In January 2015 Scotland moved from a targeted system of free school meal (FSM) provision to a universal service for children in P1 to P3 as part of a policy focussed on reducing health inequalities. Previously FSM were available only for school-aged children whose parents/carers receive certain benefits, or for 16-18 year olds who themselves receive benefits. Following a competitive tendering process, a team of researchers from Stirling, Glasgow and Dundee Universities were commissioned by NHS Health Scotland to conduct a process evaluation of the policy to assess implementation and uptake, and to identify unintended consequences. The research used a mixed methods approach combining survey, interview and observation techniques, and comprised three linked research streams; research at school level, research at local authority level and research with parents. Data collection and analysis was conducted over two phases, and the second and final report has now been published (see below).
ISM Staff: Douglas Eadie (PI), Martine Stead and Allison Ford
Chambers S, Ford A, Boydell N, Moore L, Stead M and Eadie D (2016). Universal free school meals in Scotland: A process evaluation of implementation and uptake. [Conference abstract]. European Journal of Public Health, 26(Suppl 1): 183. doi:10.1093/eurpub/ckw169.025
Eadie D, Ford A, Stead M, Chambers S, Boydell N, Moore L and Anderson A (2016). Process evaluation of the implementation of Universal Free School Meals (UFSM) for P1 to P3: Research with Schools and Local Authorities (2014/15 RE013). NHS Health Scotland, February. http://www.healthscotland.com/uploads/documents/26927-UFSM%20main%20report%202016.pdf
Ford A, Eadie D and Stead M (2015). Process evaluation of the implementation of Universal Free School Meals - Research with parents. Edinburgh: NHS Health Scotland. http://www.healthscotland.com/documents/26326.aspx
In 2014 the Scottish Government commissioned research to investigate the scale and nature of food marketing on Scotland’s youth. Questions on exposure as well as purchase responses to a range of currently prevalent food and drink marketing methods were administered to 2,285 school students aged 11-18 years. Its purpose was to provide evidence on the current Scottish food and drink marketing landscape and its impacts.
Survey findings provided evidence and insights on the marketing landscape in which young people are making food choices and which marketing methods are most salient and/or effective in eliciting purchase. It provided quantitative data on Scottish youth’s exposure to commercial food and drink marketing, the food and drinks being promoted and by what means, as well as the impact of marketing on their purchase choices.
Survey results provided a baseline against which the future progress of the Scottish Government’s ‘Supporting Healthy Choices’ marketing related objectives could be monitored and evaluated. It was anticipated that repeat survey waves, along with other dietary public health evidence would also provide a means through which changes in commercial food and drink marketing practices and their contribution to the Scottish nations’ dietary public health and wellbeing could be monitored and evaluated. Additionally, evidence from this and future surveys could inform the design, development and implementation of future intervention planning aimed at reducing adverse impacts of marketing on the nation’s dietary health and wellbeing.
ISM Staff: Georgina Cairns
Cairns G (2015). The Impact of Food and Drink Marketing on Scotland's Children and Young People. Stirling: Institute for Social Marketing, University of Stirling. REPORT
This was third in a series of Institute for Social Marketing linked research projects on food marketing policy, commissioned by the Scottish Government. The aim of the three projects was to identify and ultimately implement a policy intervention to constrain the impact of high fat, salt sugar foods and drinks marketing on food behaviours and associated health consequences. The PAS 2500 project provided technical and scientific support to the Scottish Government as the policy intervention developed in detail and implemented. The project provided a series of synthesised evidence papers and briefing/summary papers on current knowledge and knowledge gaps, as well as attendance at key meeting and advice and comment on significant developmental and process decisions. A key research outcome would be documentation analysis and publication of the policy development process and the early impact of its implementation in the context of international and Scottish Government dietary public health policy objectives.
ISM Staff: Georgina Cairns, Laura Macdonald, Kathryn Angus and Martine Stead
Cairns G, Mcdonald L, Angus K and Stead M (2013). High Fat, Salt, Sugar Foods Marketing, Purchase and Consumption: Evidence for PAS 2500. Stirling: University of Stirling, Institute for Social Marketing. Available here
The Scottish Government sponsored the development of a third party (British Standards Institute) standard for responsible food marketing. The policy was intended to shift food marketing towards practices and impact more supportive of dietary public health goals than current industry norms.
The aim of the research project was to support the development of science-based standard specifications that were applicable and sustainable. The research did this by identifying and exploring key stakeholder perceptions and insights on their development and implementation. Specific research objectives identified:
ISM Staff: Georgina Cairns, Laura Macdonald and Douglas Eadie
Cairns G and Macdonald L (2016). Stakeholder insights on the planning and development of an independent benchmark standard for responsible food marketing. Evaluation and Program Planning, 56: 109-120. doi:10.1016/j.evalprogplan.2016.03.009
Cairns G, Macdonald L and Eadie D (2013). Developing a Standard for the Responsible Marketing of Food and Drink: Stakeholder Perceptions of Benefits, Barriers and Enablers. Stirling: University of Stirling, Institute for Social Marketing. Available here
Mapping and Exploring Policy Options to Constrain Non-broadcast Advertising of High Fat, Salt and Sugar Foods to Children (2009-2010)
(Commissioned by the Scottish Government)
This project aimed to scope the policy options available to the Scottish Government and assess the health impact implications. The work involved a rapid appraisal of the international landscape of non-broadcast marketing activities and policy responses. The research examined both statutory and voluntary regulatory frameworks, and provided an overview of marketing activities, expenditure and trends in non-broadcast medium and the scale and nature of children's exposure to these activities.
The current evidence base confirmed that the marketing landscape continues to be heavily skewed towards the promotion of energy-dense, nutritionally poor diets. This is both disappointing and contrary to public health strategic intentions to encourage better practice and the stated commitments of the commercial food, marketing and advertising sectors to ‘support consumers in making appropriate choices ….. and in understanding the role of diet and physical activity in healthy lifestyles'.
Internationally there are a number of policy initiatives, developments and evaluations aiming to identify effective measures to reduce children's exposure and susceptibility to the advertising and marketing of nutritionally low quality foods and beverages. ISM work on this project and its collaboration in a number of other international projects with similar aims is helping to build a stronger evidence base for effective policy to address rising prevalence rates for childhood obesity.
ISM Staff: Georgina Cairns and Gerard Hastings
Cairns G (2012). Evolutions in food marketing, quantifying the impact and policy implications. Appetite. Online
ISM revised and updated its 2006 systematic review for the World Health Organization. The review found commercial food marketing aimed at children and young people continued to be intensive and predominantly for low quality nutrition foods. The review did not identify any evidence of significant change in the nature or extent of commercial food marketing practice. An emerging evidence base on food marketing using new channels such as digital media and viral networks was noted, although TV advertising remains the most heavily researched medium. The evidence that food marketing influences food preferences, purchase, and consumption and diet-related health outcomes was once again confirmed. The review evidence was commissioned to support, and was used in the development of a Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children. The recommendations were subsequently endorsed at the 63rd World Health Assembly, May 2010.
ISM Staff: Georgina Cairns, Kathryn Angus and Gerard Hastings
Cairns G, Angus K, Hastings G and Caraher M (2012). Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. Appetite. Online
Cairns G, Angus K and Hastings G (2009). The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence to December 2008. Prepared for the World Health Organization. Available here
Evaluation of the Impact and Implementation of New School Food Policy (2007-2011)
(Commissioned through the Public Health Research Consortium and in collaboration with the University of Newcastle)
School food transformed with the introduction of compulsory food-based and nutritional standards for England and Wales. New standards introduced in September 2006 required that:
All primary schools were to be fully compliant by September 2008 and all secondary schools by September 2009. This study, conducted through the Department of Health-funded Public Health Research Consortium in collaboration with the University of Newcastle, aims to measure the effect of these changes on both the food and nutrient intake of children aged 4-6 years and 11-12 years both at school and throughout the day. The project will evaluate the implementation, impact and cost-benefit of this policy with respect to diet and health in children in cohort schools in the north east of England. The process evaluation component of the study examines the following questions: have the school food requirements been implemented fully in the schools to be investigated? If so, what was the process of this implementation and how is this change regarded by key stakeholders? In doing so, the research will examine the extent to which the policy has been adopted and implemented, and any departures from or modifications to those intended, including factors responsible for these differences.
Reports available here
ISM Staff: Martine Stead, Douglas Eadie, Joanne Freeman (left 2008) and Oona Brooks (left 2010)
Exploration of Adult Food Portion Size Tools (2007-2008)
(Commissioned by NHS Health Scotland)
This research project led by the University of Dundee explored the theoretical basis for the development of quantitative guidance of adult food portion sizes and investigated both general public and health professional perceptions of the need for a portion size tool. Qualitative research comprising in-depth interviews with dieticians, health promotion practitioners, practice nurses and community pharmacists and focus group discussion groups with members of the Scottish public was carried out. The findings of the research with the health professionals suggested that portion advice was both required and desired by clients. The focus group discussions highlighted that the extent of support for quantitative guidance varied according to gender and general interest in food and diet. Exploration of the most effective ways of communicating portion size guidance for healthy eating revealed that the design of future food portion communication tools should draw on the Department of Health format for communication on fruit and vegetable portions (photo, handy measure and weight for 12 items depicted on a postcard). Findings from this research also indicated that messages (on frequency of consumption and serving sizes) should be presented in a variety of translational descriptions (eg. handfuls, weight, cup size). This research will contribute to the design of a new food portion guidance tool for use by the general public and health professionals in Scotland.
ISM Staff: Martine Stead and Joanne Freeman (left 2008)
Anderson AS, Freeman J, Stead M, Wrieden WL and Barton KL (2008). Consumer views on portion size guidance to assist adult dietary choices. Journal of Human Nutrition and Dietetics, 21(4): 375.
How Do Young People Engage with Food Branding (2007-2008)
(Commissioned through the Public Health Research Consortium)
The prevalence of obesity in children and young people continues to increase, with 30% of boys and 26% of girls under 11 years overweight in 2003, and halting this upward trend is an important public health priority. Food marketing is recognised to be an important influence on children's diet, particularly through the growing dominance of youth-oriented brands like Coca Cola and McDonalds. Branding is a powerful marketing tool for the adolescent market. It supports young people's efforts to use the symbolism embedded in consumer products to create, foster and develop their self-identity, and low-income teenagers appear to be particularly brand-loyal. However, very little is known about young people's relationship to food brands and its influence on their food choices.
The project filled this gap. It aimed to investigate (i) how young people engage with food branding, particularly with branded foods high in fat, sugar and salt, and (ii) potential gender and socioeconomic differences in its influence on food preferences, including young people's independent food purchases. Three phases of work were conducted: qualitative focus groups, questionnaire development and piloting, and a cross-sectional survey of 1200 school pupils, selected from a random sample of comprehensive schools stratified by LEA.
The project equipped policymakers with a better understanding of how food branding worked. This understanding was important for informing future food marketing regulation (eg. for branded school vending machines, sports sponsorship and brand-stretching, as well as on measures to 'disrupt' branding, such as prominent labelling of high fat or salt products). It also provided a baseline study to monitor the impact of regulatory policies relating to food marketing on young people.
ISM Staff:Martine Stead, Laura McDermott (left 2008) and Louise Hassan (left 2007)
Stead M, McDermott L, MacKintosh AM and Adamson A (2011). Why healthy eating is bad for young people's health: Identity, belonging and food. Social Science and Medicine, 72(7): 1131-1139. Available here
Buywell: Evaluation of a Targeted Marketing Intervention to Influence Food Purchasing Behaviour by Low Income Consumers (2006-2008)
(Funded by the National Prevention Research Initiative. In Collaboration with the Institute for Retail Studies at the University of Stirling, the University of Dundee and the Co-operative Retail Group)
National surveys show that low income consumers in the UK consistently eat less fruit, veg, wholegrain bread and other healthy products, and more foods high in sugar, fat and salt than higher income consumers. Public education and campaigns are not on their own sufficient to narrow inequalities in diet; what is needed are interventions which modify the environment in which food choices are made. The government White Paper on public health speaks of harnessing marketing techniques to encourage 'behaviour that builds health'. The Buywell study investigated whether direct marketing interventions targeted at and tailored specifically for low income consumers (for example, direct mail price promotions for specific healthier products) triggered changes in food purchasing behaviour.
Formative research with low income consumers was used to develop targeted marketing interventions to encourage and facilitate healthier food purchases. The impact on purchases of targeted and associated products were assessed through analysis of retail sales data pre-, during and post-intervention. A survey examined consumer views on and response to the marketing intervention, and process and cost evaluations assessed the feasibility and implications of implementation from the retailer's perspective.
The study added to the evidence base on the effectiveness of ecological interventions in general and marketing interventions in particular, for addressing health inequalities in diet. By demonstrating the impacts and costs of marketing interventions delivered by food retailers, its findings had important implications both for nutrition policy and for industry.
ISM Staff: Martine Stead, Douglas Eadie and Anne Marie MacKintosh
Stead M, MacKintosh AM, Findlay A, Sparks L, Anderson AS, Barton K and Eadie D (2017). Impact of a targeted direct marketing price promotion intervention (Buywell) on food-purchasing behaviour by low income consumers: a randomised controlled trial. Journal of Human Nutrition and Dietetics, online 17th February. doi:10.1111/jhn.12441
The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence (2006)
(Commissioned by the World Health Organization)
A review of the extent and nature of food promotion to children and its effects on their food knowledge, preferences and behaviour was undertaken on behalf of the World Health Organization in preparation for the WHO meeting of stakeholders on "Marketing food and non-alcoholic beverages to children" held in Oslo (2-4 May 2006). The review updated and extended upon two earlier reviews of food promotion to children undertaken for the UK Food Standards Agency and the World Health Organization in 2003 and 2004 respectively.
The study used systematic review methods to identify and assess evidence of food promotion's effects. It found that in both developed and developing countries: (i) there is a great deal of food promotion to children, particularly in the form of television advertising; (ii) this is typically for highly processed, energy dense, unhealthy products with evocative branding; and (iii) that children recall, enjoy and engage with this advertising. Evidence from more complex studies (capable of establishing causality) shows that this promotional activity is having an effect on children. It can have an effect on specific types of nutritional knowledge and influence their food preferences, encouraging them to ask their parents to purchase foods they have seen advertised. Food promotion has also been shown to influence children's consumption and other diet-related behaviours and outcomes. These effects are significant, independent of other influences and operate at both brand and category level. These more complex studies have all been undertaken in the developed world. However survey research shows that children respond to advertising in much the same way regardless of their country's place on the development ladder.
The study confirms that global action is needed on the marketing of food to children.
ISM Staff: Laura McDermott (left 2008), Martine Stead, Kathryn Angus and Gerard Hastings
Hastings G, McDermott L, Angus K, Stead M and Thomson S (2006). The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence. Technical Paper Prepared for The World Health Organization. Available here
McDermott L, O’Sullivan T, Stead M and Hastings G (2006). Food advertising, pester power and its effects. International Journal of Advertising, 25(4): 513-539.
Systematic Review of Research on the Effects of Food Promotion to Children (2002-2003)
(Commissioned by the Food Standards Agency)
This major study was the first ever systematic review to examine evidence of the effects of food promotion on children. It sought to answer the highly topical question of whether children's food behaviour and diets are influenced by food advertising and other forms of promotion. Specifically, it reviewed evidence of the extent and nature of food promotion to children; how children respond to food promotion; whether it influences their food preferences; and if it does, the extent of that influence compared to other factors and whether the influence applies to types of food as well as brands.
The review reached a number of significant conclusions about the link between promotional activities and children's eating behaviour. In particular, it concluded that food advertising to children does have an effect, particularly on children's preferences, purchase behaviour and consumption, and these effects are apparent not just for different brands but also for different types of food. Since its publication in 2003, the report has acted as a catalyst to UK and European policy debate on this highly important public health issue.
ISM Staff: Gerard Hastings, Martine Stead, Laura McDermott (left 2008), Anne Marie MacKintosh, Kathryn Angus, Dr Alasdair Forsyth (left 2003)
Co-Investigators: Dr Michael Rayner, University of Oxford; Dr Christine Godfrey, University of York; and, Dr Martin Caraher, City University
Stead M, McDermott L and Hastings G (2007). Towards evidence-based marketing: The case of childhood obesity. Marketing Theory, 7(4): 379-406.
Hastings G, McDermott L and Stead M (2004). Food advertising and children: There is an effect - get over it. Innova: Food and Beverage Innovation, January/February: 27-28.
McDermott L, Hastings G and Stead M (2004). Food promotion to children: A time for action. ChildRIGHT, 205: 14-16.
Stead M, McDermott L and Hastings GB (2004). From the billboard to the school canteen: How food promotion influences children. Education Review, 17(2): 17-23 .
McDermott L, Hastings G, Stead M, Mackintosh AM, Rayner M, Godfrey C, Caraher M and Angus K (2004). Evidence-based marketing: The transferability of the systematic review to marketing research. European Marketing Academy Conference, Murcia, Spain.
Systematic Review of the Effectiveness of Social Marketing Nutrition and Food Safety Interventions (2004-2005)
(Commissioned by Safefood Ireland)
The public health community has met with growing demands to intervene on matters relating to nutrition and food safety. Rapidly increasing obesity rates and the increased risk of chronic disease have sparked efforts to improve dietary health. Similarly, there is a need to reduce the risk of food poisoning, food borne illness and other problems associated with matters of food safety.
This systematic review evaluates the effectiveness of social marketing interventions designed to influence people's knowledge, perceptions, and behaviour in relation to nutrition (food, diet and diet-related health) and food safety (food handling, preparation, poisoning and labelling). It employs rigorous, transparent, and replicable procedures to critically appraise evidence and seeks to determine which approaches have had the best effect. The research will guide the development of future social marketing efforts in these areas.
ISM Staff: Laura McDermott (left 2008), Gerard Hastings, Kathryn Angus and Martine Stead
McDermott L, Stead M, Hastings G, Angus K, Banerjee S, Rayner M and Kent R (2005). A Systematic Review of the Effectiveness of Social Marketing Nutrition and Food Safety Interventions - Final Report - Prepared for Safefood. Stirling: Institute for Social Marketing. Report
Systematic Review of the Effects of Food Marketing on Children in Developing Countries (2003-2004)
(Commissioned by the World Health Organization)
This systematic review extended the scope of the FSA Review of Food Promotion to Children by examining the effects of food marketing on children in the developing world. Consistent with the first review's findings, this research found that children from developing countries are heavily exposed to food advertising which promotes high salt, sugar and fat products, that they recall and like this advertising, and use it to prompt their own and parents' purchase decisions.
None of the studies was methodologically sound enough to determine whether or not a causal relationship existed between food promotion and children's food behaviour and diet. However, the findings of the FSA review, which examined promotion in developed countries, suggest that it is logical to assume that food advertising in developing countries is likely to have an influence, albeit hitherto unmeasured, on children.
ISM Staff: Laura McDermott (left 2008), Gerard Hastings, Kathryn Angus and Martine Stead
Co-Investigators: Dr Michael Rayner, University of Oxford
Assisting Dietary Change in Low Income Communities: Assessing the Impact of a Community-based Practical Food Skills Intervention ('CookWell') (2000-2002)
(In collaboration with the University of Dundee; Commissioned by the Food Standards Agency Food Acceptability and Choice Research and Development Programme)
The Dundee-led CookWell project developed, implemented and evaluated a transferable, community-based, food-skills programme aimed at increasing consumption of fibre-rich starchy carbohydrates, fish, vegetables and fruit and decreasing the consumption of fat in adults living in low-income areas. Immediately after the intervention participants increased their fruit consumption by the equivalent of one portion per week. However, this effect was not sustained 6 months after the end of the intervention phase. No changes were detected in fat intake or consumption of other key foods. An increase in the percentage of people cooking from basic ingredients was recorded and participants also reported increased confidence in cooking from basic ingredients, cooking basic menu items (lentil soup and white sauce). These increases were sustained 6 months after the intervention and were also noted in the qualitative interviews carried out at this time. The results of the assessments contribute to the evidence base on the contribution and value of food skills to healthy dietary choices at reasonable costs. The materials and methods used in the project will be taken forward with the Scottish Community Diet Project. The tutor's manual has been well received and is to be made available on the Internet by the Food Standards Agency during 2003. The manual will be useful for anyone who wants to set up a cooking skills group in their local community.
ISM Staff: Martine Stead
Wrieden WL, Anderson AS, Longbottom PJ, Valentine K, Stead M, Caraher M, Lang T, Gray B and Dowler E (2007). The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices - An exploratory trial. Public Health Nutrition, 10: 203-211.
Stead M, Caraher M, Wrieden W, Longbottom P, Valentine K and Anderson A (2004). Confident, fearful and hopeless cooks: Findings from the development of a food-skills initiative. British Food Journal, 106(4): 274-287.
Development and Evaluation of a School-based Intervention to Increase Children's Fruit and Vegetable Consumption (1999-2000)
(In collaboration with the University of Dundee; Commissioned by the Food Standards Agency)
This study, led by the University of Dundee and in collaboration with the University of Newcastle-upon-Tyne, comprised the development and evaluation of a school-based intervention to increase intake of fruit and vegetables in children aged 5-11 years. Formative research was conducted to develop and pre-test an appropriate intervention strategy comprising curriculum materials and protocols, catering guidelines, peer and community support initiatives and pupil learning materials. The resulting novel intervention used the DC Thompson 'Bash Street Kids' as a theme, and has been rigorously evaluated.
ISM Staff: Martine Stead and Douglas Eadie
Anderson AS, Porteous LEG, Foster E, Higgins C, Stead M, Hetherington M, Ha M-A and Adamson AJ (2005). The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables. Public Health and Nutrition, 8(6): 650-656.
The Development of Interventions to Improve the Diet of Girls and Young Women from Populations at Risk of Low Birth Weight
(Commissioned by the Food Standards Agency. In collaboration with the European Institute of Health and Medical Sciences at the University of Surrey and the Centre for Public Health Nutrition Research at the University of Dundee)
The project addressed the Food Standard Agency's need to understand the physiological and psychological basis upon which young women make food choices. It targeted young women from low-income British and minority ethnic communities at risk of low birth weight. In particular it determined the factors that may have inhibited sensible dietary choices and piloted an intervention to overcome these factors. The women's knowledge, beliefs and attitudes towards food choices were assessed pre- and post-intervention. Qualitative focus groups were conducted pre-intervention to gain an understanding of current food choices and consumptions. Focus groups were conducted post-intervention to explore any changes resulting from the intervention programme. Interviews were also conducted with a control group of women of similar backgrounds to the intervention participants, who were not involved in the intervention.
ISM Staff: Susan MacAskill and Elinor Devlin (left 2005)
Lawrence JM, Devlin E, MacAskill S, Kelly M, Chinouya M, Raats MM, Barton KL, Wrieden WL and Shepherd R (2007). Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK. Journal of Human Nutrition and Dietetics, 20(4): 311-319.
Exploration of Dental Patients' Views on Dietary Interventions in Dental Services
(In collaboration with the University of Dundee; Commissioned by the Department of Health)
This research, conducted in conjunction with the University of Dundee for the Department of Health, used focus groups to explore dental patients' perceptions and experiences of dental attendance, their expectations of the extent to which the dentist's role should embrace dietary advice, and their views on the acceptability of receiving dietary interventions as part of dental services.
ISM Staff: Martine Stead and Susan MacAskill
Exploration of General Public Attitudes Towards the Scottish Healthy Choices Award Scheme
(Commissioned by the Health Education Board for Scotland)
This study was conducted to evaluate the Scottish Healthy Choices Award Scheme, the first national award scheme of its kind in Scotland. The Award is open to all catering establishments throughout Scotland who wish to offer healthy food choices and a healthy environment to their customers. Three key groups - award assessors, caterers and the general public (customers) - participated in the evaluation, which used a mixed methods approach to investigate assessors' experiences of implementing the Scheme in their health board area; attitudes and experiences of caterers and managers' applying for the Award; and awareness and attitudes of customers towards the Award Scheme and its impact on their eating habits. The findings were used to guide the on-going development of the Scheme and its roll out to key business sectors.
ISM Staff: Douglas Eadie, Susan MacAskill