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1. The impact of environmental risks on elementary school children’s health
Provide an outline of your paper. The purpose of this paper is to demonstrate your ability to
review and summarize five (5) original research articles on a health Services
Administration topic. Remember, use the five (5) research articles proposed in assignment
#3 submission.
Paper Outline
I. Introduction
a. Motivation to study this topic (Why this work is important; keep general and cite
statements)
b. Objectives (Goals of this paper)
c. Organizational overview of the paper (will review 5 research articles etc.).
II. Literature Review
a. background information on the topic
b. specific information to assist the reader’s understanding
b. key terms
III. Analysis Approach (What was done; describe the population/subjects, methods, type of
research; statistics used, etc.)
a. authors last name (Research article 1)
b. authors last name (Research article 2)
c. authors last name (Research article 3)
d. authors last name (Research article 4)
e. authors last name (Research article 5)
IV. Results (What was found)

2. a. authors last name (Research article 1)
b. authors last name (Research article 2)
c. authors last name (Research article 3)
d. authors last name (Research article 4)
e. authors last name (Research article 5)
V. Discussion (how results contribute to knowledge in the field, e.g. compare results to
literature)
a. Heading for discussion
b. gaps in the research review
c. overall strengths and weaknesses of the research articles
d. Needed future work in the field
VI. Conclusions
a. Summary of objectives and approach of this paper
b. Major findings of this paper
c. Important implications of this paper’s findings
d. Recommendations based upon the review of these 5 research articles
The Impact of TV Advertisements on Elementary School Children's Food Behaviors
Assignment #4: Outline Panther ID #1234567 Florida International University HSA 4700:
Quality and Evidence- Based Healthcare Services; Section RVC Dr. Chanadra Whiting
01/01/2020
The Impact of TV Advertisements on Elementary School Children's Food Behaviors I.
Introduction a. Motivation to study this topic • Estimates suggest 37 percent of all school-
age children are overweight or obese (Harris, et al.) • Longitudinal studies support
television screen time is directly related to increased risk for children being overweight or
obese (Robinson, et al.) • Unhealthy food advertising comprises a majority of television food
advertisements (Story, et al.) • Review of current literature can provide an opportunity to
better understand the relationship between food television advertisements and obesity
risks in elementary school children to guide public health policies b. Objectives • To
determine the public health implication of TV advertisements on elementary school-age
children’s food consumption behaviors c. Organizational overview of paper • Review of the
current literature regarding television advertising and its effect on children’s attitudes and
behaviors regarding food consumption and its relationship to obesity risk • Review of five
primary research articles concerning the subject of television advertising and child food
consumption effects • Presentation of the results of the five primary research articles
reviewed • Discussion of results, noted gaps and limitations, and conclusions drawn from
evidence II. Literature Review a. Background information on topic • Childhood obesity

3. represents a persistent public health crisis in the U.S. affecting more than a third of
elementary school-age children • Causes of childhood obesity are multifactorial and involve
physical activity behaviors, food consumption behaviors, nutritional knowledge, parental
and peer influences, food access, and genetics
• Excessive television viewing has been identified as a risk for child obesity both due to its
association with sedentary activity as well as food consumption behaviors • Television food
advertisements have been shown to affect food consumption attitudes and behaviors •
Public health recommendations concerning television food advertising have not been
adequately defined to guide clear public policies b. Specific information to assist the
reader’s understanding • Television food advertising includes ads promoting unhealthy
foods, healthy foods, and food education • Potential impacts of television food advertising
on children include effects on nutritional knowledge, attitudes about food types, and food
consumption behaviors c. Key terms • Body mass index is a measure of calculation based
on height and weight used to assess obesity • Overweight children are defined as having a
BMI greater than 25 kg/m2 • Obese children are defined as having a BMI greater than 30
kg/m2 III. Analysis Approach Description of search methodologies, search databases,
inclusion criteria, exclusion criteria, and key words to be described. a. Harris, et al. • AIM:
To assess the effect that watching food ads versus non-food ads had on children’s eating
behaviors while watching television • SUBJECTS: A total of 118 children, ages 7-11 years,
were randomized to an experimental group and a control group • METHODS: Children were
randomized to an intervention group that watched a 14-minute cartoon with food ads while
the other control group watched a similar length
cartoon with non-food ads. Both groups were provided snacks and water for consumption if
they chose. Measures of snack consumption were assessed using ANOVA statistical analysis.
• RESEARCH TYPE: Randomized controlled trial b. Dixon, et al. • AIM: To assess the
impact of television viewing of various television ads on children’s knowledge, attitudes,
and behaviors concerning healthy and unhealthy foods • SUBJECTS: A total of 919 5th and
6th graders in Australia sampled by survey and enrolled in experimental trial involving 3
treatment groups and one control group • METHODS: Pre-test survey regarding television
viewing habits and eating attitudes and behavior was collected a week before the
experiment. Children were then randomized into one of four groups: (1) junk food ads, (2)
junk food and healthy food ads, (3) healthy food ads, and (4) no food ads (control). Pretest
responses and post-test responses were analyzed by AONVA statistics to determine
variations in responses based on existing knowledge and behaviors and the interventions •
RESEARCH TYPE: Cross-sectional survey and randomized controlled trial c. Andreyeva, et
al. • AIM: To assess the impact of watching television ads promoting soft drinks, fast food,
and cereals on consumption of these food types in elementary school-age children •
SUBJECTS: Large cross-sectional survey of 55 consumer markets involving thousands of
children in elementary school grades collected from the Early Childhood Longitudinal
Survey • METHODS: Data from the ECLS was compared to Neilson Company data regarding
television viewing habits matched with television content involving ads related to fast food,
cereals and soft drinks. This data was then compared to body weight and food
consumption behaviors identified in the cross-sectional survey. Statistical analysis using

4. ANOVA was used to determine significance. • RESEARCH TYPE: Cross-sectional surveys d.
Hanks, et al. • AIM: To determine the impact of healthy food advertisements on healthy
food choices and behaviors among elementary school-age children • SUBJECTS: Ten
elementary schools participated in this experiment involving over 22,000 elementary
school-age children. • METHODS: Schools were divided into three groups with one
displaying a banner along its salad bar depicting vegetable cartoon characters. The second
group provided students with a short segment health education cartoon featuring vegetable
characters. The third group received both of the above interventions. Pre-intervention food
behaviors and post-intervention food behaviors were assessed and compared by statistical
analysis. • RESEARCH TYPE: Pre-test, post-test research design with multiple interventions
e. Halford, et al. • AIM: To determine if food ads increase food consumption behaviors in
elementary children • SUBJECTS: A total of 42 children ages 9-11 years from Liverpool were
recruited and divided into three groups based on body mass index: lean, overweight, and
obese. • METHODS: Pre-experimental questionnaires were administered to determine food
consumption and television viewing patterns. Half of the participants watched cartoon
followed by 8 food ads while the other half were watched the same cartoon and 8 non-food
ads. Participants were then assessed in a post-test format to determine which ads they
recalled watching. The participants were then invited back and
performed the same experiment but switched the ad content. Data was then collected from
all students and compared based on body weight and ad recognition. • RESEARCH TYPE:
Observational, crossover design IV. Results a. Harris, et al. • Children watching food ads
consumed 45 percent more than those viewing non-food ads. The children’s consumption
behavioral changes were not related to hunger. The authors concluded that food ads prime
automated eating behaviors in children and are unrelated to food brand being advertised.
b. Dixon, et al. • Findings showed that increased television use and increased exposure to
television ds promoting junk foods were associated with a more positive attitude about junk
foods. Likewise, increased television use alone was linked to increased junk food
consumption. However, ads for healthy foods also increased attitudes and beliefs for
healthy foods. The authors concluded that varying television ad content could be an
effective way to promote healthy food attitudes and behaviors in children and reduce junk
food preferences. c. Andreyeva, et al. • Results demonstrated that for every 100 soft drink
ads watched, consumption of soft drinks increased by 9.4 percent. For every 100 fast food
ads seen, consumption increased 1.1 percent. No correlation existed between ad exposure
and overall body weight, but fast food ads were more commonly viewed in children with
BMI meeting overweight criteria. The authors concluded that unhealth food ad viewing
increasing consumption of unhealthy foods, and this consumption is junk food group
specific to an extent.
d. Hanks, et al. • The researchers found that children exposed to the vegetable cartoon
banners increased vegetable food consumption by 90.5 percent. They also found that
children exposed to both interventions (group 3) increased vegetable consumption by
239.2 percent. They concluded that healthy food ads involving age-appropriate content was
effective in improving healthy vegetable consumption in elementary school0age children.
e. Halford, et al. • Results of the final analysis showed that the obese group of children

5. recognized more of the food ads than lean children. Likewise, those children who
recognized food ads had higher food consumption behaviors. Finally, all groups increased
food consumption after seeing the food ads. The authors concluded that exposure to food
ads cues food intake behaviors, and also that some children have a heightened alertness to
these ads. V. Discussion a. Heading for discussion • Relationship between television food
advertisements and food consumption in elementary school children b. Gaps in the
research reviewed • Each of the five articles examined the relationship between food ads
on television and children’s attitudes and behaviors regarding food consumption. However,
variations exist regarding experimental designs, ad content, measures of children’s
behaviors and attitudes, and duration of interventions. Gaps therefore
exist regarding the degree of influence these ads have on children’s food consumption
behaviors. c. Overall strengths and weaknesses of the research articles • Of the five
research experiments, strengths included large participant numbers, sound experimental
methodologies, positive associations in each between television ad viewing and changes in
food consumption behaviors, and detailed statistical analyses • Weaknesses of the studies
demonstrated significant variance in measures in assessing food consumption and attitude
among participants, variations in the content of television ads seen, and variations in the
duration of the interventions d. Needed future work in the field • Greater consistency in
metrics used to assess children’s attitudes and behaviors regarding food consumption is
needed • Longer duration studies to assess long-term impacts of television ad changes
would be beneficial • Additional studies to assess the impact of healthy food ads versus the
impact of unhealthy food ads would help identify weighted effects of each • Studies are
needed to better define the role television ads can serve in relation to other anti-obesity
interventions including cost assessments VI. Conclusions a. Summary of objectives and
approach of this paper
• The review explored the effect that television advertisements have on food consumption
attitudes and behaviors among elementary school children by examining five primary
research studies b. Major findings of this paper • The research shows that television ads
clearly affect children’s food consumption attitudes and behaviors in both positive and
negative ways and can serve as a strategy to guide healthier behaviors. However, the degree
of impact this has in reducing overall obesity among children is not well defined c.
Important implications of this paper’s findings • Further studies are needed to better define
the role that food advertisement policies may play in reducing childhood obesity among
elementary school children. The positive correlations noted in these five research studies
support further investigation into how such policies may be implemented and how their
effect measured d. Recommendations based upon the review of these 5 research articles •
The evidence supports practices among educators and parents to limit exposure to
unhealthy food television advertisements among elementary school children while
encouraging exposure to healthy food ads and those providing nutritional education.
Policymakers may also consider public health policies to place restrictions on unhealthy
food ads, but further evidence is likely needed before the public is convinced of these
approaches. Researchers, as such, should further explore the degree of impact these policies
could have by assessing effects over longer periods of time and in combination with other

6. interventions.
References Harris, JL, Bargh, JA, & Brownell, KD. (2009). Priming effects of television
food advertising on eating behavior. Health Psychol. 2009; 28(4): 404-413.
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The effects of television advertisements for junk food versus nutritious food on children's
food attitudes and preferences. Soc Sci Med. 2007; 65(7): 1311-23.
doi.org/10.1016/j.socscimed.2007.05.011 Andreyeva T, Kelly IR, & Harris JL. Exposure to
food advertising on television: associations with children's fast food and soft drink
consumption and obesity. Econ Hum Biol. 2011; 9(3): 221-33.
doi.org/10.1016/j.ehb.2011.02.004 Hanks AS, Just DR, & Brumberg A. Marketing vegetables
in elementary school cafeterias to increase uptake. Pediatrics. 2016; 138(2): e20151720.
doi.org/10.1542/peds.2015-1720 Halford JC, Gillespie J, Brown V, Pontin EE, & Dovey TM.
Effect of television advertisements for foods on food consumption in children. Appetite.
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Fleming-Milici F, Calvert SL, & Wartella E. Screen media exposure and obesity in children
and adolescents. Pediatrics. 2017; 140(Supplement 2): S97-101. doi:10.1542/peds.2016-
1758K Story M, & French S. Food advertising and marketing directed at children and
adolescents in the US. Int J Behav Nutri Phy. 2004; 1(1): 3. doi.org/10.1186/1479-5868-1-3