Food and Diet

Obesity and Alcohol Use: Is There a Role for Dually Focused Intervention in Young Adults (18-25) to Tackle Unhealthy Eating and Drinking and Effectively Reduce Future Health Inequalities (2016 - 2018)
(Funded by the Public Health Research Consortium, Department of Health)

Levels of obesity have risen steadily over the past two decades. Thirty-three percent of regular drinkers in the UK are at risk of related health and other problems.

Alcohol use peaks in early adulthood and can exacerbate weight gain. Liver disease is the third most common cause of premature death in the UK and it is increasingly seen in 15-44 year olds. A high body mass index and heavy drinking are independently associated with liver disease but, in combination, they produce a supra-additive risk of damage. Thus we need to develop interventions focused on both behaviours, especially as they can become closely inter-linked in people’s day-to-day lives.

The aim of the study was to explore the links between unhealthy eating behaviour and risky alcohol use in the social, emotional and cultural lives of young adults (aged 18-25), including perceptions of risks, benefits, costs and consequences of these behaviours in early adulthood, and to work with young adults to co-design a dually focused intervention to help reduce health risk and social inequalities due to excess weight gain and alcohol consumption.

To do this the team carried out: a systematic review, secondary quantitative data analysis of national datasets, in-depth qualitative interviews, and workshops.

ISM Staff: Martine Stead and Niamh Fitzgerald 

External: Ashley Adamson (lead), Eileen Kaner, Stephanie Scott and Wendy Wrieden, Newcastle University; and, Chris Power, University College London


Pilot Research Study for the Policy Research Centre for Cancer Prevention, Cancer Research UK: Youth Policy Surveys (YPS) (2016 - 2018)
(Funded by Cancer Research UK)

This project will support the Cancer Research UK Policy Research Centre for Cancer Prevention (PRCP) in the development of two new national youth surveys, one on alcohol and the other obesity. Institute for Social Marketing (ISM) staff will provide insight and training to the PRCP team in how such studies are carried out, and will also provide research support, advice, and collaboration on publications. Data from the surveys will be used to monitor patterns of youth consumption and perceptions of alcohol and obesity and the impact marketing has on these.

ISM Staff: Martine Stead, Douglas Eadie, Anne Marie MacKintosh, Jennifer McKell and Linda Bauld


Healthcare Retail Standards Evaluation (2016 - 2017)
(Funded by NHS Health Scotland)

Obesity and diet related disorders present a major challenge to public health in Scotland. Around two thirds of adults are overweight with increased risk for diabetes, cardiovascular disease and some types of cancer (including breast and bowel). Over the last two decades the Scottish Government and partners have implemented a number of key policies to improve diet and health, including a Good Food Nation, Scotland’s overarching food and drink policy which places a strong emphasis on the role of food in improving health.

The purpose of this study is to contribute to meeting the overall Healthcare Retail Standard (HRS) evaluation objectives and complement the evaluation exercises being conducted by NHS Health Scotland and SGF.

The objectives are to:

  • Explore retailers’ understanding of and attitudes towards the HRS and its requirements.
  • Explore variations between retailers and retail outlet types in their attitudes towards and experience of implementing the HRS and in their perceptions of customers’ response and impact on their business.
  • Examine the following after implementation of all or parts of the HRS:
    • changes in the price of a selected range of products representing a standard food offer
    • the types and characteristics of customers using selected retail outlets
    • changes in the frequency of customers’ use of selected retail outlets
    • changes in customers’ motives for visiting hospital retail outlets and the types of products they purchase
    • customers’ awareness of HRS-related changes in selected retail outlets
  • Assess variations in customer shopping patterns (including types of product purchased and frequency and motives for use) by socio-economic status.

In order to achieve these objectives, we are conducting a mixed methods study comprising data collection exercises: a retailer and trolley service audit, and a customer exit survey.

ISM Staff: Martine Stead, Douglas Eadie, Anne Marie MacKintosh and Jennifer McKell

Other Stirling Colleagues: Leigh Sparks, Institute for Retail Studies

External: Annie Anderson, University of Dundee; Andy MacGregor, ScotCen and Jean Adams, Unviersity of Cambridge


Phase 2 Research to Support the Evaluation and Implemenation of Adult Cooking Skills Interventions in the UK: Pilot RCT with Process and Economic Evaluation Components (2013-2015)
(Funded by the Public Health Research Consortium, Department of Health)

Dietary improvements have the potential to reduce the prevalence of obesity and certain chronic diseases. Determinants of diet are complex, although increasing consideration is being given to cooking skills and whether improvements to these could lead to dietary improvements.

This research had three aims: 1) to analyse existing data to explore associations between cooking skills and diet in the UK population; 2) to conduct analysis of an existing cooking skills intervention to determine its theoretical basis and fidelity; and 3) to conduct a pilot study that would simulate a proposed definitive RCT of a cooking skills intervention. The outcome of these three aims answered the overarching research questions of whether cooking skills interventions were likely to be effective and whether robust evaluation of cooking skills interventions was both practical and feasible.

ISM’s element of the study assessed the extent to which delivery of the intervention, in practice, adheres to the protocol contained within the course manual in terms of specified content and teaching methods, and the extent to which it was capable of engaging participants. It also assessed the extent to which delivery of the programme was typically consistent, or variable, across intervention sites, at different points in the course curriculum, and at the same point in the curriculum but at different points in time. In order to assess these, we conducted observations of two sessions at each of the six intervention sites.

ISM Staff: Martine Stead and Richard Purves

External: Led by Martin White, University of Newcastle


Process Evaluation of the Implementation of Universal Free School Meals in Scotland (2015-2016)
(Commissioned by NHS Health Scotland)

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.

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.

Supporting Healthy Choices
(Commissioned by the Scottish Government)

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

Scientific Advisory Support for Implementation of PAS 2500
(Funded by the Scottish Government)

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

Responsible Advertising and Marketing of Food Publicly Available Specification (PAS)
(Commissioned by the Scottish Government)

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:

  • Incentives and disincentives to stakeholder engagement in the process.
  • Potential barriers to a constructive and timely standards development process.
  • Options and resources available to address and resolve anticipated barriers.
  • Underpinning principles critical to effective and enduringly relevant standards.

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
(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

Systematic Review on 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. 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
(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:

  • School lunches were free from low quality meat products, sugared fizzy drinks, crisps and chocolate or other confectionery.
  • High quality meat, poultry or oily fish was available on a regular basis.
  • Pupils were served a minimum of two portions of fruit and vegetables with every meal.
  • Any deep-fried items were restricted to no more than two portions in a week.
  • The only drinks available were to be water, milk, pure fruit juices, yoghurt drinks and tea/coffee.

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
(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
(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
(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


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