Socio-economic differences in diet, physical activity and leisure-time screen use among Scottish children in 2006 and 2010: are we closing the gap?

OBJECTIVE: To investigate socio-economic differences in children's diet, activity and inactivity and changes in these differences over 4 years during which new policies on food in schools were introduced. DESIGN: Two cross-sectional surveys in which diet was assessed by FFQ and physical activity and inactivity were assessed by interviewer-administered questionnaire. Socio-economic status was assessed by the area-based Scottish Index of Multiple Deprivation. SETTING: Scotland, 2006 and 2010. SUBJECTS: Children aged 3-17 years (n 1700 in 2006, n 1906 in 2010). RESULTS: In both surveys there were significant linear associations between socio-economic deprivation and intakes of energy, non-milk extrinsic sugars (NMES) as a percentage of food energy, sugar-sweetened beverages, confectionery, crisps and savoury snacks and leisure-time screen use (all higher among children in more deprived areas), while intakes of fruit, fruit juice and vegetables showed the opposite trend. In 2010 children in more deprived areas engaged in more physical activity out of school than those in more affluent areas, but between 2006 and 2010 there was an overall reduction in physical activity out of school. There were also small but statistically significant overall reductions in intakes of confectionery, crisps and savoury snacks, energy and NMES and saturated fat as a percentage of food energy, but no statistically significant change in socio-economic gradients in diet or activity between the two surveys. CONCLUSIONS: Interventions to improve diet and physical activity in children in Scotland need to be designed so as to be effective in all socio-economic groups.

Food environments of young people: linking individual behaviour to environmental context.

Background: We aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes. Methods: Young people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008-09) and a study conducted in 2011-12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool. Results: Over 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and 'takeaway and fast food' outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar. Conclusions: This work provides details of 'where' young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments.

Patterns of sugar-sweetened beverage consumption amongst young people aged 13-15 years during the school day in Scotland.

BACKGROUND: There is currently little research regarding sugar-sweetened beverage (SSB) consumption patterns of young people though adolescents are thought to be frequent consumers of these drinks. There is no research regarding the other foods and drinks consumed alongside SSBs by young people. The aim of this paper is to explore the patterns of SSB purchase and consumption amongst young people aged 13-15 years. METHODS: A purchasing recall questionnaire (PRQ) was administered online in seven case study schools with 535 young people aged 13-15 years. Nutrient composition (kilocalories, fat, saturated fat, sodium and sugar) was also calculated for food/drink purchases. Chi-Square and Wilcoxon-Mann Whitney tests were conducted to examine patterns of SSB consumption and sugar/kilocalories consumption for SSB consumers and non-consumers. RESULTS: SSB consumers were significantly more likely to consume a drink at mid-morning break. Fewer consumed food at mid-morning break, ate food before school or ate food at lunchtime, but this was not statistically significant. A higher percentage of SSB consumers consumed 'unhealthy' food and drinks in comparison to young people who did not consume a SSB. Both median lunchtime sugar consumption (40.7 g vs 10.2 g) and median sugar as a percentage of Kcals (39% vs 14%) were significantly higher for SSB purchasers in comparison to non-purchasers. CONCLUSION: The analysis highlights that SSB purchasers consume significantly more sugar at lunchtime than non-purchasers. However, both purchasers and non-purchasers exceeded WHO (2015) recommendations that sugar consumption be halved to form no more than 5% of daily energy intake. This study provides new insights for public health stakeholders and schools. Multifaceted and inventive strategies relevant to young people will be required to achieve the new WHO recommendations.

Food and drink purchasing habits out of school at lunchtime: a national survey of secondary school pupils in Scotland.

BACKGROUND: Food and drink purchasing habits of pupils out of school at lunchtime may be contributing to poor dietary intakes and overweight and obesity. The aim of this study was to identify the places from which purchases were made, types of food and drinks purchased and, the reasons for purchasing food or drinks out of school. METHODS: A survey of the food and drinks purchasing habits of secondary school pupils (11-16 yrs) out of school at lunchtime was conducted in Scotland in 2010. A face-to-face interview and a self-completion questionnaire was designed to identify the food outlets used at lunchtime, types of food and drinks purchased and pupils' reasons for purchasing food or drinks out of school. Height and weight were measured and BMI centiles used to classify pupils as normal weight, overweight or obese. Results were compared by age group, sex, BMI group and level of socio-economic deprivation. RESULTS: Of the 612 pupils who completed the survey, 97 % reported having access to places selling food or drinks out of school at lunchtime, and of these 63 % made purchases. A higher proportion of pupils from more deprived areas reported purchasing food or drinks out of school, but the proportion making purchases did not differ significantly by sex or BMI group. Supermarkets were the outlets from which pupils reported most often making purchases, with fewer purchasing food or drinks from fast food takeaways, and this did not differ significantly by socio-economic deprivation. Reasons for making purchases included availability of preferred food and drinks, some of which are restricted for sale in schools, and social reasons, such as wanting to be with friends. Sandwiches and non-diet soft drinks were items most commonly purchased, followed by confectionery and diet soft drinks. However, less than 10 % of all the secondary school pupils reported purchasing these foods every day. CONCLUSIONS: Supermarkets, not just fast food outlets, should be considered when developing strategies to improve the dietary habits of pupils at lunchtime. The importance of food preferences and social reasons for purchasing food and drinks need to be acknowledged and integrated in future interventions.

Attitudes to weight and weight management in the early teenage years: a qualitative study of parental perceptions and views.

BACKGROUND: As most young teenagers grow up in families, parents might be well situated to facilitate and support their weight management and thereby prevent or manage obesity prior to adulthood. AIM: This paper explores parents' perceptions of, and views about, their teenage children's weight and the factors that influence parents' weight management strategies. DESIGN, SETTING AND PARTICIPANTS: We conducted two qualitative studies in Scotland, UK, involving in-depth interviews with the parents of overweight/obese and 'normal' weight 13-15 year olds (n = 69). FINDINGS: Parents' concerns about their own weight provided useful context for understanding their attitudes or actions with regards to their teenage child. Some parents described their teenager's weight as being of concern to them, although puberty often introduced confusion about a child's weight status. Genetic explanations were very often put forward as a way of making sense of teenage weight or body size. Frustration about advising teenagers about weight management was expressed, and some parents worried about giving their growing child a 'problem' if they directly raised concerns about weight with them. DISCUSSION: Parents' views about their own weight as well as social and moral norms about labelling a teenager as overweight or as needing help with their weight could usefully inform patient-centred service development. Parent/teenage partnerships and supporting parents to create a healthy home in which teenagers can make healthier choices are suggestions for intervention development. CONCLUSION: The study highlights the importance of taking parents' perceptions into account when developing family-based interventions to address teenage overweight and obesity.

'I don't think I ever had food poisoning'. A practice-based approach to understanding foodborne disease that originates in the home.

Food stored, prepared, cooked and eaten at home contributes to foodborne disease which, globally, presents a significant public health burden. The aim of the study reported here was to investigate, analyse and interpret domestic kitchen practices in order to provide fresh insight about how the domestic setting might influence food safety. Using current theories of practice meant the research, which drew on qualitative and ethnographic methods, could investigate people and material things in the domestic kitchen setting whilst taking account of people's actions, values, experiences and beliefs. Data from 20 UK households revealed the extent to which kitchens are used for a range of non-food related activities and the ways that foodwork extends beyond the boundaries of the kitchen. The youngest children, the oldest adults and the family pets all had agency in the kitchen, which has implications for preventing foodborne disease. What was observed, filmed and photographed was not a single practice but a series of entangled encounters and actions embedded and repeated, often inconsistently, by the individuals involved. Households derived logics and principles about foodwork that represented rules of thumb about 'how things are done' that included using the senses and experiential knowledge when judging whether food is safe to eat. Overall, food safety was subsumed within the practice of 'being' a household and living everyday life in the kitchen. Current theories of practice are an effective way of understanding foodborne disease and offer a novel approach to exploring food safety in the home.

Socioeconomic Differences and the Potential Role of Tribes in Young People's Food and Drink Purchasing Outside School at Lunchtime.

Socioeconomic deprivation has been linked to food consumption practices, but studies investigating the food environment around schools provide mixed findings. Peer influence and marketing cues are considered important influencers of young people's behaviors. This study used a tribal theory lens to investigate the factors affecting pupils' purchasing and consumption of food/drinks outside schools at lunchtime. A survey was conducted with 243 pupils from seven UK secondary schools of differing socioeconomic status (SES). A purchasing recall questionnaire (PRQ) was developed and administered online at the participating schools to capture food and drink purchasing, intake, and expenditure. No significant differences were found in terms of energy and nutrients consumed or food/drink expenditure between pupils from schools of lower and higher SES. Enjoyment of food shopping with friends was linked with higher food energy intake and spend. Higher susceptibility to peer influence was associated with greater influence from food advertising and endorsements. Without ignoring the impact that SES can have on young people's food choices, we suggest that tribal theory can be additionally used to understand pupils' eating behaviors and we present implications for social marketers and policy makers.

Making sense of eating, weight and risk in the early teenage years: views and concerns of parents in poorer socio-economic circumstances.

This paper reports findings from a qualitative study which examined the perceptions and understandings underpinning the dietary practices in families with 'normal' weight and 'overweight' young teenagers living in poorer socio-economic circumstances. Thirty four parents/main food providers of boys and girls aged 13-14 years from socio-economically disadvantaged areas in Eastern Scotland were interviewed. Within the home there was a strong acknowledgement of these early teenagers' own food preferences; parents also saw them as having increasing responsibility for their own food choices outwith the home but these were often described as 'not healthy' choices. However, parents saw dietary issues as of fairly low priority in the hierarchy of health-relevant and other risks facing their teenagers. Equally, these interviewees felt that issues around body shape and size at this age were less potentially problematic than the risks to teenagers' mental or physical health of their becoming obsessed with weight loss. Parents often made sense of their teenager's body size and shape in terms of the variety of body types in families and inherited traits. Interviewees seemed to lack a discourse to understand weight and overweight in this age group, falling back on understandings derived from the adult lifestage.

Children's Food and Drink Purchasing Behaviour "Beyond the School Gate": The Development of a Survey Module.

Many children eat a diet which supplies a higher than recommended amount of nonmilk extrinsic sugars and saturated fatty acids. The school setting is often targeted for nutrition intervention as many children consume food at school. In Scotland, attempts have been made to improve the nutritional content of food in schools and attention has now turned to food and drink available "beyond the school gate." This paper describes the development of a module on food and drink purchasing behaviour. The Food Purchasing Module was designed to collect data, for the first time, from a representative sample of children aged 8-16 years about food and drinks purchased on the way to/from school, during break time/free periods, and at lunchtime, from outlets around schools. Cognitive testing of the module highlighted that younger children find self-completion questionnaires problematic. Older children have fewer problems with self-completion questionnaires but many do not follow question routing, which has implications for the delivery of future surveys. Development of this survey module adds much needed evidence about effectively involving children in surveys. Further research exploring food and drinks purchased beyond the school gate is needed to continue to improve the nutritional quality of children's diets.

Food, eating and taste: parents' perspectives on the making of the middle class teenager.

This paper reports findings from a qualitative study of views and understandings of dietary practices in middle class families. Thirty five parents/main food providers of boys and girls aged 13/14 years, living in Eastern Scotland, were interviewed about their and their teenagers' everyday lives, food, health and family practices. One of our aims was to understand more about the social and cultural conditions which might be promoting more positive dietary health and physical well-being amongst middle class families. Most parents' accounts appeared rooted in a taken-for-grantedness that family members enjoyed good health, lived in relatively secure and unthreatening environments regarding health and resources, and were able to lead active lives, which they valued. Although controlling teenagers' eating practices was presented as an ongoing challenge, active supervision and surveillance of their diets was described, as was guiding tastes in 'the right direction'. Parents described attempts to achieve family eating practices such as commensality, cooking from scratch, and encouraging a varied and nutritional 'adult' diet and cosmopolitan tastes, though work and activities could compromise these. These middle class families might be characterized as having future oriented 'hierarchies of luxury and choice', in which controlling and moulding teenagers' food practices and tastes was assigned a high priority.