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6 Discussions D iscussions throughout the workshop elaborated on and extended issues raised by the presenters. This final chapter compiles com- ments made by workshop participants to revisit several major topics discussed during the workshop and to point toward future developments. MULTIPLE LEVELS OF INTERVENTION Many workshop participants observed that change needs to occur on multiple levels to counter an influence as pervasive as the marketing of foods and beverages to children and youth. For example, Samantha Graff, ChangeLab Solutions, stated that a prominent message from the antitobacco movement has been that multiple levels of intervention are needed to change people’s environment so as to make healthier choices easier. These changes can include education in schools, conversations with physicians, media campaigns, institutional changes involving employers and workplaces, and changes in laws or policies such as taxes or retail licensing ordinances. Graff explained that countermarketing must be part of a much larger environmental and social strategy to change social norms. Several workshop participants pointed to interventions in addition to those identified by the presenters. William Dietz, formerly of the Centers for Disease Control and Prevention (CDC), observed that standard crite- ria for what constitutes healthier products are starting to emerge, which is driving the reformulation of food. As an example of such a change, a procurement policy initiated at CDC and now extending across the rest of 49

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50 CHANGE IN FOOD MARKETING TO CHILDREN AND YOUTH the federal government is improving the nutrition criteria for foods sold in government cafeterias and vending machines. Dietz also observed that, according to a recent survey conducted by the Rudd Center, almost as many people mistrusted government as mis- trusted industry. An honest broker providing information about food and the media, supported by both industry and government, is needed, he said. Bipartisan language and framing will be essential given the divisiveness of current political discourse. Finally, Dietz said that champions are needed to move the issue for- ward. Such champions, who could lead a grassroots initiative focused on children’s exposure to media, need to be found and motivated to act, he suggested. Several observers pointed out that community mobilization is an essential part of a change movement. Initiatives such as MomsRising and S ­aludable work because they create platforms and the necessary infra- structure to connect people and empower communities, said Terry Huang, University of Nebraska Medical Center. Huang suggested that community mobilization requires integrated social marketing, not just a particular health message. According to Cheryl Healton, American Legacy Founda- tion, another step might be for foundations to counter the money that food companies give to community organizations for various purposes. Elaine Kolish, Children’s Food and Beverage Advertising Initiative (CFBAI), called attention to the continuing need for a large social market- ing campaign that would help educate parents about healthy eating. She pointed out that yearly research shows that most consumers still do not know what calories are, much less how few or how many to eat. Filling an information gap will not solve the obesity crisis, but other efforts will be hampered unless this gap is addressed, Kolish noted. Opinions differed on whether it is necessary to demonize companies, their products, or the tactics they use to sell those products. Healton, for example, argued that getting people emotionally involved can be an impor- tant motivator. She also said that in a social movement, people are pushing back against the status quo and forging a new path. Dietz added that the aggressive responses by the food and beverage industry to the recommen- dations of the federal Interagency Working Group on Food Marketed to Children increased polarization around this issue, even though the recom- mendations were voluntary. THE AGE CUTOFF The question of the age at which children and youth no longer need to be protected from food marketing arose repeatedly during the work- shop discussions. Today, industry self-regulation applies to children through

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DISCUSSIONS 51 age 11, which means that children and youth aged 12 and older receive no special protection from food marketing. But Monifa Bandele of ­ omsRising M said the need to include older children in self-regulation initiatives is raised repeatedly in feedback from the organization’s members. Feedback from members on middle school children, in particular, indicated that they are more vulnerable to marketing than their younger and older counterparts. Jennifer Harris of the Rudd Center pointed out that younger children often watch programming aimed at older groups, which exposes them to ads for unhealthy foods that are not subject to self-regulation. Children may not be more than 35 percent of the audience for this programming, but they still can gain considerable exposure to food marketing by watching it. Children aged 12-14 are exposed to more food ads than any other group of children and youth, observed Harris. They also have their own money and can go to stores or fast-food restaurants to buy unhealthy prod- ucts. A major policy change Harris advocates is including 12- to 14-year- olds in the CFBAI pledges. As an example of a campaign that crosses the 11-12 age boundary, Dietz mentioned the CDC-sponsored VERB™ campaign, which focused on 9- to 13-year-olds. This is a segment of the population that still has the capacity to change its behavior in response to positive messages, he noted. Public health campaigns need to consider developmental stages, he said, not just chronological age. Kolish did not foresee including 12- to 14-year-olds in self-regulation initiatives in the immediate future. As children grow older, they have rights and responsibilities that younger children do not. Also, efforts directed at children younger than 11 have an effect on older children who are not among the audiences covered by self-regulation. Kolish does not think food companies would support an extension above age 11 at present. Heather Rubin of The Walt Disney Company said the company seeks to motivate everyone it reaches to make healthier choices. Disney does make an effort to limit exposure to food ads among children older than 12, although change is inevitably an iterative process. Continued dialogue will help the company better understand the issues affecting the audiences it reaches. Finally, Cathy Polley, Food Marketing Institute (FMI), observed that much of what happens in supermarkets applies to a wide range of ages. For example, 12-14 is an ideal age group for cooking classes because that is when many children start to get involved in the kitchen. MEDIA LITERACY Several workshop participants spoke about the need for educational campaigns to build the media literacy of parents and children regarding food marketing. Awareness of the vast efforts of the media to market

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52 CHANGE IN FOOD MARKETING TO CHILDREN AND YOUTH to children and shape discourse is needed to develop allies, said Dietz. C ­ hildren are subject to forces they do not understand and about which they have not been taught to think critically. In addition, the focus of an edu- cational campaign needs to extend beyond food. Young children can name more beers than American presidents. MomsRising and Saludable are good examples of how to link awareness with strategies for change, Dietz said. Kelly Brownell, James Rowland Angell professor of psychology, pro- fessor of epidemiology and public health, and director of the Rudd Center at Yale University, questioned how media literacy efforts can be carried out well enough to counteract what industry is doing. Furthermore, media literacy initiatives can have the effect of letting industry off the hook by suggesting that both sides are being heard. Safeguarding the public health does not mean exposing people to a toxic substance and then giving them the skills to counteract it. The better approach would be to eliminate the toxic influence in the first place, Brownell suggested. Kolish, who worked at the Federal Trade Commission (FTC) before coming to CFBAI, said self-regulation works better than outside regula- tion in the food arena. She pointed out that the FTC is not eager to issue regulations in such a complex area. Rather, it supports good self-regulation, which it defines as actions that are independent, accountable, and transpar- ent. Kolish noted that companies have different capacities to change, which makes a one-size-fits-all regulation unwieldy. Also, she believes, when com- panies participate in setting expectations, compliance is better than is the case with government regulation. LOOKING TOWARD THE FUTURE The marketing environment will continue to change, said Joseph Thompson, surgeon general, State of Arkansas, and director of the ­ rkansas A Center for Health Improvement at the University of Arkansas for Medical Sciences. In particular, the way in which children get information will be different in the future. Mass marketing is giving way to multilevel, individu- ally tailored, electronically immediate messaging. Thompson suggested that research, evaluation, and surveillance will be necessary to keep pace with this transformation. Brownell noted that research has produced impressive documentation of the amount of food advertising seen by children and adolescents, even though the technologies being used by the industry remain ahead of the research. When all means of marketing are combined, however, unhealthy foods are being marketed to children even more intensively, and the least healthy foods are being marked the most aggressively. Self-regulation has not produced enough progress, Brownell continued. Industry takes self-

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DISCUSSIONS 53 regulation more seriously when the threat of outside regulation increases, but it moves slowly, which does not yield the rapid progress that is needed. Two possibilities beyond self-regulation are legislation and regulation. But legislative initiatives are not currently active, and the efforts of the Interagency Working Group on Food Marketed to Children to advance regulation were squelched, said Brownell. A remaining option is public pressure on companies to change their marketing practices. The question Brownell posed is how the public can be mobilized. Despite the lip service paid to children, actions do not match words, Dietz observed in wrapping up the workshop. Children are society’s most vulnerable population, and those who care the most about them need to be mobilized. Parents will need to be on the front lines of such a mobilization, especially mothers, for whom trust is a significant issue and mistrust is a powerful motivator. Perhaps the issues could be related to various kinds of freedom, including freedom from disease, freedom to be active, or freedom to have access to healthful foods, Dietz said.

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