Child-Oriented Marketing on Cereal Packaging: Associations With Sugar Content and Manufacturer Pledge.

Objective: To assess sugar content and child-oriented promotional features on packaging among cereals manufactured by companies with varying Children's Food and Beverage Advertising Initiative (CFBAI) participation.

Design: Ready-to-eat dry cereals (n = 159) were purchased from southeastern US grocery stores in September 2018. Content analysis of 159 ready-to-eat dry cereal boxes, coded for sugar content and presence of 8 child-oriented features.

Main Outcome Measures: Frequencies of each promotional feature and number of features per box, level of participation in CFBAI, and sugar content by serving and ounce.

Analysis: Chi-square tests of independence analyzed correspondence between measures of sugar content. Extent of features per box based on sugar content and CFBAI participation were assessed with analyses of variance (ANOVAs).

Results: Most cereals (81%) contained <13 g of sugar per serving, meeting the sugar content requirement for child-directed advertising. Cereals' sugar content classifications varied between sugar per serving and sugar per ounce metrics (P < .001). Among low-sugar per serving cereals, 28% were classified as moderate-sugar per ounce, whereas 55% of moderate-sugar per serving cereals had high-sugar per ounce. Games/activities and trade characters were especially common (62% and 49%, respectively), particularly on high-sugar per ounce cereals (P < .001, respectively). Child-oriented features were rare on low-sugar cereals and highest on cereals with higher sugar content per ounce produced by CFBAI-participating companies (F8,158 = 12.33, P < .001).

Conclusions And Implications: Variable cereal-suggested serving sizes may contribute to consumers' misunderstanding of sugar content. CFBAI manufacturers continue to market cereals with high sugar to children. Food and beverage regulatory policy could be strengthened if CFBAI companies apply marketing pledges to brand mascots, adopt standardized metrics for sugar content, and limit added sugar content to the recommended <6 g/serving target used by the Special Supplemental Nutrition Program for Women, Infants, and Children program.