Reducing the volume, exposure and negative impacts of advertising for foods high in fat, sugar and salt to children: a systematic review of the evidence from statutory and self-regulatory actions and educational measures

Purpose: To identify and review evidence on 1) the effectiveness of statutory and self-regulatory actions to reduce the volume, exposure or wider impact of advertising for foods high in fat, sugar and salt (HFSS) to children, and 2) the role of educational measures. Design/methodology/approach: A systematic review of three databases (Medline, CINAHL and PsycINFO) and grey literature was carried out. Relevant evidence included studies evaluating advertising bans and restrictions, advertising literacy programmes and parental communication styles. Relevant media included TV, internet, radio, magazines and newspaper advertising. No studies were excluded based on language or publication date. Findings: Forty-seven publications were included: 19 provided evidence for the results of statutory regulation, 25 for self-regulation, and six for educational approaches. Outcome measures varied in approach, quality and results. Findings suggested statutory regulation could reduce the volume of and children's exposure to advertising for foods HFSS, and had potential to impact more widely. Self-regulatory approaches showed varied results in reducing children's exposure. There was some limited support for educational measures. Discussion: Consistency in measures from evaluations over time would assist the development and interpretation of the evidence base on successful actions and measures to reduce the volume, exposure and impact of advertising for foods HFSS to children

Time to address the double inequality of differences in dietary intake between Scotland and England

Geographical disparities in health outcomes have been evident across the UK for decades. There is limited recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. Twelve years of UK food purchase data (2001-2012) were pooled and used to estimate household level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than England (e.g. fruit and vegetables 267g/day (99%CI 259-274g/day) vs. 298g/day (99%CI 296-301g/day), P<0.001). Likewise, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower income groups (e.g. red and processed meat consumption in the lowest income quintile was 65g/day (99% CI 61-69g/day) in Scotland vs. 58g/day (99% CI 57-60g/day) in England, P<0.001, but similar in the highest income quintile (58g/day (99%CI 54-61 g/day) vs. 59g/day (99% CI 58-60 g/day) respectively). A poorer diet in Scotland compared to England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries

Identifying dietary differences between Scotland and England:a rapid review of the literature

Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England.A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted.Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders.Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities

Weight management for overweight and obese men delivered through professional football clubs : a pilot randomized trial

Peer reviewedPublisher PD

SWAT 76 evaluation:Randomised evaluation of sending pre-notification cards to trial participants before a face-to-face primary outcome measurement to increase attendance

Grant information: The SWAT evaluation and the ActWELL trial were funded by the Scottish Government (BC/Screening/17/01). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).Publisher PD

Awareness of lifestyle and colorectal cancer risk:findings from the BeWEL study

It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration.Additional co-author: The BeWEL team. The BeWEL Team consists of Shaun Treweek, Fergus Daly, Jill Belch, Jackie Rodger, Alison Kirk, Anne Ludbrook, Petra Rauchhaus, Patricia Norwood, Joyce Thompson, and Jane Wardle

‘It was called a grab bag and nobody wanted to grab them’:Teachers’ perceptions of school lunches during the COVID-19 pandemic - a regional case study

Background: The COVID-19 pandemic brought changes to school lunches leading to concerns over acceptability and uptake by vulnerable children. Data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (uptake pre-pandemic was 66%). The current work aimed to identify teachers’ perceptions of meal provisioning in primary schools during the first year of the pandemic. Methods: Using an online survey (21 multiple choice questions and open text) and interviews, primary school teachers shared their views on food quality, quantity, choices, and factors influencing uptake of school lunches. Interviews were recorded, transcribed, and thematically analysed according to factors influencing consumption.Results: The survey was completed by 41 teachers and eight undertook interviews. Around one third (29%) believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively due to the substitution of the hot lunch with sandwiches, portion sizes, choice, and perceived value for money. Concerns were expressed about acceptability and how far meals contributed to food security.Conclusions: Further work on food provisioning is needed to identify ways to provide a nutritional safety net for vulnerable children

Meeting the challenges of recruitment to multicentre, community-based, lifestyle-change trials : a case study of the BeWEL trial

Peer reviewedPublisher PD

Letter on “Sharing trial results directly with trial participants and other stakeholders after the SARS-CoV-2 pandemic hit the UK:experience from the ActWELL trial

Acknowledgements We would like to thank our ActWELL participants who attended the events for their interest and enthusiasm in making the events a success. We would like to thank Susan MacAskill for giving us permission to use a quote from her email to us. We are also grateful to the technical support who got us through all events, Cormac Staunton (of stauntonmedia.ie). We would also like to acknowledge and thank Dr Katie Gillies and Dr Seonaidh Cotton for their contribution to the design of the evaluation survey. HSRU is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. This work was supported by The Scottish Government, grant number BC/ Screening/17/01.Peer reviewedPublisher PD