Abstract
Powell, L. M., Szczypka, G., Chaloupka, F. J., & Braunschweig, C. L. (2007). Nutritional content of television food advertisements seen by children and adolescents in the United States. Pediatrics, 120(3), 576–583.
The purpose of this study was to conduct a large-scale assessment of child and adolescent exposure to nutritional television advertising using Neilsen Media Research television ratings. The authors identified the 170 top-rated broadcast network, cable, and syndicated television shows for children (2–11 years old) and adolescents (12–18 years old), and examined every national advertisement aired on those shows over a 9-month period. Excluded from the sample were programs aired on Spanish-language television. Previous literature indicated that television advertising influences food consumption patterns and dietary intake and is associated with adiposity. It is estimated that America’s youth watch, on average, 3 hours and 19 minutes of television per day, and the authors identified 9.5 minutes of product advertising during each hour on television. Children see an average of 18 advertisements for food products per day that are equivalent to 30 seconds each, and teens see 10 per day.
The sample included 167,838 product advertisements for children and 182,340 product advertisements for teens. Data analysis focused on advertisements that were food products rather than food-related products, fast-food and non-fast-food restaurants, or other products. Food product advertisements included 50,351 advertisements equivalent to 30 seconds, or 30% of all advertisements for children (2–11 years of age) and 47,955 food product advertisements (18.3%) for adolescent viewers. The nutritional content of these products was analyzed using U.S. Food and Drug Administration serving sizes, nutritional food labeling, or (as a last resort) direct manufacturer information.
Food product advertising for child viewing included 451 distinct food brand items. Nutritional analysis indicated the food products advertised for children were high in sugar (46.1% of calories), fat (17.9% of calories), and saturated fats (5.9% of calories). The average sodium content was 180.1 mg per serving, and the average fiber content was 0.7 g per serving. Looking at all food product advertisements viewed by children, 97.8% were high in fat, sugar, or sodium, and 81% were low in fiber.
Food product advertising for adolescents included 613 distinct food brand items. Nutritional analysis indicated that the advertised food products were high in sugar (49.1% of calories), fat (18.9% of calories), and saturated fats (6.9% of calories). The average sodium content was 154.1 mg of sodium per serving and the average fiber content was 0.7 g per serving. Eighty-nine percent of the food products advertised for adolescents were high in fat, sugar, or sodium, and 77% were low in fiber.
The researchers also examined advertisements according to race. While there were small differences in advertising exposure for black and white children, black adolescents were exposed to considerably more high-sugar product advertisements than white adolescents. Researchers concluded that “the overwhelming majority of food-product advertisements seen on television were of poor nutritional content” (p. 580).
TAKE TO WORK MESSAGE
Healthy People 2010 (U.S. Department of Health and Human Services, 2000) national health goals identify physical activity and obesity as leading health indicators. Daily television watching and exposure to poor nutritional health messages puts youth at risk for health problems. School nurses can take heed from this data to formulate plans at the individual student, classroom, district, and professional level. Assess student television viewing habits, activity levels, exposure to poor nutrition messages, and oral health habits after consuming high sugar content foods. This information can assist in planning health education and other interventions to counteract the effect of these messages.
School nurses can prepare a “Food Facts” board each month featuring a popular food product and an alternative healthy choice showing a comparison of the sugar, fat, and sodium content. They can also work with classroom teachers to show students how to read labels and determine appropriate nutrients with developmentally and culturally appropriate examples. School nurses should consider approaches to parent education for their school district by distributing fact sheets to increase awareness of advertising messages and to illustrate ways to make healthy food choices simple, affordable, and culturally relevant. School nurses should consider partnering with health educators and community professionals to help students, parents, and community members improve media literacy so they can discern media messages that pose risks for health.
Professionally, it is important that school nurses are positive role models for healthy food choices by eating well and helping staff select healthy food choices. Serving as a member of the nutrition team in the coordinated school health program, school nurses can raise awareness of foods high in fat, sugar and sodium in the school nutrition plan. Finally, school nurses can work with school nurse organizations and other professional groups to advocate for more responsible food advertising, including formal product advertising restrictions for young viewers.
Hansen, M. L., Gunn, P. W., & Kaelber, D. C. (2007). Underdiagnosis of hypertension in children and adolescents. JAMA. 298, 874–879.
According to the authors, hypertension and pre-hypertension are well-defined, prevalent, asymptomatic, chronic conditions in children and adolescents that may be classified as essential or secondary to another disease process. Hypertension in children has been shown to correlate with a family history of hypertension, low birth weight, and excess weight. It has also been shown to be an independent risk factor for hypertension in adulthood and to be associated with early markers of cardiovascular disease.
National guidelines define hypertension during childhood as blood pressure measured on three different visits at or higher than the 95th percentile for age, sex, and height. Prehypertension is defined as average blood pressure at or higher than the 90th percentile for age, sex, and height, or more than 120/80 mm Hg but less than the 95th percentile at three or more visits. While it is estimated that the prevalence of hypertension is between 2% and 5%, the researchers hypothesized that the diagnosis of hypertension and pre-hypertension in children and adolescents is frequently undiagnosed by pediatric clinicians.
The electronic records of all children and adolescents between 3 and 18 years (n = 14,187) who received at least three well-child care visits between June 1999 and September 2006 at a large tertiary care health system were reviewed for variables related to the diagnosis of hypertension. There were a total of 53,911 patient visits contributing to the data. At the most recently recorded visit, the mean age of the sample was 8.8 years, the mean weight-for-age percentile was the 66th percentile, and the mean height-for-age percentile was the 60th percentile. Fifty percent of the participants were African American, and 49% were female.
Criteria for hypertension were met by 507 children (3.6%). Of the children with hypertension, only 131 (26%) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record, indicating that 376 of 507 participants (74%) had undiagnosed hypertension. In addition, 7 of the 17 participants (41%) with stage 2 hypertension were undiagnosed. Family history of hypertension was documented in 18% of the 507 patients with hypertension. Even if the family disclosed that there was a history of hypertension, this was not found to increase the odds of identification of abnormal blood pressure. Criteria for prehypertension were met by 485 children (3.4%). Of these children, only 55 (11%) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record.
TAKE TO WORK MESSAGE
While blood pressure screening in schools is not typically mandated, the use of blood pressure measurement is a standard part of the assessment measures performed by nurses. Since a student who presents in the health office is often there for a health complaint, blood pressure measurements should be included. An elevated reading (at or above the 90th percentile) can alert the school nurse to the need for follow-up when the student is free from complaints. The underdiagnosing of hypertension and the consideration that this may be due in part to not using the gender-, age-, and height-specific charts for interpreting blood pressure readings, should alert school nurses to the need to have both the age specific growth charts (http://www.cdc.gov/growthcharts/) and the blood pressure charts readily available in the health office at all times for interpretation of blood pressure readings. For example, an 11-year-old boy who is 53″ tall would be considered prehypertensive (>90th percentile) if his blood pressure was 114/74, but this would be considered normal for an 11-year-old male who was 60″ tall.
In addition to health office visits, students entering schools for the first time and students undergoing physical assessments for sports clearance often have their most recent blood pressure measurement noted on those records from their primary care providers. Family members often share family-related health problems either on the health records or during conversations with the school nurse. In either case, the school nurse is in a good position to recognize risk factors for hypertension when this information is shared.
It is important for the school nurse to analyze blood pressure measurements and determine if the student needs follow-up in the school from this one-time measurement. The only way to properly do this is by using the guidelines that are gender, age, and height specific. These guidelines are available in the publication, The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents from the U.S. Department Of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute available at www.nhlbi.nih.gov/guidelines/hypertension/hbp-ped.htm. Entering the data into an electronic record that links to algorithms for determining hypertension could reduce the work of school nurses and increase the likelihood of improved detection of hypertension. This area would be appropriate for further study.
The references in this article refer the reader back to the national guidelines for blood pressure monitoring, including charts for interpretation, the recommended equipment, and the methods for monitoring blood pressure. For instance, hypertensive blood pressure readings taken with an automatic cuff need to be retaken in the proper sequence using an ausculatory method. Automatic machines need regular calibration, and the size of the cuff needs to be appropriate for the arm size. School nurses need to assure that the proper equipment and procedures are followed when taking blood pressure measurements.