Summary of main findings
This study found that adolescents across Australia, Canada, Chile, Mexico, UK and USA are self-reporting considerable amounts of time viewing screen-based media, although these self-reported estimates include simultaneous viewing of multiple media. Digital media accounted for the most time on screens and social media use varied by platforms. Across all countries, self-reported exposure to advertisements in the past 30 days was most frequent on television, followed by digital media and gaming platforms. Between-country differences were identified: participants in the UK reported less daily exposure to fast food and sugary drink advertisements, whereas participants in the USA reported greater daily exposure to fast food advertisements. Most importantly, our results show that in all countries, self-reported exposure to advertisements increased with greater screen time. Analyses suggested important differences in self-reported exposure to screen-based media and social media platforms between age groups, with older adolescents generally reporting a greater exposure.
Relationships with existing knowledge
The estimates from this study are similar to other international estimates of self-reported screen time. In the USA, screen time among children 8–12 years in 2019 was estimated to be 4 hours 44 min, and 7 hours and 22 min among 13–18 year olds,32 compared with over 9 hours in the current study among the older age group. A large national Canadian study from 2013 to 2014 suggests that youth ages 13–18 spent on average between 7.6 hours and 8 hours in front of screens daily (depending on province and sex),33 very similar to the current findings of approximately 8.5 hours among older adolescents. However, the current estimates appear to be higher than several European estimates from various countries,34 which may be due to differences in the types of questions asked and the study context that may affect recall and self-report. Even with limitations on the precision of screentime estimates due to self-report, most participants in the current study exceeded screen time guidelines across countries, which recommend entertainment screen time be limited to less than 2 hours daily for school-aged children and adolescents.35–37 Screen time has previously been associated with youth obesity,38 39 poorer diet quality40 and consumption of less healthy foods and beverages.41 42 The general level of exposure reported among the sample, while an approximation, is cause for concern.
The large proportion of adolescents reporting using social media platforms has important implications for food and beverage marketing. Companies are increasingly developing strategies to engage with their audience through these media platforms, which have a high likelihood of reaching children and adolescents even when they are not the primary target audience. Research from Canada has estimated that children ages 7–11 years were exposed to food and beverage marketing (of which the great majority is ‘less healthy’) on social media apps 30 times per week while adolescents ages 12–16 years were exposed on average 189 times per week.23 In our study, adolescents reported using two social media platforms on average, therefore exposing them to various types and amounts of marketing strategies across platforms. For instance, Instagram—the most commonly reported social media platform among participants—is known to promote poor nutritional quality foods and are commonly promoted through popular brand accounts using a range of marketing strategies that appeal to a young audience, such as competitions and the use of characters.43 Unhealthy food brands on Facebook are known to use techniques such as competitions based on user-generated content, interactive games and apps.44
In this study, a greater proportion of adolescents reported exposure to advertisements for unhealthy foods or drinks on television compared with websites, social media applications or gaming sites. Greater reporting may be in part due to the different types of advertising between these channels. In order for children and adolescents to be aware of advertisements, they need not only to be able to identify the difference between an advertisement and other content but also to understand the persuasive intent behind the message.15 Self-reported exposure to advertisements on television may have been higher as it is more easily identifiable compared with digital marketing, which often uses subtle marketing techniques (eg, celebrity endorsements by influencers and native advertising designed to imitate editorial content) and is frequently disguised as entertainment.15 16 On digital media, adolescents may simply be less able to discriminate advertisements from other content, making marketing on these channels particularly alarming. Digital marketing via advertisements is typically targeted, using cookies and other means, which record personal preferences, online activity and location and these data are then used to personalise and target the content of marketing to individual users, therefore increasing the persuasive power of marketing.10 11 The subtle advertising techniques used on digital media, such as influencer endorsements or advergames, may be more likely to bypass children’s and younger adolescents’ cognitive awareness. Our data align with marketing expenditure data, an objective indicator of marketing efforts by companies: fast food advertisement expenditures are the highest for television, although digital marketing expenditures increased by 74% between 2012 and 2019.45 However, digital marketing expenditures are likely underestimated as not all industry spending can be captured and spending is not necessarily associated with the reach of the message on digital media.46 Therefore, both self-reported exposure data and the general digital marketing expenditure data likely underestimate the amount of digital marketing to which adolescents are currently exposed.
Self-reported daily exposure to advertisements was common for both fast food and sugary drinks, with 34% and 25% of the sample reporting daily exposure, respectively, in all countries. Perhaps unsurprisingly, those reporting more screen time were more likely to report daily exposure to sugary drinks and fast food advertisements. Differences across countries may in part relate to differences in restrictions on marketing directed at children. In the UK, where participants were less likely to self-report daily exposure to advertisements for fast food and sugary drinks than those in all other countries, a total ban of advertisements for unhealthy foods and beverages has been in place since 2007 during and adjacent to television programmes appealing to children and adolescents under the age of 16.47 The lower likelihood of self-reported exposure to advertisements aligns with what would be expected with the UK’s current policy in place, although evidence on the impact of the UK policy is mixed. Findings suggest that despite some changes in children’s exposure, advertisements typically shifted to other media channels, implying important loopholes in regulations.48 49 In the USA, where participants were more likely to report daily exposure to fast food advertisements than those in all other countries, voluntary self-regulatory approaches to restrict marketing by the industry are the only form of marketing restrictions, which target children under 12 years of age on media where the audience is mostly children50 and have largely proven ineffective at decreasing children’s exposure to marketing for unhealthy products.45 51 52 It is important to note that the present study cannot capture the effectiveness of restrictive marketing policies by its cross-sectional design, but studying trends in self-reported screen time, social media use and exposure to advertisements annually over time using the IFPS should help evaluate the impact of impending policies, such as the recently announced policy in the UK, which will ban online advertising by the end of 2022 and ban advertising of foods high in fat, sugar and salt between 5:30 am and 9:00 pm.53–55
Age group was an important predictor for reported screen-based media and social media exposure, with older adolescents reporting spending more time on screens and using social media platforms more than younger adolescents. Older adolescents may be an age group of particular interest to marketers because of their greater spending power compared with younger adolescents, which also increases with age, therefore having the potential to create life-long brand relationships and product consumers.56 57 Marketers target adolescents through digital media by using ‘ubiquitous connectivity, personalisation, peer-to-peer networking, engagement, immersion and content creation’, which are features especially appealing to this age group.57 In our study, there were no differences in self-reported daily exposure to sugary drink and fast food advertisements between age groups. Despite adolescents having an improved ability to recognise advertisement content and the persuasive intent of marketing compared with children, adolescents may be even more vulnerable to digital food marketing, because of their increased use of these platforms as well as desire to conform with social norms in their peer group.58 59 Greater exposure to digital and social media platforms may also increase the number of subtle marketing strategies, for example, viral marketing (peer-to-peer), contests, quizzes and marketing by influencers, which may not be captured in self-report measures if the participant is unable to identify these as marketing strategies.
Strengths and limitations
This study has a large sample size, and the same measures were used across countries, allowing justifiable comparisons between countries. Many studies use gross rating points or expenditure data as a proxy for exposure to advertising. While the latter provide objective data, they are unlikely to be accurate for digital advertising46 and do not indicate who is exposed at the individual level, including individual-level correlates. More intensive approaches—such as devices that directly monitor websites or device usage—provide precise measures of exposure to marketing but are typically less feasible at a population level. One of the major strengths of this study is the wide range of social media platforms and the differentiated locations of exposure to screen-based advertising assessed. Self-reported exposure to food marketing is a method used by researchers in large population samples58 60 61 as a subjective indicator of actual exposure, although actual exposure is likely to be higher because of the frequent and implicit nature of marketing, resulting in a probable underestimation of exposure to marketing. Our measures may further underestimate exposure as such a measure may be less reliable in a sample of adolescents due to risk of recall errors, and inability to recognise all forms of marketing (particularly in digital media).15
This study is subject to limitations common to survey research. Respondents were recruited using non-probability-based sampling; therefore, although the data were weighted by age group, sex, region and ethnicity (except in Canada), the findings do not provide nationally representative estimates. In addition, there were notably higher levels of missing data for BMI in the UK. The measures used also have some limitations. For example, time spent watching cable television versus on streaming applications (Netflix, Crave, Amazon Prime Video, etc) was not distinguished in this study. The amount of marketing exposure on cable television and free streaming websites compared with subscription platforms (that are typically ad-free) is likely very different, and this may play an important role in understanding the amount of exposure. Additionally, adolescents retrospectively self-reported the estimated screen time spent on each media channel rather than using a more objective approach, and this may have been influenced by whether or not a parent was present when completing the survey. This approach has not yet been validated in the literature but nevertheless seems comparable to self-report estimates from other surveys. Responses may not be precisely accurate and likely overestimate the absolute amount of screen time reported by youth as overall exposure was calculated by summing self-reported exposure to individual media channels and, thus, may include simultaneous use of multiple screens. Indicators of simultaneous viewing of screens were not directly measured in the survey. Nevertheless, this tool allows for comparisons of the relative amount of exposure across countries, as it is likely that the challenge of estimations, and associated error, would be similar across countries. Finally, the measures did not distinguish between recreational screen time and screen time that was spent for school purposes (eg, on websites).
These results reinforce the need to implement restrictive policies on marketing of unhealthy food and beverages appealing to a young audience, not only on television but also on digital media considering the widespread self-reported usage of social media platforms among adolescents across countries and the persuasiveness of marketing that is often targeted. Future research examining children’s and adolescents’ exposure to digital marketing, as well as research modelling of the impact of potential policy measures, are likely to be important in making the case for restricting less healthy food and beverage content via these channels.62 This study also demonstrated the variety of media channels that are being used by adolescents, even though their content may not be ‘child-targeted’63 (ie, social media, websites, etc) but are indeed ‘child appealing’.62 64 Almost all social media platforms (such as Instagram, Facebook and Snapchat) have a minimum age of 13 to register,65–67 but previous research has suggested that nearly a quarter of children aged 8–11 years have an account,68 demonstrating that self-imposed age restrictions are not effective. Our results were similar, with the younger adolescents (10–13 years) self-reporting widespread usage of social media platforms. The high rates of social media usage and self-reported exposure to advertisements via this medium further demonstrates the need for restrictions to limit exposure to this vulnerable age group.
The results of this study will be useful for future research as a baseline for comparison with exposure to less healthy food marketing after the implementation of marketing policies and also in comparing adolescents’ exposure to screen-based media and marketing after important worldwide events leading to possible changes in media consumption habits, such as changes in exposure as a result of the COVID-19 pandemic.69
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