Anemelo handbook background information

Project number: 2017-1-UK01-KA201-036769
Project title: Augmented reality and new media against online promotion
of unhealthy foods (ANEMELO)
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The content in this document only reflects the views of the
project responsibles. The European Commission is in no
way responsible for any use that may be made of the
information it contains.
ANEMELO HANDBOOK
BACKGROUND INFORMATION
Version: 1.0
Date: 19.4.2018
Author: Onno Hansen-Staszyński (Ezzev Foundation)
Revision: Beata Staszyńska-Hansen (Ezzev Foundation), Bram Alkema, Arjan Haring, Rolf Visser

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INTRODUCTION
This document encompasses the draft version of the background information for the teacher
Handbook that will be created within the project Augmented reality and new media against
online promotion of unhealthy foods (ANEMELO).
The background information in this document concerns adolescent habit forming in general and
ways in which producers of junk food and drinks can stimulate habit forming in adolescents by
nudging them to eat and drink their products binge-like as an automated behavior on cue, either
by internal cues or by external cues.

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TABLE OF CONTENTS
Introduction.............................................................................................................................................................................. 2
Table of Contents ................................................................................................................................................................... 3
1. General background information.............................................................................................................................. 6
1.1 Habit formation.......................................................................................................................................................... 6
1.1.1 The concept ......................................................................................................................................................... 6
1.1.2 Changing already formed habits ............................................................................................................... 7
1.2 The adolescent brain ............................................................................................................................................... 7
1.2.1 Introduction ........................................................................................................................................................ 7
1.2.2 Adolescence......................................................................................................................................................... 8
1.2.3 Adolescents and habit formation.............................................................................................................. 9
1.3 Sources overview ....................................................................................................................................................10
1.3.1 Habit formation...............................................................................................................................................10
1.3.2 The adolescent brain.....................................................................................................................................10
2. Game-related background information................................................................................................................12
2.1 Level 1: Marketing ..................................................................................................................................................12
2.1.1 Introduction ......................................................................................................................................................12
2.1.2 Triggering behavior of advertising........................................................................................................12
2.1.2.1 Advertisment provides cues.............................................................................................................13
2.1.3 Ad filtering and awareness ........................................................................................................................14
2.1.4 Marketing and habit formation................................................................................................................15
2.2. Level 2: Immersion................................................................................................................................................15
2.2.1 Introduction ......................................................................................................................................................15
2.2.2 Strengthening both consumption and the narrative.....................................................................16
2.2.3 Repeat behavior ..............................................................................................................................................17
2.2.4 Immersion and habit formation ..............................................................................................................17
2.3. Level 3: Personalization......................................................................................................................................18

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2.3.1 Introduction ......................................................................................................................................................18
2.3.2 Profiling...............................................................................................................................................................18
2.3.2.1 The concept...............................................................................................................................................19
2.3.2.2 Profiling instruments...........................................................................................................................20
2.3.2.3 Profiling and adolescents...................................................................................................................20
2.3.3 Target audience analysis.............................................................................................................................20
2.3.3.1 The concept...............................................................................................................................................21
2.3.3.2 TAA in practice........................................................................................................................................21
2.3.3.3 TAA and adolescents............................................................................................................................22
2.3.4 Persuasion profiling......................................................................................................................................22
2.3.4.1 The concept...............................................................................................................................................22
2.3.5 Hazards of profiling, persuasion profiling and TAA ......................................................................23
2.3.6 Personalizing communication and habit formation ......................................................................24
2.4. Level 4: Food and drinks as reward..............................................................................................................26
2.4.1 Dopamine ...........................................................................................................................................................26
2.4.2 Adolescents and dopamine........................................................................................................................26
2.4.3 Sugar, fat and habit formation..................................................................................................................27
2.4.4 Sugar, fat and adolescent habit formation..........................................................................................28
2.4.5 Long-term effects............................................................................................................................................28
2.5 Level 5: Social media as reward.......................................................................................................................29
2.5.1 Introduction ......................................................................................................................................................29
2.5.2 The concept .......................................................................................................................................................30
2.5.3 The impact of social media.........................................................................................................................30
2.5.4 Social media and adolescents ...................................................................................................................31
2.6 Level 6: Changing the metabolistic system.................................................................................................32
2.6.1 Introduction ......................................................................................................................................................32
2.6.2 The concept .......................................................................................................................................................33
2.6.3 Long-term effects............................................................................................................................................33

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2.6.4 Discussion ..........................................................................................................................................................33
2.7 Sources overview ....................................................................................................................................................35
2.7.1 Level 1: Marketing..........................................................................................................................................35
2.7.2 Level 2: Immersion........................................................................................................................................36
2.7.3 Level 3: Personalization..............................................................................................................................38
2.7.4 Level 4: Food and drinks as reward ......................................................................................................42
2.7.5 Level 5: Social media as reward ..............................................................................................................43
2.7.6 Level 6: Changing the metabolistic system........................................................................................44

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1. GENERAL BACKGROUND INFORMATION
1.1 HABIT FORMATION
1.1.1 THE CONCEPT
In his book Hooked Nir Eyal describes how consumer habits are formed through conscious
engineering by companies. According to him, succesful companies have found a way to link their
products to specific consumer daily routines and emotions. They offer solutions that are to come
to mind immediately whenever a consumer enters the specific daily routine or experiences the
specific emotion. This enables companies to sell their products to consumers without spending
significant resources on advertising.
Eyal distinguishes four steps in the so-called Hooked Model companies use to automate their
sales. The first step is the cue that is to be the starting-point of consumer behavior: the trigger.
This trigger can be external or internal. External triggers can take the form of advertising or of
favorable press mentions. Internal triggers are negative consumer emotions: “Feelings of
boredom, loneliness, frustration, confusion, and indecisiveness often instigate a slight pain or
irritation and prompts an almost instantaneous and often mindless action to quell the negative
sensation.”
The second step is the action that is evoked by the trigger. Without an action following a cue, the
cue is worthless in the process of habit formation. The initiation of the action should be easier for
the consumer than thinking so that the consumer’s response to the cue can be automated over
time.
The action following the trigger equals behavior in anticipation of a reward. The experiencing of
the reward is step three. This reward should be more than a predictable result of the action, it
should trigger desire. The reward provided should evoke a further craving in consumers.
The best way to evoke consumer craving is to provide variable rewards, as was found by
psychologist Michael Zeiler. While predictable rewards lead to routine, variable awards spark
interest and attention. Rewards can take the form of social confirmation, of material objects such
as food and physical objects, and of rewards of the Self: “intrinsic rewards of mastery,
competence, and competition”.
The fourth and final step in the Hooked Model is investment. This builds on the fact that the more
time and effort are invested into a product or service, the more these are valued. Ever more
investment leads to ever more commitment to a product or service.
Eyal stresses that it is not enough to get consumers to complete the four-step cycle once: “to
create the habit, users must first use the product through multiple cycles of the Hook Model.

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Therefore, external triggers must be used to bring users back around again and again to start
another cycle.”
1.1.2 CHANGING ALREADY FORMED HABITS
To change a habit once it is forged is not easy. Charles Duhigg nevertheless presents an option
to attempt it. His approach also consists of four steps.
Step one, according to Duhigg, is to identify the routine: “it’s the behavior you want to
change”. Step two is to experiment with rewards: “By experimenting with different rewards, you
can isolate what you are ACTUALLY craving, which is essential in redesigning the habit.” Step
three is to isolate the cue: “identify categories of behaviors ahead of time to scrutinize in order
to see patterns.” Five possible categories need to be taken into account: location, time,
emotional state, other people, and immediately preceding action. Duhigg’s fourth step is to have
a plan: “you can change to a better routine by planning for the cue and choosing a behavior that
delivers the reward you are craving.” In other words, Duhigg advises to interfere in Eyal’s step
two (action) but not in steps one (cues) and three (rewards). In his view bad behavior thus can
be replaced with good behavior.
Creating a new habit takes a lot of time and perseverance. During this time it helps to frame
one’s determination in terms of “I don’t” (consume junk food or drinks) rather than “I can’t”
(consume junk food or drinks). The first frame shows one’s power over a situation and declares
what kind of person one is. The second frame hands over power to an unnamed outside agent.
Adam Alter agrees with Duhigg’s proposition but adds: “Though [Duhigg’s] Golden Rule is a
useful guide, different addictions demand diferent routine overrides. ... Each underlying motive
implies a different solution. ... Even if the solution doesn’t come easy, the first step is
understanding why the addiction was rewarding in the first place, and which psychological
needs it was frustrating in the process.”
1.2 THE ADOLESCENT BRAIN
1.2.1 INTRODUCTION
Researcher Ronald Dahl points at a health paradox for adolescents. On the one hand
adolescence is a developmental period of strength and resilience: “Compared to young children,
adolescents are stronger, bigger, and faster, and are achieving maturational improvements in
reaction time, reasoning abilities, immune function, and the capacity to withstand cold, heat,

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injury, and physical stress.” On the other hand during adolescence “overall morbidity and
mortality rates increase 200%” when compared to younger children.
One of the major causes of Dahl’s health paradox is the restructuring process of the brain that
takes place during adolescence. While the brain of younger children mainly consists of grey
matter that facilitates the learning of almost anything, as a kind of all-purpose organ, in the
adolescent brain the amount of grey matter is significantly reduced while the amount of white
matter is significantly increased: rarely used brain connections are eliminated while important
brain connections are strengthened by means of a white insulation that enables high-speed
connections and shorter regeneration time. As a result the brain specializes and becomes more
effective.
While the reduction of grey matter (“pruning”) proceeds in a region-specific, nonlinear fashion,
the strengthening of white matter (“myelination”) starts at the back of the brain and slowly
proceeds forward. This means that the brain parts associated with body regulation, movement
and emotions are upgraded first and the brain parts responsible for the control and
coordination of thoughts and behavior stay under construction until one reaches one’s late mid-
twenties. The effect of the reconstruction of the adolescent brain is that in situations in which
emotions clash with reflection, emotions nearly always win out. Adolescent brains are not less
capable of reflection and control, but their capability to consider and reconsider is ineffective in
situations in which emotions flare up.
Besides the changes in grey and white matter another major change related to the adolescent
brain takes place: the dramatic growth of the dopamine system. As will be described in chapter
3.4 the neurotransmitter dopamine is an important factor in learning, as it is linked to desire,
rewards and establishing whether a situation, experience or outcome is worth noticing.
The process of brain reconstruction is not the only developmental process taking place during
adolescence. Hormonal changes cause the adolescent body to grow fast and to change its
composition (f.i. store more fat). Sex hormones prepare the adolescent body for reproduction.
All these large developmental processes take place independently of each other and the order in
which their separate phases become active may differ significantly per individual.
1.2.2 ADOLESCENCE
Adolescence is a period in which young children start to find their own way in life. The adults on
whom they have relied before become relatively less important. Peers and youngsters, who are
slightly older such as popular vloggers, take over the function of parents and teachers as role
models.

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Positive peer comments start to trigger large rewards in the adolescent brain, comparable to the
intake of psychoactive substances. Since adolescents are far more sensitive to rewards than
adults this means peer pressure is a major factor in the lives of adolescents.
While their ability to think abstractly is slowly developing, adolescents’ lack of life experience
hinders them in coming to balanced decisions. For a lack of data, adolescents approach
challenges rationally, which takes time. At any point during this prolonged process emotions
might be triggered to simply overtake the decision-making process. As a result, it is hard for
adolescents to learn from their mistakes, understand the consequences of their actions to the
end and keep themselves far from activities that are forbidden. Since in addition adolescents
expect bigger rewards for activities in comparison to adults and younger children, assess
pleasant situations as less risky, love intensity and passion and have a lower base level of
satisfaction in life, they are more risk-prone and prefer short-term goals.
The presence of peers, and the quest for peer acceptance, is an important factor in risk-taking,
but also isolation from one’s peer group is. This isolation looks slightly different for girls (being
excluded from groups of girls who discuss what is going on around them) and for boys (being
excluded from group activities such as team sports or gaming). Other stimulants of risk-taking
are low grades at school, a loss of trust of parents or other important adults, a negative home
situation and impulsivity in the form of a preference for sensation seeking or for first acting and
then thinking.
Risk-taking is an essential precondition for adolescents to find out what is important for them in
life and to select peers as friends and sexual partners. Therapists call adolescence a second
chance for youngsters, since they are able to reorganize the life they had thus far. It is a time in
which a basic identity is created that forms the basis for the adolescent’s adult life. Memories
formed during adolescents are deeply seated. This can be seen in Alzheimer patients who
cannot remember what they did yesterday but do remember their life as a young individual.
While most adolescents do not experience extreme problems as a result of risk-taking, around
twenty percent do. Examples of extreme problems are: addiction to psychoactive substances,
serious accidents, violence, murder, sex-related health problems, mental health problems such
as depression, eating disorders, self-mutilation and suicide. It is important to keep in mind that
these problems are not the result of a lack of knowledge or understanding. As researcher
Laurence Steinberg summarizes: “the factors that lead adolescents to engage in risky activity
are social and emotional, not cognitive”.
1.2.3 ADOLESCENTS AND HABIT FORMATION
Because of its reconstruction the adolescent brain is at its peak of openness to learning and
experiencing. This holds good for harmonious activities as well as for obsessive. The adolescent
brain can quickly learn a new language, become ever better in sports and in playing a musical

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instrument, but can also rapidly train itself to smoke cigarettes or marijuana, drink alcohol or
eat junk food. The plasticity of the brain during adolescence is so substantial, that significant IQ
changes occur: one third of all youngsters acquire a higher IQ at this age while one third of them
significantly lowers their IQ.
The adolescent openness to risky and intensely rewarding experiences leaves them more
vulnerable to the risk of getting addicted in comparison to adults. Adolescent addictions, in turn,
can last throughout the youngsters’ whole lives: the majority of adult addicts started their
addiction during adolescence. The younger adolescents start taking psychoactive substances,
the more impact these substances are likely to have and the more risk they run to stay addicted
throughout their lives. This is the logic behind setting age limits on drinking alcohol.
Those adolescents who get addicted have a higher chance on other major problems such as
mental health problems. These mental health problems are likely to continue into their adult
life, just as addictions are.
1.3 SOURCES OVERVIEW
1.3.1 HABIT FORMATION
 Adam Alter (2017) Irresistable.
 Charles Duhigg (2012) The power of habit.
 Nir Eyal (2014) Hooked.
 Simone Stolzoff (2018) The formula for phone addiction might double as a cure. In
Wired, 2.1.2018. https://www.wired.com/story/phone-addiction-formula/
1.3.2 THE ADOLESCENT BRAIN
 Jane Anderson et al. (2016) THE TEENAGE BRAIN: UNDER CONSTRUCTION. AMERICAN
COLLEGE OF PEDIATRICIANS. MAY 2016. https://www.acpeds.org/the-college-
speaks/position-statements/parenting-issues/the-teenage-brain-under-construction
 Aurélien Bernheim et al. (2013) Controversies about the enhanced vulnerability of the
adolescent brain to develop addiction. In: Frontiers in pharmacology.
 Sarah-Jayne Blakemore et al. (2006) Development of the adolescent brain: implications
for executive function and social cognition. In: Journal of child psychology and psychiatry,
47:3/4.
 Sarah-Jayne Blakemore (2012) Imaging brain development: The adolescent brain.
In: NeuroImage 61, 2012.

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 Eveline Crone (2017) The adolescent brain – changes in learning, decision-making and
social relations. Taylor & Francis Ltd.
 Ronald Dahl (2004) Adolescent brain development: a period of vulnerabilities and
opportunities. In: Annals of the New York Academy of Sciences.
 Dopamine Neurotransmitter. The role of neurotransmitter dopamine in movement and
cognition. (nd) In: Psychologist World.
https://www.psychologistworld.com/biological/neurotransmitters/dopamine
 Nicole Hair et al. (2015) Association of Child Poverty, Brain Development, and Academic
Achievement. In: JAMA Pediatr. 2015 September.
 Daniel Hoops and Cecilia Flores (2017) Making Dopamine Connections in Adolescence.
In: Trends in Neurosciences, Volume 40, Issue 12, p709–719, December 2017.
DOI: https://doi.org/10.1016/j.tins.2017.09.004
 Frances Jensen and Amy Ellis Nutt (2015) The teenage brain – a neuroscientist’s survival
guide to raising adolescens and young adults. Harper.
 Krista Lisdahl et al. (2013) Dare to delay? The impacts of adolescent alcohol and
marijuana use onset on cognition, brain structure and function. In: Frontiers in
psychiatry, July 2013.
 Dan Lubman et al. (2014) Cannabis and adolescent brain development.
In: Pharmacology & Therapeutics.
 Amy C. Reichelt (2016) Adolescent Maturational Transitions in the Prefrontal Cortex
and Dopamine Signaling as a Risk Factor for the Development of Obesity and High
Fat/High Sugar Diet Induced Cognitive Deficits. In: Front. Behav. Neurosci., 13 October
2016 | https://doi.org/10.3389/fnbeh.2016.00189
https://www.frontiersin.org/articles/10.3389/fnbeh.2016.00189/full
 Daniel Romer (2010) Adolescent risk taking, impulsivity, and brain development:
implications for prevention. In: Dev. Psychobiol. 52 (3), April 2010.
 Daniel Siegel. Dopamine and Teenage Logic. In: The Atlantic, 24.1.2014
https://www.theatlantic.com/health/archive/2014/01/dopamine-and-teenage-
logic/282895/
 Lindsay Squeglia et al. (2015) Brain Development in Heavy Drinking Adolescents. In: Am
J Psychiatry. 2015 June 1.
 Laurence Steinberg (2008) A social Neuroscience Perspective on Adolescent Risk-
Taking. In: Dev Rev. 2008 Mar; 28(1): 78–106. doi: 10.1016/j.dr.2007.08.002.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396566/
 Laurence Steinberg (2010) Commentary: A behavioral scientist looks at the science of
adolescent brain development. In: Brain Cogn., Feb 2010.
 Linda Van Leijenhorst et al. (2010) What Motivates the Adolescent? Brain Regions
Mediating Reward Sensitivity across Adolescence. In: Cerebral Cortex, January 2010.
 Erin Walsh (2016) Dopamine and the teenage brain, In: Dr. Dave Walsh, 1.11.2016
http://drdavewalsh.com/posts/223
 Emma Young (2017) Iceland knows how to stop teen substance abuse but the rest of the
world isn’t listening. In: Independent, 17.1.2017. https://www.independent.co.uk/life-
style/health-and-families/iceland-knows-how-to-stop-teen-substance-abuse-but-the-
rest-of-the-world-isn-t-listening-a7526316.html

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2. GAME-RELATED BACKGROUND INFORMATION
2.1 LEVEL 1: MARKETING
2.1.1 INTRODUCTION
Most adolescents think that marketing is the same as advertising. Indeed advertising is the most
noticeable part of marketing, since it is prominent by design. But marketing has more and more
subtle components. Examples of marketing tactics are: the way products and packages are
designed (featuring cartoon characters or celebrities), the availability of the products in shops,
the placement of products on the shelves (near the register), the chosen price ranges (now 2 for
1), and upselling: influencing customers to buy larger meals and drinks or to add high-calorie
toppings or sides to their order.
On top of these marketing tools public consumption proves to friends what eating behavior is
permissable, how big servings should be and what brands are “cool” and which aren’t. This
signalling behavior is as much part of promotion as the advertising itself. A lot of marketing
research, sales planning goes into alignment of event triggers coming from product design,
packaging, placement, price and promotion.
Promotion can be described as “any form of communication or message that is designed to, or
has the effect of, increasing the recognition, appeal and/ or consumption of particular products
and services”. Advertising, the most recognizable part of marketing for adolescents, is “the paid
public presentation and promotion of ideas, goods, or services by a sponsor that is intended to
bring a product to the attention of consumers through a variety of media channels such as
broadcast and cable television (TV), radio, print, billboards, the Internet, or personal contact”. It
is advertising on mass media that provides adolescents with cues that nudge them towards
immediate binge-like automated snack eating and drinking behavior.
2.1.2 TRIGGERING BEHAVIOR OF ADVERTISING
The mere exposure of adolescents to marketing messages is sufficient to nudge them to changes
in their behavior as desired by the sender of the marketing messages. Exposing adolescents to
alcohol-related messages, for instance, increases the probability of them starting to drink

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alcohol within the next months by 9% - 15%. Every alcohol-related advertisement, seen by
adolescents, increases the number of alcoholic drinks they consume by 1%.
Research on advertising attention found that adolescents pay more attention to food and
beverage advertising than to any other form of advertising. This makes food and drink
advertising effective when aimed at them: exposing children and adolescents to food and drinks
advertisements increases their food intake. One study for instance found that children, aged 7-
11, watching cartoons with food advertisements ate 45% more snack food than children in the
same age group watching the same show with non-food related advertisements.
The majority of food and drinks advertisements that children and adults are exposed to
promote high-calorie, low-nutrient foods, that are high in fats, salt or sugar (HFSS), especially
sugary breakfast cereals, confectionary, high fat savory snacks, soft drinks and quick service
restaurants.
While TV advertising still is the main medium for food advertising in the EU, it is in decline
while internet and digital marketing are on the rise. Parents are mostly unaware of the amount
of advertisements for unhealthy food and drinks that children and adolescents are exposed to
online.
Studies link the increase in overweight and obese adolescents to the advertising of sugar and
fat-dense junk foods. Amy Reichelt of RMIT University concludes: “Advertising for food and
beverages communicates food cues, priming the consumption of unhealthy foods and
beverages.”
2.1.2.1 ADVERTISMENT PROVIDES CUES
The exposure of adolescents to products by means of advertisements consists of more than just
displaying products or brand characteristics. In advertisements narratives are presented in
which unhealthy products are not shown as being unhealthy but rather as containing healthy
ingredients that empower consumers to live a good life. The promoted image of unhealthy
products is that these products are normal and innocent: they can be enjoyed every day, even in
larger quantities, without negative effects. The advertisement narrative links positive and
agreeable emotions and experiences to unhealthy food products.
One of the strategies followed by producers of unhealthy foods and drinks is to support
academic research that substantiates claims about the healthy character of some ingredients in
their products while trying to suppress studies that might expose hazards of consuming their
unhealthy products. The desired outcomes of academic studies are used by marketers to steer
the discussion about the products in a positive direction and create a positive narrative around
the products and brands.

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2.1.3 AD FILTERING AND AWARENESS
Most people are unaware of the influence of the external cues provided by advertising. And if
they are aware, they think advertising only effects others. The pro-health coalition Living Loud
hypothesizes that this is the result of a conscious effort by advertising specialists: “Great
advertising is designed to quietly influence people, to go consciously unnoticed, that’s why 62%
of people think advertising doesn’t affect their purchase decisions.”
Marketers have various instruments to increase the chances that their messages remain
consciously unnoticed. An effective instrument is to blur the lines between advertising and
other types of information. Marketers use hybrid content types such as advertorials and try to
seamlessly integrate marketing material into general content so that it becomes ever more
difficult to distinguish advertisements from regular information. Creating positive narratives
around products and brands instead of straightforward promoting the sales of products, as
described above, is another effective instrument.
Younger children do not have a mature understanding yet of the persuasion tactics used by
marketers. This understanding is slowly acquired, although outdated developmental models of
adolescent development claimed otherwise. A slow shift in the judgment about the truthfulness
of advertisements by youngsters provides an indicator of this. While 8% of 8-11 year olds think
that TV advertisements “always” tell the truth about the products they are selling, 4% of 12-15
year olds do. For “mostly” telling the truth the percentages are 31% (8-11) and 34% (12-15)
and for “sometimes” 45% (8-11) and 48% (12-15). With regard to internet advertising 4% of 8-
11 year olds thinks that these “always” tell the truth, against 2% 12-15 year olds. 28% (8-11)
and 27% (12-15) think that internet advertisements “often” tell the truth, and 50% (8-11) and
58% (12-15) think they “sometimes” speak the truth. This example highlights that adolescents
do not suddenly become more marketing literate. Age cuts for the legal age that marketers may
expose children to marketing will therefore always be arbitrary.
In order to understand the persuasion tactics used by marketers it is essential that children and
adolescents recognize advertisements for what they are. And here lies a challenge, partially
because of marketer efforts to blur the lines between advertisements and content and partially
because of relatively low digital skills that children and adolescents display. Researcher danah
boyd writes: “Just because teens are comfortable using social media to hang out does not mean
that they’re fluent in or with technology. Many teens are not nearly as digitally adept as the
often-used assumption that they are “digital natives” would suggest. .... As sociologist Eszter
Hargittai has quipped, many teens are more likely to be digital naives than digital natives.”
As a result, children and adolescents have a low awareness of the amount of advertising they
see and frequently understate this amount. Quite often they do not recognize advertisements as
such. For instance, it was found that a majority of adolescents cannot identify advertisements on
the search results page of Google, despite them being distinguished in a box with the word ‘Ad’
in it. Another finding is that almost half of the adolescents are not aware that vloggers, who are

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an important point of reference to them, may be paid to endorse products. WHO claims that
among adolescents conscious awareness of food and drinks marketing, as well as the ability and
the motivation to resist are “often not present”.
Children and adolescents do not perceive themselves as having low marketing literacy. On the
contrary many see themselves as “empowered consumers capable of limiting their exposure to
or influence by marketing”. Many claim to have strategies to avoid advertising, such as looking
away, using the time to do something else or ignoring advertisements by mentally filtering them
out.
2.1.4 MARKETING AND HABIT FORMATION
Marketing efforts by food and drinks producers are the first step in getting children and
adolescents to form and sustain the habit of consuming unhealthy food and drinks products.
Exposure to these external cues in the form of advertisement is to trigger children and
adolescents into action: the immediate consumption of an unhealthy food or drinks product.
The experience of the actual consumption of a product that follows the exposure to external
cues (see chapter 10), together with the systematic loading of the brand with positive
narratives, providing value in the form of immersive experiences that alleviate negative internal
states (internal cues, see chapter 8), offering personalized communication (chapter 9), using
social media channels and variable rewards (chapter 11), and changing the consumers’
metabolic system (chapter 12) are to take children and adolescents from one-off consumption
to eating and drinking unhealthy products binge-like as an automated behavior on cue.
2.2. LEVEL 2: IMMERSION
2.2.1 INTRODUCTION
According to the British Heart Foundation food and drinks producers use specialized online
marketing instruments to capture the attention of youngsters: in their marketing material they
include images of other children, cartoon characters, or of celebrities or other familiar persons;
they offer competitions, games or apps that are appealing to the target group; they hand out free
gifts or prizes such as free downloads or free merchandise that is appealing to the target group;
and provide links to social networking websites. These instruments enable marketers to
capture youngsters’ attention for longer periods of time and provide a deeper sense of
engagement compared to traditional forms of advertising.

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The vast majority of food and drinks producers who employ these online instruments to target
youngsters, either within their own online environment or on the most popular sites for
youngsters, are producers of products that are high in calories and low in nutritional value. The
products promoted in the online environments are predominantly not permitted to be
advertised on TV. The WHO calls these methods “stealth marketing techniques”.
The specialized online marketing instruments are effective, far more effective than TV
campaigns. Researchers found a positive relationship between immersive environments and
popularity and engagement. For instance, among the 20 most popular gaming websites for
children, 11 contain advergames promoting unhealthy food products.
The reason the specialized marketing instruments are effective is that children and adolescents
feel entertained by them. Youngsters engage with them to escape negative internal states that
they experience far more frequently than adults, such as feelings of boredom, loneliness,
frustration, confusion, and indecisiveness. These negative feelings “often instigate a slight pain
or irritation and prompt an almost instantaneous and often mindless action to quell the
negative sensation.” The specialized food and drinks marketing instruments provide youngsters
with a relief from their inner anxiety and present an entertaining, immersive world of unhealthy
food and drinks as the immediate answer to many of the challenges they face.
2.2.2 STRENGTHENING BOTH CONSUMPTION AND THE NARRATIVE
The aim of the specialized market instruments is to trigger immediate consumption, to expose
children and adolescents to the brand narratives behind the products and to get youngsters to
draw in their friends.
A study concerning advergames promoting HFSS-products (high in fat, salt or sugar) showed
that exposure to these advergames is linked to an increased consumption of HFSS-products,
while exposure to advergames promoting fruit led to an increased consumption of fruit, but not
at the expense of HFSS foods. As a result of youngsters playing another advergame, it was found
that 30% reported to have asked their parents to buy the advertised product.
Youngsters within a branded environment are intended to experience the claim that the brand
helps consumers live a good life. Nesquick, for instance, presented in an advergame a Nesquick
bunny that jumped higher after eating the cereal. Children who played the game were found to
be more likely to think Nesquick made them fit. Another cereal advergame evoked more
positive expectations among children about the taste of the cereal. After the game children were
also more likely to believe that the cereal is healthy. In general, it has been established by
research that immersive marketing content can establish increased brand recognition,
increased positive brand associations and brand trust.

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2.2.3 REPEAT BEHAVIOR
The immersive nature of the specialized marketing instruments stimulates not only longer and
deeper youngster engagement but also repeat visits and repeat product consumption by them.
Brand recognition, brand trust and positive brand associations lead to a brand relationship and
greater consumer engagement which, in turn, are important elements in the creation of brand
loyalty.
Spending more time and repeated time is like an investment users make in the brand. According
to Eyal this is the last step in getting hooked: people who invest time and effort in a product or
service, value it more. This is supported by research: individuals within online brand
communities tend to focus on the benefits, rather than their costs, of their engagement.
2.2.4 IMMERSION AND HABIT FORMATION
Humans possess two different brain systems to interpret the world around them and to come to
decisions. The first system, aptly called System 1, is the default system. This system works like
an automatic pilot: it operates automatically and quickly, with little or no effort and no sense of
voluntary control. Most of the time System 1 helps individuals make the right judgments about
situations, relying on the wisdom of the group and on one’s unconscious life experiences and
successful solutions that have been gathered.
System 2, on the other hand, “allocates attention to the effortful mental activities that demand it
… The operations of System 2 are often associated with the subjective experience of agency,
choice, and concentration.” System 2 helps individuals focus on a subject, think things through
well, reflect and come to a conscious decision.
The human brain is capable of only using a limited amount of energy during the day to function.
Therefore, humans are constantly looking for shortcuts through reality to save energy. That is
why System 1 is the brain’s default interpretation and decision-making system: it provides
solutions without taking up to much effort. Attention is only focused when individuals assess
something as important and there are no other urgent tasks. Since the adolescent brain
experiences a complete rewiring, it is harder for youngsters to focus on anything while the need
to save effort for them is even more important.
If the brain finds an answer to a situation that works time and again, the answer becomes
automatic behavior to save effort. Sequences of actions are “chunked” into routine and stored in
the brain for later use when the appropriate trigger presents itself. This way, individuals do not
have to invest energy in daily activities like dressing, choosing what to eat, or how to react to a
negative internal state.

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The specialized marketing instruments used by junk food and drinks producers facilitate
automatic behavior. In case of the occurrence of a negative internal state within children or
adolescents the immersive marketing tools help take youngsters shortcuts through reality. The
shortcuts that they offer are easier than thinking or confronting uneasy feelings. Creating
automated behavior as a response to problems is the key precondition for turning behavior into
a behavioral addiction.
2.3. LEVEL 3: PERSONALIZATION
2.3.1 INTRODUCTION
Personalization of communication messages to adolescents by food and drinks industry
representatives can strengthen the nudging of adolescents towards the aim of getting them to
eat and drink unhealthy products binge-like as an automated behavior on cue.
Two types of instruments can be used to strengthen external cues (product producer content
that is to trigger consumption of the product in the form of advertising and marketing): profiling
and persuasion profiling.
A third type of instrument called ‘target audience analysis’ can be used to tune in more
effectively to adolescents’ internal cues (emotions or experiences that become associated with a
product so that the product will be consumed when these emotions or experiences occur).
2.3.2 PROFILING
In order to be able to personalize online mass communication for their clients specialized online
advertising companies use a technique called ‘profiling’.
Profiling consists of the creation of profiles of internet users’ preferences and interests, based
on tracking their behaviors on and across websites. Internet users’ online behaviors are
recorded as a digital trail that they leave behind while performing online activities such as
liking, clicking, opening websites, searching, communicating with other internet users and
linking to them, and buying products online. The resulting user data are stored in databases
owned by specialized online advertising companies. Sometimes internet users share their data
willingly and consciously, but often their data are being gathered without them knowing it and
used for purposes they never agreed on.

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The profiles that are created by specialized online advertising companies help their clients to
make predictions about the profiled internet users’ future actions and preferences. Based on
these predictions businesses are able to provide personalized services and information and
offer targeted advertising: personalized advertising that is assumed to be in line with the
profiled internet users’ preferences and interests. In addition, profiles are used by businesses to
make decisions with regard to the profiled internet users, for instance on whether they pose a
financial risk.
Specialized government organizations use profiling as well. These organizations also gather and
interpret online user information. Their aim is to increase security in society by tracking down
suspicious internet users and to detect fraud.
2.3.2.1 THE CONCEPT
The basic idea behind profiling is that individual internet users are not unique and
unpredictable but are more or less like other individual internet users. It is assumed that the
more an individual internet user exhibits online behaviors similar to other individual internet
users, the more the preferences and interests of this individual user are similar to the
preferences and interests of these other internet users.
This means that if some internet users have bought a product, this product is deemed to be also
desirable for internet users who are similar to them. Therefore, it is thought to make sense to
direct advertisements promoting the product to these similar internet users. In the same
fashion, if some internet users perform a certain action online or offline, such as liking a page, it
seems likely that similar internet users will also be willing to perform this action. And that these
similar internet users are similar to the other internet users in other ways too.
This does not mean that the individual internet user’s past behavior is unimportant. A recent
trend is to put more weight to an internet user’s own history relative to the dynamic profiles of
similar other users.
To enable profiling the activities of every individual in the world, online or offline, are captured
in shadow profiles in databases and individually linked to a catalogue of categories that allow
user classification. The catalogue of categories can be extensive: Facebook’s catalogue contains
over 52,000 categories. It is kept unclear by companies how they acquire insights in the
activities of individuals, but it can be safely assumed that they stem from the company’s own
monitoring and data bought from companies that specialize in registering offline and online
activities that are linked to identifiable individuals and sell their data.
Thanks to profiling businesses are hoping to be able to send their advertising messages to
individuals who are actually interested in their products, or are interpreted as being interested,
and are able to personalize the services and information that they offer to individual internet
users to attain higher user satisfaction.

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A recent development in profiling is employing Artificial Intelligence that more broadly predicts
how internet users will behave, what they will buy, and what they will think. Facebook for
instance experiments with a self-improving, artificial intelligence-powered prediction engine
named “FBLearner Flow”.
2.3.2.2 PROFILING INSTRUMENTS
The simplest profiling instruments simply register what individual internet users do within a
single app or site. To be able to do this effectively the instruments must be able to identify
return visits, either by requiring users to log in or to identify their smartphones, laptops or
other devices, with or without user consent. More complicated instruments monitor what
individual users do across multiple apps or sites. This can be achieved by providing a log-in tool
that allows users to log-in to multiple apps and sites, providing services within multiple apps or
sites, such as ‘Likes’ and sharing options, or identify individual user devices.
2.3.2.3 PROFILING AND ADOLESCENTS
More than half of 12-15 year olds who go online are aware of personalized advertizing. One in
five of 12-15 year olds think that everybody sees the same advertisements; one in four is not
sure.
According to WHO, unhealthy food and drinks producers use targeting to influence adolescents.
They analyze their engagement with advertisings, purchase histories, flavour preferences, geo-
location data to enable real-time targeting online and offline and, for instance, weather
dependent targeting (think for instance: ice-cream). WHO claims that also especially vulnerable
subgroups are targeted whose rates of overweight and obesity are significantly higher.
2.3.3 TARGET AUDIENCE ANALYSIS
A more recent technique to enable personalized online communication on a mass scale is target
audience analysis (TAA). TAA does not just gather online internet users’ behavior data to
predict their future behavior like profiling does. It strives to understand and then influence
individual internet users’ behaviors, values, attitudes, beliefs and norms. To that aim it gathers a
broad range of data, from whether the individuals feel in control of their lives to who they
respect and what media habits they have.
TAA strives to create “psychographic profiles” for individual internet users, based on the five
factor personality model as developed by Tupes and Christal, Digman, and Goldberg. The five

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factor personality model discerns five personality dimensions, often called “the Big Five”:
Openness, Conscientiousness, Extroversion, Agreeableness, and Neuroticism.
2.3.3.1 THE CONCEPT
In 2013 Kosinski, Stillwell and Graepel published an influential paper in which the five factor
personality model was linked to easily available digital records of behavior: Facebook Likes.
Initially using a “Big Five” personality test, information from individual internet users’ Facebook
profiles and online surveys they created a model by means of which they were able to predict a
range of highly sensitive personal attributes just by analyzing an individual users’ Likes. The
sensitive personal attributes encompassed among others: sexual orientation, ethnicity, religious
and political views, personality traits, intelligence, happiness, use of addictive substances, age,
and gender. For dichotomous attributes such as “single or in a relationship” or “uses drugs” they
achieved a 60%-95% prediction accuracy. For numeric variables such as “openness” or “age”
the prediction accuracy was much lower: 17%-75%.
In 2014 Youyou, Kosinski and Stillwell followed up with a paper that presented findings of a
separate study: computer predictions based on an analysis of Facebook Likes were found to be
more accurate in assessing an individual’s “Big Five” scores than their work colleagues,
cohabitants or friends, family members and nearly equaled the scores of the individual’s spouse.
The computer predictions also outperformed humans on attributes such as an individual’s
substance use, political attitudes, and physical health.
2.3.3.2 TAA IN PRACTICE
The most known organization to use TAA in order to micro-target and try and influence
individual internet users is Cambridge Analytica. The company was linked to a handful of
election campaigns in Africa and, notoriously, to the 2016 Trump election campaign and
probably the 2015-2016 Brexit Leave-campaign. As was described by Kosinski, Stillwell and
Graepel the company combined “Big Five” personality tests in the form of online quizes with
information scraped from many million individual internet users’ Facebook profiles to create
psychographic profiles. These profiles were used to micro-target individual internet users on
Google, Snapchat, Twitter, Facebook and YouTube with personalized messages that aimed to
influence the future behavior of these users: dissuade individuals with unwanted behaviors,
values, attitudes, beliefs and norms from voting while persuading individuals in doubt to decide
and vote for the option preferred by the Cambridge Analytica sponsors. This was called:
“behavioral microtargeting with psychographic messaging”.
In 2018 details of Cambridge Analytica’s activities were revealed by whistleblowers and
numerous press publications. They caused a public and political uproar, mainly because a large
majority of the Facebook data that were seemingly used by Cambridge Analytica were used

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without consent or even knowledge of the individual internet users involved. Cambridge
Analytica is only one of many companies employing TAA.
2.3.3.3 TAA AND ADOLESCENTS
WHO claims that unhealthy food and drinks marketing does target adolescents when they are at
their most vulnerable, for instance when an adolescent experiences frustration for not reaching
another game level.
2.3.4 PERSUASION PROFILING
An alternative to TAA is persuasion profiling based on the work by Robert Cialdini. Cialdini
identified six “weapons of influence” to which the System 1 decision-making system (see
chapter 3.2.4) is vulnerable: reciprocation, commitment and consistency, social proof, liking,
authority, and scarcity. When these principles of persuasion are used on other individuals their
default reaction is to go along with what is proposed. Concretely this means that if individuals
receive a gift, they are more open to a request by the giver. The same thing happens when
individuals have publically taken a first step, when a lot of other people do the same thing, when
individuals are asked by a person they like or value as an expert, and when they believe there is
little time or little of something left.
2.3.4.1 THE CONCEPT
It has been found that each of Cialdini’s principles of persuasion work offline as well as online.
They are at their most effective when they are used separately.
Cialdini’s principles work between humans online, but also between machines and humans:
internet users are easily swayed by machine compliments and feel a loyalty towards the
machines they worked with. According to some studies machines are even more trusted by
humans than other humans and might have an ever bigger potential to influence individuals.
Research has found that different individuals are susceptible to different persuasion principles.
While for some internet users social proof is a convincing argument when deciding between
options, for others scarcity or authority are more effective weapons of influence while social
proof for instance for them might even work counterproductive.
The individual persuasion principles that work for an individual internet user are relatively
stable over time and work for that internet user on all fields, from buying junk food and drinks

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products to voting in an election. Stored internet user persuasion profiles therefore open up the
option to personalize nudging individuals towards one choice rather than another.
2.3.5 HAZARDS OF PROFILING, PERSUASION PROFILING AND TAA
As the Cambridge Analytica case show using personalization instruments is not without risks.
First of all, there is the new European Regulation on the protection of natural persons (2016),
valid from May 25, 2018. Its aim is to strengthen European citizens’ rights on data protection. It
concerns all organizations and individuals gathering and storing EU-citizens’ personal data. The
country of origin of the organizations and individuals processing the data is irrelevant.
Regarding personal data (defined as information related to identified or identifiable natural
persons) the Regulation requests transparency on how and why data gatherers use these data,
limits the use of the data gathered to the purposes explicitly communicated at the moment of
the collection, limits the data collection to the minimum needed to serve the purpose for which
they are gathered, requires the data gathered to be accurate, limits the storage of the data for
only as long as required by the purpose for which they were gathered, and installs security
measures against unauthorized use or accidental loss of the data. In addition, data gatherers are
required to manage and track compliance to the Regulation. Thus, profiling, TAA, and maybe
also persuasion profiling may only be legally employed under precondition of active and specific
consent. The common practice of gathering data without active and specific consent in the
European Union could lead to serious financial sanctions.
Secondly, profiling and TAA are not popular among internet users, and especially not among
younger internet users. Persuasion profiling is unknown to them. The younger the internet
users, the less positive they generally are about the personalization instruments. As a result, any
supposed overreach of the instruments can result in a public scandal in which trust and
confidentially issues are raised.
Thirdly, the profiles resulting from profiling, persuasion profiling and TAA are far from
infallible. They are based on insufficiently proven political, moral and ideological assumptions
and imprecise mechanisms. Their best possible outcome is not a description of reality but a
prediction about an individual’s future behavior that has a chance of actually happening. At the
same time, the instruments can have major effects. Based on profiling or TAA, individuals can be
stigmatized and as such be excluded from products or services or be charged more than others
for the same products or services.
Fourthly, there is a lack of oversight over marketers using profiling and TAA and they are rarely
held accountable. For those being profiled there is a lack of redress. It remains to be seen
whether these negative sides of personalization marketing will be sufficiently countered by the
GDPR.

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The most visible example of linking consequences to constructed profiles can be found in China
where a “social credit system” collects individual user data both online and offline and nudges
behavior TAA-style towards behaviors the government endorses. The credit system aims to
“allow the trustworthy to roam everywhere under heaven while making it hard for the
discredited to take a single step.” In practice this means that people who are interpreted to have
a negative profile are banned from buying airplane or train tickets for a year, are less eligible for
a mortgage or a job, have less schooling options for their children and have less chances of
getting a date. Those who are interpreted to have a positive profile receive special rewards. The
social credit system currently is voluntary but will be obligatory in 2020.
In the Netherlands a fraud detection system called “System Risk Indication”, or SyRI, creates
risk profiles for all citizens using public information that was published by these citizens and
information that they provided to government institutions for other purposes. Anyone who
appears to match a certain profile is investigated further. In the UK a similar system exists to
detect social welfare fraud.
2.3.6 PERSONALIZING COMMUNICATION AND HABIT FORMATION
Studies show that targeting individual internet users with individual persuasion principles
changes the outcome of decision-processes significantly: one in five individuals is influenced to
make another choice. But not all personalization based on profiling strengthens the
effectiveness of external cues (product producer content that is to trigger consumption of the
product in the form of advertising and marketing). Important is, besides choosing the right
persuasion principle, the moment of the external cue, the depth of the cue and the breath of the
cue. For immediate reminders a high level of personalization is effective but for later reminders
a medium level is more effective. For trusted producers high depth and narrow breath is
effective, while for less trusted producers high depth rather raises privacy concerns.
The effectiveness of TAA on strengthening internal cues (emotions or experiences that become
associated with a product so that the product will be consumed when these emotions or
experiences occur) is less clear. The internal cues provided by Nir Eyal as being conductive to
habit formation (feelings of boredom, loneliness, frustration, confusion, and indecisiveness) are
not easily identified by TAA. In the 2013 paper by Kosinski, Stillwell and Graepel the attribute
that seems the closest to these cues, satisfaction with life, showed a prediction accuracy of only
17%, the lowest of all studied attributes: “The relatively lower prediction accuracy for
[satisfaction with life] ... may be attributable to the difficulty of distinguishing long-term
happiness from mood swings which vary over time. ... users’ Likes accrue over a longer period
and, so, may be suitable only for predicting long-term happiness.” In the 2014 study by Youyou,
Kosinski and Stillwell found that computer predictions outperformed humans on twelve of the
thirteen studied attributes but not on life satisfaction.

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The doubts surrounding the effectiveness of TAA with regard to the attribute life satisfaction in
specific did not stop Cambridge Analytica to include it in its list of potential attributes of the
psychographic profiles they offered their clients.
Facebook itself tinkered in 2014 with TAA regarding life satisfaction in an experiment on
689,000 Facebook users. During the experiment the platform studied the effects of reducing
user exposure to their friends’ posts with positive emotional content and to friends’ posts with
negative emotional content. Facebook concluded that posted emotions are contagious. The
experiment caused a public outcry.
In 2017 Facebook took the question of identifying internal adolescent cues related to habit
formation a step further. An internal Facebook report claimed that the social network can
establish when young users feel “stressed”, “defeated”, “overwhelmed”, “anxious”, “nervous”,
“stupid”, “silly”, “useless”, and a “failure” by means of real-time monitoring of posts and pictures.
This report was allegedly presented to a client, an Australian bank, but this is denied by
Facebook. Facebook stated that it does not “offer tools to target people based on their emotional
state”.
It is unclear how effective TAA might be in using internal user cues to influence user behavior.
Of the three requirements needed to be effective (alternative messages must be available to
send to different types of internet users, individual internet users must be identified and a
method must be available to measure success) the crucial requirement, a method to measure
success, often is absent.
During the 2018 uproar about Cambridge Analytica the effectiveness of TAA was fundamentally
questioned, especially since company representatives did not seem to rely on TAA only but
seemed willing to add dirty tricks to their digital toolkit in order to achieve changes in the
behavior of the individual internet users they micro-targeted with their messages. Potential
clients also disclosed that these representatives were “surprisingly vague about its specifics and
too quick to dismissively cry ‘Analytics’”.
Scientist Aleksandr Kogan, who worked with Cambridge Analytics, does not believe that micro-
targeting is an effective way to use datasets. According to him the accuracy of the data in the
profiles is extremely exaggerated. In his opinion the possibility to be completely wrong about a
profiled person is much higher than the possibility to be completely right.
Sandra Matz, a colleague of Kosinski and Stillwell, states that there might have been some
impact on people who have no idea what they’re voting for, but, according to her, different
targeting methods would have gotten similar results. Business psychologist Andrew Redman
and MIT Sloan professor Dean Eckles agree with her. The only advantage that Eckles sees is that
the method is cheaper than comparable methods.
On the other end of the spectrum stands Brad Parscale, Donald Trump’s digital director. He
claims that the targeted ads on Facebook by the Trump campaign are the reason Trump won the

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2016 elections. Former Google design ethicist Tristan Harris sees the identification of internal
adolescent cues by Facebook as an example of the kind of granular information that is “a perfect
model of what buttons you can push in a particular person” to keep people hooked.
2.4. LEVEL 4: FOOD AND DRINKS AS REWARD
2.4.1 DOPAMINE
Of all chemicals that play a part in human functioning dopamine probably is the best known. It
has been called the Kim Kardashian of neurotransmitters because it has acquired a celebrity
status within pop culture as the pleasure chemical. But, dopamine is far more than that.
Dopamine plays a role in controlling the flow of information in the brain, supporting memory,
attention and problem solving, as well as planning and controlling body movements. As such,
dopamine, or rather the loss of dopamine, has been linked for instance to Parkinson’s disease.
Certainly, dopamine is released by rewarding experiences, but sometimes unpleasant
experiences evoke a dopamine release too. Dopamine is also produced when a pleasurable
activity is expected, whether it will happen or not. Therefore, neuroscientists see dopamine
rather as involved in desire than in pleasure only. Dopamine seems to be important in
establishing whether a situation, experience or potential outcome is worth noticing. It co-
decides about the importance individuals attach to stimuli. In the end, dopamine is not about
“liking” something, it is about “wanting” something. This wanting can be very intense and it can
occur even without actually liking something.
2.4.2 ADOLESCENTS AND DOPAMINE
During adolescence the dopamine system evolves dramatically. The basic level of dopamine
production seems to be lower during adolescence in comparison to younger children and adults
while seemingly important actions trigger more dopamine and the resulting high dopamine
levels are far less kept in check. Since expected and experienced rewards involve higher levels
of dopamine, risky and unhealthy but seemingly pleasant activities are associated by
adolescents with positive consequences.
This does not mean that the logical thinking and basic information-processing abilities of
adolescents are impaired. Adolescents perform no worse than adults at perceiving risks or
assessing their vulnerability to risks. Rather, the parts of the brain that enable adolescents to
calmly assess, reflect and come to a decision are less developed during adolescence than the

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dopamine system and have a weaker voice in choosing which types of behavior to pursue. In
case of stimuli that are deemed important, dopamine wins out in decision-making. Reward-
seeking adolescents thus are more prone to engage in risky and unhealthy behavior than
younger children or adults.
Between adolescents large variations in the amount of dopamine released can be found.
According to studies some adolescents are “high risk takers”, while others are “low risk takers”.
Alcohol and other addictive psychoactive substances can induce adolescents who generally are
not seen as “high risk takers” to take more risks. The presence of friends is another factor: it
doubles the amount of risk-taking behavior among adolescents. Social acceptance and
compliments by friends trigger high amounts of dopamine to be released.
2.4.3 SUGAR, FAT AND HABIT FORMATION
The consumption of high sugar food and drinks, and especially those that are fructose-ridden,
leads to a release of dopamine. Withdrawal from high sugar foods, on the other hand, can lead to
cravings. Researchers found that the rewards and cravings that are evoked by sweetness, and
especially by a binge-like consumption of sugar, are even more profound than that of addictive
drugs like cocaine.
Every addictive drug, be it amphetamine, cocaine, nicotine, alcohol or sugar, causes the
dopamine system to release many times more dopamine than usual. These unnaturally large
rewards are not filtered in the brain because the brain pathways that tame impulses are still
weak and easily overrun. The drug-related rewards go directly into the brain and overstimulate
the brain.
The release of large amounts of dopamine as a result of consuming sweet foods and drinks, and
ever more also as a result of the expectation of the taste of these foods and drinks, is crucial in
the process of habit forming. Dopamine draws attention to important actions, noting that a
reward is on its way, and, if the reward is met, it enables the behavior to become a habit. If the
reward is not met, behavior will be adapted in the future.
When released in natural amounts dopamine stimulates learning. The dopamine released in
large amounts by long-term binge-like consumption stimulates bad learning, i.e. addiction.
Natasha Dow Shultz comments: “When that happens, we lose our willpower. Evolution has not
prepared our brains for these drugs, so they become overwhelmed and screwed up. We are
abusing a useful and necessary system. We shouldn’t do it, even though we can.”
When the overstimulation occurs over a longer period of time the dopamine system starts to
release less and less dopamine as a reaction to the repeated triggers so that increasing amounts
of junk food and drinks or psychoactive substances are needed to claim the same level of

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rewards. At the same time, the production of dopamine between hits decreases ever more,
leading to more intense craving. In this way an addiction spiral is created.
2.4.4 SUGAR, FAT AND ADOLESCENT HABIT FORMATION
Studies have found that for adolescents external cues, and especially food-related cues, are
more likely to draw their attention compared to adults. These cues evoke responses that are
independent of whether adolescents are actually hungry: snacking of unhealthy food can be
triggered by food advertisements even when an adolescent is in no need of food. This is mainly
caused by the increased adolescent sensitivity to reward-related cues.
When stimulated by external rewards, more dopamine is released by the adolescent brain than
by the adult brain while checks on dopamine production in the adolescent brain are still mostly
under construction. This means that the desire for high fat and high sugar food and drinks
products and the consumption of these products trigger a higher dopamine production and thus
is more important for adolescents. The result is hardly surprising: adolescents consume more
unhealthy food and drinks products compared to adults. Adolescents eat more fast food, eat
more often in fast food restaurants, and have a higher intake of sugar. They also are more prone
to unhealthy food overconsumption. Research has found that the independent money
adolescents typically have is used to buy junk food and drinks as an identity marker to set them
apart from adults.
Increased impulsiveness and higher risk-taking among adolescents lead to higher adolescent
vulnerability to addiction. The increased amounts of dopamine released as a result of the desire
for and the consumption of unhealthy food and drinks stimulate a learning process in which
snacking fast food becomes a bad habit. This habit formation is only very ineffectively countered
by logical thinking and balanced reflection. Concern about the negative consequences of ever
more automated binge-like eating and drinking of unhealthy product is often drown out by
impulse snacking and the positive short-term rewards that are expected by adolescents. The
adolescent brain is not yet very skilled in seeing the big picture.
2.4.5 LONG-TERM EFFECTS
The dopamine-related long-term effects of high fat and high sugar products overconsumption
are profound, especially in case of prolonged binge-like consumption. The overconsumption of
unhealthy food and drinks can have an impact on behavior as well as on mental processes like
perception, memory, judgment, and reasoning. This impact is comparable to effects resulting
from the intake of psychoactive substances.

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Changes in behavior that might be caused by long-term overconsumption are: intolerance to
delayed gratification, exaggerated emotional responses, and the development of responses that
are not appropriate to the context to which an individual reacts.
Long-term overconsumption can also lead to, among others, deficits in long-term memory
formation, learning impairments, higher levels of anxiety, and higher risks of developing
neuropsychiatric disorders, including depression, eating disorders and addiction.
Habits formed as a result of these changes can be self-sustaining. Research links obesity to
impulsive and risky decision-making, anxiety, drug abuse and ADHD. Obese individuals overall
have an even higher sensitivity to external cues, like images of high-calorie food images such as
commonly displayed in food advertising.
The changes in the adolescent dopamine system are very likely to continue in adult life, thereby
making the formed habits, and their associated changes, permanent.
2.5 LEVEL 5: SOCIAL MEDIA AS REWARD
2.5.1 INTRODUCTION
Adding high doses of fat and sugar to their products is not the only option producers of
unhealthy food and drinks have to trigger adolescent dopamine. Another powerful option is
using social media as a channel of communication with youngsters. Social media like Facebook
and Instagram are designed to hook users by means of providing little hits of dopamine every
now and then.
While the dopamine shots get users to form habits, social media communication channels in
addition enable junk food marketers to build one-on-one relationships with consumers.
Teenagers are an important user group for social marketing since they are heavy users of
mobile devices and social media. Because of their sensitivity to peer attention and compliments
they are also eager to share experiences and content with their peers on social media.
Social media provide producers of junk food and drinks the opportunity for direct
communication with youngsters and for publishing their marketing messages immediately into
youngsters’ media feeds. Social media extend the reach of unhealthy products to adolescents’
social networks.

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2.5.2 THE CONCEPT
Sean Parker, the founding president of Facebook, sheds light on the relation between social
media and triggering dopamine: “The thought process that went into building these
applications, Facebook being the first of them, … was all about: ‘How do we consume as much of
your time and conscious attention as possible? … that means that we need to give you a little
dopamine hit every once in a while, because someone liked or commented on a photo or a post
or whatever. And that’s going to get you to contribute more content, and that’s going to get you
… more likes and comments … It’s a social validation feedback loop … you’re exploiting a
vulnerability in human psychology. … The inventors, creators – it’s me, it’s Mark [Zuckerberg],
it’s Kevin Systrom on Instagram, it’s all of these people – understood this consciously. And we
did it anyway.” This is why tech gurus like Steve Jobs made sure that their children had limited
access only to technology.
The effectiveness of social media is based on the principle of variable rewards. Whereas high fat,
high sugar products always provide similar rewards in the form of dopamine, social media are
less predictable. Social media users do not know if and when they will receive Likes and
comments, and how much. This unpredictability lies at the heart of for instance gambling
addictions.
Social media companies are well aware of the power of variable rewards. When an app called
Lovematically was launched that let users automatically like every picture on their newsfeed,
and thus eliminated the variability out of the reward system, Instagram shut it down after two
hours for violating its Terms of Use.
For Nir Eyal variable rewards form the third phase in the process of habit formation. He
explains why this type of rewards is so powerful: “Experiences with finite variability become
increasingly predictable with use and lose their appeal over time. … Variable rewards … satisfy
users’ needs while leaving them wanting to reengage with the product.”
2.5.3 THE IMPACT OF SOCIAL MEDIA
Social media are competing among themselves to grab as much digital attention as they can
because digital attention equals revenue streams. The fierce competition forces social media
sites to employ any means possible to draw people in and keep them in. In a provocative
internal memo Facebook vice-president Andrew ‘Bozz’ Bosworth wrote: “We connect people. …
Maybe it costs a life by exposing someone to bullies. Maybe someone dies in a terrorist attack
coordinated on our tools. And we still connect people. The ugly truth is that we believe in
connecting people so deeply that anything that allows us to connect more people more often is
*de facto* good. …That’s why all the work we do in growth is justified.”

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Although Facebook representatives, including Zuckerberg and Bosworth, have publicly
distanced themselves from these statements, Bosworth’s ugly truth is probably not far from
describing the philosophy of many social media founders and developers to expand by any
means possible and think about the consequences later. According to Chamath Palihapitiya,
former Facebook vice-president of user growth the short-term, dopamine-driven feedback
loops lead to the destruction of “how society works. No civil discourse, no cooperation,
misinformation, mistruth”. Sean Parker agrees: “It literally changes your relationship with
society, with each other. It probably interferes with productivity in weird ways. God only knows
what it’s doing to our children’s brains.” Media watchdog Common Sense, adds: “Tech
companies are conducting a massive real-time experiment on our kids”.
2.5.4 SOCIAL MEDIA AND ADOLESCENTS
Research found that the longer people dwell on social media sites like Facebook, the more
negative their mood is afterwards. This effect does not occur when people are merely browsing
on the internet while feeling bored. Several potential reasons have been found for this negative
effect of social media use. This effect seems to be caused, first of all, by a feeling that nothing
meaningful has been done while being on Facebook. Secondly, many users, and especially girls,
compare themselves negatively to the curated self-presentations by others. In general, it seems
that when people spend a lot of time on social media while only passively consuming
information, that is: reading but not interacting with people, they tend to feel worse afterwards.
The social media dopamine feedback loop only seems to function when people use social media
to interact with others and receive affirmation. Even scrolling through one’s own Facebook
pages helps individuals to feel better, because the activity reminds them of past affirmations.
Social media allow junk food producers to enter the dopamine-steered adolescent domain of
peer pressure. By means of personalization, immersion, and games, they provide dopamine
rewards for adolescents. They do not only entertain youngsters but also affirm them, thus
imitating their meaningful interactions with peers and helping them to avoid the
disappointment that usually follows just wasting time on social media. Especially the games that
marketers of unhealthy food and drinks provide bring excitement, evoking small shots of
dopamine. The rewards in the games can be as small as a sound or a white flash on the screen
emerging as a reaction to player activities or as big as winning a game. The phenomenon of
dopamine highs triggered by a game is known as “fiero”. The game micro-feedback that
immerses players is called “juice”.
By following-up on the expectation of social media rewards by adolescents and allowing them to
avoid negative moods caused by not finding peer affirmation, producers of high fat high sugar
products stimulate learning: dopamine as a reward follows dopamine released by the
expectation of rewards. This process causes the stimuli provided by the marketers to seem

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important to adolescents. It enables high fat high sugar product marketers to effectively push
their advertisements and narrations to youngsters.
2.6 LEVEL 6: CHANGING THE METABOLISTIC SYSTEM
2.6.1 INTRODUCTION
In the previous chapters a number of important instruments were presented that are available
to producers of junk food and drinks in order to nudge adolescents to eat and drink their
products binge-like as an automated behavior on cue.
In chapter 3.1 the most commonly used type of external triggers, advertising, was discussed as
part of Nir Eyal’s step one to activate adolescents in a four-step process of getting them hooked.
In chapter 3.2 it was shown how Eyal’s second type of cues, internal triggers, can be made
instrumental to activate adolescents into action. Both types of triggers can be employed more
effectively by means of personalization, as was put forward in chapter 3.3.
In chapters 3.4 and 3.5 Eyal’s step three was described: rewards that follow upon adolescent
activities that are triggered by external and internal cues. Adding significant amounts of fat and
sugar to food and drinks product evoke predictable releases of dopamine, while communicating
by means of social networks trigger variable dopamine hits.
The marketing instruments portrayed in chapters 3.1 (advertising), 3.2 (immersion), 3.3
(personalization) and 3.5 (social media) lead to Nir Eyal’s fourth step: investment. These
instruments do not just aim at immediate consumption of unhealthy food and drinks but also
aim at ensuring future repeat consumption. The logic behind this is, according to Eyal, that the
more time and effort is invested into a product or service, the more the product or service is
valued.
The ever more positive valuation of junk food and drinks that is the consequence of step four
leads adolescents back to step two, an action that is easier than thinking, again and again
nudged towards this action by means of external triggers and the experience that the action
helps them to escape their frequent negative internal states.
While the marketing instruments create a product-specific lasting consumption loyalty enabling
automated binge-like eating and drinking, biological instruments lay a general groundwork for
eating and drinking high fat high sugar products by means of stimulating addiction-like
behavior (chapter 3.4) and by changing the metabolic system.

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2.6.2 THE CONCEPT
The NGO Living Loud, a coalition of health professionals, digital technology experts, and
marketing and communication specialists, explains the process of changing the metabolic
system by means of product ingredients: “the main meals we now eat are much higher in
refined carbohydrates, such as pasta, bread and rice and much lower in high-density
wholegrains and good natural fats such as animal fats and dairy. Our gut rapidly digest refined
carbs into glucose, which courses through our body sending our pancreases, liver and other
organs into overdrive. Your body is so concerned by the damage that high glucose (think sticky
blood) could cause that is releases extra insulin to burn the glucose and rapidly turns the excess
glucose into fat. The big problem is a couple of hour later your fully revved engine has burned
through all that fuel, your blood glucose drops and your brain switches to emergency lifesaving
mode, it powers down all non-critical energy-burning functions, releasing hormones to make
you feel lazy and hungry. So you reach for the quick energy-fix carb snacks, burn through those
until lunchtime, then tea, dinner, and a bedtime snack all the while knackering your metabolic
system, piling fat on your organs and setting yourself up nicely for diabetes. This is all no
accident of nature. It is the creation of extraordinary food scientists working in laboratories.
They have refined the perfect blend of salt, sugar and fat to feel great in the mouth, stimulate the
pleasure sensors in the brain and still leave us feeling hungry.”
2.6.3 LONG-TERM EFFECTS
The changes in the metabolic system that can be induced by added fat and sweetness, and
especially fructose, perpetuate ever quicker the hooked-cycle: they induce hunger, a greater
sensitivity to external food triggers such as commonly displayed in food advertising, and a
desire for eating more food, as well as greater impulsivity in the form of a greater willingness to
give up long-term rewards for immediate high-calorie foods.
Research found that high fructose intake can cause modifications at the level of genes. At first
two genes are changed in the brain and then, through these changes, more than 900 genes in the
brain major metabolic control center (hypothalamus) and the center for regulating learning and
memory (hippocampus). The effects of the modified genes are, among others, memory
impairment, type 2 diabetes, and obesity.
Obesity, in turn, is associated by research with impulsivity, anxiety, drug abuse and ADHD.
Obese are shown to be triggered even more by external junk food and drinks images. Those who
have obesity during adolescence usually also have obesity in adulthood.
2.6.4 DISCUSSION

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Although the description above stems from many scientific studies, on the moment it is hard to
provide a definitive account of the processes related to high intakes of unhealthy food and
drinks. Some of the research on the effects of sugar has been performed on rats, rather than on
humans. Some of the research is preliminary or based on small samples only.
As a result, larger health organizations take a rather cautious stand on the effects of sugar. WHO
for instance writes: “Free sugars contribute to the overall energy density of diets, and may
promote a positive energy balance. Sustaining energy balance is critical to maintaining healthy
body weight and ensuring optimal nutrient intake. There is increasing concern that intake of
free sugars – particularly in the form of sugar-sweetened beverages – increases overall energy
intake and may reduce the intake of foods containing more nutritionally adequate calories,
leading to an unhealthy diet, weight gain and increased risk of NCDs [Noncommunicable
diseases]. Another concern is the association between intake of free sugars and dental caries.”
The stance by larger health organizations follows the dominant paradigm that obesity is the
effect of taking more energy in (by means of consumption) than using up energy (by means of
body activities). According to this paradigm sugar is no more than a form of energy intake. The
answer to obesity, according to the paradigm, is more exercise (more energy out) while
reducing the overall intake of energy, including the intake of sugar and fat. The dominant
paradigm has no place for the sugar-related changes in the metabolic system that occur or for
the addictive-like qualities of sugar.
The biggest downside of the dominant paradigm is that it blames the victim, among them
adolescents who assumedly eat too much and exercise too little, while letting the food and
drinks industry of the hook. There is a parallel to be found here with the tobacco industry, the
gambling industry, and the tech industry. Representatives of these industries also tried to frame
the problem of addiction as a problem not inherent to their products but as a problem for a
specific niche category of people only: people who are somehow predisposed to become addicts.
Industry marketers push this narrative into the public debate while trying to silence alternative
narratives. For the food and drinks industry Cristin Kearns and her colleagues found that
industry representatives have deliberately derailed the discussion about sugar for decades. The
industry for instance has suppressed the outcomes of studies that linked eating lots of sugar to
heart disease while at the same time sponsoring a research program that successfully cast doubt
about the hazards of sugar. Natasha Schüll Dow found the same type of behavior within the
gambling industry.
Nevertheless, the industry narratives are unsubstantiated. Research by Peter Milner and James
Olds showed that anyone can become an addict under the right circumstances. Adam Alter
summarizes the implications of their findings: “there is so much more to addiction than an
addictive personality. Addicts aren’t simply weaker specimens than non-addicts; they aren’t
morally corrupt where non-addicts are virtuous. Instead, many, if not most, of them are unlucky.
... Even the sturdier of our ranks – the young G.I.s who were free of addiction when they left for
Vietnam – are prone to weakness when they find themselves in the wrong setting. And even the

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most determined addicts-in-recovery will relapse when they revisit the people and places that
remind them of the drug.”
2.7 SOURCES OVERVIEW
2.7.1 LEVEL 1: MARKETING
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advertising-conditioned-us-to-snack

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2.7.2 LEVEL 2: IMMERSION
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children-rewrite-house-rules

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cambridge-analytica

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 Simone van der Hof (2015a) Experience profiling. In: Dynamic Identity workshop.
 Simone van der Hof (2015) Online profiling of children in Europe – a legal perspective.
In: Dynamic Identity workshop.
 Mara Hvistendahl (2017) Inside China’s vast new experiment in social ranking. Wired,
14.12.2017. https://www.wired.com/story/age-of-social-credit/
 Sasha Issenberg (2015) Cruz-Connected Data Miner Aims to Get Inside U.S. Voters'
Heads. Bloomberg, 12.11.2015. https://www.bloomberg.com/news/features/2015-11-
12/is-the-republican-party-s-killer-data-app-for-real-
 Maurits Kaptein (2015) Persuasion profiling.
 Michal Kosinski, David Stillwell, Thore Graepel (2013) Private traits and attributes are
predictable from digital records of human behavior. In: PNAS March 11, 2013.
201218772; published ahead of print March 11, 2013.
https://doi.org/10.1073/pnas.1218772110.
http://www.pnas.org/content/early/2013/03/06/1218772110
 Adam Kramer, Jamie Guillory, Jeffrey Hancock (2014) Experimental evidence of
massive-scale emotional contagion through social networks. In: PNAS June 17, 2014. 111
(24) 8788-8790. https://doi.org/10.1073/pnas.1320040111.
 Sam Levin (2017) Facebook told advertisers it can identify teens feeling ‘insecure’ and
‘worthless. The Guardian, 1.5.2017. https://www.theThe
Guardian.com/technology/2017/may/01/facebook-advertising-data-insecure-teens
 Paul Lewis (2017) ‘Our minds can be hijacked’: the tech insiders who fear a smartphone
dystopia. The Guardian, 5.10.2017. https://www.theThe
Guardian.com/technology/2017/oct/05/smartphone-addiction-silicon-valley-dystopia
 Paul Lewis (2018a) ‘Utterly horrifying’: ex-Facebook insider says covert data harvesting
was routine. The Guardian, 20.3.2018
https://www.theguardian.com/news/2018/mar/20/facebook-data-cambridge-
analytica-sandy-parakilas
 Paul Lewis, Paul Hilder (2018b) Leaked: Cambridge Analytica’s blueprint for Trump’s
victory. The Guardian, 23.3.2018. https://www.theguardian.com/uk-
news/2018/mar/23/leaked-cambridge-analyticas-blueprint-for-trump-victory
 Megan McArdle (2018) Facebook is America’s scapegoat du jour. The Washington Post,
22.3.2018. https://www.washingtonpost.com/opinions/facebook-is-americas-
scapegoat-du-jour/2018/03/22/58699078-2dff-11e8-b0b0-
f706877db618_story.html?utm_term=.b12ae1d95f32
 Kevin Morris (2013) Facebook Shadow Profiles: What You Need to Know. Mashable,
26.6.2013. https://mashable.com/2013/06/26/facebook-shadow-profiles/
 John Naughton (2017) Trump digital director says Facebook helped win the White
House. The Guardian, 8.10.2017.
https://www.theguardian.com/technology/2017/oct/08/trump-digital-director-brad-
parscale-facebook-advertising
 Ofcom (2017) Children and parents: media use and attitudes report 2017.

P a g e | 41
 Sean O’Kane (2018) China will ban people with poor ‘social credit’ from planes and
trains. The Verge, 16.3.2018. https://www.theverge.com/2018/3/16/17130366/china-
social-credit-travel-plane-train-tickets
 Profiling and SyRI (2015) The Public Interest Litigation Project, 11.12.2015
https://pilpnjcm.nl/en/dossiers/profiling-and-syri/
 Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016
on the protection of natural persons with regard to the processing of personal data and on
the free movement of such data, and repealing Directive 95/46/EC (General Data
Protection Regulation) (2016). https://eur-lex.europa.eu/legal-
content/EN/TXT/PDF/?uri=CELEX:32016R0679&from=EN
 Matthew Rosenberg, Nicholas Confessore, Carole Cadwalladr (2018) How Trump
Consultants Exploited the Facebook Data of Millions. New York Times, 17.3.2018.
https://www.nytimes.com/2018/03/17/us/politics/cambridge-analytica-trump-
campaign.html
 Nitasha Tiku (2017) Get ready for the next big privacy backlash against Facebook.
Wired, 21.5.2017. https://www.wired.com/2017/05/welcome-next-phase-facebook-
backlash/
 E.C. Tupes and R.E. Christal, R.E. (1961) Recurrent Personality Factors Based on Trait
Ratings. Technical Report ASD-TR-61-97, Lackland Air Force Base, TX: Personnel
Laboratory, Air Force Systems Command.
 Sherry Turkle (2011) Alone together.
 Arjen de Vries (2015a) Online profiling – how and why? In: Dynamic Identity workshop.
 Arjen de Vries and Bibi van den Berg (2015b) Profiling teory. In: Dynamic Identity
workshop.
 Holly Watt (2018) MoD granted 'List X' status to Cambridge Analytica parent company.
The Guardian, 21.3.2018 https://www.theguardian.com/uk-news/2018/mar/21/mod-
cambridge-analytica-parent-company-scl-group-list-x
 Matthew Weaver (2018) I am used as a scapegoat – academic who mined Facebook data.
The Guardian, 21.3.2018. https://www.theguardian.com/uk-
news/2018/mar/21/facebook-row-i-am-being-used-as-scapegoat-says-academic-
aleksandr-kogan-cambridge-analytica
 WHO (2016) Tackling food marketing to children in a digital world: trans-disciplinary
 C. Wilking, M. Gottlieb, et al. (2013) State Law Approaches to Address Digital Food
Marketing to Youth. Boston, Public Health Advocacy Institute.
 Julia Carrie Wong (2018) ‘It might work too well’: the dark art of political advertisig
online. The Guardian, 19.3.2018.
https://www.theguardian.com/technology/2018/mar/19/facebook-political-ads-
social-media-history-online-democracy
 Wu Youyou, Michal Kosinski, David Stillwell (2015) Computer-based personality
judgments are more accurate than those made by humans. In: PNAS January 27,
2015. 112 (4) 1036-1040; published ahead of print January 12,

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2015. https://doi.org/10.1073/pnas.1418680112.
http://www.pnas.org/content/112/4/1036
2.7.4 LEVEL 4: FOOD AND DRINKS AS REWARD
 Serge Ahmed (2013) Sugar addiction: pushing the drug-sugar analogy to the limit.
In: Curr Opin Clin Nutr Metab Care. 2013 Jul; 16(4):434-9. doi:
10.1097/MCO.0b013e328361c8b8.
 Jane Anderson et al. (2016) THE TEENAGE BRAIN: UNDER CONSTRUCTION. AMERICAN
COLLEGE OF PEDIATRICIANS. MAY 2016. https://www.acpeds.org/the-college-
speaks/position-statements/parenting-issues/the-teenage-brain-under-construction
 M.N. Avena et al. (2006) Sucrose sham feeding on a binge schedule releases accumbens
dopamine repeatedly and eliminates the acetylcholine satiety response.
In: Neuroscience. 2006; 139(3):813-20. Epub 2006 Feb 7
 M.N. Avena et al. (2008) Evidence for sugar addiction: Behavioral and neurochemical
effects of intermittent, excessive sugar intake. In: Neurosci Biobehav Rev. 2008; 32(1):
20–39.
 Aurélien Bernheim et al. (2013) Controversies about the enhanced vulnerability of the
adolescent brain to develop addiction. In: Frontiers in pharmacology.
 Sarah-Jayne Blakemore et al. (2006) Development of the adolescent brain: implications
for executive function and social cognition. In: Journal of child psychology and psychiatry,
47:3/4.
 Sarah-Jayne Blakemore (2012) Imaging brain development: The adolescent brain.
In: NeuroImage 61, 2012.
 Eveline Crone (2017) The adolescent brain – changes in learning, decision-making and
social relations. Taylor & Francis Ltd.
 Ronald Dahl (2004) Adolescent brain development: a period of vulnerabilities and
opportunities. In: Annals of the New York Academy of Sciences.
 Dopamine Neurotransmitter (nd) The role of neurotransmitter dopamine in movement
and cognition. In: Psychologist World.
https://www.psychologistworld.com/biological/neurotransmitters/dopamine
 Daniel Hoops, Cecilia Flores (2017) Making Dopamine Connections in Adolescence. In:
Trends in Neurosciences, Volume 40, Issue 12, p709–719, December 2017.
DOI: https://doi.org/10.1016/j.tins.2017.09.004.
http://www.cell.com/trends/neurosciences/abstract/S0166-2236(17)30179-0
 Frances Jensen and Amy Ellis Nutt (2015) The teenage brain – a neuroscientist’s survival
guide to raising adolescens and young adults. Harper.
 Paul Klenowski et al. (2016) Prolonged Consumption of Sucrose in a Binge-Like Manner,
Alters the Morphology of Medium Spiny Neurons in the Nucleus Accumbens Shell.
In: Front Behav Neurosci. 2016; 10: 54.
 Krista Lisdahl et al. (2013) Dare to delay? The impacts of adolescent alcohol and
marijuana use onset on cognition, brain structure and function. In: Frontiers in
psychiatry, July 2013.

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 Dan Lubman et al. (2014) Cannabis and adolescent brain development.
In: Pharmacology & Therapeutics.
 Katie Page et al. (2013) Abdominal fat is associated with a greater brain reward
response to high-calorie food cues in Hispanic women. In: Obesity (Silver Spring). 2013
Oct; 21(10): 2029-36. doi: 10.1002/oby.20344. Epub 2013 May 29.
 Amy C. Reichelt (2016) Adolescent Maturational Transitions in the Prefrontal Cortex
 Daniel Romer (2010) Adolescent risk taking, impulsivity, and brain development:
implications for prevention. In: Dev. Psychobiol. 52 (3), April 2010.
 Daniel Siegel (2014) Dopamine and Teenage Logic. In: The Atlantic, 24.1.2014
 Laurence Steinberg (2008) A Social Neuroscience Perspective on Adolescent Risk-
Taking. In: Dev Rev. 2008 Mar; 28(1): 78–106. doi: 10.1016/j.dr.2007.08.002
 Laurence Steinberg (2010) Commentary: A behavioral scientist looks at the science of
adolescent brain development. In: Brain Cogn., Feb 2010.
 Linda Van Leijenhorst et al. (2010) What Motivates the Adolescent? Brain Regions
Mediating Reward Sensitivity across Adolescence. In: Cerebral Cortex, January 2010.
 Erin Walsh (2016) Dopamine and the teenage brain, In: Dr. Dave Walsh, 1.11.2016
http://drdavewalsh.com/posts/223
 World Health Organization (2015). Guideline: Sugars intake for adults and children.
http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf
 Emma Young (2017) Iceland knows how to stop teen substance abuse but the rest of the
world isn’t listening. In: Independent, 17.1.2017. https://www.independent.co.uk/life-
style/health-and-families/iceland-knows-how-to-stop-teen-substance-abuse-but-the-
rest-of-the-world-isn-t-listening-a7526316.html
2.7.5 LEVEL 5: SOCIAL MEDIA AS REWARD
 B.A. Feinstein et al. (2013). Negative social comparison on Facebook and depressive
symptoms: Rumination as a mechanism. In: Psychology of Popular Media Culture, 2(3),
161-170. http://dx.doi.org/10.1037/a0033111 http://psycnet.apa.org/record/2013-
25137-002
 David Ginsberg and Moira Burke (2017) Hard Questions: Is Spending Time on Social
Media Bad for Us? Facebook blog, 15.12.2017.
https://newsroom.fb.com/news/2017/12/hard-questions-is-spending-time-on-social-
media-bad-for-us/
 Sam Levin (2018) Facebook VP wrote site's actions were 'de facto good' – even if they
led to deaths. The Guardian, 30.3.2018.

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https://www.theguardian.com/technology/2018/mar/29/facebook-memo-mission-
andrew-bosworth
 Paul Lewis (2017) ‘Our minds can be hijacked’: the tech insiders who fear a smartphone
dystopia. The Guardian, 5.10.2017. https://www.theThe
Guardian.com/technology/2017/oct/05/smartphone-addiction-silicon-valley-dystopia
 Taylor Lorenz (2018) Generation Z is already bored by the internet. Daily Beast,
3.4.2018. https://www.thedailybeast.com/generation-z-is-already-bored-by-the-
internet
 Ryan Mac, Charlie Warzel and Alex Kantrowitz (2018) Growth At Any Cost: Top
Facebook Executive Defended Data Collection In 2016 Memo — And Warned That
Facebook Could Get People Killed. Buzzfeed, 30.3.2018.
https://www.buzzfeed.com/ryanmac/growth-at-any-cost-top-facebook-executive-
defended-data
 Christina Sagioglou, Tobias Greitemeyer (2014) Facebook’s emotional consequences:
Why Facebook causes a decrease in mood and why people still use it. In: Computers in
Human Behavior, Volume 35, June 2014.
https://www.sciencedirect.com/science/article/pii/S0747563214001241
 Natasha Dow Schüll (2012) Addiction by design.
 H.B. Shakya, N.A. Christiakis (2017) Association of Facebook Use With Compromised
Well-Being: A Longitudinal Study. In: Am J Epidemiol. 2017 Feb 1;185(3):203-211. doi:
10.1093/aje/kww189. https://www.ncbi.nlm.nih.gov/pubmed/28093386
 Zeynep Tufekci (2018) Why Zuckerberg’s 14-year apology tour hasn’t fixed Facebook.
Wired, 6.4.2018. https://www.wired.com/story/why-zuckerberg-15-year-apology-tour-
hasnt-fixed-facebook/
2.7.6 LEVEL 6: CHANGING THE METABOLISTIC SYSTEM
 Stephan Guyenet (2017). Bad sugar or bad journalism? An expert review of “The Case
Against Sugar”. Guyenet’s website, 26.1.2017. http://www.stephanguyenet.com/bad-
sugar-or-bad-journalism-an-expert-review-of-the-case-against-sugar/
 Cristin Kearns et al. (2017) Sugar industry sponsorship of germ-free rodent studies
linking sucrose to hyperlipidemia and cancer: An historical analysis of internal
documents. In: PLOS Biology. https://doi.org/10.1371/journal.pbio.2003460
 Paul Klenowski et al. (2016) Prolonged Consumption of Sucrose in a Binge-Like Manner,
Alters the Morphology of Medium Spiny Neurons in the Nucleus Accumbens Shell.
In: Front Behav Neurosci. 2016; 10: 54.
 Living loud (2017) Snackify: how advertising conditioned us to snack. 4.4.2017.

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 Vasanti Malik et al. (2010) Sugar-Sweetened Beverages and Risk of Metabolic Syndrome
and Type 2 Diabetes. In: Diabetes Care 2010 Nov; 33(11): 2477-
2483. https://doi.org/10.2337/dc10-1079.
 Quingying Meng et al. (2016) Systems Nutrigenomics Reveals Brain Gene Networks
Linking Metabolic and Brain Disorders. In: EBioMedicine. Volume 7, May 2016, Pages
157–166.
 Allison M. Meyers, Devry Mourra, Jeff A. Beeler (2017) High fructose corn syrup induces
metabolic dysregulation and altered dopamine signaling in the absence of obesity. In:
Plosone, https://doi.org/10.1371/journal.pone.0190206
 Katie Page et al. (2013) Effects of fructose vs glucose on regional cerebral blood flow in
brain regions involved with appetite and reward pathways. In: JAMA. 2013 Jan 2;309(1):
63-70. doi: 10.1001/jama.2012.116975.
 Katie Page (2015) Fructose, Glucose, and Your Brain. The Page Lab for Brain Regulation
of Appetite Control & Eating Behavior at
USC. https://www.drkatiepage.com/2015/05/215/
 Thomas Reinehr (2017) Long-term effects of adolescent obesity: time to act. In: Nature
Reviews Endocrinology doi:10.1038/nrendo.2017.147
 Scientific Advisory Committee on Nutrition (2015). Carbohydrates and
Health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fi
le/445503/SACN_Carbohydrates_and_Health.pdf
 Seth (2017). The Case Against The Case Against Sugar. In: The science of nutrition,
20.7.2017. https://nutritionsciencefactcheck.com/2017/07/20/the-case-against-the-
case-against-sugar/
 Gary Taubes (2016). The case against sugar. In: Aeon. https://aeon.co/essays/sugar-is-
a-toxic-agent-that-creates-conditions-for-disease

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