• Amy M Bernhardt, Cara Wilking, Mark Gottlieb, Jennifer Emond, and James D Sargent.
• Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
• JAMA Pediatr. 2014 May 1; 168 (5): 422-6.

ImportanceSince 2009, quick-service restaurant chains, or fast-food companies, have agreed to depict healthy foods in their advertising targeted at children.ObjectiveTo determine how children interpreted depictions of milk and apples in television advertisements for children's meals by McDonald's and Burger King (BK) restaurants.Design, Setting, And ParticipantsDescriptive qualitative study in a rural pediatric practice setting in Northern New England. A convenience sample of 99 children (age range, 3-7 years) was shown depictions of healthy foods in fast-food advertisements that aired from July 1, 2010, through June 30, 2011. The images from McDonald's and BK showed milk and apples. Children were asked what they saw and not prompted to respond specifically to any aspect of the images.ExposureTwo still images drawn from advertisements for healthy meals at McDonald's and BK.Main Outcomes And MeasuresChildren's responses were independently content coded to food category by 2 researchers.ResultsAmong the 99 children participating, only 51 (52%) and 69 (70%) correctly identified milk from the McDonald's and BK images, respectively, with a significantly greater percentage correct (P = .02 for both) among older children. The children's recall of apples was significantly different by restaurant, with 79 (80%) mentioning apples when describing the McDonald's image and only 10 (10%) for the BK image (P < .001). The percentage correct was not associated with age in either case. Conversely, although french fries were not featured in either image, 80 children (81%) recalled french fries after viewing the BK advertisement.Conclusions And RelevanceOf the 4 healthy food images, only depiction of apples by McDonald's was communicated adequately to the target audience. Representations of milk were inadequately communicated to preliterate children. Televised depictions of apple slices by BK misled the children in this study, although no action was taken by government or self-regulatory bodies.

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