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RES E A R C H Open Access
Food and drink purchasing habits out of
school at lunchtime: a national survey of
secondary school pupils in Scotland
Jennie I. Macdiarmid
1*
, Wendy J. Wills
2
, Lindsey F. Masson
3,4
, Leone C A Craig
1
, Catherine Bromley
5,6
and Geraldine McNeill
1,4
Abstract
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, typ es 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 we re compared by age g roup, 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 ou t of scho ol at lu nchtime, and of the se 63 % made p urchases. A higher proportion of pupils from more
deprived areas repo rted purchas ing food or dri nks out of sc hool, but the p ropo rtion 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.
Keywords: School, Children, Lunchtime, Food purchase, Supermarkets, Socio-economic deprivation
Background
Unhealthy eating habits are contributing to the high
prevalence of overweight and obesity among young
people in many countries. Thirty one percent of young
people aged 12–15 years in Scotland [1] and 35 % of
12–19 year olds in the USA [2] are classified as over-
weight or obese. In the UK the inta ke of sugar (non-milk
extrinsic sugars (NMES), similar to ‘free sugars’
1
) and
saturated fatty acids among 11–18 year olds are substan-
tially higher than the recommended population average
[3, 4]. It is estimated that 30 % of NMES come from soft
drinks, 20 % from table sugar, syrups, preserves (jams
and honey) and confectionery (sugar and chocolate) and
10 % from fruit juices and smoothies [4]. The high con-
sumption of soft drinks is not unique to the UK. In
Scotland, 32 % of boys and 21 % of girls aged 15 years
report drinking soft drinks daily, compared with 33 % of
* Correspondence: j.macdiarmid@abdn.ac.uk
1
Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
Full list of author information is available at the end of the article
© 2015 Macdiarmid et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Macdiarmid et al. International Journal of Behavioral Nutrition
and Physical Activity (2015) 12:98
DOI 10.1186/s12966-015-0259-4
boys and 31 % of girls of the same age in the United
States, and 45 % of boys and 31 % of girls in the
Netherlands [5]. A reduction in consumption of soft drinks
has been targeted in many public health strategies to im-
prove dietary intakes, especially among children [6, 7].
Schools are considered an important place to provide
an environment for healthy eating and this has become
a focus for government policy in tackling poor eating
habits and public health problems. All EU countrie s have
some school food policies based on either mandatory
regulations or voluntary guidelines to promote healthy
eating, many of which include restricting the sale of
sugar-sweetened beverages and sweet snacks [7]. In
Scotland, the Schools (Health Promotion and Nutrition)
Scotland Act 2007 set nutrient standards for school
meals, prohibited the sale of specific food and drinks in
schools (e.g. confectionery, sugar-sweetened be verages)
and limits the sale of savoury snacks high in fat and salt
[6]. After legislation or voluntary guidelines were set for
schools the attention shifted towards the types of food
and drinks available at outlets in the vicinit y of schools.
Since only 44 % of secondar y school pupils in Scotland
and 38 % in England eat lunch provided by their school
[8, 9], it was viewed that the food and drinks purchased
from other sources needs consideration.
It was estimated that there are an average of 23 ‘junk
food outlets’ in the vicinity of every secondary school in
England [10], with similar findings reported in Glasgow,
Scotland [11]. Much of the research on purchasing food
around schools has focused on the location and accessi-
bility of takeaway and fast food outlets, particularly in
deprived areas [12 –14]. Concern about the proximity
and easy access to fast food outlets being a contributory
factor in the epidemic of obesity has stimulated
much of the research, however the evidence to sup-
port this as sociation is based mainly on obser vational
studies [15–17].
Fast food outlets are only one of many places from
which young people can purchase food or drinks out of
school, and little is known about the usage of other out-
lets or the factors motivating purchases of food or drinks
out of school. The aim of this research was to identify
the range of food outlets that secondary school pupils
(aged 11–16 years) access at lunchtime, to explore some
of the factors associated with food and drink purchasing
habits out of school at lunchtime, and to compare pur-
chasing habits by age group, sex , BMI group and level of
socio-economic deprivation.
Methods
The Survey of Diet Among Children in Scotland (2010)
assessed dietary intakes, prevalence of overweight and
obesity and physical activity levels in a nationally repre-
sentative sample of children and young people aged
3–16 years living in Scotland [18]. Children aged 8 years
and older in the survey completed an additional module
on food purchasing habits (FPH) out of school [19]. A
detailed description of the survey methods has been pub-
lished previously [18]. In summary, a sample of 3048
children were invited to take part in the survey, recruited
using the Child Benefit records held by HM Revenue and
Customs (national family welfare register), with data col-
lected between June and November 2010. After an initial
opt out period, the remaining 2712 participants were sent
a food frequency questionnaire (FFQ) to complete, which
was collected by a trained field worker when they visited
the home to conduct a face-to-face interview. Interviews
were completed with 1906 children and 1816 returned an
FFQ. After exclusions for incomplete data (3 %) and ex-
treme energy intakes (5 %) 1674 FFQs were included in
the analysis. During the interview, socio-demographic
characteristics were collected, the child’s height and
weight measured and the FPH module administered. Six
hundred and fifty six children were eligible to complete
the FPH.
Food purchasing habits
The FPH module for secondary school pupils comprised
a combination of interviewer administered questions and
a self-completion questionnaire [20]. A self-completion
questionnaire was used because the interview was con-
ducted in the presence of a parent or guardian and it was
thought that some questions could be sensitive, for ex-
ample some parents may not be aware their child was
purchasing food or drinks out of school. The FPH mod-
ule was designed for this survey and pre-tested using
cognitive interviewing techniques to ensure usability and
correct interpretation of the questions. It included ques-
tions about the pupil’s perceived opportunities to pur-
chase food or drinks out of school, reported purchasing
of food or drinks out of school, a description of the places
food or drinks were purchased from and the reasons for
choosing to purchase food or drink out of school. The
majority of the questions were closed answer list s, which
were developed using a combination of expert knowledge
and feedback from the pilot interviews. Free text space
was included for pupils to add an option not listed. When
answering the questions pupils were asked to con-
sider their purchasing ha bits in “a usual school
week”. Purchases only included items bought by the
pupil for themselves , and not items bought for them
by other p eople.
Dietary assessment
Habitual dietary intake was assessed using the Scottish
Collaborative Group semi-quantitative FFQ (http://
www.foodfrequency.org Accessed Jan 8 2015) which was
completed by the pupils with help from their parent or
Macdiarmid et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:98 Page 2 of 8
guardian. They were asked to estimate the frequency of
consumption of 148 food and drink items in a typical
week, from one of nine options (ranging from ‘rarely or
never’ to ‘seven or more times a day’). The relative valid-
ity of the FFQ for assessing NMES intake as percentage
of food energy was assessed in a similar population,
comprising a subsample of 153 children aged 3–17 yrs
who completed both the FFQ and a 4-day food diary in
an earlier survey [21]. There was no significant differ-
ence between median intakes of NMES (expressed as a
percentage of food energy) from the FFQ and a 4 day
food diary (16.0 % vs. 14.9 %).
Weight status and socio-economic deprivation
Height and weight were measured and normal weight,
overweight (not obese) and obesity were defined as a
BMI <85th
,
≥85th to <95th and ≥95th percentiles , re-
spectively, based on the 1990 UK centile charts [22].
Socio-economic deprivation wa s assessed using the
Scottish Index of Multiple Deprivation (SIMD), which
provides a relative measure of deprivation by area based
on home postcode. It combines indicators over seven
domains including income, employment , health, edu-
cation, skills and training, housing, geographic access
and crime [23]. SIMD is presented as quintiles of
deprivation, with SIMD quint ile 1 bei ng the highest
level of deprivation.
Data analysis
Statistical analysis was carried out using the complex
surveys module in SPSS Statistics version 19.0 (SPSS
Inc., IBM Company, USA). The data were weighted to
take account of selection and non-response bias [18],
but unweighted sample numbers are presented in the ta-
bles. Six hundred and twelve pupils returned the FPM
from which four pupils were excluded as they reported
they did not have access to places that sell food and
drinks out of school, and therefore lacked the opportun-
ity to purchase food or drinks at lunchtime. The vari-
ation in sample size for the different analyses is
explained by missing data for individual questions, or
excluded data for questions that were completed incor-
rectly, e.g. more than one option selected when respon-
dents were asked to select only one option. Differences
in the proportion of pupils who reported purchasing
food or drinks out of school by age group, sex, quintiles
of SIMD and BMI group were assessed using the
Pearson chi-squared statistic for complex samples.
Habitual dietary intakes of energy, total fat, saturated
fatty acids and NMES, expressed as a percentage of food
energy, were compared between pupils who reported
purchasing food or drinks out of school at lunchtime
and those who did not using general linear mod els
adjusted for age, sex and SIMD quintile.
Ethics approval
The protocol for the study was reviewed and given
favourable opinion by the National Centre for Social
Research Ethics Committee (Application: P7070 Scottish
Children’s Diet Survey 2010). Informed consent was
obtained from both the parent/guardian and the child
prior to participating in the study.
Results
Six hundred and fifty six secondary school pupils aged
11–16 years were eligible to participated in the FPH
survey, of whom 612 (93.3 %) completed it, with the ma-
jority (n = 608, 96.5 %) reporting that there were places
close to their school from which they could purchase
food or drinks at lunchtime. Table 1 shows the percent-
age of pupils with access to such places who ‘ever’
bought food or drinks out of school, which wa s derived
from the question “do you ever buy food or drink out
the school grounds at lunchtime?” The frequency of pur-
chasing could therefore vary between pupils, for example
from daily to only very occasionally Sixty-three percent
of pupils with access to places selling food or drinks re-
ported that they purchased food or drinks out of school
Table 1 Percentage of pupils (with access) who report ever
purchasing food or drinks out of school at lunchtime
n % p-value
All* 608 63.0
Sex 0.077
boys 304 66.1
girls 304 59.1
Deprivation (SIMD) 0.015
1 (most deprived) 104 76.0
2 122 64.0
3 139 60.5
4 113 63.0
5 (least deprived) 130 52.6
BMI groups** 0.106
not overweight or obese 392 62.5
overweight, not obese 89 70.0
obese 103 55.3
School year 0.002
1 (11-12 yrs) 148 63.2
2 (12-13 yrs) 145 71.5
3 (13-14 yrs) 99 70.5
4 (14-15 yrs) 103 52.8
5 & 6 (15-16 yrs) 113 49.2
*sample of 608 excludes 4 pupils who reported that they did not have access
to places selling food or drinks out of school at lunchtime. **BMI groupings:
not overweight or obese <85th percentile, overweight, not obese ≥85th to <95th
percentile, obese ≥95th percentile
Macdiarmid et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:98 Page 3 of 8
at lunchtime. Pupils living in more deprived areas and
older pupils (aged 13–16 years) were more likely to re-
port purchasing food or drinks out of school at lunch-
time, but purchasing did not differ significantly by BMI
group or sex.
Some pupils purchased food or drinks from several
different places and collectively the most common places
were supermarkets, newsagents and sandwich shops/
bakeries. Fewer pupils made purchases at takeaway and
other fast food outlets. When asked which one place
they most often made purchases, supermarkets were the
most commonly reported, with a quarter of pupils
reporting making purchases there, followed by sandwich
shops/bakeries (Table 2). The places from which pupils
reported purchasing food or drinks did not differ signifi-
cantly by socio-e conomic deprivation. In addition to
purchasing food or drinks at lunchtime, 73.4 % of pupils
reported being able to access places selling food or
drinks out of school at break times, and of those with
access 23.8 % reported purchasing food or drink at this
time. Boys rather than girls (31.9 % vs 15.4 %, p < 0.001)
and older pupils (S1 to S5: 18.7 %, 14.0 %, 25.2 %.,
24.8 %, 33.3 % p = 0.042) were more likely to purchase
food or drinks out of school during break times but this
did not differ significantly across deprivation groups.
Reasons for purchasing food or drinks out of school and
for leaving the school
Reasons for purchasing food or drinks out of school and
for leaving the school grounds at lunchtime are shown
in Table 3. The most common rea sons given for pur-
chasing food or drinks from the places where they most
often made purcha ses related to liking the taste and var-
iety of foods sold in these outlets. Value for money and
the proximity of the outlet to the school were other im-
portant determining factors. Fifteen percent of pupils
reported that they bought food at these outlets because
they thought they were healthy. The most common rea-
sons given for leaving the school grounds at lunchtime
to purchase food or drinks were to be with friends and
to get food that was unavailable in school. Only a small
minority of pupils thought that school meals were ex-
pensive and gave this as a reason for purchasing food or
drinks out of school.
Types of food and drinks purchased out of school
Sandwiches and non-diet soft drinks were the items
most commonly purchased daily (Table 4). Non-diet soft
drinks were reported to be purchased every day by
12.6 % of pupils and at least once a week by 60.5 % of
the pupils who reported ever purchasing food or drink
out of school at lunchtime. Confectionery was reported
as purchased everyday by 7.6 % of pupils and at lea st
once a week by 68.6 % of pupils reporting to ever pur-
chase food or drinks. To put the prevalence of purchas-
ing by secondary school pupils into a wider context, of
those who completed the FPH module and had the
opportunity to purchase food and drinks out of school
(n = 608), only 7.8 % and 4.7 % reported buying non-diet
soft drinks or confectionery, respectively, out of school
every day at lunchtime. However 91 % and 98 % of pu-
pils of this age in the survey reported consuming these
items , respectively, whic h were also the largest contribu-
tor to NMES in the diet of pupils in survey (16 % and
13 % respectively) [18].
Dietary intakes
The intake of NMES (as percentage of food energy) in
the habitual diets of pupils who ever purchased food or
drinks out of school at lunchtime w as higher than
those pupils who did not make purcha ses out of
school (mean (95 % CI): ever 18.6 % (17.7-19.4) vs.never
Table 2 Food outlets from which pupils report most often or ever purchasing food or drinks at lunchtime
Most often purchase Outlets pupils ever purchase food or drinks**
% pupils (n = 262) %
pupils
(n =
374)
Deprivation (SIMD quintile)
Least deprived
(n = 76)
4 (n = 88) 3 (n = 60) 2 (n = 65) Most deprived
(n = 85)
p-value
Supermarkets 25.4 41.1 42.7 50.1 43.6 33.8 35.6 0.285
Sandwich shop or bakery 19.3 42.4 48.7 49.6 38.6 42.6 33.4 0.250
Takeaways, fast food, chip shops 17.2 36.5 33.8 29.0 31.1 46.6 41.2 0.133
Newsagents, sweet shops 12.2 49.0 42.6 46.3 37.7 53.1 60.2 0.083
Grocery or corner shops 8.6 27.8 25.5 21.3 30.4 37.3 27.0 0.271
Cafe, coffee shops, restaurants 5.9 15.0 16.5 9.2 22.0 18.1 12.6 0.278
Burger, chip or ice cream van 4.3 16.3 10.9 11.6 14.1 16.8 25.7 0.066
Garage, petrol station 2.2 12.0 9.8 10.3 19.6 19.2 5.5 0.055
Other* 5.0 9.1 10.0 5.1 11.2 10.7 9.6 0.739
*Includes sport centre, healthy food van, pharmacy, post office, **pupils could report more than one place
Macdiarmid et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:98 Page 4 of 8
16.6 % (15.7-17.5) p = 0.011). Total energy intake (ever
7.82 MJ (7.51-8.13) vs never 7.11 MJ (6.73-7.49) p = 0.050)
was slightly higher for those who purchased food or drinks
out of school but total fat (as a percentage of food energy)
(ever 33.1 % (32.5-33.6) vs n ever 32.4 % (31.8-33.0)
p = 0.219)) and saturated fatty acids (as a pe rcentage
of food energy) (ever 13.2 % (12.9-13.5) vs never 12.9 %
(12.6-13.3) p = 0.318)) did not differ significantly between
pupils who reported purchasing food or drinks out of
school at lunchtime and those who did not.
Discussion
This study found that most secondary school-aged pu-
pils in Scotland have access to places selling food and
drinks out of school at lunchtime, with approximately
two thirds of them making purchases at some time.
Older pupils and those from more deprived areas were
more likely to purchase food or drinks out of school at
lunchtime; nevertheless more than half of all pupils in
every sub-group reported purchasing food or drinks out of
schoolatlunchtimeatsometimepoint.Supermarkets,
Table 3 Reasons why pupils purchase food or drinks out of school at lunchtime
Reasons pupils purchase food or drinks out of school from
the places they most often purchase food or drinks
% pupils
(n = 367)
Reasons pupils leave the school to purchase food or drinks % pupils
(n = 369)
There is a wide choice of food 53.6 Because my friends do 44.2
I like the taste of the food they sell 49.9 Because I can’t get the food I want in school 39.5
It is close to the school 45.0 The canteen queue is too long 38.3
It is good value for money 43.5 I want to get out of school 36.2
I can get food there that I can’t buy at school 37.9 I don’t like school lunches 35.4
My friends buy from the same place 32.5 I don’t like the canteen 26.7
I get some exercise 32.5 I like to choose where I spend my money 25.7
I get served quickly 29.8 It’s my right to choose where I go and buy my food 24.3
I like the look of food they sell 23.1 The food I want in the canteen runs out too quickly 20.2
The food is healthy 15.3 Canteen food is too expensive 12.3
My parent/guardian tells me where to go 0.6 I want to get a break from other people 5.6
Other reasons 2.1 I get treated with respect at shops out of school 4.1
So adults can’t supervise what I buy 2.0
Other reasons 6.7
Table 4 Percentage of pupils purchasing different types of food or drinks out of school at lunchtime
Pupils who ever purchase out of school (%) All pupils (%)
(n = 367) (n = 600)
5 times per week 3-4 times per week 1-2 times per week Rarely or never 5 times per week
Foods
sandwiches 10.0 13.8 34.3 41.9 6.3
sweets or chocolate 7.6 15.2 45.7 31.4 4.7
pizza, chips or burger 4.8 13.6 39.8 42.3 5.0
crisps 5.3 8.8 32.4 53.5 3.3
fruit 4.3 5.2 23.2 67.2 2.7
cereal bars or biscuits 0.7 6.1 22.8 70.4 0.4
ice-cream or lollies 0.5 2.7 7.8 88.9 0.3
Drinks
non-diet soft drinks 12.6 17.2 30.6 39.5 7.8
diet soft drinks 9.0 13.7 28.3 48.9 5.6
plain water 7.4 13.3 29.4 50.0 4.6
plain or flavoured milk 3.5 6.4 11.9 78.3 2.2
fruit juices or smoothies 2.9 7.6 19.6 69.9 1.8
Macdiarmid et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:98 Page 5 of 8
followed by sandwich shops and bakeries, were the places
at which pupils reported most often making purchases at
lunchtime, irrespective of level of deprivation. The main
reasons given for purchasing food or drinks out of school
related to the variety of foods available and liking the foods
that were sold, some of which are banned for sale in
school. However, reasons for going out of school at lunch-
time related more to social issues, for example to be with
friends and wanting to leave the school grounds. The food
and drinks sold in school were generally not considered ex-
pensive, but purchasing food out of school was seen by
many as representing value for money.
Previous research show s that pupils with greater ac-
cess to food outlets around schools were more likely to
purchase food and drinks out of schools [14], however
the present study found that almost all secondary school
pupils across Scotland have access to places selling food
or drinks at lunchtime and break times. Interestingly, in
this study, supermarkets , rather than takeaway and fast
food outlets, were the places from which pupils reported
most often purchasing food or drinks at lunchtime. Pre-
vious research has focused on fast food outlets in the
vicinity of secondary schools [13, 24], but in this study
they were not the only or the main places where pupils
were buying food or drinks at lunchtime. A UK study of
changing retail environments around schools suggests
that whilst overa ll numbers of food outlets have not
changed in recent years, there has been an increase in
the number of grocery stores (including supermarkets)
within 800 metres of schools [25]. Supermarkets tend to
provide a wider range of foods than many takeaway out-
lets, which may represent both healthy and less healthy
choices. However, the importance of considering the
wider food environment and not focusing just on take-
aways and fast food outlets was highlighted in a recent
study, when the association between exposure to take-
aways and body weight disappeared when adjusted for
supermarket exposure [26]. The role of supermarkets in
influencing the diet should not be overlooked even
among young people; a recent study showed that 65-
75 % of added sugars consumed in the US are bought in
supermarkets or grocery stores for example [27]. It has
been reported that in supermarkets in the UK have more
shelf space allocated to the sale of energy dense snacks
(e.g. crisps , confectionery) compared with eight other
high income countries and have the second highest ratio
of space for snack foods to fruit in supermarkets (1.31:1)
[28]. In the current study, however, we were not able to
identify which foods or drinks were being purchased at
the different types of food outlets, but this could be ex-
plored in future research.
The types of food or drinks pupils are buying out of
school at lunchtime, e.g. soft drinks and confectionery,
are some of the items prohibited for sale in schools by
legislation. The restriction on the sale of these food and
drinks may explain why some pupils buy these items out
of school [29]. Sugary items such as these have long held
attraction for children and young people and it will be
difficult to restrict the consumption of them [30]. Leav-
ing the school gro unds at lunchtime was also related to
social and environmental factors; pupils reported want-
ing to be with friends and not wanting to stay in school,
for example. This is consistent with previous research
that shows that the physical and social environment
within schools (e.g. crow ded and unpleasant cafeteria
environments) are reasons that pupils leave to buy food
or drinks out of school [31–33]. There is a strong social
and cultural value to spending time with peers, including
selecting what food or drink to buy when together and
then consuming these purchases whilst walking back to
school; rejecting such opportunities may be viewed as
socially risky by young people [34, 35]. Food has an im-
portant symbolic and social meaning among teenagers,
which is often more important than the nutritional
properties and can make foods either more appealing or
distastefu l [36]. Refusing to purchase the food and drink
available in school and electing to pursue other options
is also an indicator of a young person’s growing auton-
omy and of them becoming an active consumer in the
local marketplace [37]. Our findings show that older
pupils are more likely to purchase items at local food
outlets than younger pupils, who are often still adjusting
and growing into the idea of a utonomy at luncht ime
[31, 38]. Such behaviour may be reinforced when it
resonates with practices or values experienced within the
family setting [39, 40]. These wider socio-environmental
issues need to be acknowledged and incorporated into
the development of future policies and interventions if
pupils are to be encouraged to stay in school and to eat
the food and drink provided there, when there are strong
social reasons for them not doing so.
Despite concerns about obesity and the contribution
of food purchased out of school, similar to the findings
of Héroux et al. [24], this study did not show an a ssoci-
ation between BMI group and purchasing food or drinks
out of school at luncht ime. There were no differences in
habitual intakes of energy, total fat or saturated fatty
acids between those who did and did not make pur-
chases out of school at lunchtime. Although the habitual
intake of NMES was higher among pupils who pur-
chased foods or drinks out of school at lunchtime than
those who did not, it was not possible to determine if
this was a consequence of purchases made at lunchtime
or different habitual eating patterns. Despite this, the
mean intake in both groups exceeded the recommended
population average for NMES suggesting that future
public health strategies and interventions need to extend
beyond the focus on schools and lunchtime purchases.
Macdiarmid et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:98 Page 6 of 8
However, the contribution is relatively small with less
than 10 % of all pupils surveyed purchasing confection-
ery or non-diet soft drinks at lunchtime every day.
As with all surveys, the data are based on self-reported
information from participants and in this survey pupils’
reports of food and drink purchases out of school at
lunchtime may be under- or over-reported. Causal links
cannot be inferred and we cannot assume that all pur-
chases were consumed. Care was taken when designing
the mod ule to minimise any effect of pupils not wanting
to disclose their purchasing habits in front of their par-
ents by using a self-completion questionnaire. These
data are from a nationally representative sample of sec-
ondary school-aged pupils in Scotland and provide an
important observation of food and drink purchasing
from food outlets within the vicinity of schools at
lunchtime.
Conclusions
Consideration of the places from which pupils purchase
food and drinks out of school at lunchtime needs to go
beyond the focus on fast food outlets since pupils in this
survey reported most often purchasing food or drink s at
supermarkets. The percentage of secondary school pu-
pils who purchase high sugar foods every day, such as
non-diet soft drinks and confectionery, out of school at
lunchtime was less than 10 %. This questions the em-
phasis, effort and likely impact of changing the food en-
vironment around schoo ls on improving the overall diet
of young people and tackling obesity. It remains import-
ant to improve purchasing habits at lunchtime at school
but wider public health strategies are needed to improve
the dietary intakes of young people across the whole
day. While schools can play an important role in educat-
ing young people about healthy eating, across the year
school days account for only one in three of all lunches
eaten and approximately one in eight of all meals, as-
suming three meals a day are eaten. Future interventions
and policies to improve the diets of young people also
need to acknowledge and integrate the importance of
the social a spects and peer pressures associated with
food and eating practices both within and beyond the
school gate.
Endnote
1
Non-milk extrinsic sugars are ‘free sugars’ (all sugars
added in manufacturing, cooking, or at the table, and
those in honey, syrups, fruit juices and fruit purees) plus
50 % of the fruit sugars in dried, canned and stewed
fruit.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
LFM, GM, WJW, CB, JIM, LCAC contributed to the conception of the study,
JIM, WJW, LFM, LCAC, CB contributed to the design of the FPM module, JIM,
LCAC, LFM, CB contributed to the statistical analysis and interpretation of the
data, JIM prepared the manuscript, WJW, LFM, GM contributed to and
critically reviewed the manuscript. All authors read and approved the final
manuscript.
Acknowledgements
The survey was funded by the Food Standards Agency in Scotland (Contract
FS424019 to the University of Aberdeen (2010)). The funders specified the
design of the survey and reviewed the survey but played no role in the
collection or analysis of the data or in the drafting and critical review of the
manuscript. JIM, LCAC and GM acknowledge personal support from the
RESAS, Scottish Government.
Author details
1
Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK.
2
Centre for Research in Primary and Community Care, University of Hertfordshire,
Hertfordshire, UK.
3
Institute for Health and Wellbeing Research, Robert Gordon
University, Aberdeen, UK.
4
Institute of Applied Health Sciences, University of
Aberdeen, Aberdeen, UK.
5
ScotCen for Social Research, Edinburgh, UK.
6
Scottish
Collaboration for Public Health Research and Policy, University of Edinburgh,
Edinburgh, UK.
Received: 4 February 2015 Accepted: 22 July 2015
References
1. Rutherford L, Hinchliffe S, Sharp C [eds]. Scottish Health Survey 2012 Volume 1
Main Report, National Statistics Publication for Scotland 2013. http://
www.scotland.gov.uk/Resource/0043/00434590.p df Accessed Jan 8 2015.
2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult
Obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.
3. Department of Health. Dietary reference values for food energy and
nutrients for the United Kingdom. London, United Kingdom: HMSO; 1990.
4. Bates B, Lennox A, Prentice A, Bates C, Page P, Nicholson S et al. National
Diet and Nutrition Survey Rolling Programme (NDNS RP). Results from years
1–4 (combined) for Scotland (2008/9-2011/12). Public Health England and
Food Standards Agency in Scotland, 2014.
5. Currie C, Zanotti C, Morgan A, de Looze M, Roberts C, Samdal O, et al.
Social determinants of health andwell-beingamongyoungpeople.
Health Behaviour in School-ag ed Children (HBSC) study: international
report from the 2009/2010 survey. Copenhagen: WHO Regional Office
for Europe (Health Polic y for Children and Adolescents, No. 6); 2012.
http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-
determina nts-o f-he alth- and -well- bein g-am ong- youn g-pe ople. pdf ?ua= 1
Accessed Jan 8 2015.
6. The Scottish Government. Schools (Health Promotion and Nutrition Act)
(Scotland) 2007. http://www.scotland.gov.uk/Topics/Education/Schools/
HLivi/foodnutrition Accessed Jan 8 2015
7. Bonsmann SS, Kardakis T, Wollgast J, Nelson M, Caldeira S. Mapping of
National Sc hool Food Policies across the EU28 p lus Norway and
Switzerland. JRC Science and policy reports, European Commission
2014. https://ec.europa.eu/jrc/sites/default/files/lbna26651enn.pdf
Accessed Jan 8 2015.
8. The Scottish Government. Summary statistics for attainment, leaver
destinations and healthy living, No. 3: Edition, Edinburgh, Scotland. 2103
http://www.scot land. gov.uk/Pub licat ions/2013/ 06/7503 /6 Accessed Ja n 8 2015.
9. Nelson MJ, Nicholas J, Wood L, Riley K, Russell S. Statistical Release: Take up
of school lunches in England, 2010–2011. London: School Food Trust &
Local Authority Caterers Association; 2011.
10. Childrens Food Trust. New research reveals scale of junk food temptation. 2008.
http://www.childrensfoodtrust.org.uk/blog/new-research-reveals-the-scale-of-junk-
food-tempt ation/. Acces sed 8 Jan 2015
11. Ellaway A, Macdonald L, Lamb K, Thornton L, Day P, Pearce J. Do obesity-
promoting food environments cluster around socially disadvantaged
schools in Glasgow, Scotland? Health Place. 2012;18(6):1335–40.
12. Patterson R, Risby A, Chan M-Y. Consumption of takeaway and fast food in
a deprived inner London Borough: are they associated with childhood
obesity? BMJ Open 2012. doi:10.1136/bmjopen-2011-000402.
Macdiarmid et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:98 Page 7 of 8
13. Estrade M, Dick S, Crawford F, Jepson R, Ellaway A, McNeill G. A qualitative
study of independent fast food vendors near secondary schools in
disadvantaged Scottish neighbourhoods. BMC Public Health. 2014;14:793.
doi:10.1186/1471-2458-14-793.
14. Seliske L, Pickett W, Rosu A, Jassen I. The number and type of food retailers
surrounding schools and their association with lunchtime eating behaviours
in students. Int J Behav Nutr Phys Act. 2013;10:19. doi:10.1186/1479-5868-10-19.
15. Fraser LK, Edwards KL, Cade J, Clarke GP. The geography of Fast Food
outlets: a review. Int J Environ Res Public Health. 2010;7:2290–308.
16. Truong K, Fernandesb M, Anb R, Shierb V, Sturmc R. Measuring the physical
food environment and its relationship with obesity: Evidence from
California. Public Health. 2011;124(2):115–8.
17. Davis B, Carpenter C. Proximity of Fast-Food Restaurants to Schools and
Adolescent Obesity. Am J Public Health. 2009;99(3):505– 10.
18. Masson LF, Bromley C, Macdiarmid JI, Craig LCA, Wills W, Tipping S, et al. Survey
of diet among children in Scotland (2010). Aberdeen, Food Standards
Agency: Scotland; 2012. http://www.foodstandards.gov.scot/sites/
default/files/777-1-1329_FS424019_FINAL_Pt1.pdf Accessed Jan 8 2015.
19. Wills W, Macdiarmid JI, Masson LF, Bromley C, Craig LCA, McNeill, G.
Children’s Food and Drink Purchasing Behaviour “Beyond the School Gate”:
The Development of a Survey Module'. ISRN Nutrition, 2013; 501450.
http://dx.doi.org/10.5402/2013/501450 Accessed Jan 8 2015.
20. Macdiarmid JI, Craig LCA, Wills W, Bromley C, Masson LF, McNeill G. Survey
of Diet Among Children in Scotland (2010) Volume 2: Food and drink
purchases around the school day. Scotland: Aberdeen, Food Standards
Agency; 2012. http://www.foodstandards.gov.scot/sites/default/files/777-1-
1346_Final_report_part_2_FS424019.pdf Accessed Jan 8 2015.
21. Sheehy C, McNeill G, Masson L, Craig L, Macdiarmid J, Holmes B, Nelson M.
Survey of Sugar Intake Among Children in Scotland Aberdeen: Fo od
Standards Agency Scotland, 2008. http://dera.ioe.ac.uk/7359/1/
sugarintakescot2008rep.pdf Accessed Jan 8 2015
22. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the
UK, 1990. Arch Dis Child. 1995;73:25–9.
23. Scottish Government. Scottish Index of Multiple Deprivation 2009: General
Report. Edinburgh, Scottish Government, 2009. http://www.scotland.gov.uk/
Publications/2009/10/28104046/0 Accessed Jan 8 2015
24. Héroux M, Iannotti RJ, Currie D, Pickett W, Jassen I. The food retail
environment in school neighborhoods and its relation to lunchtime eating
behaviors in youth from three countries. Health Place. 2012;18(6):1240– 7.
25. Smith D, Cummins S, Clark C, Stansfeld S. Does the local food environment
around schools affect diet? Longitudinal association s in adolescents
attending secondary schools in East London. BMC Public Health.
2013;13(1):70.
26. Burgoine T, Forouhi NG, Griffin SJ, Wareham NJ, Monsivais P. Associations
between exposure to takeaway food outlets, takeaway food consumption,
and body weight in Cambridgeshire, UK: population based, cross sectional
study. BMJ. 2014;348:g1464.
27. Drewnoski A, Rehm CD. Consumption of added sugars among US children
and adults by food purchase location and food source. Am J Clin Nutr 2014
doi:10.3945/ajcn.114.089458.
28. Thornton LE, Cameron AJ, McNaughton SA, Waterlander WE, Sodergren M,
Svastisalee C. Does the availability of snack foods in supermarkets vary
internationally? International Journal of Behavioral Nutrition and Physical
Activity. 2013;10:56.
29. Macdiarmid JI, Loe J, Douglas F, Ludbrook A, Comerford C, McNeill G.
Developing a timeline f or evaluating public health nutrition policy
interventions. What are the o utcomes and when should we expect to
see them? Public Health Nutr. 2010;14(4):729–39.
30. James A. The good, the bad and the delicious: the role of confectionery in
British society. Sociological Review. 1990;38(4):666–88.
31. Wills WJ, Backett-Milburn K, Gregory S, Lawton J. The influence of the secondary
school setting on the food practices of young teenagers from disadvantaged
backgrounds in Scotland. Healt h Educ Res. 2005;20(4 ):458–65.
32. Lawton M. O ut to lunch? G lasgow, Scottish Consumer Council 2008.
http://www.communityfoodandhealth.org.uk/wp-content/uploads/2008/
09/out-to-lunch.pd f Accessed 8 Jan 2015.
33. Sinclair S, Winkler JT. The School Fringe: what pupils buy and eat from
shops surrounding secondary schools. London: Nutrition Policy Unit,
London Metropolitan University; 2008.
34. Miles S, Cliff D, Burr V. “Fitting in and sticking out”: consumption, consumer
meanings and the construction of young people’s identities. J Youth Stud.
1998;1(1):81–96.
35. Stead M, McDermott L, MacKintosh AM, Adamson A. Why healthy eating is
bad for young people’s health: Identity, belonging and food. Soc Sci Med.
2011;72(7):1131–
9.
36. Eliott C. Food as people: Teenager’s perspectives on food personalities and
implications for healthy eating. Soc Sci Med. 2014;121:85–90.
37. Ruckenstein M. Everyday ambiguities: Food consumption in and out of
schools. 5th International Conference on Multidisciplinary Perspectives on
Child and Teen Consumption. Milan: Arcipelago Edizioni; 2012.
38. Wills WJ. Food and eating practices during the transition from secondary
school to new social contexts. J Youth Stud. 2005;8(1):97–110.
39. Backett-Milburn K, Wills WJ, Roberts EM, Lawton J. Food, eating and taste:
Parents' perspectives on the making of the middle class teenager. Soc Sci
Med. 2010;71(7):1316–23.
40. Backett-Milburn K, Wills WJ, Roberts EM, Lawton J. Food and family
practices: teenagers, eating and domestic life in differing socio-economic
circumstances. Children's Geographies. 2010;8(3):303–13.
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