The Pennsylvania State University the Graduate School Department

The Pennsylvania State University

The Graduate School

Department of Nutritional Sciences

CHILDREN’S RESPONSE TO FOOD BRANDING

AT THREE LABORATORY TEST-MEALS

A Thesis in

Nutritional Sciences

Wendy M. Stein

Submitted in Partial Fulfillment of the Requirements for the Degree of

Master of Science

August 2015

The thesis of Wendy M. Stein was reviewed and approved* by the following:

Kathleen L. Keller Assistant Professor of Nutritional Sciences and Food Science Thesis Advisor

Barbara J. Rolls Professor of Nutritional Sciences

John E. Hayes Associate Professor of Food Science

Gordon Jensen Professor of Nutritional Sciences Nutritional Sciences Department Head

*Signatures are on file in the Graduate School

iii

ABSTRACT

Food marketing has been shown to influence children’s food requests, preferences, and intake. The purpose of the following studies was to test children’s responses to a form of food marketing, known as branding, at three laboratory test-meals that varied in packaging. The aims were to (1) identify familiar and well-liked food brands in a community sample of 7-10 year-old children, (2) determine the effects of food branding on 7-10 year-old children’s meal liking and

(3) energy intake, and (4) identify child-level characteristics (e.g., weight status, external responses to food) that may explain variance in children’s responses to food branding in the laboratory.

The primary outcomes, children’s meal liking and energy intake, were measured in three meal conditions that varied by packaging: (1) Branded: packaging with familiar food brands, e.g.,

Kraft®, (2) Unbranded: plain white packaging, and (3) “Kaiyo”: packaging with a novel brand and cartoon character developed by our lab. In the pilot Brand Familiarity study, the food brands selected for the Branded condition of the main fMRI Branding study were familiar and well-liked by a community sample of children. In the fMRI Branding Study, contrary to previous findings, there were no significant effects of brand condition on children’s meal liking or energy intake using mixed models analyses. Other factors, such as children’s BMI z-score, frequency of usual consumption, and fullness may be stronger predictors of food liking and energy intake in the laboratory than food branding.

TABLE OF CONTENTS

List of Figures ...... vii

List of Tables ...... viii

Acknowledgements ...... ix

Chapter 1 Literature Review ...... 1

Childhood obesity ...... 1 Factors associated with the rise in childhood obesity ...... 1 Development of food preferences ...... 3 Evolutionary perspective: gene-environment interaction ...... 3 Early flavor exposure ...... 4 Social and environmental influences ...... 4 Food marketing and children’s eating behavior ...... 5 Food branding and children’s eating behavior ...... 6 Study aims ...... 12 Objectives and hypotheses ...... 13

Chapter 2 Children’s Brand Familiarity ...... 14

Introduction ...... 14 Developing a novel brand for 7-10 year-old children ...... 14 Testing children’s brand familiarity and emotional response ...... 16 Participants ...... 16 Study design ...... 16 Questionnaires ...... 17 Child height and weight ...... 18 Brand familiarity, emotional valence, and excitability task ...... 18 Data analysis ...... 19 Child weight status ...... 19 Brand familiarity, emotional valence, and excitability ...... 20 Results ...... 20 Child demographics ...... 21 Food brand familiarity, emotional valence, and excitability ...... 21 Discussion ...... 26

Chapter 3 Children’s Response to Food Branding at Three Laboratory Test-meals ...... 30

Introduction ...... 30 Methods ...... 30 Participants ...... 30 Study design ...... 31 Questionnaires ...... 33

Child height, weight, and percent body fat ...... 36 Meal preparation ...... 37 Test-meal liking and preference assessment ...... 38 Children’s perceived fullness ...... 39 Multi-item, ad libitum test-meals ...... 40 Data analysis ...... 44 Child weight status ...... 44 Test-meal liking ...... 44 Test-meal energy intake ...... 44 Meal liking and energy intake by brand condition ...... 45 Child-level characteristics and children’s response to food branding ...... 46 Results ...... 47 Child demographics ...... 47 Meal liking ratings and sum scores ...... 48 Test-meal energy intake ...... 51 Correlations for mixed models ...... 54 Meal liking by brand condition ...... 56 Energy intake by brand condition ...... 57 Child-level characteristics and children’s response to food branding ...... 58 Discussion ...... 60 Summary of results ...... 60 Explanations of findings ...... 63 Strengths and limitations ...... 65 Future directions ...... 67

Appendix A Brand Familiarity Study Questionnaires ...... 68

Parent Demographics Questionnaire ...... 68 Parent Brand Inventory ...... 70 Children’s TV Survey ...... 73

Appendix B Brand Familiarity, Emotional Valence, and Excitability Task ...... 77

Script and Questions ...... 77 Data Collection ...... 78

Appendix C fMRI Branding Study Questionnaires ...... 82

Parent Demographics Questionnaire ...... 82 Parent Brand Inventory ...... 84 Parent’s Ad Survey ...... 87 Infant Feeding Questionnaire ...... 89 Children’s Eating Behavior Questionnaire ...... 98 Child Feeding Questionnaire ...... 100 Child Food Neophobia Scale ...... 104 Impulsivity Questionnaire ...... 105 Kid’s Activity Questionnaire ...... 107 LOC-ED Questionnaire ...... 109 Children’s TV and Internet Survey ...... 111

Child Food Frequency Questionnaire ...... 116 Brand Liking and Wanting VAS Questionnaire ...... 118

Appendix D fMRI Branding Study Scripts ...... 120

Liking Assessment ...... 120 Freddy Fullness ...... 122

Bibliography ...... 123

vii

LIST OF FIGURES

Figure 2-1. “Kaiyo” brand design...... 15

Figure 2-2. Children’s brand familiarity measured as the percentage of children who recognized the brand...... 25

Figure 2-3. Children’s mean emotional valence and excitability ratings of test-meal brands on a 5-point scale ...... 26

Figure 3-1. Liking and preference assessment tray layout (Branded condition) ...... 39

Figure 3-2. Branded meal tray layout...... 42

Figure 3-3. Unbranded meal tray layout...... 43

Figure 3-4. Kaiyo meal tray layout...... 43

Figure 3-5. Children’s liking sum scores of the test-meal in the Branded, Unbranded, and Kaiyo conditions...... 50

Figure 3-6. Children’s liking ratings of test-meal foods and beverages in the Branded, Unbranded, and Kaiyo meal conditions...... 51

Figure 3-7. Children’s total energy intake (kcal) in the Branded, Unbranded, and Kaiyo meal conditions...... 53

Figure 3-8. Children’s energy intake (kcal) of foods and beverages in the Branded, Unbranded, and Kaiyo meal conditions...... 54

viii

LIST OF TABLES

Table 2-1. Child demographics...... 21

Table 2-2. Child-reported brand familiarity, emotional valence, and excitability...... 22

Table 2-3. Logos in the brand familiarity, emotional valence, and excitability task modified for test-meals...... 29

Table 3-1. Flowchart of study visits...... 32

Table 3-2. Liking and preference assessment foods and beverages...... 39

Table 3-3. Test-meal foods and beverages...... 42

Table 3-4. Child demographics: continuous variables...... 48

Table 3-5. Child demographics: categorical variables...... 48

Table 3-6. Children’s liking ratings and sum scores across meal conditions...... 49

Table 3-7. Children’s energy intake across meal conditions...... 52

Table 3-8. Pearson’s and Spearman’s correlation coefficients for test-meal liking...... 55

Table 3-9. Pearson’s and Spearman’s correlation coefficients for test-meal energy intake. ... 55

Table 3-10. Meal liking by brand condition with child BMI z-score...... 56

Table 3-11. Meal energy intake by brand condition with fullness, liking, and child BMI z- score...... 57

ACKNOWLEDGEMENTS

I would like to thank my committee, lab, family, and friends for their support, encouragement, and guidance over the last three years.

Chapter 1

Literature Review

Childhood obesity

Childhood obesity is one of the most serious public health issues of the 21st century.1 Globally, an estimated 170 million children are overweight (BMI-for-age greater than the 85th percentile2) or obese (BMI-for-age greater than or equal to the 95th percentile2).3 Although the prevalence of childhood overweight is highest in upper-middle-income countries, such as the United States, the epidemic is global and steadily affecting many lower-income countries.1

In the United States, the prevalence of childhood obesity has nearly tripled since the

1970s.4 In 2011-2012, close to one-third of children aged 2-19 years were classified as overweight and 17% were classified as obese.4,5 This high prevalence of childhood overweight is of concern as adult-associated health conditions, such as hypertension, type 2 diabetes, fatty liver disease, and heart disease, are showing up at increased rates in children. Because obesity is a multi-level disease affecting metabolic, digestive, respiratory, skeletal, and psychosocial systems, children today are projected to live less healthy and shorter lives than their parents.6,7

Factors associated with the rise in childhood obesity

From a broad perspective, factors associated with the rise in childhood obesity can be broken down into energy expenditure (i.e., physical activity and inactivity) and energy intake

(i.e., dietary quality, food preferences).

Active versus inactive behaviors and obesity

Sedentary behavior is considered one of the most modifiable causes of childhood obesity.8 While the United States Department of Health and Human Services recommends children aged 6-17 years participate in at least 60 minutes of physical activity each day,9 two in three children and more than 80 percent of adolescents do not meet these recommendations.10,11

With various sources of sedentary media readily available (e.g., television (TV), video games, computers, tablets), children may be displacing their time spent being physically active with being physically inactive.12

According to the Kaiser Family Foundation 2010 Report, children spend more than seven and a half hours a day in front of a screen.13 Screen time has been positively associated with energy intake14-18 and childhood overweight.8,19 Coon et al. found that children (aged 9-11 years) who watched more TV per day reported consuming significantly more red meat, pizza, salty snacks, and soda, and less fruits and vegetables.16 Because of these associations, the American

Academy of Pediatrics (AAP) recommends that parents create “screen-free zones” by removing

TVs, computers, and video games from children’s bedrooms, and by turning off TV during dinner.20 The AAP also recommends that if children do choose to engage in sedentary media, it should be high quality (i.e., educational) and for no more than 2 hours per day.20

Intake patterns and obesity

In addition to energy expenditure (or lack thereof), energy intake is a critical component of the childhood obesity epidemic. Children’s consumption patterns have changed drastically since the beginning of the 20th century. While child under-nutrition used to be of primary importance, the concern today lies in over-nutrition.21 Children do not meet dietary

3 recommendations; they consume too much fat, sugar, and sodium, and not enough fruits, vegetables, and whole grains.22-25 This dietary pattern is the result of both children’s inherent food preferences for sweet, salty, and energy-rich foods26-28 and our current obesogenic environment.29

Development of food preferences

Evolutionary perspective: gene-environment interaction

The development of food preferences is dependent on the interactions between genes and the environment. Humans are evolutionarily hardwired to seek out foods with sweet tastes indicative of energy-rich resources,27,28 and to avoid bitter tastes that are presumably indicative of toxic substances.30,31 These predispositions are thought to have evolved from a scarce environment in which the consumption of energy-rich, nutrient-dense foods was necessary for survival. Children’s food choices are largely driven by these innate taste preferences,26,27 despite the fact that we no longer live in a resource-limited environment. Our current obesogenic environment is characterized by an endless supply of large-portioned, energy-dense convenience foods.29,32

Children like sweet and salty tastes, and dislike bitter and sour tastes.27,33,34 While dietary variety is essential, the consumption of novel foods can lead to unknown consequences, such as illness or death.35 Therefore, humans developed a protective mechanism to reject unfamiliar foods, known as food neophobia, which peaks around 2 years of age.36-38 Consequentially, child food neophobia is associated with lower levels of dietary variety and higher intakes of fatty, sweet, and salty foods.39,40 However, through experience and repeated exposure, an initially rejected food can become acceptable.30,41

Early flavor exposure

Flavor exposure and familiarization begins before children are even born. Flavors and odorants from the maternal diet (e.g., vanilla, anise, garlic) are transmitted in utero to her developing fetus through amniotic fluid.42 This early transmission of flavors, or “flavor programming”, is linked to greater acceptance and enjoyment of solid foods with similar flavors later in life.43 A variety of food flavors are transmitted to human milk as well, and may influence dietary choices of breastfed infants.43 In a seminal study, Mennella and colleagues found that infants with mothers who consumed carrot juice during the last trimester of pregnancy or lactation displayed less negative facial expressions while eating carrot-flavored cereal compared to infants with mothers who consumed water during those periods.43 Because multiple exposures to stimuli tend to result in greater levels of acceptance,44,45 these early avenues of flavor exposure may strongly influence long-term dietary choices.

Social and environmental influences

As children develop, their food preferences are shaped more heavily by social and environmental influences. Efforts to control children’s diets often result in unintended consequences. For example, when parents restrict their children’s access to highly palatable, energy-dense foods, children are more likely to increase their preferences for46-48 and intake of 47,49-51 these “forbidden foods”. Likewise, when parents pressure their children to “eat their vegetables”, children are more likely to decrease their consumption of vegetables52 and may increase their consumption of fatty foods.52,53

Food marketing and children’s eating behavior

In the modern obesogenic food environment, there is an overabundance of large-portioned, energy-dense convenience foods, many of which are heavily marketed.32 We are repeatedly exposed to food advertisements from a variety of sources (e.g., TV, internet, billboards, radio).

This profuse promotion of foods, particularly foods that are highly-processed, energy-dense, and nutrient poor, is argued as a key factor fueling the childhood obesity epidemic.14,54-57 Although advertisements influence both adults and children, more recent attention has been placed on efforts to regulate the quantity and quality of food advertisements directly targeting children due to their increased susceptibility.

While TV is still the predominant outlet, food marketers are branching out to product placements in toys, games, educational materials, songs, and movies; character licensing and celebrity endorsements; and other types of media, including websites, video games, and mobile phone messaging.58 According to a 2009 Nielsen report, children aged 2-11 years watch TV an average of 30 hours per week.59 Because TV viewing time is directly associated with food- advertisement exposure, it is estimated that children see at least 11 to 13 food commercials per day, or 4,000 to 4,700 food commercials per year.60 The food industry currently spends close to

$2 billion a year marketing products to children.61 These advertisements aim to associate the targeted food product with fun, adventure, and fantasy.62,63 While voluntary actions have been made to restrict the amount of food advertisements directed at children (e.g., 2006 Council of

Better Business Bureaus’ Children’s Food and Beverage Advertising Initiative, annual Institute of

Medicine (IOM) workshops), recent data suggests that 98% of advertisements promote nutrient- poor, energy-rich foods that exceed the recommended amounts of fat, sodium, and added sugar.64

Children’s exposure to media has been linked to children’s food requests,65-70 preferences,71-79 and intake.80-84 In a prospective and cross-sectional analysis, Chamberlain et al.

6 found that 7-9 year-old children who had greater exposure to TV, movies, and video games were more likely to request the purchase of advertised foods and beverages to their parents. This relationship was found both at baseline and throughout the 20-month study.65 In a series of school-based crossover studies, Halford and colleagues found that exposing children to food advertisements consistently influenced their food preferences72,73 and snack food consumption.81-84 In 11-13 year-olds, Halford et al. found that compared to toy advertisements, exposure to food advertisements embedded within a cartoon increased children’s reported preferences for high-carbohydrate and high-fat foods.72 Although this study measured children’s momentary report of food preferences, and did not measure children’s actual food intake, Halford and colleagues tested the effects of TV advertisements on children’s food intake in four other similar studies. In these studies, compared to the toy advertisement conditions, children (aged 5-7 years and 9-11 years) ate significantly more snack foods (e.g., jelly sweets, chocolates) after watching food advertisements embedded within a short cartoon.81-84 In addition, weight status mediated the relationship between food advertisement exposure and energy intake in the 9-11 year olds. That is, children who were overweight or obese consumed more snack foods following exposure to food advertisements than non-overweight children.82,84 These studies demonstrate that exposure to TV food advertisements may impact children’s eating behavior and, depending on child age, weight status may mediate this relationship.

Food branding and children’s eating behavior

While food marketing is the process of persuading consumers to buy a product, the personality or identity of a product is its “brand”. Marketing is crucial to informing consumers about the product at hand, while the brand supplies consumers with a level of assurance or trust in the product. Companies use names, symbols, logos, characters, and/or slogans in hopes that

7 consumers will form unique, emotional attachments to their brand, and thus become life-long buyers.85 A prime example of brand loyalty can be depicted by the classic Pepsi® versus Coke® challenge.86 While the majority of consumers reported a strong preference for Coke® over Pepsi® prior to blind taste tests, the results indicated the opposite: the majority of participants actually preferred the taste of Pepsi® over Coke®.86 This study provides evidence of the strong influence that branding can have on consumers’ food choices and preferences.

Brand mascots and media characters

Children as young as 2 years old are able to recognize brands, especially when trade (e.g.,

Ronald McDonald) or licensed characters (e.g., Dora the Explorer) are used to sell products.87-89

Many food, beverage, and quick-serve chain restaurant companies throughout the globe currently use cartoon brand mascots and licensed media characters to promote food products to children, especially products that are high in fat, added sugar, and sodium.90-92 Children learn about mascots and characters through their social networks (e.g., parents and peers), the media (e.g., TV and movies), and marketing (e.g., advertisements on TV and the Internet), and can develop

‘parasocial relationships’, or one-sided emotional friendships, with their favorite characters.93 The strengths of these pseudo-friendships are driven by the attractiveness of the characters and the messages they convey.94 For instance, mascots and characters are typically coupled with memorable slogans, jingles, taglines, musical themes, and stories to associate fun, humor, and glee with a brand and its products.95-98

Several studies have shown that brand characters can increase young children’s recognition and liking of a certain food, product, or brand.87,99-112 In a randomized controlled study, de Droog et al. tested the effects of character branding on 4-6 year-old children’s preferences for sliced bananas and banana candy.106 Although most children preferred the candy

8 in all conditions, they found that children preferred the fruit to candy more often when the fruit was paired with a character. Whether the character was familiar (i.e., Dora the Explorer or

SpongeBob SquarePants) or unfamiliar (i.e., novel monkey cartoon) did not influence the results. de Droog and colleagues therefore concluded that children’s food preferences can be modified by pairing foods with a familiar well-liked character or pairing foods with an unfamiliar congruent

(matching) character (e.g., monkey with banana). These findings were replicated in a follow-up study testing the effects of conceptual congruence (e.g., rabbit with carrot) and perceptual congruence (e.g., orange rhino with carrot) on 4-6 year-old children’s liking for carrots.107

Children reported liking carrots more when they were paired with conceptually congruent unfamiliar characters (i.e., rabbits) or familiar characters (i.e., Dora the Explorer or Diego).

Similarly, Kotler et al. found that the presence of characters (both familiar and unfamiliar) influenced children’s (aged 2-6 years) preferences for and willingness to taste healthy (e.g., grapes, bananas, broccoli) and unhealthy (e.g., potato chips, chocolate) snack foods.105 The greatest effects were found when an unhealthy food was paired with a well-liked familiar character (e.g., Elmo), and a healthy food was paired with an unfamiliar character or no character.

Additionally, when children were asked to choose between a healthy food and an unhealthy food, pairing the healthy food with a familiar character did not significantly alter children’s preferences for the unhealthy food. However, when two foods within the same category (i.e., two vegetables, two fruits, or two grains) competed against each other, children were more likely to select the food paired with a character (both familiar and unfamiliar) than food without a character.

In addition to food preferences, Smits and Vandebosch found that children’s self-reported appetite (measured with pictures of increasing portions), intention to consume, and frequency of parental purchase requests increased when foods were paired with either a familiar ‘celebrity’ gnome character or an unfamiliar gnome cartoon character.104 In terms of children’s food intake,

Keller et al. found that children (aged 4-5 years) who received raw fruits and vegetables packaged

9 with a licensed character (e.g., Dora the Explorer, Elmo) increased their fruit and vegetable consumption over the course of a 6-week intervention, while children who received fruits and vegetables in plain packaging had no change from baseline.110,113 Taken together, these results suggest that characters, both familiar and unfamiliar, influence children’s food preferences, requests, and intake.

Branding and food preferences

Because a brand is the “identity” of a product, branding has an associative quality; that is, branding can serve as a bridge to familiarize consumers and, more specifically, children with a novel or, in some cases, an incongruent product. This familiarization, via branding, may influence children’s food preferences. Robinson and colleagues demonstrated that preschool children preferred both high energy-dense (e.g., chicken nuggets, French fries) and low energy-dense foods (i.e., low-fat milk or apple juice, carrots) packaged with a McDonald’s® logo over foods in plain packaging.114 At the time of this study, McDonald’s® did not offer or advertise carrots as part of their Happy Meals; therefore branding carrots with the McDonald’s® logo was incongruent. Regardless of this incongruence, children preferred the carrots in McDonald’s® packaging to carrots in plain packaging. Additionally, they found that children with more TV sets in their home and who ate food from McDonald’s® more often were the most responsive to the experimental manipulation. While this study found that branding had a powerful influence on children’s food preferences, it is important to note the following: (1) this study did not measure children’s actual food intake, therefore it is unclear whether children’s preferences correspond with intake; (2) this study was conducted in a low-income, ethnically and culturally diverse sample (87% non-white and 38% Spanish-speaking), therefore the results may not generalize to all preschool children; and (3) because this study only compared generic white packaging to

10 packaging with a McDonald’s® logo, it is difficult to interpret if children’s preferences were due to branding or simply packaging appearance (i.e., having a design).

As a follow-up to the Robinson et al. study,114 Elliot and colleagues tested preschool children’s food preferences in response to both food branding and packaging appearance.115 Their results were not as clear. They found that children preferred some foods presented in

McDonald’s® packaging over foods in plain packaging, some foods presented in colorful packaging over foods in McDonald’s® packaging, and had no preference for foods when they were presented in McDonald’s® versus Starbuck’s® packaging. Because less than 50% of children were able to correctly identify the McDonald’s® brand, these inconsistent results may be partially explained by the Canadian sample’s unfamiliarity with McDonald’s®. The effects of branding may therefore be dependent on children’s brand familiarity. In addition, their results bring up an important point to consider: packaging appearance (i.e., colorful versus plain packaging) may have more of an influence on young children’s food preferences than branding, especially when the brands are unfamiliar. Collectively, these studies demonstrate that branding and packaging design may impact young children’s food preferences.

Food branding, energy intake, and individual differences

In addition to the effects on children’s food preferences, branding has been shown to influence children’s energy intake. To further investigate the effects of branding proposed by

Robinson et al.,114 Keller and colleagues measured 7-9 year-old children’s consumption of a multi-item meal packaged with or without McDonald’s® logos. They found a trend for all children, regardless of weight status, to eat more at the branded meal compared to the unbranded meal.110 However, these effects differed in boys and girls. Boys ate a similar amount of food across both conditions, while girls ate about 100 calories more in the branded meal compared to

11 the unbranded meal.

In the same study, Keller et al.110 also measured children’s cognitive bias towards food brands using a variation of the Stroop task developed by MacLeod.116 Food images were overlaid with a word that either matched (congruent task) or did not match the image (incongruent task) and children were asked to “read the word” or “name the picture”. Overweight children, on average, took 2 seconds longer than non-overweight children to respond on the incongruent tasks, suggesting that overweight children may have a cognitive processing bias towards food brand images. This conclusion paralleled the work of Schachter and colleagues117-119 who demonstrated that overweight adults may be more responsive to external cues than non-overweight adults.

Other researchers have similarly shown that overweight children tend to have higher food cue responsiveness.120-122 In addition, two studies using functional magnetic resonance imaging

(fMRI)123,124 found that when children and adolescents (aged 9-16 years) viewed food brands they had increased activation in areas involved in motivation (i.e., orbitofrontal cortex, inferior prefrontal cortex, posterior cingulate cortex), and those with obesity had significantly less activation in an area involved in cognitive control (i.e., bilateral middle/inferior prefrontal cortex).

In a sample of ethnically diverse 4-6 year-old children, Forman and colleagues125 tested the impact of branding on children’s energy intake using foods that are commonly advertised to children (e.g., Lunchables®, Trix® Yogurt, Oreos®). Test-meals were presented in their original packaging or in plain white plastic containers. Although Forman et al. found that overweight children consumed more energy at the meals overall, they also found that overweight children consumed 40 calories more in the branded meals compared to the unbranded meals, while non- overweight children consumed 45 calories less in the branded meals.125 These differences were partially explained by differences in food brand responsiveness as a function of sex: boys ate about 45 calories more in the branded meals, while girls ate about 40 calories less. While these

12 differences in responses to branding suggest that children vary in their levels of susceptibility to external food cues, additional research is needed to understand these variations.

Study aims

The primary aims of this series of research studies were to determine the effects of food branding on 7-10 year-old children’s liking and energy intake at multi-item, ad libitum laboratory test- meals. Children’s liking and energy intake of the same multi-item meal were measured in three brand conditions: (1) Branded: packaging with familiar food brands, e.g., Kraft®, (2) Unbranded: plain white packaging, and (3) “Kaiyo”: colorful packaging with a novel brand and cartoon character developed by our lab for 7-10 year-old children. While research has demonstrated that some children prefer foods that are branded compared to foods that are unbranded, there is limited research assessing laboratory meal liking and energy intake in response to variations in food branding. The findings from studies that have assessed this relationship vary depending on child characteristics and food brand conditions. Additionally, no studies to date have incorporated a novel character and design to determine its impact on children’s meal liking and energy intake in the laboratory. This series of studies aimed to fill these gaps in the literature by measuring children’s liking and energy intake at three laboratory test-meals that varied by packaging condition, and further investigating how children’s individual characteristics impact their responses to food branding in the laboratory.

Objectives and hypotheses

1) Conduct a pilot study to identify brands that are familiar to and well-liked by a community

sample of 7-10 year-old children.

• H1.1: At least 75% of children would recognize the food brands selected for the main

study Branded condition.

• H1.2: Less than 10% of children would recognize the “Kaiyo” brand designed by our lab.

• H1.3: The food brands selected for the Branded condition and “Kaiyo” would have mean

emotional valence and excitability scores greater than 3.0 on a 5-point scale.

2) Determine the effects of branding on 7-10 year-old children’s overall test-meal liking and

liking of meal foods and beverages.

• H2: Compared to the Unbranded and “Kaiyo” conditions, foods and beverages served in

the Branded condition would be the most liked by children.

3) Determine the effects of branding on 7-10 year-old children’s total meal energy intake and

energy intake of meal foods and beverages.

• H3.1: Children would eat more in the Branded condition compared to the Unbranded and

“Kaiyo” conditions.

4) Exploratory objective: Identify potential child-level individual characteristics (e.g., weight

status, external responses to food) that explain variance in children’s response to food

branding in the laboratory.

• H4.1: Children’s laboratory test-meal energy intake would be associated with individual

characteristics, such as child weight status, sex, age, food neophobia, brand exposure,

food responsiveness, and measures of parental feeding practices (e.g., restriction).

Chapter 2

Children’s Brand Familiarity

Introduction

The pilot Brand Familiarity Study was conducted to (1) measure 7-10 year-old children’s familiarity with and emotional responses to common food and non-food brands and (2) to gain feedback on the novel brand, “Kaiyo,” designed by our lab for 7-10 year-old children prior to the main fMRI Branding Study. This data was used to select brands for the functional magnetic resonance imaging (fMRI) paradigm, select foods and brands for the test-meals, and modify the

“Kaiyo” brand for the main fMRI Branding Study. Brands that were familiar and had similar emotional response (i.e., valence and excitability) ratings above neutral were selected for the main study. The following hypotheses were tested:

1. At least 75% of children would recognize the food brands selected for the main study

Branded condition.

2. Less than 10% of children would recognize the “Kaiyo” brand designed by our lab.

3. Food brands selected for the Branded condition and “Kaiyo” would have mean emotional

valence and excitability scores greater than 3.0 on a 5-point scale.

Developing a novel brand for 7-10 year-old children

Our lab created a novel brand, “Kaiyo”, to answer the question: Which branding strategy is the most influential – familiar food brands or an unfamiliar brand with a cartoon character designed for children? As an Honors Thesis project, an undergraduate student in our lab developed the

15 brand, “Kaiyo”, to appeal specifically to 7-10 year-old children. “Kaiyo” featured a colorful background and bold logo with a “cool and hip”, rollerblading coyote cartoon character created in

Adobe Photoshop® (Adobe Systems, Inc., San Jose, CA). “Kaiyo” was finalized after internal lab evaluations on brand recognition (i.e., “Does this brand resemble a character from another source?”), age-appropriateness (i.e., Would 7-10 year-old children respond positively towards this brand?”); and liking (i.e., “How much do you like the character and brand logo?”). The design shown in Figure 2-1 was considered unrecognizable, age-appropriate, and well-liked by our lab.

Figure 2-1. “Kaiyo” brand design.

Testing children’s brand familiarity and emotional response

Participants

A community sample of 20 healthy, 7-10 year-old children and their parents from central

Pennsylvania were recruited to participate in this study. Information about the Brand Familiarity

Study was made available to families through the Families Interested in Research Studies (FIRSt) database, online advertisements, and flyers posted locally. The FIRSt database directly connects

Penn State researchers with families in central Pennsylvania. Interested parents and/or legal guardians were instructed to call the Children’s Eating Behavior Laboratory and were screened over the phone by a trained research assistant. Children aged 7-10 years with no known food allergies, learning disabilities, or medical conditions, and who regularly watched TV and used the

Internet were eligible to participate. The Institutional Review Board of The Pennsylvania State

University approved this study.

Study design

Participants completed one 90-minute session in the Children’s Eating Behavior

Laboratory at The Pennsylvania State University. Following explanations of the study procedures, voluntary participation, risks, and benefits, parents or legal guardians provided their written informed consent for their child’s participation. Children gave their verbal assent to participate following a simplified explanation of the procedures. Parents completed paper-based questionnaires in the laboratory waiting area while children participated in a one-on-one session with a research assistant in a 90-square-foot observation room, viewable through a one-way

17 mirror. Children rated 160 food and non-food brands on a 13-inch laptop computer and completed short interview-style questionnaires.

Questionnaires

Parents were asked to answer standard demographic questions (e.g., parent age, education) and complete the Parent Brand Inventory. The Parent Brand Inventory was a questionnaire developed by our lab to measure parents’ perception of their child’s familiarity with food brands (e.g., Oreo®) and non-food brands (e.g., Nike®). The questionnaire was presented as a checklist asking parents to answer, “Would your child be familiar with [BRAND]?” to the best of their ability. Parents could check “Yes”, “No”, or “I don’t know” for 94 food and 83 non-food brands. Food and non-food brands were selected through an Internet search of the most popular brands in central Pennsylvania and discussions between the project leaders and research assistants. Both healthy (e.g., Nature Valley®) and less healthy (e.g., Snickers®) food brands were included in the questionnaire. Parent questionnaires took about 30 minutes to complete.

To assess children’s TV exposure to food advertising, which has been shown to influence children’s food requests,65-70 preferences,71-79 and intake,80-84 children were asked to complete the

Children’s TV Survey. This survey was developed by our lab to measure the amount of TV children watched per day, the type of TV programs they watched, when they watched TV (e.g., during dinner), and where they watched TV (e.g., in their bedroom). Children were also asked if they usually watched commercials and what they thought commercials were for. The Children’s

TV Survey took about 15 minutes to complete. Both parent and child questionnaires can be found in Appendix A.

Child height and weight

Duplicate measures of children’s height and weight were collected in light clothing without jackets or shoes. Height was measured to the nearest tenth of a centimeter using a portable stadiometer (seca®, Chino, CA) and weight was measured to the nearest tenth of a pound using a digital scale (Tanita®, Arlington Heights, IL).

Brand familiarity, emotional valence, and excitability task

In the brand familiarity, emotional valence, and excitability task, children were asked to identify and rate 79 common food (e.g., McDonald’s®) and 80 common non-food (e.g., Nerf®) brand logos matched for size, brightness, and resolution. Additionally, the novel brand, “Kaiyo”, was integrated into the food brand logo line-up, totaling 160 images. While the Parent Brand

Inventory included 94 food brands and 83 non-food brands, to prevent child fatigue, the project leaders selected 159 food and non-food brands that they thought would be most familiar to children. Images were displayed one at a time in a pre-determined, randomized order on a 13-inch laptop computer in PowerPoint presentation mode. Children were presented with alternating blocks of 10 food brands and 10 non-food brands, with a blank slide shown before and after each block. Children were asked three questions about each brand image: (1) “Can you tell me what type of food/product this picture goes with?”; (2) “On a scale from 1 to 5, with 1 being very sad and 5 being very happy, can you tell me how sad or happy the picture makes you feel?”; and (3)

“On a scale from 1 to 5, with 1 being very bored and 5 being very excited, can you tell me how bored or excited the picture makes you feel?”. Pictorial scales, adapted from the International

Affective Picture System (IAPS),126 were used for questions (2) and (3).

Question (1) was used as a measure of children’s brand familiarity, question (2) was used as a measure of children’s brand emotional valence, and question (3) was used as a measure of children’s brand excitability. Together, these measures were used to determine which 60 food and

60 non-food brands would be included in the fMRI paradigm, and which foods and brands would be included in the test-meals of the main fMRI Branding Study. This assessment took about 45-

60 minutes to complete; including short breaks (i.e., 5-10 minutes) between blocks to prevent child fatigue. The pictorial scales and a list of the food and non-food brand images used for this assessment can be found in Appendix B.

Data analysis

Data from all 20 participants were included in the analyses. Means and standard deviations were computed for continuous variables, and frequencies (%, n) were computed for categorical variables. Data were analyzed using SPSS for Windows, Version 22.0 (SPSS Inc., Chicago, IL).

Child weight status

Children’s BMI z-scores and BMI percentiles were computed from the average of children’s duplicate height and weight measurements. Children with a BMI percentile ≥ 85 were classified as overweight and children with a BMI percentile < 85 were classified as non- overweight.2

Brand familiarity, emotional valence, and excitability

Children’s responses from the brand familiarity, emotional valence, and excitability task were analyzed to determine which food and non-food brands would be included in the fMRI paradigm, and which foods and brands would be included in the test-meals of the main fMRI

Branding Study. Children’s response to question (1) was transformed into a categorical variable with the following scores: 1=unable to recognize and unable to recall brand, 2=able to recognize and unable to recall brand, and 3=able to recognize and able to recall brand. The percent and number (n) of children who reported recognizing a brand and/or could correctly identify a food or product that corresponded with a brand were reported. Means and standard deviations of children’s responses to questions (2) and (3) were computed for each brand image. Data were then visually examined to determine if any food or non-food brands had mean emotional valence and excitability scores below a “neutral” rating of 3.0 on the 5-point scale.

Results

The primary objective of the Brand Familiarity Study was to identify brands that were familiar to and well-liked by a community sample of 7-10 year-old children. Therefore, the following hypotheses were tested:

1. At least 75% of children would recognize the food brands selected for the main study

Branded condition.

2. Less than 10% of children would recognize the “Kaiyo” brand designed by our lab.

3. Food brands selected for the Branded condition and “Kaiyo” would have mean emotional

valence and excitability scores greater than 3.0 on a 5-point scale.

Child demographics

A community sample of 20 healthy, 7-9 year-old children (mean age: 7.8 ± 0.8 years) and their parents from central Pennsylvania participated in this study. All children were White and

Non-Hispanic. Approximately half of the children (n=11) were male and 75% (n=15) were non- overweight. Additional child demographic information is shown in Table 2-1.

Table 2-1. Child demographics.

Continuous variables Mean ± SD Age (years) 7.8 ± 0.8 BMI z-score 0.3 ± 1.0 Categorical variables % (n) Sex Male 55 (11) Female 45 (9) Weight status Non-overweight 75 (15) Overweight 25 (5)

Food brand familiarity, emotional valence, and excitability

A summary of results from the food brands tested in the brand familiarity, emotional valence, and excitability task are shown in Table 2-2. A priori, project leaders decided that test- meals would include macaroni and cheese, mixed vegetables, fruit, a savory snack, a sweet snack, a fruit-flavored beverage, and a dairy beverage to provide an ample variety of textures and flavors. The results of the food brands selected for the main study Branded meal and “Kaiyo” are in bold.

Table 2-2. Child-reported food brand familiarity, emotional valence, and excitability.

% recognize Emotional valance Excitability Brand % recognize (n) and recall (n) (mean ± SD) (mean ± SD) Beverages Capri Sun 75 (15) 70 (14) 3.65 ± 1.04 3.00 ± 1.26 Coca-Cola 95 (19) 95 (19) 3.65 ± 0.93 3.20 ± 1.47 Gatorade 100 (20) 100 (20) 4.15 ± 0.88 3.75 ± 1.37 Juicy Juice 80 (16) 75 (15) 3.70 ± 0.92 3.30 ± 1.26 Kool-Aid 80 (16) 80 (16) 3.85 ± 0.81 3.65 ± 1.27 Mountain Dew 90 (18) 90 (18) 3.70 ± 1.13 3.70 ± 1.34 Nesquik 65 (13) 40 (8) 3.75 ± 0.91 3.20 ± 1.51 Ocean Spray 65 (13) 40 (8) 3.40 ± 0.94 3.00 ± 1.30 Pepsi 100 (20) 100 (20) 4.10 ± 1.12 4.15 ± 1.04 Powerade 40 (8) 35 (7) 3.55 ± 1.10 3.00 ± 1.41 Sunny Delight 35 (7) 35 (7) 3.50 ± 1.00 3.05 ± 1.36 Tropicana 55 (11) 35 (7) 3.65 ± 0.93 2.85 ± 1.31 Candy Hershey’s 100 (20) 100 (20) 4.80 ± 0.52 4.65 ± 0.81 M&M’s 100 (20) 100 (20) 4.75 ± 0.55 4.65 ± 0.75 Reese’s 100 (20) 100 (20) 4.65 ± 0.67 4.40 ± 1.05 Snickers 100 (20) 95 (19) 4.60 ± 0.60 4.45 ± 0.89 Sour Patch 95 (19) 95 (19) 4.05 ± 1.00 4.05 ± 1.05 Twizzlers 95 (19) 95 (19) 4.30 ± 0.87 4.25 ± 0.97 Condiments Aunt Jemima 55 (11) 50 (10) 3.45 ± 1.15 2.95 ± 1.47 Heinz 40 (8) 25 (5) 3.25 ± 0.91 2.65 ± 1.35 Hidden Valley 55 (11) 50 (10) 3.40 ± 1.00 2.60 ± 1.35 Jif 100 (20) 90 (18) 3.55 ± 1.10 3.30 ± 1.22 Smucker’s 50 (10) 35 (7) 3.30 ± 0.92 2.85 ± 1.42 Entrée Foods Campbell’s 60 (12) 50 (10) 3.10 ± 1.02 2.75 ± 1.12 Chef Boyardee 65 (13) 60 (12) 3.40 ± 0.94 3.15 ± 1.14 Hot Pockets 55 (11) 50 (10) 3.45 ± 1.00 3.00 ± 1.38 Kraft 65 (13) 25 (5) 3.55 ± 0.95 2.75 ± 1.25 Lunchables 95 (19) 95 (19) 3.65 ± 0.99 3.55 ± 1.43 Progresso 45 (9) 35 (7) 3.20 ± 1.01 2.55 ± 1.36 Ragù 30 (6) 20 (4) 3.30 ± 1.08 2.85 ± 1.27 SpaghtettiOs 50 (10) 50 (10) 3.50 ± 1.05 3.00 ± 1.34 Fruits and Vegetables Birds Eye 20 (4) 5 (1) 3.25 ± 1.07 2.65 ± 1.39 Dole 65 (13) 35 (7) 3.40 ± 0.94 2.90 ± 1.37 Mott’s 85 (17) 75 (15) 3.60 ± 0.82 3.25 ± 1.20 Sun-Maid 85 (17) 85 (17) 3.55 ± 0.83 3.15 ± 1.46 Grains Cheerios 100 (20) 100 (20) 3.70 ± 1.26 3.40 ± 1.39

Eggo 55 (11) 55 (11) 3.55 ± 1.15 3.25 ± 1.29 General Mills 35 (7) 15 (3) 2.85 ± 0.99 2.45 ± 1.28 Kellogg’s 75 (15) 65 (13) 3.45 ± 0.76 3.50 ± 1.10 Lucky Charms 100 (20) 100 (20) 3.95 ± 1.10 3.75 ± 1.41 Nature Valley 55 (11) 45 (9) 3.25 ± 0.64 2.50 ± 1.19 Pepperidge Farm 50 (10) 20 (4) 3.10 ± 1.02 2.85 ± 1.35 Pillsbury 30 (6) 20 (4) 3.25 ± 1.12 2.90 ± 1.25 Quaker 95 (19) 85 (17) 3.60 ± 1.31 3.00 ± 1.52 Special K 70 (14) 65 (13) 3.10 ± 1.17 2.55 ± 1.50 Trix 80 (16) 80 (16) 3.75 ± 1.12 3.60 ± 1.35 Wonder 45 (9) 25 (5) 3.30 ± 1.22 3.20 ± 1.47 Savory Snacks Cheetos 85 (17) 85 (17) 3.80 ± 1.15 3.85 ± 1.23 Cheez-It 100 (20) 100 (20) 3.90 ± 0.85 3.45 ± 1.23 Doritos 100 (20) 100 (20) 4.35 ± 0.99 4.20 ± 1.11 Fritos 60 (12) 55 (11) 3.55 ± 1.15 3.40 ± 1.23 Lay’s 85 (17) 75 (15) 4.05 ± 1.19 3.55 ± 1.28 Orville 50 (10) 45 (9) 3.60 ± 1.05 3.25 ± 1.37 Redenbacher’s Planters 95 (19) 90 (18) 3.70 ± 1.03 3.45 ± 1.32 Pringles 100 (20) 100 (20) 3.95 ± 1.10 3.90 ± 1.25 Ritz 90 (18) 90 (18) 3.80 ± 1.20 3.60 ± 1.19 Snyder’s of Hanover 55 (11) 45 (9) 3.55 ± 1.00 3.05 ± 1.50 Tostitos 80 (16) 80 (16) 4.20 ± 0.70 3.95 ± 1.32 Sweet Snacks Ben & Jerry’s 40 (8) 35 (7) 4.00 ± 1.21 3.70 ± 1.46 Betty Crocker 55 (11) 40 (8) 3.55 ± 1.15 2.90 ± 1.37 Chips Ahoy! 75 (15) 70 (14) 4.00 ± 1.03 3.70 ± 1.17 Fruit Roll-Ups 95 (19) 95 (19) 4.25 ± 0.91 4.00 ± 1.38 Keebler 95 (19) 85 (17) 4.00 ± 0.92 3.70 ± 1.34 Nabisco 35 (7) 20 (4) 3.20 ± 1.28 2.35 ± 1.18 Oreo 100 (20) 100 (20) 4.15 ± 0.99 4.45 ± 0.69 Pop-Tarts 90 (18) 90 (18) 4.15 ± 0.93 4.40 ± 1.00 Yoplait 95 (19) 90 (18) 3.45 ± 1.23 2.90 ± 1.45 Restaurants Auntie Anne’s 85 (17) 80 (16) 3.95 ± 1.15 3.70 ± 1.34 Burger King 95 (19) 90 (18) 4.05 ± 0.89 3.85 ± 1.90 Chili’s 60 (12) 50 (10) 3.75 ± 0.97 3.45 ± 1.50 Denny’s 70 (14) 60 (12) 3.40 ± 0.82 2.95 ± 1.19 Domino’s Pizza 90 (18) 85 (17) 4.25 ± 0.97 4.15 ± 1.04 Dunkin’ Donuts 95 (19) 90 (18) 3.85 ± 1.14 3.90 ± 1.37 McDonald’s 100 (20) 100 (20) 4.35 ± 1.04 4.20 ± 1.15 Pizza Hut 100 (20) 100 (20) 4.30 ± 0.87 4.45 ± 0.89 Red Lobster 95 (19) 90 (18) 3.60 ± 1.19 3.35 ± 1.46 Starbucks Coffee 85 (17) 75 (15) 3.10 ± 1.17 2.30 ± 1.30 Subway 100 (20) 100 (20) 4.45 ± 0.67 4.25 ± 1.02 Taco Bell 100 (20) 100 (20) 3.70 ± 1.13 3.30 ± 1.46 Kaiyo 5 (1) 0 (0) 3.05 ± 1.10 2.30 ± 1.13

Of the entrée foods included in the task, Kraft® was the only viable brand of macaroni and cheese. Sixty-five percent (n=13) of children recognized Kraft®, with 5 children correctly naming “macaroni and cheese” as a Kraft® product. Children’s mean emotional valence rating of

Kraft® was 3.55 ± 0.95 and children’s mean excitability rating was 2.75 ± 1.25. Birds Eye® was the only viable brand of mixed vegetables included in the task. Only 20% (n=4) of children recognized Birds Eye®, with 1 child correctly naming “frozen vegetables” as a Birds Eye® product. Children’s mean emotional valence rating of Birds Eye® was 3.25 ± 1.07 and children’s mean excitability rating was 2.65 ± 1.39. Mott’s® was the highest recognized and rated brand of fruit products. Eighty-five percent (n=17) of children recognized Mott’s®, with 15 children correctly naming “applesauce” as a Mott’s® product. Children’s mean emotional valence rating of

Mott’s® was 3.60 ± 0.82 and children’s mean excitability rating was 3.25 ± 1.20. Pringles® was one of the highest recognized and rated savory snacks included in the task. One hundred percent

(n=20) of children recognized Pringles® and correctly named “potato chips” as Pringles® products. Children’s mean emotional valence rating of Pringles® was 3.95 ± 1.10 and children’s mean excitability rating was 3.90 ± 1.25. Keebler® was one of the highest recognized and rated sweet snacks. Ninety-five percent (n=19) of children recognized Keebler®, with 17 children correctly naming “cookies” as Keebler® products. Children’s mean emotional valence rating of

Keebler® was 4.00 ± 0.92 and children’s mean excitability rating was 3.70 ± 1.34. Kool-Aid® was the highest recognized and rated brand of fruit drinks. Eighty percent (n=16) of children recognized Kool-Aid® and correctly named “fruit drinks” as Kool-Aid® products. Children’s mean emotional valence rating of Kool-Aid® was 3.85 ± 0.81 and children’s mean excitability rating was 3.65 ± 1.27. Nesquik® was the only viable brand of dairy beverages included in the task. Sixty-five percent (n=13) of children recognized Nesquik®, with 8 child correctly naming

“chocolate milk” as a Nesquik® product. Children’s mean emotional valence rating of Nesquik® was 3.75 ± 0.91 and children’s mean excitability rating was 3.20 ± 1.27. Only one child (5%)

25 reported recognizing the novel brand, “Kaiyo”. Children’s mean emotional valence rating of

“Kaiyo” was 3.05 ± 1.10 and children’s mean excitability rating was 2.30 ± 1.13. A graphical representation of children’s brand familiarity is shown in Figure 2-2, and children’s emotional valence and excitability ratings of the test-meal brands are shown in Figure 2-3.

100

Recognized brand Recognized (%) 0

Figure 2-2. Children’s brand familiarity measured as the percentage of children who

recognized the brand.

5 Emotional valence Excitability

Mean rating rating Mean 2

Figure 2-3. Children’s mean emotional valence and excitability ratings of test-meal brands on a

5-point scale. Values are depicted as means and standard errors.

Discussion

A priori, project leaders selected macaroni and cheese, mixed vegetables, fruit, a savory snack, a sweet snack, a fruit-flavored beverage, and a dairy beverage for the test-meals. These items were selected because they provided a variety of flavors and textures and have previously been used in studies with children.110,125,127 We hypothesized that (1) at least 75% of children would recognize the food brands selected for the main study Branded condition, (2) less than 10% of children would recognize “Kaiyo”, and (3) the food brands selected for the Branded condition and

“Kaiyo” would have mean emotional valence and excitability scores greater than 3.0 on a 5-point scale.

Our hypotheses were partially supported. More than 75% of children recognized Mott’s®,

Kool-Aid®, Pringles®, and Keebler®, and only 1 child (5%) reported recognizing “Kaiyo”. Of the food brands included in the brand familiarity, emotional valence, and excitability task, Kraft® was the only viable brand of macaroni and cheese. Counter to our hypothesis, only 65% (n=13) of children recognized Kraft®, with 5 children correctly naming “macaroni and cheese” as a Kraft® product. The mean excitability rating of Kraft® was 2.75 ± 1.25, also below our hypothesis of 3.0 on a 5-point scale. Other pasta entrée brands, such as Chef Boyardee® and SpaghettiOs® were of the same or less familiarity (65% and 50% recognized brand, respectively) and had mean excitability scores that were not significantly different from Kraft® (t = 1.41, p = .18 and t = .77, p

= .45, respectively). Additionally, because 95% (n=19) of children recognized Lunchables®, and

Lunchables® was rated significantly higher than Kraft® on excitability (t = 2.27, p < .05), our research team considered using Lunchables® as the main entrée brand instead of Kraft®.

However, Lunchables® is typically thought of as a cold “lunch” food, and we planned for the majority of test-meals to be during dinnertime (when 7-10 year-old children are not in school).

Therefore, Kraft® macaroni and cheese was chosen as the meal entrée and the logo was modified to include the quintessential Kraft® smiling noodle (see Table 2-3).

Because a cheese-flavored entrée was selected, the highest-rated non-cheese flavored savory snack, Pringles®, was chosen to provide the most flavor variety in the meal. For the sweet snack, Keebler® Chips Deluxe Chocolate Chip Cookies were selected instead of other more frequently recognized or higher rated snacks (i.e., Oreo® or Fruit Roll-Ups®); again, to provide the most flavor variety, and to include a sweet snack that was rated similarly to other brands in the test-meals. Of the food brands included in the task, Nesquik® was the only viable brand of dairy beverages. Contrary to our hypothesis, only 65% (n=13) of children recognized Nesquik®, with 8 children correctly naming “chocolate milk” as a Nesquik® product. However, children rated Nesquik® above neutral on emotional valence (3.75 ± 0.91) and excitability (3.20 ± 1.51).

The project leaders also decided to use Green Giant®, an alternative frozen vegetable brand to Birds Eye®, because only 20% (n=4) of children recognized Birds Eye® and children rated the excitability of Birds Eye® below 3.0 on a 5-point scale (2.65 ± 1.39). While the Green

Giant® brand was not tested with children, we thought children would be familiar with the Green

Giant® character (see Table 2-3). The “Kaiyo” brand also received a mean excitability score below 3.0 (2.30 ± 1.13). This is most likely because children were only presented with the text of the brand logo in this task (i.e., the character was not included). The logo was therefore modified to include bold, red block letters. The modifications of the test-meal brands based on the results from the Brand Familiarity Study are shown in Table 2-3.

Table 2-3. Logos in the brand familiarity, emotional valence, and excitability task modified for test-meals.

Task logo Meal logo

30 Chapter 3

Children’s Response to Food Branding at Three Laboratory Test-meals

Introduction

This chapter summarizes the study design, testing protocols, and analysis of the behavioral data from the main fMRI Branding Study. This study used a crossover design to test children’s response to food branding at three multi-item, ad libitum laboratory test-meals. Children 7-10 years old were selected for this study because this age group (8-12 years) views the most advertisements daily,57 has sufficient cognitive abilities to perform tasks associated with food liking and preference, and has previously been shown to successfully complete fMRI scans.128

Food preparation and test-meals took place in the Metabolic Kitchen and Children’s

Eating Behavior Laboratory at The Pennsylvania State University. Following explanations of the study procedures, voluntary participation, risks, and benefits, parents or legal guardians provided their written informed consent for their child’s participation. Children gave their verbal assent to participate following a simplified explanation of the procedures. The Institutional Review Board of The Pennsylvania State University approved this study.

Methods

Participants

Twenty-eight 7-10 year-old children (mean age: 8.5 ± 1.2 years) and their parents from central Pennsylvania were selected to participate in the fMRI Branding Study. Children and their parents were recruited through the FIRSt database, online advertisements, and flyers posted

31 locally. Interested parents were instructed to call the Children’s Eating Behavior Laboratory and were screened over the phone for eligibility by trained research staff. Healthy children aged 7-10 years old with no known food allergies, learning disabilities, or medical conditions, and who regularly watched TV and used the Internet, were eligible to participate. Additionally, because this study used fMRI, children were excluded from participating if they were left-handed, had any metal in or on their body that could not be readily removed (e.g., dental work), were regularly taking prescription or over-the-counter medications that could affect their cognitive response

(e.g., anti-depressants), were uncomfortable in small spaces, were red and/or green color blind, and if they or someone in their immediate family (i.e., parents or siblings) had been diagnosed with a psychiatric illness, such as depression, anxiety, or bipolar disorder. A more detailed description of child demographic information can be found in the Results section that follows.

Study design

The fMRI Branding Study had a total of four visits, each scheduled one week apart.

Three test-meal visits took place in the Children’s Eating Behavior Laboratory and one fMRI visit took place in the Social, Life, and Engineering Sciences Imaging Center (SLEIC) at The

Pennsylvania State University. See Table 3-1 for a flowchart of the study visit procedures.

Parents were instructed to have their child fast for two hours prior to their appointments and were asked to reschedule if their child was not feeling well. Each meal visit featured a different packaging condition: (1) Branded: familiar food brand labels (e.g., Kraft®, Pringles®), (2)

Unbranded: generic white labels, or (3) “Kaiyo”: colorful labels with a novel brand and cartoon character designed by our lab for 7-10 year-old children. See Figures 3-2, 3-3, and 3-4, respectfully. Children received the packaging conditions in a pre-determined randomized order, counter-balanced across participants. Meal visits took place during lunchtime (11:30 AM to 2:00

PM) or dinnertime (4:30 PM to 7:30 PM) throughout the week or over the weekend. Research

assistants worked with families to schedule their visits for the same day and time each week.

Children completed a training session in the mock/practice scanner on their third visit, and the

fMRI scan took place on their fourth visit. During the training session and scan, children were

instructed to dress in light, loose, comfortable clothing without metal fasteners and to remove all

metal (e.g., jewelry, glasses) before entering the scanner. Children were trained to “lie still like a

statue” on the bed that entered the scanner bore, and to look at images in the mirror attached to

the head coil. Children viewed 20 images of puppies and kittens for 2 minutes during the training

session, and a total of 180 food brands, non-food brands, and scrambled images for 20-25 minutes

during the fMRI procedure. A more detailed description of the fMRI portion of this study can be

found in a later publication.

Table 3-1. Flowchart of study visits.

Visit 1 Visit 2 Visit 3 Visit 4

• Consent and assent • Child food liking • Child food liking • Freddy Fullness • Child anthropometrics and preference and preference • fMRI scan • Parent questionnaires • Freddy Fullness • Freddy Fullness • Freddy Fullness • Child food liking and • Test-meal • Test-meal • Child Brand preference • Freddy Fullness • Freddy Fullness Liking and • Freddy Fullness • Child • fMRI training Wanting VAS • Test-meal questionnaires session • Freddy Fullness (LOC-ED, TV • Child questionnaires and Internet, (Impulsivity and Food Frequency) Activity)

Questionnaires

Parents and children completed several questionnaires using a computer survey program

(Qualtrics, Provo, UT). All questionnaires for the fMRI Branding Study can be found in

Appendix C.

Parent questionnaires

Parents were asked basic demographic questions (e.g., race, income, education) and about their child’s brand familiarity, media use and advertisement exposure, infant and child feeding practices, and child’s responses to foods and behavior during eating occasions. Questionnaires took parents about 45 minutes to complete.

The Parent Brand Inventory was developed by our lab to measure parents’ perception of their child’s familiarity with food and non-food brands. The responses from this questionnaire were computed into a sum score to determine children’s baseline level of brand familiarity. We hypothesized that children’s food brand familiarity would be related to children’s media usage, weight status, and test-meal energy intake.8,72,110,114,125 A more detailed description of this questionnaire can be found in Chapter 2.

The Parent’s Ad Survey was developed by our lab to evaluate family exposure to advertisements in the home (i.e., TV and Internet) and in grocery stores. Parents were asked about the amount of time they spent watching TV and using the Internet at home, the content of their

TV and Internet usage, and how often their child accompanied them to the grocery store. Their responses provided a measure of family advertisement exposure that was hypothesized to relate to children’s brand familiarity and reported media usage.

The Infant Feeding Questionnaire was developed by our lab to assess maternal dietary habits and feeding practices throughout pregnancy, lactation, and their child’s first year (e.g.,

“How did you mainly feed your child during the first year (12 months) of their life?”). This questionnaire was important to include because previous research has demonstrated that early flavor exposure may influence children’s food preferences later in life.43,129-131

The Children’s Eating Behaviour Questionnaire (CEBQ)132 was used to measure parents’ perception of their child’s response to food and beverage cues (e.g., “My child is always asking for food”). More specifically, this questionnaire evaluated 8 dimensions of children’s eating behavior: food responsiveness (FR), enjoyment of food (EOF), emotional overeating (EOE), emotional undereating (EUE), desire to drink (DD), satiety responsiveness (SR), slowness in eating (SE), and food fussiness (FF). Scores from these subscales were used as part of an exploratory aim to evaluate relationships between child-level characteristics and children’s response to food branding in the laboratory.

The Child Feeding Questionnaire133 measures 7 factors related to parents’ child-feeding perceptions, attitudes, and practices. These factors include: parents’ perceived responsibility, parents’ perceived weight, parents’ perception of their child’s weight, parents’ concerns about their child’s weight, and parents’ levels of monitoring, restriction, and pressure to eat (e.g., “I have to be sure my child does not eat too many sweets, candy, ice cream, cake or pastries.”). This questionnaire was included because research has shown that children with parents who highly restrict access to energy-dense, palatable foods are more likely to increase their preferences for46-48 and energy intake47,49-51 of these foods.

A modified 6-item version of the Child Food Neophobia Scale36,37 was used to measure children’s willingness to try new and/or unfamiliar foods. Because the test-meals included both familiar (i.e., the Branded condition) and unfamiliar (i.e., “Kaiyo” condition) brands, parents’ perception of their child’s food neophobia was hypothesized to influence children’s meal liking

35 and energy intake in the laboratory.

Child questionnaires

Child questionnaires were completed in one-on-one interviews, with the research assistant asking the child questions and recording his/her responses using a computer survey program (Qualtrics, Provo, UT). Children were asked to complete the Impulsiveness and

Venturesomeness in Children Questionnaire,134 the Kid’s Activity Questionnaire, the Loss of

Control Eating Disorder (LOC-ED) Questionnaire,135 the Children’s TV and Internet Survey, the

Child Food Frequency Questionnaire, and the Brand Liking and Wanting Visual Analog Scale

(VAS) Questionnaire. To minimize child fatigue, children completed 20 minutes of questionnaires on the first (Impulsiveness and Venturesomeness in Children Questionnaire, Kid’s

Activity Questionnaire), second (LOC-ED, Children TV and Internet Survey, Child Food

Frequency Questionnaire), and fourth (Brand Liking and Wanting VAS Questionnaire) study visits.

The Impulsiveness and Venturesomeness in Children Questionnaire developed by

Eysenck and Eysenck,134 assessed children’s impulsiveness, venturesomeness (i.e., sensation- seeking), and empathy. Items were posed as yes/no questions (e.g., “Do you generally do and say things without stopping to think?”), and research assistants explained or rephrased an item if children had difficulty understanding a question. This questionnaire was included because child- reported measures of impulsivity have been shown to positively correlate with child weight status.136

The Kid’s Activity Questionnaire was administered to determine levels of children’s physical activity and inactivity. This questionnaire was developed by our lab to assess the types of physical (e.g., soccer) and sedentary (e.g., watching TV) activities children engaged in and the

36 amount of time they spent engaging in these activities during the school year and the summer.

The LOC-ED Questionnaire135 is a structured interview that assesses binge eating and

LOC eating frequency in children (e.g., “During the past 3 months have you ever felt that you were not able to stop eating, or not able to control the type of food or amount of food that you ate?”). This questionnaire was included because binge eating is common in middle childhood (6-

12 years) and is often associated with energy intake and predictive of child overweight and adiposity.137,138

The Children’s TV and Internet Survey was an extended version of the Children’s TV

Survey explained in Chapter 2. In addition to questions about their TV usage, children were asked about their Internet usage (e.g., “About how many hours per day do you use the Internet?”) to gain a measure of children’s media exposure.

The Child Food Frequency Questionnaire was developed by our lab to assess children’s usual intake of commonly consumed foods and beverages (e.g., macaroni and cheese, pizza, soda). Age-appropriate (6-11 years) foods and serving sizes were selected from the 1994-1996

Continuing Survey of Food Intakes by Individuals (CSFII).139

The Brand Liking and Wanting VAS Questionnaire was completed on the fourth visit, following the MRI scan. Children were shown the same 120 food and non-food brands from the scan, and were asked to rate their liking of each brand and their wanting of a product or food associated with each brand on a digital 150 millimeter (mm) VAS. Children’s liking of brands and wanting for a brand’s product or food was hypothesized to relate to children’s test-meal liking and energy intake, and correspond with brain activation in the fMRI scan.140,141

Child height, weight, and percent body fat

Duplicate measurements of children’s height and weight were collected in light clothing

37 without jackets or shoes. Height was measured to the nearest tenth of a centimeter using a portable stadiometer (seca®, Chino, CA) and weight was measured to the nearest tenth of a pound using a digital scale (Tanita®, Arlington Heights, IL). Children’s percent body fat was measured in bare feet to the nearest tenth percent using a body composition analyzer (Tanita®, Arlington

Heights, IL).

Meal preparation

Test-meals included Kraft® Macaroni and Cheese, Green Giant® (or Birds Eye®)1 Mixed

Vegetables, Mott’s® Original Applesauce, Pringles® Original Potato Chips, Keebler® Chips

Deluxe Chocolate Chip Cookies, Kool-Aid® Bursts Tropical Punch, and Nesquik® Low-Fat

Chocolate Milk. Foods served warm (macaroni and cheese, mixed vegetables) and foods served chilled (applesauce, punch, chocolate milk) were prepared within 30 minutes of each visit. Shelf- stable foods (potato chips, cookies) were repackaged into individual zip-top plastic bags on a weekly basis and kept in dry storage. Macaroni and cheese was prepared on a stovetop according to manufacturer instructions. Frozen mixed vegetables were steamed with tap water in a covered bowl (Pyrex, Corning, NY) for 2 minutes and 30 seconds on high in a microwave oven (General

Electric, Fairfield, CT). Applesauce, punch, and chocolate milk were stored in the refrigerator and served at a chilled temperature. Cookies and chips were served at room temperature.

1 The manufacturer discontinued the production of Green Giant® Frozen Mixed Vegetables halfway through this study. The Green Giant® Frozen Mixed Vegetables were replaced by Birds Eye® Frozen Mixed Vegetables, which were similar in energy density and sodium content, and included the same vegetable types (peas, carrots, corn), shapes, and sizes. Although the source of mixed vegetables changed, the Branded meal mixed vegetables were packaged with Green Giant® brand labels throughout the entire study. For simplicity, these vegetables will be referred to as the Green Giant® Mixed Vegetables throughout this thesis.

Test-meal liking and preference assessment

Prior to the test-meals, children were asked to complete the test-meal liking and preference assessment. During this assessment, children tasted samples of the test-meal foods and beverages and indicated their liking and preferences. To maintain consistency throughout data collection, research assistants were trained to use specific language and scripts, and to respond neutrally to children’s comments. Before children tasted and rated the samples, research assistants introduced children to an age-appropriate 5-point hedonic smiley face scale142 (ranging from

1=super bad to 5=super good) and read a script explaining how to use the scale (see Appendix

D). Children’s understanding of the scale was confirmed by having them rate their favorite and least favorite foods using the tool. If a child gave a nonsensical rating (e.g., rating their favorite food as “super bad”), the researcher repeated the explanation of the scale until the child demonstrated his/her understanding. All children demonstrated an understanding of the scale.

Children were then presented with a tray of small, bite- or sip-size samples (0.5 g to 6 g) of each food or beverage in a clear 2-ounce soufflé cup with matching lid and a cup of water for rinsing before and after tasting each sample. Soufflé cups were labeled corresponding to the test- meal condition (i.e., Branded: familiar food brands, Unbranded: white labels, or “Kaiyo” labels).

The approximate sample amounts and tray layout are provided in Table 3-2 and Figure 3-1, respectfully. Children were asked to taste each item, one at a time, and then indicate their liking using the smiley face scale.142 Following the liking assessment, children completed a preference assessment during which they were asked to rank-order the meal foods and beverages from

7=most favorite to 1=least favorite.

Table 3-2. Liking and preference assessment foods and beverages.

Meal item Serving size Weight (g)

Kraft® Macaroni and Cheese 2 noodles 2.3 1 carrot, 1 pea, Green Giant® Mixed Vegetables 3.5 1 bean, 1 kernel Mott’s® Original Applesauce 1 tsp. 5.9

Pringles® Original Potato Chips 1/4 chip 0.5 Keebler® Chips Deluxe Chocolate Chip 1/4 cookie 4.1 Cookies Kool-Aid® Bursts Tropical Punch 1 tsp. 5.2

Nesquik® Low-Fat Chocolate Milk 1 tsp. 5.2

Figure 3-1. Liking and preference assessment tray layout (Branded condition).

Children’s perceived fullness

Research assistants used the Freddy Fullness Scale developed by Keller and colleagues143

40 to assess children’s perceived fullness before and after the test-meals. This scale is a pictorial version of a VAS that has been validated in 4-6 year-old children.143 Sheets of paper with an image of the Freddy doll were placed in a folder pocket with a 2-cenitmeter wide slider that children could slide up and down the length of the doll to indicate their perceived fullness.

Children were first read a script explaining how to use the scale (e.g., “As Freddy eats more, his stomach fills up”), and were then asked to indicate how full they would feel after “eating one cookie”, “a few more cookies”, and a “meal that made [them] feel completely full”. After the children demonstrated their understanding of the scale, they were asked to rate their perceived fullness by moving the slider to the appropriate spot on Freddy. The researcher marked the paper, and after the test session, used a ruler to measure the position of the mark from the bottom anchor to the nearest millimeter. Fullness ratings ranged from 0 mm (not full at all) to 150 mm

(completely full). Independent pre-meal and post-meal measures were recorded and difference scores were calculated to use as the covariate “fullness” in analyses.

Multi-item, ad libitum test-meals

Serving sizes for the meal foods and beverages can be found in Table 3-3. At least two servings of each item were prepared for the ad libitum test-meal, with additional servings of foods and beverages readily available. All test-meal foods and beverages were served in clear plastic containers with labels corresponding to the appropriate brand condition (i.e., Branded,

Unbranded, or “Kaiyo”). Macaroni and cheese was served in a clear 16-ounce (oz.) plastic container with matching lid, mixed vegetables and applesauce were served in clear 8-oz. plastic containers with matching lids, cookies and chips were served in clear plastic zip-top sandwich bags, and punch and chocolate milk were served in clear 9-oz. plastic cups with matching lids and straws. For each brand condition, meal items were arranged on a tray as shown in Figures 3-2,

3-3, and 3-4.

Prior to serving, test-meal foods and beverages were weighed to the nearest hundredth of a gram (g) using a digital balance. Foods presented in plastic containers were measured without lids to account for added weight from steam or condensation, and beverages were measured with lids to account for potential spillage. Pre-meal weights were recorded on participants’ meal intake data sheets.

Children were presented with an ad libitum, multi-item test-meal packaged with their assigned brand condition. Research assistants informed children that they had 30 minutes to eat as much or as little as they wanted, and that they could ask for additional servings of any item throughout the meal. While a child ate, research assistants read an age-appropriate, non-food related story (e.g., Matilda) out loud to serve as a consistent, neutral distraction. If the researcher noticed that the child finished a serving of food or stopped eating, the researcher would remind the child that s/he could have as much or as little food as s/he wanted. If the child asked for an additional serving, the researcher brought out another serving of the same size and in the same packaging. After the child indicated that s/he was finished eating, all meal items were post- weighed and recorded to the nearest hundredth of a gram on the child’s meal intake data sheet.

Table 3-3. Test-meal foods and beverages.

Energy Serving Energy Meal item Weight (g) density size (kcal) (kcal/g)

Kraft® Macaroni and Cheese 1 cup 216 799.6 3.7

Green Giant® Mixed Vegetables 1/2 cup 85 50.6 0.6

Mott’s® Original Applesauce 1/2 cup 141 121.2 0.9

Pringles® Original Potato Chips 16 chips 29 155.4 5.4 Keebler® Chips Deluxe Chocolate 3 cookies 49 261.3 5.3 Chip Cookies

Kool-Aid® Bursts Tropical Punch 6.75 oz. 211 21.1 0.1 Nesquik® Low-Fat Chocolate 8 oz. 251 159.5 0.6 Milk

Figure 3-2. Branded meal tray layout.

Figure 3-3. Unbranded meal tray layout.

Figure 3-4. Kaiyo meal tray layout.

Data analysis

Data from all 28 participants were included in the analyses. Data were analyzed using SPSS for

Windows, Version 22.0 (SPSS Inc., Chicago, IL). All statistical tests were two-tailed with a critical value of p ≤ 0.05. Means and standard deviations were computed for continuous variables, and frequencies (%, n) were computed for categorical variables.

Child weight status

Test-meal liking

Means and standard deviations were computed from children’s test-meal food and beverage liking ratings in each brand condition (possible range: 1-5 liking rating). Sum scores for children’s overall liking of the test-meals were calculated from children’s liking ratings (possible range: 7-35 liking score). Means and standard deviations of the overall test-meal liking scores and liking ratings of the meal foods and beverages are shown in Table 3-6.

Test-meal energy intake

Children’s energy intake in kilocalories (kcal) at the three test-meals were determined by multiplying the amount consumed in grams (g) by the energy density (kcal/g) calculated from the

45 nutrition facts panel on the original packaging of each food or beverage. Means and standard deviations for energy intake of the total meal and of the individual foods and beverages are shown in Table 3-7.

Meal liking and energy intake by brand condition

Mixed models were used to test the effects of brand condition (i.e., Branded, Unbranded,

Kaiyo) on children's overall test-meal liking and energy intake, and children’s liking for and energy intake of each meal food or beverage. This approach was used because mixed models with repeated measures account for correlations between measures (in ANOVA the measures must be independent) and do not assume homogeneity of variance. To determine which variables to include in the models as covariates, data were first analyzed using Pearson’s correlations for continuous variables (e.g., BMI z-score, meal liking sum score) and Spearman’s correlations for categorical variables (e.g., sex, liking rating of meal food or beverage). The following variables were tested: overall meal liking sum score, liking rating for each meal food or beverage, total meal energy intake, energy intake for each meal food or beverage, brand condition (Branded,

Unbranded, Kaiyo), week of the study visit (1, 2, or 3), child-reported fullness, child BMI, child

BMI z-score, child sex, child age (years), child body fat percentage, and frequency of usual consumption of meal foods. See Table 3-8 for meal liking correlations and Table 3-9 for energy intake correlations.

For the model of overall meal liking analyzed by brand condition, overall meal liking was associated with child BMI z-score (r = -.24, p < .03) and body fat percentage (r = -.24, p < .03).

Because child BMI z-score accounts for age, sex, and adiposity, the final model included overall meal liking analyzed by brand condition with BMI z-score as a covariate. For the models of test- meal food and beverage liking ratings analyzed by brand condition, liking ratings were associated

46 with child BMI z-score, sex, body fat percentage, and frequency of usual consumption of macaroni and cheese. Because BMI z-score is dependent on child age and sex, and was associated with child body fat percentage (r = .84, p < .0001), BMI z-score was the only covariate entered into the models. Additionally, because we did not collect data on children’s usual consumption of all test-meal foods and beverages, the final models included the liking rating of each food or beverage analyzed independently by brand condition with BMI z-score as a covariate.

For the model of total meal energy intake analyzed by brand condition, energy intake was correlated with overall test-meal liking (r =. 24, p < .03) and fullness (r = .42, p < .0001). The final model therefore included total meal energy intake analyzed by brand condition with overall test-meal liking and fullness entered as covariates. For the models of meal food and beverage energy intake analyzed by brand condition, energy intakes were associated with liking ratings of the corresponding food or beverage, BMI z-score, and fullness. The final models included energy intake of each food or beverage analyzed independently by brand condition with liking of the food or beverage, BMI z-score, and fullness as covariates.

Child-level characteristics and children’s response to food branding

Pearson’s and Spearman’s correlations were used to test for relationships between individual child-level characteristics and children’s energy intake across meal conditions in the laboratory. Child-level characteristics of interest were children’s age, sex, weight status, body fat percentage, impulsivity, food responsiveness (FR), enjoyment of food (EOF), and food neophobia score; parental food restriction, pressuring, and monitoring of the child’s diet; the number of hours children spent watching TV; and parental perception of their child’s brand familiarity.

Children’s mean energy intake in the Unbranded condition was subtracted from mean energy intake in the Branded and Kaiyo conditions to create difference scores for analyses.

Results

The primary aims of the fMRI Branding Study were to test the effects of branding on 7-10 year- old children’s liking and energy intake at three laboratory test-meals. A secondary exploratory aim was to identify potential individual child-level characteristics that may explain variance in children’s response to food branding in the laboratory. Therefore, the following hypotheses were tested:

1. The Branded meal would be most liked by children compared to the Unbranded and

Kaiyo meals.

2. Children would consume more energy from the Branded meal compared to the

Unbranded and Kaiyo meals.

3. Children’s laboratory test-meal energy intake would be associated with individual child-

level characteristics, such as child weight status, sex, age, food neophobia, brand

exposure, food responsiveness, and measures of parental feeding practices (e.g.,

restriction).

Child demographics

Twenty-eight healthy, 7-10 year-old children (mean age: 8.5 ± 1.2 years) and their parents from central Pennsylvania participated in this study. There were an equal number of boys and girls, and the majority of children were White, Non-Hispanic, non-overweight, and from families with annual household incomes greater than $50,000. A more detailed description of children’s demographic information can be found in Tables 3-4 and 3-5.

Table 3-4. Child demographics: continuous variables.

Continuous variables Min Max Mean ± SD Age (years) 7.08 10.83 8.96 ± 1.27 BMI z-score -2.31 1.89 0.20 ± 1.13

Percent body fat 2.70 33.70 20.42 ± 8.15

Table 3-5. Child demographics: categorical variables.

Categorical variables % (n) Sex Male 50 (14) Female 50 (14) Race Black 3.6 (1) Multi-racial 3.6 (1) White 92.9 (26) Ethnicity Hispanic 3.6 (1) Non-Hispanic 96.4 (27) Weight status Non-overweight 71.4 (20) Overweight 28.6 (8) Annual household income $20,000-$50,000 21.4 (6) > $50,000 67.9 (19) No response 10.7 (3)

Meal liking ratings and sum scores

Means and standard deviations for overall test-meal liking scores and liking ratings of the meal foods and beverages are shown in Table 3-6. Children’s average liking ratings across foods

49 and beverages (mean ± SD) for each brand condition were as follows: 4.13 ± 0.42 in the Branded condition, 4.11 ± 0.39 in the Unbranded condition, and 4.08 ± 0.42 in the Kaiyo condition. Sum scores for children’s overall meal liking ranged from 20 to 35 (possible range: 7-35 sum score).

Children’s overall meal liking scores (mean ± SD) across brand conditions were as follows: 28.89

± 2.97 in the Branded condition, 28.75 ± 2.73 in the Unbranded condition, and 28.54 ± 2.92 in the

Kaiyo condition. There were no significant differences in children’s average liking ratings or overall meal liking scores across the three meal conditions. There were also no significant differences in children’s independent liking ratings of meal foods and beverages across brand conditions. Graphical representations of these data are shown in Figures 3-5 and 3-6.

Table 3-6. Children’s liking ratings and sum scores across meal conditions.

Meal condition Branded Unbranded Kaiyo Meal item (mean ± SD) (mean ± SD) (mean ± SD)

Macaroni and Cheese 4.07 ± 1.21 4.11 ± 1.10 4.00 ± 1.19

Mixed Vegetables 3.68 ± 1.12 3.82 ± 1.02 3.79 ± 0.99

Applesauce 4.18 ± 0.90 4.25 ± 1.00 4.14 ± 0.93

Potato Chips 4.18 ± 0.94 4.18 ± 0.94 3.93 ± 0.98

Cookies 4.64 ± 0.62 4.64 ± 0.56 4.71 ± 0.53

Punch 3.96 ± 0.74 3.71 ± 0.90 3.93 ± 0.94

Chocolate Milk 4.18 ± 0.98 4.04 ± 1.00 4.04 ± 1.14

Average 4.13 ± 0.42 4.11 ± 0.39 4.08 ± 0.42

Sum 28.89 ± 2.97 28.75 ± 2.73 28.54 ± 2.92

Meal liking score score liking Meal 14

7 Branded Unbranded Kaiyo

Figure 3-5. Children’s liking sum scores of the test-meal in the Branded, Unbranded, and Kaiyo conditions. Sum scores were computed from children’s individual liking ratings of the meal foods and beverages (possible range: 7-35 liking score). Values are depicted as means and standard errors.

Branded Unbranded 5 Kaiyo

3 Liking rating Liking rating 2

Figure 3-6. Children’s liking ratings of test-meal foods and beverages in the Branded, Unbranded, and Kaiyo meal conditions. Liking was rated on a 5-point hedonic facial scale. Values are depicted as means and standard errors.

Test-meal energy intake

Means and standard deviations for children’s total test-meal energy intake and intake of each meal food or beverage are shown in Table 3-7. Children’s total test-meal energy intake

(mean ± SD kcal) across brand conditions were as follows: 1055.3 ± 414.2 kcal in the Branded condition, 1116.2 ± 460.4 kcal in the Unbranded condition, and 1059.1 ± 508.5 kcal in the Kaiyo condition. There were no significant differences in children’s overall meal energy intake across the three conditions. There were also no significant differences in children’s energy intake of individual meal foods and beverages across brand conditions. Graphical representations of these

52 data are shown in Figures 3-7 and 3-8.

Table 3-7. Children’s energy intake across meal conditions.

Meal condition Branded Unbranded Kaiyo Meal item (mean ± SD kcal) (mean ± SD kcal) (mean ± SD kcal)

Macaroni and Cheese 528.7 ± 344.5 551.3 ± 386.7 522.2 ± 394.0

Mixed Vegetables 16.2 ± 17.6 16.2 ± 17.6 16.7 ± 18.3

Applesauce 76.8 ± 63.0 75.3 ± 55.6 79.5 ± 53.4

Potato Chips 125.7 ± 68.9 118.9 ± 66.4 129.9 ± 75.4

Cookies 226.0 ± 155.8 256.4 ± 187.2 224.5 ± 130.6

Punch 13.7 ± 11.1 11.3 ± 8.8 11.5 ± 9.1

Chocolate Milk 68.1 ± 81.6 87.9 ± 81.6 74.7 ± 72.9

Total 1055.3 ± 414.2 1116.2 ± 460.4 1059.1 ± 508.5

1250

1000

750

500

250 Meal energy intake (kcal) intake (kcal) energy Meal

0 Branded Unbranded Kaiyo

Figure 3-7. Children’s total energy intake (kcal) in the Branded, Unbranded, and Kaiyo meal conditions. Values are depicted as means and standard errors.

700 Branded 600 Unbranded 500 Kaiyo 400

300

200 Energy intake (kcal) intake (kcal) Energy 100

Figure 3-8. Children’s energy intake (kcal) of foods and beverages in the Branded, Unbranded, and Kaiyo meal conditions. Values are depicted as means and standard errors.

Correlations for mixed models

The Pearson’s and Spearman’s correlation coefficients used to identify covariates for the mixed models analyzing children’s meal liking and energy intake by brand condition are shown in Tables 3-8 and 3-9, respectively. Significant relationships between variables are indicated in bold. Child BMI z-score was included as a covariate in models analyzing meal liking, and BMI z- scores, liking ratings or sum scores, and fullness were included as covariates in models analyzing meal energy intake.

Table 3-8. Pearson’s and Spearman’s correlation coefficients for test-meal liking.

Overall Mac & Chocolate Vegetables2 Applesauce2 Chips2 Cookies2 Punch2 meal Cheese2 Milk2 BMI z-score -.24* -.18 -.19 -.28** .13 .07 -.22* .08 Sex1,2 .09 .32** .004 .09 -.23* -.02 .06 -.15 Age .001 -.09 -.14 .10 -.01 -.19 .19 -.15 Body fat % -.24* -.07 -.17 -.30** .29** .09 -.16 -.01 Frequency2 - .45** - - .02 -.03 - - Fullness .08 .08 -.04 -.07 .06 .09 -.03 .19 Week2 -.06 .12 -.001 -.04 -.02 -.10 -.03 -.02 Condition2 -.04 -.05 .03 -.01 -.13 .04 -.01 -.04 *p ≤ .05, **p < .01 1Sex: 0=male, 1=female 2Spearman’s rho

Table 3-9. Pearson’s and Spearman’s correlation coefficients for test-meal energy intake.

Overall Mac & Chocolate Vegetables Applesauce Chips Cookies Punch meal Cheese Milk Liking .24* .44**, 2 .45**, 2 .46**, 2 .25*, 2 .48**, 2 .35**, 2 .54**, 2 BMI z-score .13 .11 -.03 -.20 .27* -.05 -.01 .22* Sex1, 2 -.14 -.02 -.14 -.26* -.43** -.07 .01 -.16 Age .22* .25* .50** .30** -.07 -.15 .28** .08 Body fat % -.07 -.09 -.14 -.30** .19 -.02 -.02 .10 Frequency2 - .11 - - .10 .04 - - Fullness .42** .27* .01 .02 .13 .44** -.01 .17 Week2 .05 .07 -.01 -.06 -.08 .03 -.04 -.04 Condition2 .003 -.01 .03 .04 -.05 -.03 -.04 .04 *p ≤ .05, **p < .01 1Sex: 0=male, 1=female 2Spearman’s rho

Meal liking by brand condition

Results from mixed models evaluating the effects of branding on children’s liking ratings at three laboratory test-meals are shown in Table 3-10. Meal condition (i.e., Branded, Unbranded, or Kaiyo) did not significantly influence children’s liking of the meal overall (F(2,80) = .12, p =

.89) or of the individual meal foods and beverages. Regardless of meal condition, children’s BMI z-score significantly predicted children’s overall test-meal liking (F(1,80) = 5.10, p < .03), liking of macaroni and cheese (F(1,80) = 6.91, p < .01), and liking of applesauce (F(1,80) = 12.10, p <

.001). Results from t-tests indicate that children with lower BMI z-scores reported higher liking scores for the overall meal (t = -2.26, p < .03), macaroni and cheese (t = -2.63, p < .01), and applesauce (t = -3.47, p < .001).

Table 3-10. Meal liking by brand condition with child BMI z-score.

Meal item Condition BMI z-score

Overall F(2,80) = .12 F(1,80) = 5.10*

Macaroni and Cheese F(1,80) = .07 F(1,80) = 6.91**

Mixed Vegetables F(2,80) = .14 F(1,80) = 2.47

Applesauce F(2,80) = .11 F(1,80) = 12.10***

Potato Chips F(2,80) = .64 F(1,80) = 1.36

Cookies F(2,80) = .14 F(1,80) = .10

Punch F(2,80) = .68 F(1,80) = .44

Chocolate Milk F(2,80) = .17 F(1,80) = .35

*p ≤ .05, **p < .01, ***p < .001

Energy intake by brand condition

Results from mixed models evaluating the effects of branding on children’s energy intake at three laboratory test-meals are shown in Table 3-11. Meal condition did not significantly influence children’s total meal energy intake (F(2,79) = .75, p = .47) or energy intake of the individual meal foods and beverages. Regardless of meal condition, children’s liking significantly predicted children’s energy intake for the meal overall (F(1,79) = 4.38, p < .05) and for each meal food and beverage; children’s fullness significantly predicted overall meal intake (F(1,79) =

18.14, p < .001) and intake of cookies (F(1,78) = 26.83, p < .001); and BMI z-score significantly predicted children’s energy intake of macaroni and cheese (F(1,78) = 5.35, p < .05), chips

(F(1,78) = 3.93, p < .05), and cookies (F(1,78) = 4.14, p < .05). Results from t-tests indicated that children with higher BMI z-scores consumed more calories from macaroni and cheese (t = 2.31, p

< .01) and chips (t = 1.98, p < .05), and children with lower BMI z-scores consumed more calories from cookies (t = -2.03, p < .05).

Table 3-11. Meal energy intake by brand condition with fullness, liking, and child BMI z-score.

Meal item Condition Fullness Liking BMI z-score

Overall F(2,79) = .75 F(1,79) = 18.14*** F(1,79) = 4.38* - Macaroni and F(2,78) =.12 F(1,78) = 3.69 F(1,78) = 37.39*** F(1,78) = 5.35* Cheese Mixed Vegetables F(2,78) = .09 F(1,78) = .03 F(1,78) = 11.48*** F(1,78) = .07

Applesauce F(2,78) = .09 F(1,78) = .31 F(1,78) = 12.36*** F(1,78) = .43

Potato Chips F(2,78) = .33 F(1,78) = .28 F(1,78) = 5.33* F(1,78) = 3.93*

Cookies F(2,78) = 1.92 F(1,78) = 26.83*** F(1,78) = 23.92*** F(1,78) = 4.14*

Punch F(2,78) = .38 F(1,78) = .04 F(1,78) = 7.86** F(1,78) = .03

Chocolate Milk F(2,78) = 1.04 F(1,78) = .23 F(1,78) = 24.80*** F(1,78) = 3.34

*p ≤ .05, **p < .01, ***p < .001

Child-level characteristics and children’s response to food branding

Pearson’s and Spearman’s correlations were used to test for relationships between individual child-level characteristics and children’s energy intake in the laboratory. Child-level characteristics of interest were children’s age, sex, weight status (BMI z-score, BMI percentile), body fat percentage, impulsivity, food responsiveness (FR), enjoyment of food (EOF), and food neophobia score; parental food restriction, pressuring, and monitoring of the child’s diet; the number of hours children spent watching TV; and parental perception of their child’s food brand familiarity.

Children’s age was positively correlated with parental perception of their child’s food brand familiarity (r = .56, p < .01)—a sum score calculated from the Parent Brand Inventory— and children’s energy intake of vegetables in the Branded (r = .57, p < .01), Unbranded (r = .44, p

< .05), and Kaiyo (r = .48, p < .01) conditions. Older children had higher food brand familiarity scores and consumed more energy from vegetables in the test-meals. Children’s sex was significantly related to their energy intake of chips in the Branded (rho = -.54, p < .01) and

Unbranded (rho = -.40, p < .04) conditions in that boys ate more calories from chips than girls.

Sex was not significantly associated with children’s consumption of chips in the Kaiyo condition

(p = .15).

Children’s impulsivity score, calculated from children’s responses to the Impulsiveness and Venturesomeness in Children Questionnaire,134 was positively correlated with parental monitoring (r = .53, p < .01) and restriction (r = .51, p < .01), and child body fat percentage (r =

.39, p < 0.04).

Children’s food neophobia score was inversely associated with children’s overall energy intake in all three conditions: Branded (r = -.37, p = .05), Unbranded (r = -.41, p < .05), Kaiyo (r

= -.46, p < .02), indicating that children with higher scores of perceived food neophobia ate less

59 during the test-meals. Children with higher food neophobia scores also ate fewer calories from macaroni and cheese and vegetables in the Branded (r = -.43, p < .02; r = -.40, p < .04) and Kaiyo conditions (r = -.50, p < .01; r = -.51, p < .01), while children’s consumption of macaroni and cheese and vegetables in the Unbranded condition approached significance (p = .07, p = .10).

In contrast to the results from children with higher food neophobia scores, children with higher scores of enjoyment of food (EOF) ate more during the Branded (r = .38, p < .05) and

Kaiyo (r = .40, p < .04) meals, while there was no significant association between EOF and energy intake in the Unbranded condition (p = .17). Additionally, children’s food responsiveness

(FR) score was positively associated with the difference in calories consumed from the Kaiyo and

Unbranded meals (r = .41, p < .03), indicating that children with higher reported FR scores had greater differences in caloric intake between the Kaiyo and Unbranded meals than children with lower FR scores.

The number of hours children watched TV daily was positively associated with the difference in calories consumed from the Branded and Unbranded meals (r = .42, p < .03), indicating that children who reported watching more hours of TV had greater differences in caloric intake between the Branded and Unbranded meals than children who reported watching less TV.

Parental concern for their child’s weight was positively associated with parents’ perception of their own weight (r = .59, p < .002), and children’s body fat percentage (r = .75, p <

0.001), BMI z-score (r = .72, p < 0.001), and food responsiveness score (r = .40, p < .04).

Parental restriction was inversely associated with energy intake of vegetables in the Branded (r =

-.47, p < .02), Unbranded (r = -.41, p < .04), and Kaiyo conditions (r = -.39, p = .05), such that higher levels of restriction were associated with lower vegetable consumption. Parental pressure to eat was positively associated with food fussiness (r = .43, p < .03), and inversely associated

60 with energy intake of vegetables in the Kaiyo condition (r = -.43, p < .03; BR: p = .19; UN: p =

.47) and child body fat percentage (r = -.45, p < .02).

Discussion

The primary aims of this series of research studies were to determine the effects of food branding on 7-10 year-old children’s liking and energy intake at multi-item, ad libitum laboratory test- meals. We hypothesized that the Branded meal would be most liked by children, and children would consume more energy from the Branded meal compared to the Unbranded and Kaiyo meals. Additionally, we hypothesized that individual child-level characteristics, such as weight status, sex, age, and measures of child eating behaviors (e.g., food responsiveness) and parental feeding practices (e.g., restriction) would be related to children’s response to food branding in the laboratory.

Summary of results

Overall, there were no significant effects of brand condition on children’s meal liking or energy intake. Regardless of brand condition, child BMI z-score predicted liking of the overall test-meal, liking of macaroni and cheese, and liking of applesauce, such that children with lower

BMI z-scores reported higher liking ratings. Children’s liking ratings were predictive of overall test-meal energy intake and intake for all meal foods and beverages. BMI z-score was independently predictive of children’s energy intake of macaroni and cheese, chips, and cookies.

Children with higher BMI z-scores ate more macaroni and cheese and chips, and children with lower BMI z-scores ate more cookies. These results have been replicated in previous studies

61 demonstrating that children with higher BMI z-scores consumed more savory fats than sweet fats in the laboratory.144

Because of the small sample size, we entered a limited number of covariates into the mixed models. For example, while correlation analyses revealed associations between children’s meal liking and energy intake and child sex, age, and weight status, only BMI z-score—an age- and sex-dependent measure of child weight status—was included as a covariate in the models.

Other child-level characteristics may also influence children’s eating behavior in the laboratory.

For instance, when children’s frequency of usual consumption of macaroni and cheese was included as a covariate in the model analyzing children’s liking of macaroni and cheese by meal condition, the effect of BMI z-score was no longer significant (p = .92). Instead, we found that children’s frequency of usual consumption of macaroni and cheese significantly predicted children’s liking of macaroni and cheese independent of meal condition and BMI z-score (F(1,79)

= 17.15, p < .0001). That is, children who ate macaroni and cheese more often reported a higher liking for macaroni and cheese in the laboratory (t = 4.14, p < .0001). Therefore, the results from these analyses should be interpreted with caution and suggest that while meal condition did not influence children’s meal liking or energy intake, child-level characteristics may play an important role.

Relationships between individual child-level characteristics and children’s response to food branding in the laboratory were analyzed by Pearson’s and Spearman’s correlations to generate hypotheses for future studies. Results from correlation analyses corresponded with results found in previous studies.

As shown previously by Forman and colleagues,125 food brand familiarity scores were positively associated with child age, such that older children had higher food brand familiarity scores than younger children. Additionally, food brand familiarity scores were not significantly associated with energy intake at the Branded (p = .51), Unbranded (p = .41), or Kaiyo (p = .82)

62 conditions, and adjusting for age did not change these results. Older children also consumed more vegetables in all meal conditions, which may be related to children’s previous exposure to vegetables.27,41,145

Children’s impulsivity score, calculated from children’s responses to the Impulsiveness and Venturesomeness in Children Questionnaire,134 was positively associated with child body fat percentage and parental monitoring and restriction. Impulsivity has previously been shown to correlate with child weight status,136 and parents of children who demonstrate more impulsive or sensation-seeking behaviors may be more likely to monitor their child’s eating behavior and restrict their access to highly palatable foods.

Children with higher scores of perceived food neophobia ate less from the meals in all brand conditions. While the food brands selected for the Branded meal were familiar and well- liked by the community sample tested in the Brand Familiarity Study, it is possible that children in the fMRI Branding Study, especially those who were perceived as highly food neophobic, may have been less familiar with these brands. This unfamiliarity with food brands in the Branded condition, and the novelty of the laboratory experience, may partially explain this relationship.

Additionally, because of the small sample size (n=28), children with lower food neophobia scores were not separated from children with higher food neophobia scores in analyses. Future studies, with a larger sample size, should assess the relationships between children’s food neophobia, food branding, and children’s liking and intake of meals inside and outside of the home.

In contrast to the results from children with higher food neophobia scores, children with higher scores of enjoyment of food ate more during the Branded and Kaiyo meals than children with lower scores of enjoyment of food. Additionally, children’s food responsiveness score was positively associated with the difference in calories consumed from the Kaiyo and Unbranded meals. These results indicate that children who were perceivably more responsive to food cues ate

63 more during meals packaged with a design (i.e., familiar food brands or novel brand with cartoon character) than children with lower perceived enjoyment of food and food responsiveness scores.

The number of hours children reported watching TV daily was positively associated with the difference in calories consumed from the Branded and Unbranded meals, indicating that children who reported watching more TV had greater differences in caloric intake between the

Branded and Unbranded meals than children who reported watching less TV. A possible explanation is that children who watched more TV may have been more familiar with the brands in the Branded meal and this brand familiarity may have influenced children’s energy intake in the Branded meal.

As shown previously,133 parental concern for their child’s weight was associated with parents’ perception of their own weight, and children’s body fat percentage, BMI z-score, and food responsiveness score. Therefore, parents who are concerned about their own weight may fear for their child’s weight, especially if their child has a high percentage of body fat and BMI z- score. Children who are perceived as more food responsive, or highly in tune to food cues, may also warrant greater parental weight concerns.

Parental restriction was associated with less consumption of vegetables in all brand conditions, and pressure to eat was associated with less consumption of vegetables in the Kaiyo condition. Prior research has shown that children with parents who restrict their access to highly palatable foods and/or pressure their children to eat are less likely to try or less willing to eat healthier foods, such as vegetables.50-52,146

Explanations of findings

Although previous literature has shown that branding influences children’s food preferences114,115 and energy intake,110,125 brand condition had no significant effect on children’s

64 meal liking or energy intake in this study. Potential explanations for our findings are described in the following paragraphs.

First, this study had a small (n=28), homogenous sample. Previous studies testing children’s responses to food branding included larger samples (n>40) of ethnically, culturally, and socio-economically diverse children.110,114,125 Therefore, results from the predominately high- income, White, non-overweight sample in this study may not be representative of other 7-10 year- old children.

Another explanation is that children in this study were unfamiliar with the brands used in the Branded meal. As demonstrated by Elliot and colleagues,115 branding may have less of an impact on children’s food preferences, and potentially intake, when the brands are unfamiliar.

Although children’s brand familiarity was not directly assessed in the fMRI Branding Study, a measure of parents’ perception of their child’s brand familiarity was included. The results from the Parent Brand Inventory were as follows: 85.7% (n=24) of parents indicated that their child would be familiar with Kraft®, 35.7% (n=10) with Green Giant®, 50% (n=14) with Mott’s®,

85.7% (n=24) with Pringles®, 60.7% (n=17) with Keebler®, 82.1% (n=23) with Kool-Aid®, and

60.7% (n=17) with Nesquik®. Based on these responses, some children may have been more familiar with the foods brands than others, which may have influenced their responses to food branding in the laboratory.

Additionally, children may not have been excited by the brands included in the Branded condition or Kaiyo. While we did not measure children’s emotional valence or excitability in the fMRI Branding Study, children completed a brand liking and wanting assessment following the fMRI scan. Children were asked to rate on a 150 mm VAS how much they liked and would want something from each brand included in the fMRI paradigm. The results from the test-meal brands are as follows: ratings for Kraft® ranged from 0-150 mm with means and standard deviations

(SDs) of 77.5 ± 45.9 for liking and 73.5 ± 40.4 for wanting; ratings for Green Giant® ranged from

0-150 mm with means and SDs deviations of 81.7 ± 52.2 for liking and 78.1 ± 52.4 for wanting; ratings for Mott’s® ranged from 0-150 mm with means and SDs of 93.7 ± 47.0 for liking and 84.0

± 53.0 for wanting; ratings for Pringles® ranged from 0-150 mm with means and SDs of 117.0 ±

46.5 for liking and 115.5 ± 49.2 for wanting; ratings for Keebler® ranged from 0-150 mm with means and SDs of 107.6 ± 43.7 for liking and 99.7 ± 47.8 for wanting; ratings for Kool-Aid® ranged from 23-150 mm with means and SDs of 88.7 ± 45.9 for liking and 75.5 ± 53.1 for wanting; and ratings for Nesquik® ranged from 0-150 mm with means and SDs of 75.3 ± 47.2 for liking and 74.4 ± 49.1 for wanting. These findings demonstrate that children varied in their liking and wanting for the food brands in the Branded meal. While children’s mean liking scores for all brands were above a neutral rating of 75.0, mean scores of wanting for Kraft® and Nesquik® were below 75.0. Therefore, the brands selected for the Branded meal may not have been exciting enough to influence children’s meal liking and energy intake in the Branded condition compared to the Unbranded and Kaiyo conditions.

Along the same lines, children may not have noticed the differences in packaging across conditions. While many children noticed that the foods were the same, research assistants were instructed not to mention anything to the children about the packaging and to revert their attention to a different subject if they asked about the packaging. While labels were placed on the lids, around the containers, and on one side of the plastic zip-top bags, children may not have paid much attention to the brands once they started tasting foods and/or eating the meal. Because we did not ask children about the packaging, it is unclear whether or not children noticed the variations in packaging across conditions.

Strengths and limitations

There were several study strengths worth discussing. First, this study used a crossover

66 design to test children’s response to food branding at three multi-item, ad libitum laboratory test- meals that varied by packaging: (1) Branded: familiar food brands (e.g., Kraft®, Pringles®), (2)

Unbranded: generic white labels, and (3) Kaiyo: colorful novel brand with a cartoon character designed by our lab for 7-10 year-old children. While research has demonstrated that some children prefer foods that are branded compared to foods that are unbranded,114,115 there is limited research that has assessed children’s laboratory meal liking and energy intake in response to variations in food branding. Second, incorporating a novel character and design allowed us to determine how strategies commonly used in food marketing impact children’s meal liking and energy intake in the laboratory. Third, the multi-item meals included seven foods and beverages that provided a variety of flavors and textures. Having a variety of flavors and textures in the meals enabled us to measure which foods and food brands 7-10 year-old children like and prefer.

Fourth, contrary to the approach taken by Forman and colleagues,125 this study served meal foods and beverages in the same containers across packaging conditions. By keeping the containers the same in all conditions, we were able to measure children’s response to branding without this confounding factor. Fifth, several measures of individual child-level characteristics were measured to generate hypotheses for future studies. Lastly, this study was designed with an fMRI component to determine the mechanism behind children’s response to branding. In future analyses we may find children’s neurobiological responses to branding correlate with their meal liking and energy intake in the laboratory.

In addition to the study strengths, there were some limitations. A main limitation of this study was the small (n=28), homogenous sample. While this study was powered a priori for 30 participants to determine the relationships between the behavioral data and fMRI data, this study was not powered to detect differences between groups (e.g., high versus low food neophobia) or to test for interactions between individual child-level characteristics and children’s meal liking and energy intake. These individual characteristics likely drove the high levels of variability in

67 this study. Therefore, these results should be interpreted with caution. Another limitation of this study is that we did not assess children’s brand familiarity or excitability directly. While we tested children’s brand familiarity and excitability in the pilot study, and included measures of parents’ perception of their child’s brand familiarity and children’s liking and wanting of brands in this study, it is unclear how familiar children in this study were with the brands in the Branded meal. Because the Branded condition included seven different food brands, children may have varied greatly in their familiarity with and emotional response to these brands. Therefore, children’s brand familiarity and excitability are important variables for future studies to measure directly.

Future directions

These pilot data reveal that some children may be more vulnerable to the effects of food branding than others. Future studies should be powered to detect differences in individual child- level variables, such as food neophobia and weight status, which may have drove the high variability in this study. Additionally, other factors, such as frequency of usual consumption, fullness, and food liking may be stronger predictors of children’s energy intake of foods and beverages in the laboratory than food branding. Future studies—with larger, heterogeneous samples—are needed to determine the effects of food branding on children’s meal liking and energy intake in the laboratory and more naturalistic environments. If future research consistently finds a link between food branding and children’s food liking and energy intake, these results may pave the way for new marketing regulations of healthy and unhealthy foods to children.

Appendix A

Brand Familiarity Study Questionnaires

Parent Demographics Questionnaire

Instructions: Please answer these questions as best you can so we can know a little more about you and your child. If you feel uncomfortable answering a question, you may leave it blank.

1. First, what is your relationship to the child? ______

2. Please fill in the following information as accurately as you can:

Mother of child’s height: ______weight: ______Father of child’s height: ______weight: ______

3. List the highest level of education completed for the child's:

Mother a) 8th grade or below b) Some high school c) Completed high school d) Some college e) Completed college f) Some graduate school g) Completed graduate school

Father a) 8th grade or below b) Some high school c) Completed high school d) Some college e) Completed college f) Some graduate school g) Completed graduate school

4. Was your child breastfed? ______

If yes, for how long was he/she breastfed? ______

5. Who is primarily responsible for feeding your child?

a) Mother b) Father c) Both d) Other (please state) ______

6. Was your child born pre-mature? ______

If yes, by how many weeks? ______

7. What was your child's birth weight? ______Birth length? ______

8. Are you or anyone in your household currently receiving Supplemental Nutrition Assistance Program (SNAP) benefits (formerly known as Food Stamps)?

a) Yes b) No c) Do Not Know

9. Is your child Hispanic or Latino?

a) Yes b) No

10. What is the race of your child? (select all that apply):

a) American Indian or Alaskan Native b) Asian c) Black or African American d) Native Hawaiian or Pacific Islander e) White

Parent Brand Inventory

Instructions: Would your child be familiar with these brands? Please answer as best you can.

Not sure / Not sure / Brand Yes No Brand Yes No Don’t know Don’t know

McDonald's Taco Bell Barilla Velveeta Motts Pepperidge Farm Snickers Kool-Aid Lay’s Butterfinger Nabisco Fruit Roll-up Sprite Fresh Express Eggo Uncle Ben’s Planters Hostess Cheez-its Ragu Kraft Wendy’s Cocoa Puffs Cool Whip

Juicy Juice Fritos

Pillsbury Tropicana

Sour Patch Kids Smuckers

Jif Chiquita

Crisco Blow Pop

Heinz Frosted Flakes

Mrs. Butterworth Hot Pockets

Lucky Charms Doritos

Crunch Bar CocaCola

Kashi Miracle Whip

Trix Wonder Bread

Capri Sun Laffy Taffy

Ritz Nesquik

Nestle Pizza Hut

Lunchables Quaker

KFC Triscuit

Green Giant Skittles

Orville Redenbacher Sunmaid Cheetos Burger King Dunkin’ Donuts Pepperidge Farm Pringles Dole SpaghettiOs Starbucks M&Ms Froot Loops

Not sure / Not sure / Brand Yes No Brand Yes No Don’t know Don’t know Hershey Best Buy Subway Glad Chips Ahoy Crayola Sunny Delight Chrysler Del Monte CATA Hidden Valley Valvoline Pepsi Old Navy Campbell’s UPS Land o’ Lakes Target Tootsie Roll PNC Bank Corn Flakes Palmolive Chick-fil-a Walmart Hellman’s LG V8 Macy's Turkey Hill Swiffer Tostitos Hampton Inn I can’t believe it’s Home Depot not butter! Reese’s AT&T Cheerios Staples Oreo Volkswagon Chef Boyardee Apple Rice Krispies Tide Keebler Dodge Annie’s Elmer's Abercrombie & Twix Fitch Gap Charmin Nike Lysol Playstation Johnson & Johnson Verizon Pampers Lowe’s Comcast Dawn Bounty Dick’s Sporting T-mobile Goods Honda Barbie Maybelline Citizen’s Bank Scrubbing Bubbles Sears Toyota Lego Matchbox Dial

Not sure / Brand Yes No Don’t know Midas Days Inn Nintendo Adidas Ziploc Hasbro Kleenex American Eagle Mattel Q-tips Google LeapFrog Juicy Couture M&T Bank Diesel Yahoo Sony

Children’s TV Survey

Instructions: The scientist will read these questions for you and after each question they will give you a choice of answers. Pick the best answer.

1. Do you watch television (TV)?

Yes:______No:______

2. If you watch TV, can you remember about how many hours per day you watch TV?

a. about 1 hour b. about 2 hours c. about 3 hours d. about 4 hours e. more than 4 hours

3. Can you tell me how many TVs are in your home? ______

4. Do you have a TV in your bedroom?

Yes:______No:______

5. When you watch TV, do you watch the commercials?

Yes:______No:______

6. What do you think commercials are for? There is no wrong answer.

______

7. Do you watch TV during dinner?

Yes:______No:______

8. Please tell me if you watch these TV Channels:

Not sure / TV Channel YES NO I don’t know Nickelodeon

Disney Channel

Cartoon Network

ABC

CBS

NBC

PBS

FOX

Discovery Channel

Animal Planet

TLC

MTV

VH1

ESPN

9. Tell me what you know about the following shows:

Heard of it Never heard Seen it a few TV Show but never Watch it a lot of it times seen it Spongebob Squarepants The Adventures of Jimmy

Neutron Shake It Up iCarly

Drake and Josh

Fanboy and ChumChum

Hannah Montana

Wizards of Waverly Place

Degrassi

Jessie

Victorious

The Fairly Oddparents

A.N.T. Farm

Power Rangers

Supah Ninjas

The Penguins of Madagascar

Austin and Ally

Arthur

House of Anubis

Good Luck Charlie

American Idol

Wipeout

Phineas and Ferb

Heard of it Never heard Seen it a few TV Show but never Watch it a lot of it times seen it Big Time Rush

The Electric Company Sports Programs (basketball, football, or other sports) America’s Funniest Home

Videos

10. Do you watch other any other TV shows that we did not talk about? Can you remember what they are?

______

Appendix B

Brand Familiarity, Emotional Valence, and Excitability Task

Script and Questions

Instructions: “I am going to show you lots of pictures. You may know some of them, but not others. That’s okay. For each picture, I will ask you to tell me what product or food you think the picture goes with, how happy or sad the picture makes you, and how exciting or boring you think the picture is. We have a lot of pictures to show, so we will stop and take a few breaks in between. There are no right or wrong answers. Do you have any questions before we start? If not, let’s begin.”

1. Can you tell me what type of food/product this picture goes with?

Record child response: ______

2. On a scale from 1 to 5, with 1 being very sad and 5 being very happy, can you tell me how sad or happy the picture makes you feel?

3. On a scale from 1 to 5, with 1 being very bored and 5 being very excited, can you tell me how bored or excited the picture makes you feel?

Data Collection

Sad / Bored / Sad / Bored / Food / Food / Brand Happy Excited Brand Happy Excited Product Product (1-5) (1-5) (1-5) (1-5) Johnson & Samsung Johnson

Yahoo Comcast

Harley Davidson NBC Abercrombie & Colgate Fitch

Dawn Oral-B

Nerf Ebay

Facebook Bing

Target Visa

Bounty Sony

Playstation Crayola

Nabisco Kaiyo

Ragu Domino's

Pepsi Betty Crocker

Campbell's Tostitos

Tropicana Burger King

Snickers Special K

Jif Quaker

Kool-Aid Mott's

Doritos Reese's

Kraft Nature Valley

Sad / Bored / Sad / Bored / Food / Brand Response Happy Excited Brand Happy Excited Product (1-5) (1-5) (1-5) (1-5) NFL IBM

AT&T Apple

Nintendo Little Tikes

MTV Matchbox

Lowe's Charmin

BMW Pampers

Elmer's Playskool

Gap Teen Nick ty Eggo

Mattel Subway

Lay's Yoplait Pepperidge Ben & Jerry's Farm Sunny Delight Sun-Maid

Kellogg's Ocean Spray

Starbucks Pillsbury

Ritz Cheerios

Pop-tarts Powerade

Capri Sun M&M's

Fritos Lego

McDonald's Toys "R" Us

American Eagle Hanes

Barbie Hasbro

Sad / Bored / Sad / Bored / Food / Brand Response Happy Excited Brand Happy Excited Product (1-5) (1-5) (1-5) (1-5) USPS Ikea

Webkinz Adidas

Fisher-Price Tide

3M Oreo

Google Lunchables

ESPN Chili's

Taco Bell Birds Eye

Cheez-It Aunt Jemima

Cheetos Planters

Progresso Chips Ahoy!

Pizza Hut Snyder's

Heinz Fruit Roll-Ups

Keebler Smucker's

Twizzlers hp

Juicy Juice UPS

Red Lobster Kleenex Scrubbing Cannon Bubbles Ziploc Twitter American Intel Express Microsoft Walt Disney

T-Mobile Ford

Nike Glad

Sad / Bored / Sad / Bored / Food / Brand Response Happy Excited Brand Happy Excited Product (1-5) (1-5) (1-5) (1-5) Warner Brothers Hidden Valley

Sour Patch Chef Boyardee

Hershey's Wonder

Nesquick Hot Pockets

Denny's Trix

Mountain Dew Pringles

SpaghettiOs Lucky Charms

General Mills Dole

Gatorade Auntie Anne's

Dunkin Donuts

Coca-Cola

Dell

Master Card

Xbox Philadelphia Eagles

FedEx

Honda

Lysol

Walmart

Best Buy

Sears Orville Redenbacher's

Appendix C

fMRI Branding Study Questionnaires

Parent Demographics Questionnaire

Instructions: Please answer these questions as best you can so we can know a little more about you and your child. If you feel uncomfortable answering a question, you may leave it blank.

1. First, what is your relationship to the child? ______

2. Please fill in the following information as accurately as you can:

Mother of child’s height: ______weight: ______Father of child’s height: ______weight: ______

3. List the highest level of education completed for the child's:

Mother a) 8th grade or below b) Some high school c) Completed high school d) Some college e) Completed college f) Some graduate school g) Completed graduate school

Father a) 8th grade or below b) Some high school c) Completed high school d) Some college e) Completed college f) Some graduate school g) Completed graduate school

4. Was your child breastfed? ______

If yes, for how long was he/she breastfed? ______

5. Who is primarily responsible for feeding your child?

a) Mother b) Father c) Both d) Other (please state) ______

6. Was your child born pre-mature? ______

If yes, by how many weeks? ______

7. What was your child's birth weight? ______Birth length? ______

8. Are you or anyone in your household currently receiving Supplemental Nutrition Assistance Program (SNAP) benefits (formerly known as Food Stamps)?

a) Yes b) No c) Do Not Know

9. Is your child Hispanic or Latino?

a) Yes b) No

10. What is the race of your child? (select all that apply)

a) American Indian or Alaskan Native b) Asian c) Black or African American d) Native Hawaiian or Pacific Islander e) White

11. What was your total or combined family income, before taxes, in 2013?

a) Less than $20,000 b) 20,000-$35,000 c) $36,000-$50,000 d) $51,000-$75,000 e) $76,000-$100,000 f) More than $100,000

Parent Brand Inventory

Instructions: Would your child be familiar with these brands? Please answer as best you can.

Not sure / Not sure / Brand Yes No Brand Yes No Don’t know Don’t know

Juicy Juice Fritos

Pillsbury Tropicana

Sour Patch Kids Smuckers

Jif Chiquita

Crisco Blow Pop

Heinz Frosted Flakes

Mrs. Butterworth Hot Pockets

Lucky Charms Doritos

Crunch Bar CocaCola

Kashi Miracle Whip

Trix Wonder Bread

Capri Sun Laffy Taffy

Ritz Nesquik

Nestle Pizza Hut

Lunchables Quaker

KFC Triscuit

Green Giant Skittles

Orville Redenbacher Sunmaid Cheetos Burger King Dunkin’ Donuts Pepperidge Farm Pringles Dole SpaghettiOs Starbucks M&Ms Froot Loops

Not sure / Brand Yes No Don’t know Midas Days Inn Nintendo Adidas Ziploc Hasbro Kleenex American Eagle Mattel Q-tips Google LeapFrog Juicy Couture M&T Bank Diesel Yahoo Sony

Parent’s Ad Survey

Instructions: Please read the following questions and answer them to the best of your ability.

1. Do you watch television (TV)?

Yes:______No:______

2. If you watch TV, about how many hours per day you watch TV?

a. about 1 hour or less b. about 2 hours c. about 3 hours d. about 4 hours e. about 5 hours or more

3. How many TVs are in your home? ______

4. When you watch TV, do you watch the commercials?

Yes:______No:______

5. Do you watch TV during dinner?

Yes:______No:______

6. What 5 TV networks do you watch most often (e.g., ABC, NBC)?

1. ______2. ______3. ______4. ______5. ______

7. Do you use the Internet at home?

Yes:______No:______

If you use the Internet at home, about how many hours per day do you use the Internet at home?

a. about 1 hour or less b. about 2 hours c. about 3 hours d. about 4 hours e. about 5 hours or more

8. What 5 websites do you visit most often (e.g., Google, Yahoo)?

1. ______2. ______3. ______4. ______5. ______

9. How many computers are in your home? ______

10. How many times per week does your family usually go to the grocery store?

a. 1 time/week or less b. 2 times/week c. 3 times/week d. 4 times/week e. 5 times/week or more

11. Does your child come along with you when you go to the grocery store?

Yes:______Sometimes:______No:______

Infant Feeding Questionnaire

Instructions: Please answer the questions in this survey to the best of your ability. In question #1, you will be asked to report whether you (a) mainly breast-fed your child or (b) mainly formula-fed your child. Please answer this question with the method you remember using most often in your child’s first year, even if you did both. After answering question #1, go to questions #2-24 if you marked (a), or skip to questions #25-47 if you marked (b).

1. How did you feed your child during the first year (12 months) of their life? a. Mainly breastfed (Continue to Q#2) b. Mainly formula- fed (Skip to Q#25)

If you chose “Mainly breast-fed” for question #1, continue to Q # 2. Otherwise, skip to Q# 25:

2. How many months was breast- milk the only way you fed your child? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

3. Did you smoke while breast-feeding? a. Yes b. No

4. Did you consume alcohol when breast-feeding? a. Yes b. No

5. Did you feed your child formula while breast-feeding? a. Yes (Continue to Q#6) b. b. No (Skip to Q#10)

If “yes” to Q#5, continue to Q#6. Otherwise, skip to Q #10:

6. How old was your child when you first fed him or her formula? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

7. How many months was your child fed breast milk and formula at the same time? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

8. How many months total did you feed your child formula? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

9. When you fed your child formula, what type of formula did you feed your child? a. Milk- based formula (like Enfamil LIPIL, Similac Advance, and Good Start Supreme) b. Soy- based formula (like Enfamil ProSobee, Isomil, and Good Start Supreme Soy) c. Hydrolysate formula (like Nutramigen, Pregestamil, and Alimentum) d. Other, please list ______

10. How many months total did you breast- feed your child (including the time you were also giving them formula)? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

11. Did you pump breast milk and feed your child this milk from a bottle? a. Yes (Continue to Q#12) b. No (Skip to Q#16)

If “yes” to Q#11, go to Q. 12. Otherwise, skip to Q# 16:

12. How old was your child when you first pumped breast milk? a. Less than 1 month b. 1-3 months c. 4-6 months d. Older than 6 months e. Don’t remember

13. When you started to give your child pumped breast milk, how often did your child get milk in this form (pumped milk in a bottle)? a. Less than 1 time per day b. 1 time a day c. 2 times a day d. 3 times a day or more e. Don’t remember

14. How often did your child finish his or her bottle of breast milk? a. Never b. Rarely c. Sometimes d. Often e. Always

15. How often did you encourage your child to finish all of his or her bottle? a. Never b. Rarely c. Sometimes d. Often e. Always

16. When breastfeeding, how often did your child let go of the breast by him or her-self? a. Never b. Rarely c. Sometimes d. Often e. Always

17. How old was your child when you stopped breastfeeding, including pumping breast-milk? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

18. How old was your child when you first fed them juice? a. Less than 1 month b. 1-3 months c. 4-6 months d. More than 6 months e. Don’t remember

19. How old was your child when he or she was first given solid foods (e.g., baby food or cereal)? a. 1-3 months b. 4-6 months c. 7-9 months d. Older than 9 months e. Don’t remember

20. What solid food did your child eat first? a. Infant cereal b. Pureed fruits (eg. peaches, pears, bananas, etc.) c. Pureed vegetables (eg. carrots, green beans, potatoes, etc.) d. Pureed sweet foods (eg. puddings, ice cream, etc.) e. Don’t remember

If you can remember any of the foods your child liked when he/she was a baby, please list them:

______

21. How did your child first react to solid foods? a. Liked very much b. Neutral (Neither liked nor disliked) c. Disliked very much d. Refused to eat it at first. e. Don’t remember

22. During the time when you were weaning your child from the bottle or breast, how often did they eat solid foods? a. Less than once a day b. Once a day c. Twice a day d. 3 or more times a day e. Don’t remember

23. Currently, how willing is your child to try new foods? a. Very unwilling to try new foods b. Unwilling to try new foods c. Neutral (Neither willing or unwilling) d. Moderately willing to try new foods e. Very willing to try new foods

24. Does your child have any food allergies? a. Yes, please list ______b. No

If you circled in question #1 that you mainly breast-fed your child and have answered the above questions you are finished with this part of the survey and do not need to answer questions #25-47.

If you chose (b) “Mainly formula-fed” on question #1, begin here:

25. How old was your child when you first fed him or her formula? a. Birth b. Less than 1 month c. 1-3 months d. 4-6 months e. Don’t remember

26. What type of formula did you mainly feed your child? a. Milk- based formula (like Enfamil LIPIL, Similac Advance, and Good Start Supreme) b. Soy- based formula (like Enfamil ProSobee, Isomil, and Good Start Supreme Soy) c. Hydrolysate formula (like Nutramigen, Pregestamil, and Alimentum) d. Other, please list ______

27. Why did you choose this type of formula to feed your child? a. My child liked it b. It was the least expensive and/or easiest to get c. My child had food allergies and needed it d. Other reasons, please list ______e. Don’t remember

28. Did you feed your child any other type of formula? a. Yes (Continue to Q#29) b. No (Skip to Q#31)

If “yes” go to Q#29, if “no” skip to Q#31:

29. What other types of formula did you feed your child? a. Milk- based formula (like Enfamil LIPIL, Similac Advance, and Good Start Supreme) b. Soy- based formula (like Enfamil ProSobee, Isomil, and Good Start Supreme Soy) c. Hydrolysate formula (like Nutramigen, Pregestamil, and Alimentum) d. Other, please list ______

30. Why did you change formulas? a. Didn’t like the first formula b. Was allergic to the first formula c. Doctor recommendation d. Availability or price e. Other, please list ______

31. Did you breast-feed your child for any period of time? a. Yes (Continue to Q#32) b. No (Skip to Q#38)

32. How often did you smoke while breastfeeding? a. Never b. Rarely c. Sometimes d. Often e. Always

33. How often did you consume alcohol while breastfeeding? a. Never b. Rarely c. Sometimes d. Often e. Always

34. About how many weeks did you breast- feed your child before giving them formula? a. Less than 1 week b. 2-4 weeks c. 4-6 weeks d. More than 6 weeks e. Don’t remember

35. Did you pump breast milk and feed your child this milk from a bottle? a. Yes (Continue to Q#36) b. No (Skip to Q#38)

36. (If “yes” to Q#35) How old was your child when you first pumped milk? a. Less than 1 month b. 1-3 months c. 4-6 months d. Older than 6 months e. Don’t remember

37. How many weeks total did you breast- feed your child (including the time you may also have been giving them formula? a. Less than 1 week b. 2-4 weeks c. 4-6 weeks d. More than 6 weeks e. Don’t remember

38. How many months total was your child fed formula? a. 1- 3 months b. 4-6 months c. 7-9 months d. 10-12 months e. More than 12 months

39. How often did your child drink all of his or her bottle of formula? a. Never b. Rarely c. Sometimes d. Often e. Always

40. How often did you encourage your child to finish all of his/her bottle? a. Never b. Rarely c. Sometimes d. Often e. Always

41. How old was your child when you first fed them juice? a. 1-3 months b. 4-6 months c. 7-9 months d. Older than 9 months e. Don’t remember

42. How old was your child when he or she was first exposed to solid foods (baby foods)? a. 1-3 months b. 4-6 months c. 7-9 months d. Older than 9 months e. Don’t remember

43. What solid food did your child eat first? a. Infant cereal b. Pureed fruits (eg. peaches, pears, bananas, etc.) c. Pureed vegetables (eg. carrots, green beans, potatoes, etc) d. Pureed sweet foods (eg. puddings, ice cream, etc) e. Don’t remember

If you can remember any of the foods your child liked when he/she was a baby, please list them:

______

44. How did your child first react to solid foods (baby foods)? a. Liked very much b. Neutral (Neither liked nor disliked) c. Disliked very much d. Refused to eat it at first. e. Don’t remember

45. During the time when you were weaning your child from the bottle, how often did they eat solid foods (baby foods)? a. Less than once a day b. Once a day c. Twice a day d. 3 or more times a day e. Don’t remember

46. Currently, how willing is your child to try new foods? a. Very unwilling to try new foods b. Unwilling to try new foods c. Neutral (Neither willing or unwilling) d. Moderately willing to try new foods e. Very willing to try new foods

47. Does your child have any food allergies? a. Yes, please list ______b. No

48. Age (Parent):______Weight (Parent):______Height (Parent):______

49. What is the highest level of education you have completed? a. Junior high school b. High school or G.E.D. c. Technical school d. College e. Advanced degree

50. During your child’s first year (12 months) of life what was your marital status? a. Single b. Not married but living with the baby’s mother/ father c. Married d. Living with extended family e. Other, please explain: ______

51. Where did you usually buy food from during your child’s first year (12 months) of life? a. Supermarket b. Bodega/ convenient store c. Farmer’s market d. W.I.C. e. Other, please list:______

52. How often does your family eat fruit? a. Every day b. Most days of the week (4-6) c. A few days a week (2-3) d. Less than once a week e. Rarely, less than once a month

53. How often does your family eat vegetables? a. Every day b. Most days of the week (4-6) c. A few days a week (2-3) d. Less than once a week e. Rarely, less than once a month

Mother’s Food Preferences Which of the following foods do you remember eating while you were pregnant or when your child was young (age 1 year or less)? Please circle the foods you remember eating during this time.

Broccoli Pears Garlic / cheese bread Custard Brussels sprouts Plums Chinese takeout Jello (flavored) Carrots Grapes Mozzarella sticks Hard candy Celery Mango French fries Cotton candy Corn Melons Onion rings Milk chocolate Cabbage Pineapple Potato chips Dark chocolate Green beans Avocado Tortilla chips Marshmallows Peas Peanut butter Pretzels Black coffee Coffee with cream/ Spinach / greens Eggs Popcorn with butter milk Popcorn without Tomatoes Buttermilk Regular soda butter Squash Parmesan cheese Nachos Diet soda Blue/Roquefort Mushrooms Biscuits Caffeinated drinks cheese Peppers Sharp cheddar cheese Cinnamon rolls 100% fruit juice Legumes (e.g., Swiss cheese Rice Kool-Aid kidney beans) Potato (white) Plain yogurt Pancakes or waffles Iced Tea (sweetened) Iced Tea Sweet potato / yams Steak (beef) Cereal (unsweetened) Hamburger / Onions / scallion Sandwich bread Milk (whole fat) Cheeseburger Milk (low-fat or Radishes Tacos Pasta skim) Turnips Hot dog Rolls Chocolate Milk Sour pickles Pork / ham Cakes Hot Chocolate Garlic Bacon Pies / pastry Beer or other alcohol Hot peppers Chicken Cheesecakes Snapple Apples / applesauce Fried chicken Doughnuts Gatorade Apricots Turkey Cookies Lemonade Bananas Ground meat Brownies Berries Sausage Muffins Lemons / limes Fish (white fish) Ice cream Orange / tangerine Shellfish (shrimp) Frozen yogurt Grapefruit Salmon Milkshake Peaches / nectarines Fried fish Caramel Pears Pizza Puddings

Are there are any other foods you can remember eating while you were pregnant or when your child was young (age 1 year or less) that were not listed? Please list them here: ______

Children’s Eating Behavior Questionnaire

Instructions: Please read the following statements and tick the boxes most appropriate to your child’s eating behavior. If you cannot answer a question for any reason, feel free to leave it blank.

Some- Never Rarely Often Always times My child loves food □ □ □ □ □ My child eats more when worried □ □ □ □ □ My child has a big appetite □ □ □ □ □ My child finishes his/her meal quickly □ □ □ □ □ My child is interested in food □ □ □ □ □ My child is always asking for a drink □ □ □ □ □ My child refuses new foods at first □ □ □ □ □ My child eats slowly □ □ □ □ □ My child eats less when angry □ □ □ □ □ My child enjoys tasting new foods □ □ □ □ □ My child eats less when s/he is tired □ □ □ □ □ My child is always asking for food □ □ □ □ □ My child eats more when annoyed □ □ □ □ □ If allowed to, my child would eat too much □ □ □ □ □ My child eats more when anxious □ □ □ □ □ My child enjoys a wide variety of foods □ □ □ □ □ My child leaves food on his/her plate at the end of a meal □ □ □ □ □ My child takes more than 30 minutes to finish a meal □ □ □ □ □ Given the choice, my child would eat most of the time □ □ □ □ □ My child looks forward to mealtimes □ □ □ □ □ My child gets full before his/her meal is finished □ □ □ □ □ My child enjoys eating □ □ □ □ □ My child eats more when she is happy □ □ □ □ □ My child is difficult to please with meals □ □ □ □ □ My child eats less when upset □ □ □ □ □ My child gets full up easily □ □ □ □ □ My child eats more when s/he has nothing else to do □ □ □ □ □ Even if my child is full up s/he finds room to eat his/her □ □ □ □ □ favourite food If given the chance, my child would drink continuously □ □ □ □ □ throughout the day My child cannot eat a meal if s/he has had a snack just □ □ □ □ □ before If given the chance, my child would always be having a □ □ □ □ □ drink My child is interested in tasting food s/he hasn’t tasted □ □ □ □ □ before

My child decides that s/he doesn’t like a food, even □ □ □ □ □ without tasting it If given the chance, my child would always have food in □ □ □ □ □ his/her mouth My child eats more and more slowly during the course of □ □ □ □ □ a meal

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Child Feeding Questionnaire

Instructions: Using the scale below, please circle one number for each question which best corresponds to your answer. Please answer about your child who is in our study.

Never Seldom Half of time Most of time Always 1. When your child is home, how often are 1 2 3 4 5 you responsible for feeding him/her? 2. How often are you responsible for deciding 1 2 3 4 5 what your child’s portion sizes are? 3. How often are you responsible for deciding if 1 2 3 4 5 your child has eaten the right kind of foods?

Instructions: Using the scale below, please indicate how you would classify your own weight at each of these 4 time periods listed below. (Please circle ONLY ONE number for each time period)

Markedly Markedly Underweight Average Overweight underweight overweight 4. Your childhood (5 to 1 2 3 4 5 10 years old) 5. Your 1 2 3 4 5 adolescence

6. Your 20’s 1 2 3 4 5

7. Currently 1 2 3 4 5

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Instructions: Using the scale below, please indicate how you would classify your child’s weight at each of these 6 time periods listed below. (Please circle only one number for each time period)

Markedly Markedly Underweight Average Overweight underweight overweight 8. Your child during the first 1 2 3 4 5 year of life 9. Your child as 1 2 3 4 5 a toddler

10. Your child 1 2 3 4 5 as a preschooler 11. Your child kindergarten 1 2 3 4 5 through 2nd grade 12. Your child from 3rd through 1 2 3 4 5 5th grade 13. Your child from 6th through 1 2 3 4 5 8th grade

Instructions: Using the scale below, please circle one number for each question which best corresponds to your answer. Please answer about your child who is in our study.

Slightly Slightly Very Unconcerned Neutral unconcerned concerned concerned 14. How concerned are you about your child eating too 1 2 3 4 5 much when you are not around him/her? 15. How concerned are you about your child having to 1 2 3 4 5 diet to maintain a desirable weight?

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16. How concerned are you about your 1 2 3 4 5 child becoming overweight?

Instructions: Using the scale below, please circle one number for each question which best corresponds to your answer. Please answer about your child who is in our study.

Slightly Slightly Disagree Neutral Agree disagree agree 17. I have to be sure my child does not eat too many sweets 1 2 3 4 5 (candy, ice cream, cake or pastries). 18. I have to be sure my child does not 1 2 3 4 5 eat too many high fat foods. 19. I have to be sure my child does not eat too many of 1 2 3 4 5 his/her favorite foods. 20. I intentionally keep some foods out 1 2 3 4 5 of my child’s reach. 21. I offer sweets (candy, ice cream, cake or pastries) to 1 2 3 4 5 my child as a reward for good behavior. 22. I offer my child his/her favorite foods 1 2 3 4 5 in exchange for good behavior. 23. If I did not regulate or guide my child’s eating, he/she 1 2 3 4 5 would eat too many junk foods. 24. If I did not regulate or guide my 1 2 3 4 5 child’s eating, he/she would eat too many

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of his/her favorite foods. 25. My child should always eat all of the 1 2 3 4 5 food on his/her plate. 26. I have to be especially careful to 1 2 3 4 5 ensure my child eats enough. 27. If my child says “I’m not hungry” I 1 2 3 4 5 try to get him/her to eat anyway. 28. If I did not guide or regulate my child’s eating, he/she 1 2 3 4 5 would eat much less than he/she should.

Instructions: Using the scale below, please circle one number for each question which best corresponds to your answer. Please answer about your child who is in our study.

Never Rarely Sometimes Mostly Always 29. How much do you keep track of the sweets (candy, ice 1 2 3 4 5 cream, cake or pastries) that your child eats? 30. How much do you keep track of the snack food (potato 1 2 3 4 5 chips, Doritos, cheese puffs) that your child eats? 31. How much do you keep track of the 1 2 3 4 5 high fat foods that your child eats?

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Child Food Neophobia Scale

Instructions: Please answer the following questions about your child to the best of your ability.

Strongly Strongly Disagree Agree disagree agree 1. My child does not 1 2 3 4 trust new foods. 2. If my child doesn’t know what’s in a food, 1 2 3 4 he or she won’t try it. 3. My child is afraid to eat things he or she has 1 2 3 4 never had before 4. My child will eat 1 2 3 4 almost anything 5. My child is very particular about the food 1 2 3 4 he or she will eat. 6. My child is constantly sampling new and 1 2 3 4 different foods.

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Impulsivity Questionnaire

Instructions: I am going to read some questions to you. After each question, I would like you to say “YES” or “NO” based on how you feel. There are no right or wrong answers or trick questions. Try not to think that much about what the questions mean, just do your best. Okay?

Question Yes / No 1. Would you enjoy water skiing? 2. Do you have a hard time sitting still? 3. Do you often want more excitement? 4. Do you prefer to eat foods you know rather than trying new ones? 5. Would you feel sorry for a lonely stranger in a group? 6. Do you enjoy taking risks? 7. Would you like to be a rock star? 8. Do you get very interested in your friend’s problems? 9. Do you save your money? 10. Would you like to jump out of a parachute? 11. Do you worry about how animals feel? 12. Do you often buy things that you don’t need? 13. Would you prefer an exciting job with travel and adventure to an office job? 14. Do unhappy children who feel sorry for themselves annoy you? 15. Do you often do or say things without stopping to think? 16. Would you like to own an adventure playground? 17. Do you feel sorry for children who are very shy? 18. Do you often get into trouble because you do things without thinking? 19. Would you enjoy betting your own money if you had the chance to win more? 20. Do you think it is silly for people to cry when they are happy? 21. Do you do your homework quickly without double-checking the answers? 22. Do you like diving off the high-dive? 23. Do you get happy when your friends are happy, or sad when your friends are sad? 24. Has anyone ever told you that you are impulsive? 25. Do you like when new things happen, even when they are frightening and strange? 26. When one of your friends is upset, do you get upset too? 27. Do you usually think carefully before you do something? 28. Would you like to learn to fly an airplane? 29. Do you ever get really involved with how a character in a movie or book feels? 30. Do you often do things at the last minute? 31. Do you like to take chances?

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32. Do you get very upset when you see someone cry? 33. Do you sometimes break rules? 34. Do you act very carefully when you are in a new situation? 35. Does it make you laugh when you see others in a group laughing? 36. Do you often say things without thinking about them? 37. At an amusement park, do you like the darts and side shows better than you like the roller coasters and bumper cars? 38. Do you get worried when others around you are worried? 39. Do you get involved in things and then later wish you could get out of them? 40. Do you like to take charge? 41. When your friends talk about their problems, do you try to change the subject? 42. Do you get so excited about new projects that you don’t think about possible problems you might run into? 43. Even though you could fall and get hurt, would you like to climb a mountain? 44. Do you get bored easily? 45. Would you like to travel to exciting places? 46. Can you understand why some people get upset so easily? 47. Do you think that planning ahead takes the fun out of things? 48. Do you sometimes like doing things that are a little frightening? 49. Do you stay happy even when your friends are upset about something? 50. Is it hard for you to stay out of trouble? 51. Would a life with no danger be too boring for you? 52. Do you feel annoyed when someone you are with is crying? 53. Would you avoid doing something if it is dangerous? 54. Do you prefer getting into a swimming pool slowly to diving straight in? 55. Are you often surprised at how people react to what you do or say? 56. Do you get very annoyed if someone keeps you waiting? 57. Would you enjoy skiing very fast down a steep mountain? 58. Do you like watching people open presents? 59. Would you prefer an unexpected trip to one that was planned for a while?

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Kid’s Activity Questionnaire

Instructions: Please answer the following questions to the best of your ability. Answer each question for the school year and summer.

During the school year, how Less than many times a week do you Never 1-2 times 3-5 times 6-7 times once engage in the following? Swimming Ride your bike Bowling Play soccer Basketball Baseball or softball Hiking Fishing Running or jogging Tennis Football Volleyball Play golf Go mountain climbing or rock climbing Ride your scooter Ride your skateboard Go in-line roller skating Go snowboarding Go skiing Play video games Watch TV Use the computer Play outside at recess Play inside at recess During the school year, how Less than 30 min to More than much time do you spending Never 1-2 hours 30 min 1 hour 2 hours doing the following? Homework Riding a bus Riding in a car

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During the summer, how Less than many times a week do you Never 1-2 times 3-5 times 6-7 times once engage in the following? Swimming Ride your bike Bowling Play soccer Basketball Baseball or softball Hiking Fishing Running or jogging Tennis Football Volleyball Play golf Go mountain climbing or rock climbing Ride your scooter Ride your skateboard Go in-line roller skating Go snowboarding Go skiing Play video games Watch TV Use the computer Play outside at recess Play inside at recess During the summer, how Less than 30 min to More than much time do you spending Never 1-2 hours 30 min 1 hour 2 hours doing the following? Homework Riding a bus Riding in a car

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LOC-ED Questionnaire

Please answer “Yes” or “No” to the following questions by putting an “X” in the appropriate box. While you were Yes No eating… 1. During the past 3 months have you ever felt that you were not able to stop eating, or not able to control the type of food or amount of food that you ate?

If you answered “Yes” – Please continue below. If you answered “No” – STOP – turn in your form.

2. How many times did this happen: a. In the past month? ____ Times b. 2 months ago? ____ Times c. 3 months ago? ____ Times (If you can’t remember, please give your best guess)

Answer the following questions based on the last time you felt like you lost control or were unable to stop eating. Yes No Before you started eating:

3. Were you hungry?

4. Were you trying to cut back or eat less food than usual?

5. Did you have a bad feeling, like angry, sad, or lonely before you ate?

6. Were you feeling bored or tired before you ate?

7. Did something bad happen to make you want to eat? (For example: Had a fight with a friend, got in trouble with a parent) 8. Did something good happen to make you want to eat? (For example: Did well on a test went to a party or celebration)

9. Did you keep eating even though you were full or had already eaten enough?

10. Did the amount of food feel like too much for you at the tiem time?

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11. Do you think other people would think you ate too much food?

12. Were you eating in secret or trying to hide the food you were eating?

13. Did it feel like you were eating more than others?

14. During any time when you were eating, did you feel numb or like you spaced or zoned out?

After you finished eating: Yes No

15. Did you feel badly about yourself for eating or about what you ate? For example, did you feel guilt, shame, unhappiness, or another kind of bad feeling?

16a. Did you throw up?

16b. If yes, did you make yourself throw up?

17. Did you use laxatives or any kind of pills to make the food go out of your body?

18. Did you exercise for an hour or more, in order to make up for the food that you ate?

19. Did you not eat anything at all for a whole day or more because you ate too much?

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Children’s TV and Internet Survey

Instructions: The scientist will read these questions for you and after each question they will give you a choice of answers. Pick the best answer.

1. Do you watch television (TV)?

Yes:______No:______

2. If you watch TV, can you remember about how many hours per day you watch TV? a. about 1 hour b. about 2 hours c. about 3 hours d. about 4 hours e. more than 4 hours

3. Can you tell me how many TVs are in your home? ______

4. Do you have a TV in your bedroom?

Yes:______No:______

5. When you watch TV, do you watch the commercials?

Yes:______No:______

6. What do you think commercials are for? There is no wrong answer.

______

7. Do you watch TV during dinner?

Yes:______No:______

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8. Please tell me if you watch these TV Channels:

Not sure / Yes No I don’t know

Nickelodeon

Disney Channel

Cartoon Network

ABC

CBS

NBC

PBS

FOX

Discovery Channel

Animal Planet

TLC

MTV

VH1

ESPN

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9. Tell me what you know about the following shows:

Heard of it Never heard Seen it a few but never Watch it a lot of it times seen it Spongebob Squarepants

The Adventures of Jimmy Neutron

Shake It Up iCarly

Drake and Josh

Fanboy and ChumChum

Hannah Montana

Wizards of Waverly Place

Degrassi

Jessie

Victorious

The Fairly Oddparents

A.N.T. Farm

Power Rangers

Supah Ninjas

The Penguins of Madagascar

Austin and Ally

Arthur

House of Anubis

Good Luck Charlie

American Idol

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Wipeout

Phineas and Ferb

Big Time Rush

The Electric Company Sports Programs (basketball, football, or other sports) America’s Funniest Home Videos

10. Do you watch other any other TV shows that we did not talk about? Can you remember what they are? ______

11. Do you use the Internet?

Yes:______No:______

12. If you use the Internet, about how many hours per day do you use the Internet?

a. about 1 hour b. about 2 hours c. about 3 hours d. about 4 hours e. more than 4 hours

13. Do you use the Internet in school?

Yes:______No:______

14. How many computers are in your home? ______

15. Do you have your own computer?

Yes:______No:______

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16. Do you use the Internet during dinner?

Yes:______No:______

17. Tell me what you know about the following Internet sites:

Never heard Heard of it but Used it a few Use it a lot of it never use it times Google.com FunBrain.com NickJr.com Disney.com HotWheels.com PoissonRouge.com RoaryTheRacingCar.com CartoonNetwork.com Barbie.com PBSKids.org ThomasAndFriends.com Facebook.com Twitter.com Tumblr.com Myspace.com ClubPenguin.com Pinterest.com PopTropica.com MoshiMonsters.com Webkinz.com StarDoll.com CoolMath-Games.com NeoPets.com PrimaryGames.com Fantage.com Nick.com Bing.com Kids.Yahoo.com HoneyDefender.com LuckyCharms.com FrostedMiniWheats.com FrootLoops.com

18. Do you use any other any other websites that we did not talk about? Can you remember what they are? ______

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Child Food Frequency Questionnaire

Instructions: Please fill in the box for each question. Answer all of the questions for each food group.

Less More How often do you eat the 1-2 6-7 Never than 3-5 times than 7 following per week? times times once times Breads and Grains White bread Dark bread Cooked cereal, such as oatmeal Rice Macaroni and cheese Spaghetti and tomato sauce Pizza Vegetables Carrots String beans Peas Corn Baked potato Mashed potatoes Baked beans Fruits Apple Applesauce Banana Dairy Skim milk Whole milk Ice cream Protein Beef, such as hamburger Pork chops, steaks, roast Fish, such as fried flounder Chicken Chicken based soup Tomato based soup Scrambled eggs Peanut butter

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Beverages Tea Fruit drinks Soft drinks Snacks Potato chips Corn chips/ Doritos Popcorn Desserts Muffin Cookie Doughnut Pie Chocolate Other candy without chocolate Miscellaneous foods Tomato ketchup Salad dressing Butter Mayonnaise Brown gravy Syrup

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Brand Liking and Wanting VAS Questionnaire

Instructions: Please answer the following questions to the best of your ability.

Screenshot from Qualtrics Survey.

Food and non-food brands included in survey. Ragu NBC Sun-Maid Planters Pepsi Cartoon Network Elmer’s Lunchables Campbell’s Oral-B Gap Synder’s Tropicana Burger King ty Smucker’s Jif Quaker Little Tikes Fisher-Price Samsung Mott’s The North Face Kohl’s Disney Nature Valley Ocean Spray Google Nickelodeon Sunny Delight Keebler ESPN Colgate Ebay Twizzlers General Electric

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Dawn Old Navy Juicy Juice Pringles Kool-Aid Visa Pillsbury Lucky Charms Doritos Sony Mac Dole Kraft Crayola Matchbox Green Giant Chili’s Lay’s Charmin McCormick Betty Crocker Kellogg’s Playskool Ziploc Nerf Starbucks Lego Microsoft Facebook Ritz Taco Bell T-Mobile Target Capri Sun Chex Mix Verizon Bounty Hot Wheels Cheetos Nike PlayStation AT&T Progresso Sour Patch Tostitos Nintendo Pizza Hut Nesquik Hostess Puma Toys R Us Mountain Dew Nutter Butter Bic Animal Planet Life Honey Maid Sun Chips Hasbro Gatorade Reese’s McDonald’s UPS Tide PBS Kids Subway JCPenney Adidas Comcast Yoplait Heinz hp Scrubbing Bubbles Glad Barilla Walmart Ford Dell Dannon Best Buy Barilla Walmart Coca-Cola Sears Chef Boyardee Trix

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Appendix D

fMRI Branding Study Scripts

Liking Assessment

Peryam & Kroll 5-point smiley face scale.

Smiley Face Scale Training Script

Introduction: “Let’s play a fun food game, okay?

Part 1: Explanation of Five-point Scale I am going to give you some fun foods to taste and I want you to taste each one and use these smiley faces to tell me how they taste, okay? (Present Smiley face scale to the child)

I have this card with five little faces that we can use today. (Point to the face that says “super good”) Do you see this face? This guy is smiling a lot because he just tasted something that is “super good.” If you taste something that is “super good” point to this face.

(Point to the face that says “good”) Do you see this face? This guy is smiling, but not as much as this one (the “super good” face). He is smiling because he just tasted something that is “good.” If you taste something that is “good” point to this face.

(Point to the face that says “bad”) Do you see this face? This guy is frowning because he just tasted something that is “bad.” If you taste something that is “bad” point to this face.

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(Point to the face that says “super bad”) Do you see this face? This guy is really frowning? He just tasted something that is “super bad.” If you taste something that is “super bad” point to this face.

(Point to the face in the middle, “maybe good, maybe bad”) This last face in the middle is for something that you taste that is not good, but not bad either. Use this face if something is in the middle, or if you just can’t decide.

Testing the child’s understanding of the scale.

What is your favorite food? So, if I gave you some (favorite food) to taste, which face would you point to? (Allow child to point to the face to make sure they understand. If the child points at “good” or “super good” the child’s response is correct and assume they understand).

What is your least favorite food, or a food you think is yucky? So, if I gave you some (least favorite food) to taste, which face would you point to? (Allow child to point to the face to make sure they understand. If the child points at “bad” or “super bad” the child’s response is correct and assume they understand).

Great work, now one more question and we will start our tasting game. What if I gave you something to taste and it you couldn’t decide if it was good or bad? What face would you point to? (Allow child to point to the face to make sure they understand. Most children will point to the middle face, but some children point to “bad” or “good” and give additional explanations why. We have counted these responses as correct, as long as they don’t pick “super good” or “super bad.”)

If the child does not understand, go through the explanation again.

Okay, let’s start the game. Ready? Give child one food item at a time, allowing them to taste and rate each one. Have them sip water between each food.

Smiley Face Scale Refresher Script

For use when a child comes back after their first visit, to make sure they remember how to use the scale.

“It’s so great to see you again. Did you have fun last time? We are going to play another tasting game today. Do you remember our smiley faces? Can you remind me again how to use them? (Have child go through the explanation of each face. If they have trouble remembering, remind them what each face means. If the child does not remember, go through Parts 1 and 2 above again).

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Freddy Fullness

Introduction: “I have a doll here whose name is Freddy. You can use Freddy to tell how full your stomach feels after eating food or a meal, like breakfast, lunch, or dinner. For example, if you hadn’t eaten anything and your stomach felt empty, you’d put the slider at the very bottom. If you ate so much and were so full that you felt like you could burst and you couldn’t possibly eat anymore, you’d put the slider at the top. Why don’t you try to move the slider to get a feel for it? “ (Allow child to demonstrate how the slider can move up and down Freddy’s tummy.)

“Now, I have a few questions for you, and I want you to move the slider up and down Freddy’s tummy to tell me how full you think you would be. Okay?”

“Imagine if you ate just a little bit, like one cookie, how full do you think your stomach would feel?” (If child moves the slider more than 25%, ask whether he/she is sure that’s really a little bit. Moving the slider too far for a little may indicate the child doesn’t understand.)

“Now, imagine that you ate a few more cookies, how full do you think your stomach would feel?” (Any response between the last one and the top is acceptable.)

“Now imagine that you ate so many cookies that you didn’t want any more, but you could still eat something else, how full do you think your stomach would feel?”(Child should put the slider between 60 and 80% of the distance.)

“Now, if you ate so much that you couldn’t possibly eat anymore of ANY food, how full do you think your stomach would feel?” (Child should use the maximum.)

“Do you understand how Freddy works?” (Allow child to respond. If child is still unclear, go through explanation again.)

Fullness Determination and Study Meal

“Can you use Freddy to show me how full your stomach feels right now? Remember, if your stomach feels empty, you push the rectangle to the bottom of the page like this.” (Push the slider to the bottom of the page.)

“If you have eaten a lot and you can’t possibly eat anymore, you push the rectangle all the way to the top like this.” (Push the slider to the top of the page.)

“Do you understand? Great! Move the rectangle to show me how you feel right now.” (Let child use Freddy to rate how full he/she feels.)

123

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