Child pestering for unhealthy food and drinks: A mixed-method exploration of environmental triggers, parent and child experience, and impact on purchasing

Background Childhood obesity is a national health priority. Over a third of children are living with overweight or obesity when leaving primary school aged 11 years. The UK Government plan to halve childhood obesity by 2030, reducing inequalities in prevalence and associated health outcomes. Obesity is attributed to environments that drive children s preference for and consumption of foods and beverages (hereafter: foods) high in fats, salts and/or sugar (HFSS). Following the Government s 2020 obesity strategy, the placement of HFSS products in key locations (checkouts, store entrances, end-of-aisle) has been prohibited in most retailers since October 2022. Restriction of HFSS products by volume price will be implemented in England in October 2025, alongside new HFSS advertising restrictions on television before 9pm and paid-for HFSS advertising online. Due to notable research gaps, it is not known how these regulations will affect children s requests for HFSS foods. Aims and objectives This project will: Assess prevalence and nature of child pestering for HFSS foods, including how this varies by advertising exposure, sociodemographic characteristics, and context (Work Package (WP) 1). Explore diverse experiences of pestering for parents and children (WP2). Quantify the impact of pestering on family purchasing of HFSS foods and assess promotional triggers of pestering (WP3). We will achieve these aims through three linked Work Packages (WP), each with specific research questions. WP1 will take a national approach. Subsequent WPs will adopt case study approaches for deeper insights (WP2) and to estimate size of effect (WP3). Methods In WP1 we will conduct an online survey in a national representative sample of parents/carers (n=1050) of children aged 1-18 years in England. The survey will explore child advertising exposure, pestering experiences, pestering triggers, and parental responses and strategies with quantitative comparisons by sociodemographic characteristics (e.g., socioeconomic status) via general linear regression models. In WP2 we will conduct 16 focus groups, 8 with parents/carers (n=40) and 8 with children (n=40), with a diverse sample. The design will be guided by the findings of WP1, but the discussion will include exploration of food promotion, pestering triggers, perceptions and response strategies. Recordings of sessions will be transcribed verbatim and thematic content analysis will be applied. WP3 will involve a convergent parallel mixed-methods approach, involving an intercept survey (n=480 parents who have immediately exited supermarkets after food shopping with children) and go-along interviews (direct observation while families (n=30) conduct their food shopping). Data from each component will be analysed independently and then synthesised. Timelines for delivery We propose a 24-month project starting May 2025. Dissemination and impact The evidence generated can support refinement and development of UK and international public health policies leading to population health improvements. A focus on sociodemographic factors will ensure evidence is available for policies to be designed to reduce inequalities. Our results will also be of interest to the public health research community and the public. We will work with the Obesity Health Alliance as a dissemination partner and our PPI group to maximise the quality and reach of our dissemination and impact.