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. 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
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. 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. 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.
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.
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
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 and most tobacco abuse begins by age
16. 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.
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
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. Approximately 2 million
teenagers begin smoking cigarettes each year. 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.
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.
Advertising for Camel cigarettes was more effective among
children and adolescents than among adults. Camel's share
of the illegal children's cigarette market represents sales
of $476 million per year--one-third of all cigarette sales
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.
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. Nonetheless,
American children view nearly 2000 beer and wine commercials
per year on television. Alcohol advertising specifically
targets young people by showing the supposed advantages of
drinking--more friends, greater prestige, more fun, and greater
sex appeal--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.
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.
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. Guidelines for appropriate sexual content
in advertising messages exist and should be followed.
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
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
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,
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
8. Funding should be increased to continue the study of the
effects of television and other media on behaviors of children
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
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
5. Liebert RM, Sprafkin JN. The Early Window: Effects of Television
on Children and Youth. 3rd ed. New York, NY: Pergamon Press;
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;
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.
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
20. Rosen DS, Xiangdong M, Blum RW. Adolescent health: current
trends and critical issues. Adolesc Med: State of the Art
21. Postman N, Nystrom C, Strate L, Weingartner C. Myths,
Men, & Beer. Washington, DC: AAA Foundation for Traffic
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.