We thank the author for their interest in our work and for highlighting the importance of timely surveillance of food marketing on social media. We also agree with their central thesis that content prevalence is not equivalent to adolescents’ exposure and appreciate their suggested approach to bridge inference about adolescent exposure from content exposure data.
Their first suggestion, to weight prevalence estimates by views, is a straightforward approach to bridging this gap when we only have access to content prevalence data. However – and as they specify – ideally these would be reflective of adolescent engagement with the posts, which, given the type of data (i.e. publicly available social media content posted by highly followed influencers), may not be achievable.
Their second suggestion, to implement bounded sensitivity analyses for missing nutrient profiles, is particularly interesting given the amount of missing data for unbranded foods. This type of analysis could help set floor and ceiling values for the unbranded content, which, as the authors point out, could help better estimate the difference in the health profile between branded and unbranded food and beverages featured.
Their third suggestion, to audit posts for multiple products among a random subset, would provide quantitative evidence in support of the fact that by only selecting one product in each video, we underestimated the true extent of food content prevalence. Additionally, from a methodological perspective, conducting such an audit in a random subset of posts is practical given the time-intensive nature of social media content analysis, where coders must pay attention to the images shown, the audio and the written caption.
While these suggestions provide feasible approaches for approximating adolescent exposure from content prevalence data, more direct measurement of adolescent exposure is crucial. In fact, our collective work on food marketing and social media motivated a larger evaluation of the impact of state-level social media policies on exposure to food marketing among adolescents on social media. As part of this larger evaluation, adolescent participants have agreed to share their social media feeds (by screen-recording their time on social media), allowing for direct measurement of exposure to food content by adolescents(Reference Albert, Abrams and Cassidy1).
Additionally, we want to emphasise that while we agree that assessing adolescent exposure has important policy implications, this was outside the scope of our study. We want to reiterate that content prevalence data can in and of itself be beneficial to inform policy and regulation, by focusing the spotlight on those who produce social media content, rather than those (including adolescents) who consume that content. We need to hold social media companies, influencers and food brands accountable for the content posted online, especially given that the majority of American adolescents use TikTok and, in 2020, a third of TikTok users were estimated to be under the age of 14(Reference Faverio and Sidoti2,Reference Zhong and Frenkel3) . Given that our sample focused exclusively on the most popular TikTok influencers, the algorithm was likely showcasing their content. We previously reported that among the 89 influencers who posted food/beverage content, individual food/beverage posts, on average, had garnered > 9 million views and > 1 million ‘likes’ each(Reference Dupuis, Musicus and Edghill4). Whether adolescents are the intended or actual audiences for these influencers(Reference Lafontaine, Hanson and Wild5), influencers’ reach and persuasive power among adolescent viewers has been well-documented(Reference Bragg, Lutfeali and Gabler6,Reference Coates, Hardman and Halford7) , and these data can support evidence-based regulation.
Financial support
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number R01CA248441. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The National Institutes of Health had no role in the design, analysis or writing of this article.
Conflict of interest
There are no conflicts of interest.
Marie Bragg was a Senior Behavioral Expert at the Federal Trade Commission in the Bureau of Consumer Protection’s Division of Advertising Practices at the time of the study. The views in this paper do not represent those of the Federal Trade Commission or the Commissioners.
Authorship
R. D.: Writing (original draft), writing (review and editing). A. A. M.: Writing (review and editing). O. C.: Writing (review and editing). M. A. B.: Writing (review and editing).