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Citation:

Pempek TA, Calvert SL. Tipping the balance: use of advergames to promote consumption of nutritious foods and beverages by low-income African American children. Arch Pediatr Adolesc Med. 2009 Jul;163(7):633-7.


PubMed ID: 19581546
Study Design:
Randomized Controlled Trial
Class:
A - Click here for explanation of classification scheme.
NEUTRAL: See Research Design and Implementation Criteria Checklist below.
Research Purpose:

There were two purposes for this study:

  1. To determine whether advergames promote intake of less healthful foods.
  2. To determine if advergames help in promotion of healthful food choices and intake patterns.

Advergames are defined here as online computer games that are geared toward selling a specific brand, for example, children's games that may appear on a food company's web site.

Inclusion Criteria:

Low-income African-American children from urban public elementary schools were included, with no other inclusion criteria described.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment - from 5 elementary schools in Washington, DC, but the method of recruitment was not described

Design - Randomized controlled trial

Blinding used - not applicable

Intervention - Subjects were randomly assigned to one of the following 3 conditions:

  • Two versions of a Pac-Man style advergame were used, one with a healthful food version and the other with less healthful foods.
  • Control condition, in which children selected and ate a food and beverage snack before playing the healthier version of the advergame

Statistical Analysis 

  • A 3 x 2 between-subjects analysis of variance was used to test for effects of the game on the food and beverage selection and intake.
  • X2 analysis
  • Two-factor analysis of variance was used to assess selection of snacks, beverages, and food.
  • Means reported as SD
  • Bonferroni post-hoc tests
Data Collection Summary:

Timing of Measurements

  • Children were to play the games for no more than 5 minutes but could stop before the time limit if desired. Two levels of each game were played, with a pause between level 1 and 2 for explanation on how to play the next level. A game would be played through levels 1 and 2, the child would answer a few questions and have a snack and a beverage, then resume playing levels 1 and 2 again.
  • Points were awarded or subtracted based on foods and beverages that were selected. The snack and beverage choices were the same as what was depicted in the recently played game level.
  • Questions about the game and Internet usage were read aloud by the researchers, and the children's answers were recorded.

Dependent Variables

  • Snack and beverage choices

Independent Variables

  • Two versions of an advergame, one with healthful foods and one with less healthful foods
  • The items shown in the healthful foods advergame were a banana and orange juice. The other advergame featured a bag of chips and soda. These items matched the actual snack choices that were available to the children.
  • The control group selected and consumed a beverage and snack before playing the healthful food advergame. The children answered questions about Internet habits, informed of the study's purpose, and sent back to the classroom.

Control Variables

Description of Actual Data Sample:

Initial N: 30 children (15 boys, 15 girls)

Attrition (final N): 30

Age: mean age 9.5 years

Ethnicity: All subjects were African-American

Other relevant demographics: from a mostly low-income area with 97% of the population being non-Hispanic blacks and 37% of children being poor in 2000.

Anthropometrics - not described

Location: 5 elementary schools in the Washington DC area

Summary of Results:

Key Findings

  • The average game-playing time was 9 minutes 32 seconds (SD of 2 minutes 22 seconds).
  • A larger number of healthful snacks were selected by the children who played the advergame with healthful foods (mean, 1.40 {0.24]) than the children in the other advergame group (mean, 0.20 [0.24]).
  • Of the 30 total children, 14 from all experimental groups did not select healthful snacks. The remaining 16 children selected at least one healthful snack. Nine children who played the healthful foods advergame selected at least one healthful snack, compared with 6 in the control group and 1 in the less healthful advergame group.
  • Children were asked what the advergame wanted them to drink, and 27 of 28 children answered correctly. Two children did not answer the question. When asked what the advergame wanted them to eat, 25 out of 28 children had the correct answer.

     

Author Conclusion:

Findings suggest that concerns about online advergames that market unhealthy foods are justified.  However, advergames may also be used to promote healthier foods and beverages.  This kind of social marketing approach could tip the scales toward the selection of higher-quality snacks, thereby helping to curb the obesity epidemic.

Reviewer Comments:

Recruitment methods and inclusion/exclusion criteria not well described, small numbers of subjects in groups.  Results based on 10 minutes of exposure, long-term effects of advergames on food and beverage choices were not assessed.


Research Design and Implementation Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)
Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?
Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to nutrition or dietetics practice?
Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies)
Yes
 
Validity Questions
1. Was the research question clearly stated?
Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?
Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated?
Yes
  1.3. Were the target population and setting specified?
Yes
2. Was the selection of study subjects/patients free from bias?
???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?
???
  2.2. Were criteria applied equally to all study groups?
Yes
  2.3. Were health, demographics, and other characteristics of subjects described?
Yes
  2.4. Were the subjects/patients a representative sample of the relevant population?
???
3. Were study groups comparable?
Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)
Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?
Yes
  3.3. Were concurrent controls used? (Concurrent preferred over historical controls.)
Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?
N/A
  3.5. If case control or cross-sectional study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some cross-sectional studies.)
N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?
N/A
4. Was method of handling withdrawals described?
Yes
  4.1. Were follow-up methods described and the same for all groups?
Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)
Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for?
Yes
  4.4. Were reasons for withdrawals similar across groups?
N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study?
N/A
5. Was blinding used to prevent introduction of bias?
???
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?
???
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)
???
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?
N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status?
N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results?
N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?
???
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied?
Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described?
N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?
No
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured?
Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described?
N/A
  6.6. Were extra or unplanned treatments described?
N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?
Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient?
N/A
7. Were outcomes clearly defined and the measurements valid and reliable?
???
  7.1. Were primary and secondary endpoints described and relevant to the question?
Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern?
Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur?
No
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?
Yes
  7.5. Was the measurement of effect at an appropriate level of precision?
No
  7.6. Were other factors accounted for (measured) that could affect outcomes?
No
  7.7. Were the measurements conducted consistently across groups?
Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators?
Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately?
Yes
  8.2. Were correct statistical tests used and assumptions of test not violated?
Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals?
Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?
N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?
Yes
  8.6. Was clinical significance as well as statistical significance reported?
Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error?
N/A
9. Are conclusions supported by results with biases and limitations taken into consideration?
Yes
  9.1. Is there a discussion of findings?
Yes
  9.2. Are biases and study limitations identified and discussed?
Yes
10. Is bias due to study’s funding or sponsorship unlikely?
Yes
  10.1. Were sources of funding and investigators’ affiliations described?
Yes
  10.2. Was the study free from apparent conflict of interest?
Yes
 
 

Copyright American Dietetic Association (ADA).