Claire Thompson

Understanding interactions with the food environment: An exploration of supermarket food shopping routines in deprived neighbourhoods.

Despite a sustained academic interest in the environmental determinants of diet, relatively little is known about the ways in which individuals interact with their neighbourhood food environment and the use of its most important element, the supermarket. This qualitative study explores how residents of deprived neighbourhoods shop for food and how the supermarket environment influences their choices. Go-along interviews were conducted with 26 residents of Sandwell, a uniformly deprived metropolitan borough in the West Midlands, UK. Routine approaches to food shopping are characterised in terms of planning and reliance on the supermarket environment. Four distinct routines are identified: chaotic and reactive; working around the store; item-by-item; and restricted and budgeted. This suggests that residents of deprived neighbourhoods do not have uniform responses to food environments. Responses to supermarket environments appear to be mediated by levels of individual autonomy. A better understanding of how residents of deprived neighbourhoods interact with their food environment may help optimise environmental interventions aimed at improving physical access to food in these places.

The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families

Introduction Recent systematic reviews suggest that there is a dearth of evidence on the effectiveness of large-scale urban regeneration programmes in improving health and well-being and alleviating health inequalities. The development of the Olympic Park in Stratford for the London 2012 Olympic and Paralympic Games provides the opportunity to take advantage of a natural experiment to examine the impact of large-scale urban regeneration on the health and well-being of young people and their families. Design and methods A prospective school-based survey of adolescents (11–12 years) with parent data collected through face-to-face interviews at home. Adolescents will be recruited from six randomly selected schools in an area receiving large-scale urban regeneration (London Borough of Newham) and compared with adolescents in 18 schools in three comparison areas with no equivalent regeneration (London Boroughs of Tower Hamlets, Hackney and Barking & Dagenham). Baseline data will be completed prior to the start of the London Olympics (July 2012) with follow-up at 6 and 18 months postintervention. Primary outcomes are: pre–post change in adolescent and parent mental health and well-being, physical activity and parental employment status. Secondary outcomes include: pre–post change in social cohesion, smoking, alcohol use, diet and body mass index. The study will account for individual and environmental contextual effects in evaluating changes to identified outcomes. A nested longitudinal qualitative study will explore families’ experiences of regeneration in order to unpack the process by which regeneration impacts on health and well-being. Ethics and dissemination The study has approval from Queen Mary University of London Ethics Committee (QMREC2011/40), the Association of Directors of Childrens Services (RGE110927) and the London Boroughs Research Governance Framework (CERGF113). Fieldworkers have had advanced Criminal Records Bureau clearance. Findings will be disseminated through peer-reviewed publications, national and international conferences, through participating schools and the study website (http://www.orielproject.co.uk).

What does it mean to be a 'picky eater'? A qualitative study of food related identities and practices.

Picky eaters are defined as those who consume an inadequate variety of food through rejection of a substantial amount of food stuffs that are both familiar and unfamiliar. Picky eating is a relatively recent theoretical concept and while there is increasing concern within public health over the lack of diversity in some childrens diets, adult picky eaters remain an under researched group. This paper reports on the findings of a qualitative study on the routine food choices and practices of 26 families in Sandwell, West Midlands, UK. Photo elicitation and go-along interview data collection methods were used to capture habitual food related behaviours and served to describe the practices of nine individuals who self identified or were described as picky eaters. A thematic analysis revealed that those with the food related identity of picky eater had very restricted diets and experienced strong emotional and physical reactions to certain foods. For some this could be a distressing and alienating experience that hindered their ability to engage in episodes of social eating. Further research is needed to illuminate the specific practices of adult picky eaters, how this impacts on their lives, and how possible interventions might seek to address the challenges they face.

Everyone was looking at you smiling: East London residents' experiences of the 2012 Olympics and its legacy on the social determinants of health.

Mega-sporting event regeneration, as a specific approach to urban renewal, uses impending host-city status as a catalyst for revitalisation and has the potential to improve health both through addressing deprivation and by promoting increased sport and physical activity among the host-citys population. This qualitative study explored how hosting of the London 2012 Games impacted upon the way East London residents perceived and experienced the social determinants of health in their local neighbourhood. We conducted narrative family interviews, go-along interviews and video focus group workshops with 66 Newham residents, aged 12-55 years, immediately after the Games. A narrative analytic approach examined accounts of health and wellbeing experiences in terms of neighbourhood change and the spectacle of the Games. Participants of this qualitative study generally welcomed the respite and the unexpected chance to live in a cleaner, safer and more unified environment. However, this positivity was underscored by an acute awareness that this was a very temporary situation and one that was intended to support the event rather than residents.

A health and social legacy for East London: Narratives of 'problem' and 'solution' around London 2012

Policies and programmes that tackle neighbourhood deprivation have long been a feature of urban policy in the UK and elsewhere. Large-scale urban regeneration and neighbourhood renewal programmes have been deployed as the primary vehicle to improve the health and life chances of residents of deprived neighbourhoods. Often these areas have a long history of efforts at regeneration and redevelopment and, over time, have become labelled as ‘problem areas’ in need of constant intervention. The bid for the London 2012 Olympic and Paralympic Games was successful partly due to its promise to deliver a lasting health and social legacy by using the Games as a driver of regeneration in East London. Despite limited evidence for the effectiveness of such an approach, regeneration schemes tied to sporting events have emerged as popular strategies through which cities strive to enhance their urban fabric. Running through the core of the London 2012 bid was a discourse of East London as a ‘problem’ in need of a regeneration ‘solution’ that the Olympics uniquely could deliver. As a result, a wider narrative of East London was generated: as unhealthy; mired in poverty; desperate for jobs; with an inadequate and outdated built environment. The Olympic legacy was thus positioned as a unique once-in-a-lifetime solution ‘accelerating’ regeneration in East London, and delivering substantive change that either might not have happened, or would otherwise have taken decades. Through documentary analysis of published Government policy documents for the period 2002-2011, we demonstrate how the ‘problem’ of East London was used as political justification for London 2012. We argue that the Olympic legacy was deliberately positioned in neoliberal terms in order to justify substantial economic investment by the UK government and suit the needs of the International Olympic Committee. Finally, whilst acknowledging that regeneration may indeed result, we also speculate on the potential legacy and possible challenges for the people in East London left by this neoliberal and entrepreneurial strategy.

Change in non-alcoholic beverage sales following a 10-pence levy on sugar-sweetened beverages within a national chain of restaurants in the UK: interrupted time series analysis of a natural experiment

Background This study evaluates changes in sales of non-alcoholic beverages in Jamie’s Italian, a national chain of commercial restaurants in the UK, following the introduction of a £0.10 per-beverage levy on sugar-sweetened beverages (SSBs) and supporting activity including beverage menu redesign, new products and establishment of a children’s health fund from levy proceeds. Methods We used an interrupted time series design to quantify changes in sales of non-alcoholic beverages 12 weeks and 6 months after implementation of the levy, using itemised electronic point of sale data. Main outcomes were number of SSBs and other non-alcoholic beverages sold per customer. Linear regression and multilevel random effects models, adjusting for seasonality and clustering, were used to investigate changes in SSB sales across all restaurants (n=37) and by tertiles of baseline restaurant SSB sales per customer. Results Compared with the prelevy period, the number of SSBs sold per customer declined by 11.0% (−17.3% to −4.3%) at 12 weeks and 9.3% (−15.2% to −3.2%) at 6 months. For non-levied beverages, sales per customer of children’s fruit juice declined by 34.7% (−55.3% to −4.3%) at 12 weeks and 9.9% (−16.8% to −2.4%) at 6 months. At 6 months, sales per customer of fruit juice increased by 21.8% (14.0% to 30.2%) but sales of diet cola (−7.3%; −11.7% to −2.8%) and bottled waters (−6.5%; −11.0% to −1.7%) declined. Changes in sales were only observed in restaurants in the medium and high tertiles of baseline SSB sales per customer. Conclusions Introduction of a £0.10 levy on SSBs alongside complementary activities is associated with declines in SSB sales per customer in the short and medium term, particularly in restaurants with higher baseline sales of SSBs.

How might the London 2012 Olympics influence health and the determinants of health? Local newspaper analysis of pre-Games pathways and impacts.

Objectives To conduct a content analysis of pre-Games local media coverage of the potential impact on health and the determinants of health in Newham, the site of the Olympic Park. Design Local newspaper content analysis. Setting Olympic park host site of the London Borough of Newham. Outcome measures Media coverage of employment, physical activity and well-being. Results Three hundred and 51 articles meeting the inclusion criteria were included in the analysis. The overwhelming majority of the articles took a positive perspective on the Olympic Games being hosted in Newham with less than 10% (32/351) addressing potential adverse effects. The frequency of articles reporting on both employment and well-being increased significantly over time (p=0.002 and p=0.006, respectively). A non-significant increasing trend was observed for physical activity (p=0.146). New employment opportunities and the promotion of physical activity in young people were the pathways most frequently reported in the local media. However, much less attention is devoted to understanding the uncertainties about how much of these new opportunities will directly improve the determinants of health in the Newham population. Conclusions Pre-Games reporting on the impact on health and the determinants of health increased over time in the London Borough of Newham, and is overwhelmingly positive. However, specific uncertainties around the true nature of its impact on local employment and physical activity were articulated. Further evaluation of the tangible impacts on population health, and the determinants of health and health inequalities from the London 2012 Olympics, is required.

Contrasting approaches to 'doing' family meals: a qualitative study of how parents frame children's food preferences.

Abstract Family meals, as acts of domestic food provisioning, are shaped by the competing influences of household resources, food preferences and broader cultural norms around dietary practices. The place of children’s food tastes in family meal practices is particularly complex. Food tastes stand in a reciprocal relationship with family food practices: being both an influence on and a product of them. This paper explores how parents think about and respond to their children’s food preferences in relation to family meal practices. A qualitative study was conducted with residents of Sandwell, UK. The results presented here are based on the responses of nine key participants and their families. Photo elicitation methods generated participant food photo diaries that were used to inform subsequent interviews. A thematic analysis revealed two contrasting ways of incorporating children’s tastes into family meal routines: (1) ‘what we fancy’ and (2) ‘regulated’. The former entails repeatedly consulting and negotiating with children over what to cook for each meal. It is supported by the practical strategies of multiple and individually modified meals. The latter relies upon parents developing a repertoire of meals that ‘work’ for the family. This repertoire is performed as a series of ‘set meals’ in which any requests for variation are strongly resisted. Our findings add to the small body of literature on household food provisioning and suggest that achieving the idealised ritual of the family meal is underpinned by a range of values and strategies, some of which may run counter to health messages about nutrition.

Proportional responsibility versus individual responsibility for healthy eating: a complex systems analysis

Abstract Background Most public health interventions on diet place responsibility on individuals (eg, to use information to make healthy food choices); on a population level, such strategies are ineffectual. Here we report on research into perceptions of responsibility for healthy eating, using a complex systems framework. The aim of the research was to provide insights into the impact of the food system—rather than single variables—on the publics diet. Methods The data gathered comprised eight industry and government documents, from the baseline of Foresights 2007 obesity report to the 2011 Public Health Responsibility Deal, including corporate signatories to the latter; eight focus groups with members of the public; and 18 interviews with representatives from sectors responsible for creating the food environment (ie, food industry, government, and non-governmental organisation). Responsibility for healthy eating was explored using Foucauldian discourse analysis; this incorporated consideration of the properties of complex systems, such as the inter-relatedness of actors and the fluid, non-linearity of interactions, interventions, and outcomes. Findings The data show that despite claims of shared responsibility for dietary behaviour, government and corporations use rhetoric and measures that deflect regulations or action for which they are responsible that could help improve the populations diet, such as food reformulation or advertising restrictions. They also favour downstream interventions, such as food labelling, that place high agency on individuals, rather than more effective, upstream, regulatory or fiscal strategies. Interpretation Problematising responsibility highlights how the onus is mostly on individuals for healthy food choices even though individuals themselves have the least power over key drivers of those choices: taste, cost, convenience, promotions. A complex systems approach helps explain how the mismatch between power and responsibility contributes to a food system in which many people consume diets detrimental to their health. Proportional responsibility offers a counterfactual framework to the dominant policies that attribute ultimate responsibility for eating healthily to individuals, given that they have proportionally less influence over the determinants of their food choices than do government and the food industry. This concept could be explored as a potential framework for examining whether policies attribute responsibility for health-promoting behaviour proportionally to a groups capacity to act. Funding This research was funded by Queen Mary University of London and the London School of Hygiene & Tropical Medicine as a PhD scholarship (to NS).

Identifying populations and areas at greatest risk of household food insecurity in England

Despite the increasing recognition of household food insecurity as a policy issue, there is currently no routine measurement of food insecurity in the UK. There is nothing to suggest that Government will address this in the near future for all parts of the UK. In which case, policy makers and campaigners might instead seek out consistent and robust measures of the population-level factors which are known to contribute to food insecurity. However, no systematic measures exist, meaning that resources may not be targeted at those areas most in need. This paper presents the first objective estimate of high population-level risk of household food insecurity in English neighbourhoods (4.09% of the population, 95%CI 4.08-4.10) using public data. Estimated geographic distribution of factors contributing to household food insecurity is customisable to local pressures and is adaptable to settings outside of England.