Critical Marketing

Tobacco Control

The Marketing of Electronic Cigarettes in the UK: Direct and Indirect Promotion through Traditional, Digital and Social Media (2013)
(Funded by Cancer Research UK)

This project analysed how electronic cigarettes (e-cigarettes) are being marketed in UK newspapers and magazines; retail trade press; tobacco journals; company press releases; through television clips and other traditional communication channels and sources. It also investigated marketing on online social network sites.

ISM Staff: Marisa de Andrade, Gerard Hastings, Kathryn Angus, Richard Purves and Diane Dixon

de Andrade M, Hastings G, Angus K, Purves R and Dixon D (2013). The Marketing of Electronic Cigarettes in the UK. Commissioned by Cancer Research UK. Stirling: Institute for Social Marketing, November.

Addictions and Lifestyles in Contemporary Europe - Reframing Addictions Project (ALICE RAP)
(2011 - 2016)
(Funded by the European Commission)

ALICE RAP aims to study and analyse the development and place of well-acknowledged and new addictions as a major societal trend in Europe in relation to governance and public policies and responses. The study involves 67 research institutions from 25 European countries covering the humanities, social sciences and biological and medical sciences. Its scientific objectives are:

  1. To describe the ownership of addictions through an historical study of addiction over the ages, an analysis of public and private stakeholder views and through image analyses, of professional and citizenship views.
  2. To study how addictions are classified and defined, followed by estimates of their health, social and economic impact.
  3. To investigate determinants of addiction through a coordinated and cohesive social, economic and biological analysis of initiation, transition into problem use and transition into and out of dependence.
  4. To analyze the business of addiction through studies of revenues, profits and participants in legal and illegal trade, the impact of suppliers on addictive substance use and behaviours, and analyses of webs of influence on policy responses.
  5. To study addictions governance by describing the views and forces that determine the ways societies steer themselves and by stock taking of present governance practices to old and emerging addictions.
  6. To analyze youth as customers through considering the impacts of new technologies on promoting and mitigating use, by studying the interrelations of culture and biology, and by determining features that promote resilience and nudge young people to reduce problematic use.

ISM is contributing specifically to Objectives 1 and 4.

ISM Staff: Martine Stead, Kathryn Angus, Richard Purves, Gerard Hastings, Anne Marie MacKintosh and Crawford Moodie

Young People’s Access to, and Use of, Tobacco in Scotland
(Funded by SHEFCE)

This study was funded by SHEFCE through the Scottish School of Public Health. The research explored the views of between 70 and 80 14-16 years olds in three disadvantaged areas of Scotland regarding use of and access to tobacco, with a focus on current smokers and those who had tried smoking. The interviews with young people were put in the context of tobacco supply and tobacco control efforts in these communities as perceived by professionals who were also interviewed as part of the study.

ISM Staff: Linda Bauld and Douglas Eadie

Independent Retailers and the Demise of Smoking: A Scoping Study
(Funded by the Department of Health)

This project aimed to assess the potential for recruiting independent and local retailers to assist public health manage tobacco sales decline in the UK. The study comprised three stages: (1) a literature and market review clarifying the current state of knowledge regarding local and convenience retailing, focussing specifically on tobacco, and covering possible retail-focused solutions to aid decline and enhance health promotion; (2) interviews conducted with a range of retailers (n=14 across the UK) to understand the possibilities for change; and (3), from these two data collection exercises, ideas were developed for working with retailers via an iterative process within the project team.

ISM Staff: Douglas Eadie, Kathryn Angus and Gerard Hastings; and Leigh Sparks from the Institute of Retail Studies, Stirling University

UK Centre for Tobacco Control Studies (UKCTCS) (2008-2013)

The Centre is a strategic partnership of nine UK universities in England and Scotland (Nottingham, Bath, Birmingham, Edinburgh, Stirling, Queen Mary, UCL, York and Bristol) involving leading tobacco control researchers from a range of disciplines.

Each institution will work together to deliver a programme of original research, policy development, advocacy, teaching and training.

UKCTCS is part of a £20 million investment into public health research, funded by the UK Clinical Research Collaboration (UKCRC) comprising the Economic and Social Research Council, The British Heart Foundation, Cancer Research UK, the National Institute for Health Research and the Medical Research Council.

ISM Staff: Gerard Hastings and Abraham Brown (left 2012)

Ford A, Moodie C and Hastings G (2012). The role of packaging for consumer products: Understanding the move towards 'plain' tobacco packaging. Addiction Research and Theory, 20: 339-347.

Review 'Forever Cool: The Influence of Smoking Imagery on Young People' (2007-2008)
(Funded by the British Medical Association Board of Science)

This report considers the effect of smoking imagery on young people (under 25 years) in the UK. It begins by examining trends in smoking prevalence and initiation, goes on to review the different forms of pro-smoking imagery and the evidence for how they can affect behaviours and attitudes among young people. It concludes by exploring effective ways of reducing young people's exposure to positive images of smoking – and increasing their exposure to positive images of health. A number of recommendations for reducing the influence of pro-smoking imagery on young people are given.

Forever Cool Report

ISM Staff: Gerard Hastings and Kathryn Angus - Online Database and series of Marketing Case Studies based on UK Tobacco Industry Advertising Agency Documents
(Funded by NHS Health Scotland (formerly Health Education Board for Scotland))

In 1999, the House of Commons Health Select Committee acquired access to internal documents of the main advertising agencies of the UK tobacco industry as part of its investigation into the conduct of the tobacco industry. Previously only accessible to the public through the House of Commons library, this fully searchable database is now available to a global audience. Launched in December 2003 the site attracted a huge amount of interest with over 350,000 hits and 8,500 downloads in its first week.

The resource provides some fascinating insights into the strategies used by the UK tobacco industry. A series of marketing Case Studies examining issues such as tobacco sponsorship and tobacco marketing and young people have been developed using relevant search terms. Each Case Study contains many extracts from the internal documents demonstrating how the UK tobacco industry and their advertising agencies market their products.

ISM Staff: Douglas Eadie, Elinor Devlin (left 2005) and Kathryn Angus

Devlin E, Hastings GB, Eadie DR, Angus, K and Stead M (2004). Smoking prevention: where social and critical marketing meet. Presentation to the Academy of Marketing conference, Cheltenham, UK 7-9th July.


A Monitor of the Tobacco Advertising Ban in the UK
(Funded by Cancer Research UK)

In February 2003, a comprehensive ban on tobacco promotion came into effect in the United Kingdom, which prohibited tobacco marketing through print and broadcast media, billboards, the Internet, direct mail, product placement, promotions, free gifts, coupons and sponsorship. This study (known as the Youth Tobacco Policy Survey), initiated in 1999, monitors young people's awareness and involvement with tobacco marketing, alongside their smoking knowledge, attitudes and behaviour before, during and after the implementation of these controls on tobacco advertising and promotion. It represents a shift away from the reliance upon econometric models to assess the impact of implementing controls on tobacco marketing. This research involves repeat cross-sectional surveys administered to adolescents in Scotland, England, Wales and Northern Ireland. Measures are taken approximately every two years and the first two surveys, conducted in 1999 and 2002 provide baseline measures, collected prior to the new regulations on tobacco advertising and promotions. Surveys have been conducted in 2004 (18 months after the first stage of the ban), 2006, 2008 and again in 2011. Key measures within the surveys include, awareness of a range of forms of tobacco marketing, awareness of cigarette brands, perceptions of prevalence of smoking, smoking behaviour and smoking intentions.

A second strand to the research is an audit of the industry's marketing activities which takes place on an ongoing basis. It aims to identify and detail any innovations or changes in tobacco industry marketing to both consumers and retailers.

CTCR Staff: Anne Marie MacKintosh, Crawford Moodie, Gerard Hastings, Allison Ford, Gayle Tait (left 2009), Louise Hassan (left 2007), Susan Anderson (left 2005) and Elinor Devlin (left 2005)

Related publications:
Moodie C, MacKintosh AM and Hastings GB (2013 Online). Young people’s response to pictorial warnings on the reverse panel of cigarette packs: A repeat cross-sectional study. Tobacco Control. doi:10.1136/tobaccocontrol-2013-050999.

Ford A, Moodie C, MacKintosh AM and Hastings G (2013 online). Adolescent perceptions of cigarette appearance. European Journal of Public Health. doi: 10.1093/eurpub/ckt161.

Ford A, MacKintosh AM, Moodie C, Richardson S and Hastings G (2013). Cigarette pack design and adolescent smoking susceptibility: a cross-sectional survey. British Medical Journal Open, 3: e003282.

Ford A, Moodie C, MacKintosh AM and Hastings G (2013). How children perceive tobacco packaging and possible benefits of plain packaging. Education and Health, 31(2): 83-88.

Moodie C, Ford A, MacKintosh AM and Hastings GB (2012). Young people’s perceptions of cigarette packaging and plain packaging: An online survey. Nicotine and Tobacco Research, 14: 98-105.

Moodie C, Angus K and Ford A (2012 Online). The importance of cigarette packaging in a ‘dark’ market: The ‘Silk Cut’ experience. Tobacco Control. doi:10.1136/tobaccocontrol-2012-050681.

Brown A and Moodie C (2012). Adolescent perceptions of tobacco control measures in the UK. Health Promotion Practice, 13(1): 41-47.

MacKintosh AM, Moodie C and Hastings G (2012). The association between point-of-sale displays and youth smoking susceptibility. Nicotine and Tobacco Research, 14: 616-620. doi: 10.1093/ntr/ntr185

Moodie C and Hastings GB (2011). Making the pack the hero, tobacco industry response to marketing restrictions in the UK: Findings from a long-term audit. International Journal of Mental Health and Addiction, 9: 24.

Moodie C and Hastings GB (2010). Tobacco packaging as promotion. Tobacco Control, 19:168-170.

Moodie C, MacKintosh AM and Hammond D (2010). Adolescents’ response to text-only tobacco health warnings: Results from the 2008 UK Youth Tobacco Policy Survey. European Journal of Public Health, 20: 463-469.

Brown A, Moodie C, Hastings G, MacKintosh AM, Hassan L and Thrasher J (2010). The association of normative perceptions with adolescent smoking intentions. Journal of Adolescence, 33: 603-614.

Moodie C, MacKintosh AM and West R (2010). Adolescents' awareness of, and involvement with, illicit tobacco in the United Kingdom. Tobacco Control, 19: 521-522.

Brown A and Moodie C (2009). Tobacco marketing influences on smoking intentions via normative beliefs. Health Education Research, 24: 721-733.

Grant IC, Hassan L, Hastings G, MacKintosh AM and Eadie D (2008). The influence of branding on adolescent smoking behaviour: Exploring the mediating role of image and attitudes. International Journal of Nonprofit and Voluntary Sector Marketing, 13(3): 275-285.

Moodie C, MacKintosh AM, Brown A and Hastings G (2008). The effect of tobacco marketing awareness on youth smoking susceptibility and perceived prevalence, before and after the introduction of a tobacco advertising ban. European Journal of Public Health, 18(5): 484-490.

MacKintosh A, Harris F and Hastings G (2008). Measures to assess the effectiveness of restrictions on tobacco marketing communications. In IARC Handbooks of Cancer Prevention, Tobacco Control, Volume 12: Methods for Evaluating Tobacco Control Policies. Lyon, France: IARC.

Devlin E, Anderson S, Borland R, MacKintosh AM and Hastings GB (2006). Development of a research tool to monitor point-of-sale promotions. Social Marketing Quarterly, XII(1): 29-39.

'Keep Smiling, No-one's Going to Die': A Review of Internal Documents from UK Tobacco Advertisers

In 1999, the House of Commons Health Select Committee required disclosure of internal documents from the UK tobacco industry's main advertising agencies as part of their investigation into tobacco. The documents are unique because they come from ad agencies rather than the tobacco companies themselves, as is the norm with disclosed tobacco documents. They are particularly revealing because the ad agencies are not nearly so circumspect as their tobacco clients.

As special advisor to the Committee, Gerard Hastings was asked to review and report back on their contents. The results of this analysis are damning (BMJ 2000; Vol 321:366-371). They show that tobacco advertising is deliberately used to increase consumption as well as brand share, and that marketing - advertising combined with new product development, pricing and distribution - has a powerful effect on young people. Shockingly the documents also reveal calculated attempts to exploit the smuggled tobacco market and down play the health consequences of smoking. However, perhaps the most chilling aspect of the documents is their gung ho, flippant tone that raises not the slightest qualm about the consequences of their actions. 'Keep Smiling, No-one's Going to Die' was how one creative director signed off his letter to a tobacco client; it also the title of the report we produced on these shameful documents.

ISM Staff: Douglas Eadie, Elinor Devlin (left 2005) and Kathryn Angus

Hastings GB and MacFadyen L (2000). A day in the life of an advertising man: Review of internal documents from the UK tobacco industry's principal advertising agencies. British Medical Journal, 321(5 August): 366-371. Read the Hastings and MacFadyen publication here

Tobacco Marketing and Young People (1998-1999)
(Funded by Cancer Research UK)

The tobacco industry uses a range of communications and promotional techniques to reach its key target groups with relevant and credible messages about smoking. Enduring brand images are a result of a carefully balanced mix of advertising, couponing, sampling, brand-stretching, packaging, point-of-sale communications, product placement and the internet. Research was conducted between January 1998 and December 1999 to investigate the impact of tobacco related marketing communications on young smokers in the UK. Observational, qualitative and quantitative methodologies were used.

CTCR Staff: Lynn MacFadyen, Gerard Hastings and Anne Marie MacKintosh

Related publication:
MacFadyen L, Hastings GB and MacKintosh AM (2001). Cross sectional study of young people's awareness of and involvement with tobacco marketing. British Medical Journal, 322(3 March): 513-517. Read the MacFadyen, Hastings and MacKintosh publication here


The Use of New Media in Alcohol Marketing
(Commissioned by SHAAP (Scottish Health Action on Alcohol Problems))

In analysing the internal marketing documents from both alcoholic beverage producers and their advertising agencies for the Health Select Committee (see below), it was apparent that there has been a rapid growth in the use of new media (ie. digital forms of communication such as the internet, mobile devices, electronic games, blogs and podcasting) to market alcohol in recent years, yet this is an area which presents particular challenges to the current system of self-regulation. This report examines the use of new media to market leading alcohol brands in the UK using a case study approach.

ISM Staff: Oona Brooks (left 2010)

Report: Brooks O (2010). 'Routes to Magic' - The Alcoholic Beverage Industry’s Use of New Media in Alcohol Marketing. Stirling: Institute for Social Marketing.

Health Select Committee Alcohol Document Analysis
(Commissioned by the Health Select Committee and the Alcohol Education and Research Council (AERC))

As part of its 2009 investigation into the conduct of the UK alcohol industry, the House of Commons Health Select Committee obtained access to internal marketing documents from both producers and their advertising agencies. These documents were then analysed by the Institute for Social Marketing.

These revealed major shortcomings in the current self regulatory codes covering alcohol advertising. Specifically, the codes do not, as they are supposed to, protect young people from alcohol advertising; prevent the promotion of drunkenness and excess; or the linking of alcohol with social and sexual success. Nor do they even attempt to address sponsorship, and the documents show this is being systematically used to undermine rules prohibiting the linking of alcohol with youth culture and sporting prowess. Finally, the codes are extremely weak in their treatment of new media which are rapidly become the biggest channel for alcohol promotion. The result is a regulatory system that is impossible to police and vulnerable to exploitation.

ISM Staff: Gerard Hastings, Oona Brooks (left 2010), Kathryn Angus, Martine Stead, Thomas Anker (left) and Tom Farrell (Open University)

Report: Hastings G (2010). Memorandum by Professor Gerard Hastings - 'They'll drink bucket loads of the stuff'. An analysis of internal alcohol industry documents. Read the report here

Hastings G, Brooks O, Stead M, Angus K, Anker T and Farrell T (2010). Failure of self regulation of UK alcohol advertising (Alcohol advertising: The last chance saloon). British Medical Journal, 340: 184-186. Read the Hastings, Brooks, Stead, Angus, Anker and Farrell publication online here

Assessing the Cumulative Impact of Alcohol Marketing Communications on Youth Drinking (2006-2009)
(Commissioned by the National Prevention Research Initiative (NPRI))

The last decade saw a significant increase in alcohol consumption in the UK and a growth in binge drinking amongst young people. These trends were responsible for raising particular health concerns as there is now clear evidence of a link between regular recreational alcohol use in adolescence and alcohol dependence in early adulthood. This study aimed to examine the marketing communication techniques used by the UK alcohol industry to assess its impact on youth drinking and risk taking during the period when most young people start experimenting with alcohol, from ages 13-15.

It addressed four deficiencies in the current evidence base. Firstly, whilst the evidence indicated that alcohol promotion had a reinforcing effect on young people's drinking, there was a paucity of research to establish whether or not it was implicated in the onset of drinking and harmful drinking patterns. Secondly, the evidence focused almost exclusively on traditional 'above-the-line' advertising (television, billboards, magazine advertising etc) and failed to take account of new, largely unregulated interactive media such as, the web, and the mobile phone. Thirdly, no attempt was made to examine the cumulative impact of marketing communications in establishing evocative alcohol brands. Finally, no one had checked for any differential effect on gender and by affluence and deprivation.

The study addressed these gaps and played a proactive role in developing evidence-based policy to respond with countervailing social marketing and smarter regulation.

ISM Staff: Ross Gordon (now based at the University of Wollongong), Gerard Hastings, Douglas Eadie and Anne Marie MacKintosh

Co-Investigators: Dr Fiona Harris, Open University; Professor Avril Taylor, University of Paisley; Dr Amanda Amos, University of Edinburgh; Sally Haw and Mary Allison, NHS Health Scotland

Gordon R, Harris F, Moodie C and MacKintosh AM (2011). Assessing the cumulative impact of alcohol marketing on young people’s drinking: Cross sectional data findings. Addiction Research and Theory, 19(1): 66-75.

Hastings G and Sheron N (2011). Editorial: Alcohol marketing to children. British Medical Journal, 342: d1767.

Hastings G (2011). Letter to Editor – Impact of alcohol marketing on youth drinking. Alcohol and Alcoholism, 46(4): 506.

Gordon R, Hastings GB and Moodie C (2010). Alcohol marketing and young people’s drinking: What the evidence base suggests for policy. Journal of Public Affairs, 10: 88-101.

Gordon R, Moodie C, Eadie D and Hastings GB (2010). Critical social marketing - The impact of alcohol marketing on youth drinking: Qualitative findings. International Journal of Nonprofit and Voluntary Sector Marketing, 15(3): 265-275.

Gordon R, MacKintosh AM and Moodie C (2010). The impact of alcohol marketing on youth drinking behaviour: A two-stage cohort study. Alcohol and Alcoholism, 45(5): 470-480.

Alcohol Marketing: Influence on Young People's Alcohol Consumption

(Commissioned by the World Health Organization)

At the 2001 World Health Organization Ministerial Conference on Young People and Alcohol considerable concern was expressed about the nature and pervasiveness of marketing and advertising by the alcohol industry. Explicit examples were shown of alcohol promotion exploiting the themes of sexual, sporting and lifetime success and achievement, often in direct violation of advertising codes. Furthermore, many of the advertising examples displayed images of excessive consumption. In addition, marketing stretches beyond the realms of billboards, magazine pages and television screens. The retail outlet, the price charged, packaging and even the alcoholic product itself are all open to marketing manipulation. The purpose of this review was to examine what evidence (if any) exists to demonstrate that marketing and advertising by the alcohol industry may influence young people's consumption of alcohol. It had the following objectives:

  • To identify the ways in which the alcohol industry markets its products to young people.
  • To examine the influence of alcohol marketing on young people's consumption of alcohol.
  • To include evidence from non-English sources, in particular evidence from developing and transitional countries.

The results of the study were published in the WHO Monograph series.

ISM Staff: Emma Cooke (left 2002), Gerard Hastings and Susan Anderson (left 2005)

Hastings G, Anderson S, Cooke E and Gordon R (2005). Alcohol marketing and young people's drinking: A review of the research. Journal of Public Health Policy, 26: 296-311.

Designer Drinks and Young People

(Commissioned by the Health Education Board for Scotland)

The emergence, in the mid 1990's of a new range of fortified wines and strong white ciders (so called 'designer drinks') and the appeal of these drinks to under 18's was the focus of mounting public concern. This study, conducted on behalf of HEBS, was the first major primary research study to test claims about the appeal of designer drinks to under 18's.

Qualitative and quantitative research was conducted with young people aged 12-17 in the West of Scotland. The qualitative research comprised eight focus group discussions while the survey was conducted with over 800 young people aged 12-17. The survey sample was drawn from the Community Health Index for Argyll and Clyde Health Board area using a multi-stage random procedure and a response rate of 78% was achieved.

The study found that adolescent drinking varied considerably between the ages of 12 and 17. Fourteen and fifteen year olds in particular were found to be keen to test their limits with alcohol and drink to intoxication although they did not necessarily like the taste of alcohol or enjoy the process of drinking. Designer drinks were seen to have particular characteristics that met the needs of this group by minimising the costs and maximising the effects of drinking. They appealed to young people, often more so than conventional drinks, and popularity peaked between the ages of 13 and 16. The brand imagery - in contrast with that of more mainstream drinks - matched many 14 and 15 year olds' perceptions and expectations for drinking. Furthermore, consumption of designer drinks was found to be associated with drinking in less controlled environments, heavier drinking and greater drunkenness.

The study concluded that designer drinks were a cause for concern and highlighted the need for policy debate, assessing the desirability of these drinks and the extent to which further controls on marketing were required.

ISM Staff: Anne Marie MacKintosh and Gerard Hastings

MacKintosh AM, Hastings GB, Hughes K, Wheeler C, Watson J and Inglis J (1997). Young people, alcohol and designer drinks - conventional drinks are a much greater threat to health than designer drinks. British Medical Journal, 314: 1623. Letter

Hughes K, MacKintosh AM, Hastings GB, Wheeler C, Watson J and Inglis J (1997). Young people, alcohol and designer drinks: quantitative and qualitative study. British Medical Journal, 314: 414-418. Read the Hughes, MacKintosh, Hastings, Wheeler, Watson and Inglis article here 

MacKintosh AM, Hastings GB, Hughes K, Wheeler C, Watson J and Inglis J (1997). Adolescent drinking: The role of designer drinks. Health Education,6: 213-224.


Mapping and Exploring Policy Options to Constrain Non-broadcast Advertising of High Fat, Salt and Sugar Foods to Children
(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. The research also provides 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. Read the Cairns publication online here

Systematic Review of the Extent, Nature, and Effects of Food Promotion to Children
(Commissioned by the World Health Organization)

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. ORead the Cairns, Angus, Hastings and Caraher publication online here

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. Read the Cairns, Angus and Hastings publication here

How Do Young People Engage with Food Branding
(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. Read the Stead, McDermott, MacKintosh and Adamson publication here

The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence
(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

McDermott, O'Sullivan T, Stead M and Hastings G (2006). Food advertising, pester power and its effects. International Journal of Advertising, 25(4): 513-539.

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.

Systematic Review of Research on the Effects of Food Promotion to Children
(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.

Report available:

  • Review of Research on the Effects of Food Promotion to Children Part One: Main Report
  • Review of Research on the Effects of Food Promotion to Children Part Two: Appendice

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 Effects of Food Marketing on Children in Developing Countries
(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



Breast Milk Substitutes (BMS) and Related Products: A Social Marketing Analysis of BMS Marketing Strategies and Approaches (2019)

(Funded by the World Health Organization (WHO))

Breast milk is a product of unsurpassed quality: it maximises the baby’s life chances; protects and enhances the mother’s health; is completely sustainable and is free to use. Despite all this, Breast Milk Substitutes (BMS) take up around 60% of the ‘market share’ in infant feeding, thus ‘outperforming’ breast milk in many parts of the world. This small-scale exploratory research is designed to contribute to a larger WHO study which aims to a) find out why BMS outperforms breast milk using a marketing framework, and b) suggest ways in which public health can rebalance the equation and win back market share for breast milk. The aim of this sub-study is to gain a producers’ perspective on BMS marketing, how BMS compete against breast milk and how the market might develop in the future. It combines two distinct but complementary components: C1 semi-structured interviews with marketing practitioners and people who are active in the field of BMS/breast milk advocacy who have an awareness of marketing issues; and C2, a review of data from academic and practitioner databases to describe the global BMS market and BMS marketing strategies. The study is due to report in summer 2019.

ISM Staff: Gerard Hastings, Kate Hunt, Douglas Eadie and Kathryn Angus