
5. Liebert RM, Sprafkin JN. The Early Window: Effects of Television on Children and Youth. 3rd ed. New York, NY: Pergamon Press; 1988
6. Dietz WH, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75:807-812
7. Wong ND, Hei TK, Qaqundah PY, Davidson DM, et al. Television viewing and pediatric hypercholesterolemia. Pediatrics. 1992;90:75-79
8. Johnston LD, O'Malley PM, Bachman JG. Monitoring the Future Study, 1975-1993. Rockville, MD: National Institute on Drug Abuse (NIH Pub No 94-3809); 1994
9. US Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1994
10. Atkin CK. Effects of televised alcohol messages on teenage drinking patterns. J Adolesc Health Care. 1990;11:10-24
11. Centers for Disease Control. Cigarette advertising--United States, 1988. MMWR. 1990;39:261-265
12. Strasburger VC. Adolescents, drugs, and the media. Adolesc Med: State of the Art Rev. 1993;4:391-415
13. Kawane H. The influence of the US tobacco industry in foreign markets. N Engl J Med. 1991;325:815-816
14. DiFranza JR, Tye JB. Who profits from tobacco sales to children? JAMA. 1990;263:2784-2787
15. Centers for Disease Control. The Surgeon General's 1989 Report on Reducing the Health Consequences of Smoking: 25 Years of Progress (Executive Summary). MMWR. 1989;38(suppl):1-32
16. Blum A. The Marlboro Grand Prix: circumvention of the television ban on tobacco advertising. N Engl J Med. 1991;324:913-917
17. Fischer PM, Schwart MP, Richards JW, et al. Brand logo recognition by children aged 3 to 6 years. JAMA. 1991;266:3145-3148
18. DiFranza JR, Richard Jr JW, Paulman PM, et al. RJR Nabisco's cartoon camel promotes Camel cigarettes to children. JAMA. 1991;266:3149-3153
19. National Center for Statistics and Analysis. National Highway Traffic Safety Administration. Traffic Safety Facts 1993: A Compilation of Motor Vehicle Crash Data From the Fatal Accident Reporting System and the General Estimates System. Washington, DC: National Center for Statistics and Analysis; 1993. US Department of Transportation publication DOT HS 808 169.
20. Rosen DS, Xiangdong M, Blum RW. Adolescent health: current trends and critical issues. Adolesc Med: State of the Art Rev. 1990;1:15-31
21. Postman N, Nystrom C, Strate L, Weingartner C. Myths, Men, & Beer. Washington, DC: AAA Foundation for Traffic Safety; 1988
22. American Academy of Pediatrics Committee on Adolescence. Sexuality, contraception, and the media. Pediatrics. 1986;78:535-536
23. Jones EF, Forrest JD, Goldman N, et al. Teenage pregnancy in developed countries: determinants and policy implications. Fam Plann Perspect. 1985;17:53-63
24. Advocates for Youth. Guide to Responsible Sexual Content in Television, Films, & Music. Washington, DC: Advocates for Youth; 1989

---------------- The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
PEDIATRICS (ISSN 0031 4005). Copyright (c) 1995 by the American Academy of Pediatrics.
No part of this statement may be reproduced in any form or by any means without prior written permission from the American Academy of Pediatrics except for one copy for personal use.