BACKGROUND Children are inhabitants of a media-rich environment rife in extensive, sophisticated, and persistent techniques that are used to market unhealthy food. Exposure is known to influence children's attitudes, choices, and consumption, yet further research is required to explore the influence of contemporary techniques within online games. OBJECTIVE To explore the influence of modern advertising on children's attitudes, choices, and consumption, techniques (ie, banner advertising, advergame, and rewarded video advertising) were used to promote an unfamiliar confectionery brand within an online game. DESIGN A between-subjects randomized experimental study. PARTICIPANTS/SETTING Children (aged 7 to 12 years [n=156]) were recruited in New South Wales, Australia, between September and November 2017. INTERVENTION Children were required to play a 4-minute online game, complete some questionnaires, and choose one snack to consume afterward. Children were randomly assigned to one of four conditions: a control group with no advertising, and three experimental conditions that promoted an unfamiliar confectionery brand via a banner advertisement, advergame, or rewarded video advertisement. MAIN OUTCOME MEASURES Questionnaires included the assessment of attitudes to the test brand before and after the game, enjoyment of the game, and children's awareness of advertising. Food choice was recorded and food consumption was measured by weighing the snack in grams, which was translated into kilocalories. STATISTICAL ANALYSES PERFORMED Statistical tests included analyses of variance, Kruskal-Wallis test, and χ2 test. RESULTS Attitudes toward the perception of fun (P=0.06) and taste (P=0.21) of the test brand were not influenced by condition. Children who were exposed to the rewarded video advertising chose the test brand significantly more than children in the other three conditions (P<0.002). Condition did not influence overall energy intake measured in grams (P=0.78) or kilocalories (P=0.46). CONCLUSIONS Children's choice of the test brand was significantly influenced by the rewarded video advertising condition (compared with control, banner advertising, and advergame conditions). This technique is prevalent across online and application games that children play yet the effects of using rewarded video advertising to promote food brands have not been explored from a public health perspective. This study contributes to the understanding of modern strategies used to market unhealthy foods to children.

中文翻译：

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数字游戏设计中的广告投放影响儿童对广告零食的选择：一项随机试验

背景技术儿童是充斥着广泛、复杂和持久的技术的富媒体环境的居民，这些技术被用于销售不健康食品。众所周知，接触会影响儿童的态度、选择和消费，但还需要进一步研究以探索当代技术在网络游戏中的影响。目的 为了探索现代广告对儿童态度、选择和消费的影响，使用技术（即横幅广告、广告游戏和奖励视频广告）在网络游戏中推广一个陌生的糖果品牌。设计 一项受试者间随机实验研究。参与者/环境 儿童（7 至 12 岁 [n=156]）于 2017 年 9 月至 11 月在澳大利亚新南威尔士州招募。干预 要求孩子们玩 4 分钟的网络游戏，完成一些问卷，然后选择一种零食食用。儿童被随机分配到四个条件之一：一个没有广告的对照组，以及三个通过横幅广告、广告游戏或奖励视频广告宣传陌生糖果品牌的实验条件。主要观察指标 问卷包括游戏前后对测试品牌的态度、游戏的乐趣和儿童对广告的认知度的评估。记录食物选择，并通过以克为单位称重小吃来衡量食物消耗，克数转换为千卡。执行的统计分析 统计检验包括方差分析、Kruskal-Wallis 检验和 χ2 检验。结果 对测试品牌的乐趣（P=0.06）和口味（P=0.21）感知的态度不受条件的影响。接触奖励视频广告的儿童选择测试品牌的次数明显多于其他三种情况下的儿童（P<0.002）。条件不影响以克 (P=0.78) 或千卡 (P=0.46) 为单位测量的总能量摄入。结论 儿童对测试品牌的选择受到奖励视频广告条件的显着影响（与对照、横幅广告和广告游戏条件相比）。这种技术在儿童玩的在线和应用程序游戏中很普遍，但尚未从公共卫生的角度探讨使用奖励视频广告来推广食品品牌的效果。