Brand to ban: What young people really think about energy drinks

Posted by Professor Amelia Lake, Fuse Deputy Director; Dr Helen Moore, Fuse Associate; and Grace Stewart - Teesside University. 

Walk into any corner shop, and you’ll see them lined up in the fridge: brightly coloured cans promising energy, improved focus and even hydration. They’re everywhere online too, all over social media feeds... What are we talking about? Energy drinks. They have become a familiar part of the landscape in the UK, but particularly for young people who are consuming them in ever increasing numbers; the question is, why are they so popular, and what is being done about it?

What are energy drinks?

High-caffeine energy drinks are soft drinks that contain at least 150 milligrams (mg) of caffeine per litre of drink, which is higher than other soft drinks. Back in 2018, Jamie Oliver led a campaign that resulted in many retailers voluntarily banning sales to under-16s. Fast forward to July 2024, and the new Labour Government announced in the King’s Speech that it would restrict the sale of energy drinks to under-18s. There is currently a live Government consultation around banning the sale of high-caffeine energy drinks to children which will close on 26 November 2025. If you want to contribute, please do so.

Our research

Our mixed-method qualitative study was published in the Journal of Human Nutrition and Dietetics this week. The work was carried out in North-East England and sheds light on the reasons behind young people still consuming these drinks in large numbers, and what they, the consumers, really think could be done about it.

Our research involved:

• Focus groups with 50 students aged 9–14 years old
• A survey completed by 22 Year 9 students (aged 13–14 years old)

The aim was to understand how children and young people perceive energy drinks and hydration drinks, and to explore their consumption habits post the UK’s 2018 voluntary sales ban to under-16s. This follows on from our earlier work published in 2017.

What did we find?

• 81.8% of surveyed students (13-14 year olds) consume energy drinks, with boys drinking more frequently than girls.
• Most young people drink EDs 2-4 times a week, and many started before age 12 years.
• Taste, branding, and peer influence were major motivators.
• Corner/local shops were the most common purchase point, often with little enforcement of age restrictions.
• Hydration drinks (e.g. PRIME) are seen as healthier alternatives, though their actual health impact is still unclear.

So, why are energy drinks so popular?

Through the focus groups, we learned that young people are really clued-up about energy drinks. They talked about branding, marketing, taste, peer influence, cost, and just how easy it is to get hold of them. From YouTube ads to celebrity endorsements (think F1 and YouTubers like Logan Paul and KSI), marketing was seen as a powerful force driving consumption. One young person said:

“If I made the exact same drink, in a bottle, no one would buy it.”

Bright colours, cool designs, and slogans were all cited as reasons that young people are drawn to these products. Many of the young people taking part in the research knew that they were being targeted by the manufacturers, but they didn’t mind. In fact, some saw energy drinks as part of their identity, linked to gaming, sports, or just being “cool.”

Policy gaps and opportunities

Despite the 2018 voluntary ban mainly in supermarkets, energy drinks remain easily accessible. Many children believed there was a legal age restriction but said that they could still buy energy drinks from shops or online without ID checks. This links back to the importance of the current live consultation around Energy Drinks and sales restrictions.

This raises an important point for policymakers to consider: if energy drinks are still seen as aspirational, accessible, and part of youth culture, young people will find ways to get them, or switch to similar products that exist outside of the ban. There needs to be a wider strategy to tackle this, which means tighter regulation of marketing (anywhere that young people spend their time - including online spaces), effective, up-to-date, accurate education about the health impacts of energy drinks and the tactics used by manufacturers, and importantly including young people in this conversation.

Our research shows that young people are not passive consumers of energy drinks. They’re thoughtful, aware, and influenced by a range of social and cultural factors that need to be understood if we want to reduce energy drink consumption.

Our study had several possible interventions suggested by young people:

• Actual legislative enforcement of age restrictions.
• Changing product placement in stores (e.g., away from essentials and in areas similar to cigarettes and alcohol).
• Duller packaging and clearer health warnings.
• Wider awareness around health risks.

Why this matters

Energy drinks are linked to a range of health issues; from insomnia and anxiety to obesity and poor academic performance. Yet, their appeal among young people remains strong, driven by clever, pervasive, marketing in addition to peer influence.

Our paper highlights the urgent need for strong policy action, increased awareness, and further research in this space.

Images:

1: Photo by (Joenomias) Menno de Jong from Pixabay

2: Photo by thom masat on Unsplash (with modifications)

Energy drinks may be commercially lucrative but what is more valuable than the health of our children?

Posted by Amelia A Lake, Professor of Public Health Nutrition at Teesside University, and Shelina Visram, Senior Lecturer in Public Health at Newcastle University

As we prepared our new review on the health effects of the consumption of energy drinks by children and young people, we have been dwelling more and more on the Commercial Determinants of Health.

The Commercial Determinants of Health are defined by the World Health Organisation (WHO) as: 

“...the private sector activities that affect people’s health, directly or indirectly, positively or negatively.”

The WHO definition goes on to expand on how these activities might include the private sector influencing:

“...the social, physical and cultural environments through business actions and societal engagements; for example, supply chains, labour conditions, product design and packaging, research funding, lobbying, preference shaping and others.”

Now cast your mind back to pre-Covid… a Government consultation on the banning of energy drinks had a 93% backing to restrict the sale of these drinks to under 16s. There was even a Green Paper proposing this. Yet, there has been inaction (helpfully summarised here by Sustain: the alliance for better food and farming).

What is causing this inaction? Is it a turnaround in evidence that suggests these drinks are not as harmful as previously thought, or is there something else going on...? Perhaps, instead there are some pretty significant commercial interests at stake; but what could be more valuable than the health and wellbeing of our children and young people?

Energy Drinks are VERY commercially viable. They have been the fastest growing sector of the soft drink market for some time. In 2020 the global market was worth $45.80 billion and this is projected to grow at an annual rate of 8.2%. In an article in December 2023, The Grocer described the hydration drink and energy drink market as “buoyant”.

Research has found that around one in three young people (under 18) say that they regularly consume energy drinks, typically containing high levels of caffeine and sugar in combination with other ingredients known to have stimulant properties. On average, young people in the UK consume more energy drinks than those in other European countries.

You may be familiar with the labelling on energy drinks:

Image courtesy of www.parliament.uk (by URL)

‘‘High caffeine content. Not recommended for children or pregnant or breast-feeding women’’

Under current labelling rules, any drink, other than tea or coffee, that contains over 150mg of caffeine per litre requires this label and should state the amount of caffeine in milligrams per 100ml of the drink.

Yet why do we see these drinks unrestricted and available to children and young people, not just in the UK but globally? Some countries have attempted to regulate energy drinks (see our research for more on this).

Our new review of the global evidence around energy drinks and the health impacts on children and young people shows a worrying increase in the types of health outcomes associated with their consumption. This includes mental as well as physical health behaviours. Not only health impacts but wider impacts around sleep and educational attainment.

This new review is the latest of many which have highlighted the impacts of these products to our younger population.

We accept the evidence is from mostly cross-sectional studies, exploring association rather than causation. Experimental studies to establish causation have both ethical and feasibility issues. We have argued before that the precautionary principle should be applied. This country bans the sale of a number of items to young people (fireworks, crossbows, knives) presumably these don’t have the large commercial interests or lobbying groups that the energy drink industry has?

Why are we applying a higher standard of evidence to energy drinks, if it isn’t around their commercial value?

The evidence is here, the labels clearly say these drinks are not suitable for children. How many more studies are needed before policy action is enacted?

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Fuse Podcast about this Energy Drinks research

Listen to the latest episode of the Fuse podcast ‘Public Health Research and Me’, in which host and Fuse Public Partner Cheryl Blake chats with Amelia and Shelina about their research, to cut through the confusion and ask some the questions that you want to know about Energy Drinks.
> Listen now

Find out more

• News item on the latest research
• Research paper in full
• Research brief (2-page summary)
• Timeline of Fuse energy drink research activity and impact
• Original review in 2016

Images:

2. Courtesy of www.parliament.uk (by URL) > Parliamentary business > Publications & records > Energy drinks and children > 4 Labelling and advertising: 

https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/821/82107.htm#_idTextAnchor031

The views and opinions expressed by the authors are those of the authors and do not necessarily reflect those of Teesside University, Newcastle University, or Fuse, the Centre for Translational Research in Public Health.

By invitation-only, at a secret location, with no agenda - this is Sci Foo ‘unconferencing’

Amelia Lake, Associate Director of Fuse and Reader in Public Health Nutrition at Teesside University

I’ve been back home from Sci Foo for more than a week. I’m not missing the Californian sunshine as the North East weather has actually been rather seasonal, but I am missing two things; the incredible Google micro-kitchens and the people I had the good fortune to meet.

Before the email arrived - which incidentally, I almost deleted thinking it was another spam invitation to a fictional conference in some far flung location - I hadn’t heard of Sci Foo. Thankfully, I forwarded it to our University Director of Corporate Communications and Public Relations, who was suitably excited.

That was April.  Fast forward to July and I’m on a 10-hour flight to San Francisco (feeling very relieved that I don’t have to entertain the kids on such a long haul). At this point I’m still not that clear what an ‘unconference’ conference is.

When I arrive, I have to download Uber to my phone (not a necessity when living in rural north Yorkshire) and I find my destination with only jet lag to contend with - a theme common throughout my three days at Sci Foo. To be fair, I had jet lag before getting here courtesy of a three-year-old.

On Friday evening, we are bused to the top secret Google X complex and it starts – as all good things should – with food. I can’t remember the last time I went to an event where I didn’t know anyone at all other than some vaguely recognisable faces from the twittersphere.
But with food came conversation. 

Participant-driven 'rugby scrum' 

At around 8pm the conference started (bearing in mind that I had been awake since 3am) and the message was clear. Be inclusive, be kind, be curious and talk to people from as many diverse fields as possible. That was very easy, as I soon discovered, most people were doing or studying things I hadn’t heard of, or had zero comprehension. It was awe inspiring.

I soon discovered that an ‘unconference’ is completely participant-driven and from a distance this looked a bit like a rugby scrum.                                 

       But with encouragement from my new found food friends I joined the pack and put down a session on ‘silencing science’ - discussing whether our role as scientists is to be neutral or advocates. I met Prof Shaun Hendy and Dr Siouxsie Wiles both phenomenal science communicators from the University of Auckland, New Zealand and we devised a session for Saturday morning based on the range of experiences Shaun had collated in his book ‘Silencing Science’.

The rest of the day was incredible – from sessions on trust in science, to the future of scientific publishing – and did I say that the food was great?! Sleep deprivation is nothing when you have access to kettles with higher and lower temperatures depending on the type of tea you select.

On Sunday morning it was my turn to give a ‘lightening talk’ on our Fuse energy drink research, alongside a handful of other presenters. Speakers one and two were incredible with amazing graphics, audio and visuals. My more low-tech approach highlighted the powerful words of our young respondents, illustrating what the consumption of energy drinks means to them.

Sci Foo was only three days but it felt longer, in a good way. There were many highlights, including holding a Woolly Mammoth’s actual tooth during breakfast [add photo], discussing galaxy formations with cosmologist and Prof of Physics Risa Wechsler and attending a session on ‘fully automated luxury feminism’!

There can’t be many conferences – no make that occasions in life - where you can share the same room with the most influential skateboarder in history, Rodney Mullen and a Nobel Laureate.

I hit a conference high attending Sci Foo. It was incredible and lots of people worked very hard to make it such a brilliant event. Particularly Cat Allman, the team from O’Reilly Media, Digital Science, Nature Publishing Group and Google Inc.

My take home message is: if you ever get invited to one of these ‘Foo’ events, say yes - you won’t regret it.


Images:
2: Courtesy of Alex Cagan: https://twitter.com/ATJCagan/status/1149897137640988672
3: Amelia Lake with Prof Shaun Hendy
4: Quotes from the young people involved in Fuse energy drinks research
5: Amelia Lake with a Woolly Mammoth tooth 

It is time to ban the sale of energy drinks to children in the UK

Guest post by Prof Amandine Garde, Dr Amelia Lake and Dr Shelina Visram

In 2016 in the UK alone we consumed 679 million litres of high sugar, high caffeine drinks known as “energy drinks”. Described as the fastest growing sector of the soft drink market, they have become a major public health concern and have been subject to both a House of Commons Science and Technology Committee Enquiry (April – December 2018) and a Department of Health and Social Care consultation (which closed on 21 November 2018).

In the report it published on Tuesday (4 December), the Committee found that “the current quantitative evidence alone is not sufficient to warrant a statutory ban”, though it noted that “societal concerns could justify a ban on the sale of energy drinks to children”. This conclusion is puzzling for several reasons.

Energy drinks and children

Firstly, a growing body of evidence has established that energy drinks consumption, particularly by children, is associated with a wide range of harmful effects.

• Whilst childhood and adolescence are periods of rapid growth requiring adequate sleep and good nutrition, energy drinks play a role in disrupting sleep (1 - see references below).
• It is established that energy drinks are highly erosive in terms of dental health: they have low pH and a high non-reducing sugar content (2).
• Consumption is also linked to increased energy intake and therefore obesity (3). Hence the proposal of the UK Government to ban the sale of energy drinks to children in the second iteration of its Childhood Obesity Action Plan, published in August 2018, and the public consultation that followed.
• However, energy drinks consumption is also linked to physical symptoms such as headaches, stomach aches and sleeping problems (with some evidence of a dose-response effect), as well increased risk-taking behaviours, including binge drinking, smoking, illicit drug use, screen time and poor dietary behaviours (4). Moreover, mixing energy drinks with alcohol increases the risk of injury and unsafe driving (5) and 6).

Secondly, the Committee has failed to engage with the fact that gathering “quantitative evidence” on the impact of energy drinks on child health would be unethical (other than the aforementioned studies, which tend to involve large-scale, school-based surveys).

To our knowledge, there have been no experimental studies involving children’s use of other age-restricted products such as alcohol, tobacco, aerosols, solvents, fireworks, knives, crossbows, petrol or even Christmas crackers (sales of which are restricted in England to those aged 12 and over). Why should energy drinks be subjected to a higher standard of evidence than any of these products?

Thirdly, the evidence base has not prevented other countries from regulating the sale of energy drinks to children. In Europe, Lithuania introduced a ban on the sale of these drinks to under 18s in 2016, followed by Latvia, whilst Norway and Sweden are reflecting on similar legislation.

It is therefore unclear why the Committee has concluded that existing evidence is insufficient to adopt a similar law in the UK. The rationale seems to lie in the absence of a “causal link” between energy drinks consumption and childhood obesity, tooth decay and other diet-related diseases. This arguably demonstrates a lack of understanding by the Committee of the strategies required to address complex and multifactorial nature of these diseases.

It is indeed difficult to establish a causal link between the various measures adopted and the burden of non-communicable diseases: no single policy option can realistically tackle broad phenomena, such as growing obesity rates or tooth decay, when taken in isolation.

Governments must ensure that public health is effectively protected, and they can invoke the precautionary principle in the event of any outstanding scientific uncertainty regarding the impact of energy drinks consumption on public health. Hence, probably, the acknowledgement from the Committee that “it would be legitimate for the Government to go beyond the evidence that is available at the moment and implement a statutory ban based on societal concerns and evidence, such as the experience of school teachers and pupils”.

The logic of their reasoning is nonetheless difficult to follow. There is no doubt that the Government should introduce legislation banning the sale of energy drinks to children, following the lead of Lithuania and Latvia. This would not amount to going beyond the evidence; it would be acting on the basis of existing evidence. It is this body of evidence that has prompted very real and major societal concerns of the effects of energy drinks on our children’s health.

Fourthly, the call of the Committee for more effective labelling measures should not be envisaged as providing an alternative to a ban on the sale of energy drinks to minors; it should only be viewed as complementing such a ban. This is all the more so as labelling could increase existing health inequalities. Children and young people from all backgrounds consume energy drinks. However, as the Committee has noted “energy drinks are consumed disproportionately by disadvantaged groups”.

There may indeed be a link between regular consumption of energy drinks and eligibility for free school meals (FSM), which is often used as an indicator of lower socio-economic status. The 2018 Health-Behaviour in School-Aged Children Survey found that, among those who reported that they drank at least one energy drink per day, 23% received FSM, whereas those who said that they never drank energy drinks or did less than once a week, 11% received FSM (compared to 13% of FSM recipients across the whole sample). A study conducted in schools in the South West England also found that being eligible for FSM was significantly associated with drinking energy drinks once a week or more (Richards and Smith, 2016).

Energy drinks have no place in a healthy diet

Finally, the Committee does not seem to be aware that the Government has a duty to protect the rights of all children to the enjoyment of the highest attainable standard of health and to adequate nutritious food. Energy drinks have no place in a healthy diet. Shifting the responsibility of protecting them onto business actors, such as food manufacturers or food retailers, is highly problematic, not only because a voluntary ban will fail to create the level playing field within which all these actors should operate, but also because it will fail to protect child health and their rights and cannot therefore contribute to an effective obesity prevention strategy.

The Responsibility Deal has failed; regulatory measures that apply to all and are duly enforced are required to address the growing burden of obesity, tooth decay and other diet-related diseases. The conclusion that a statutory ban would be too restrictive is ideological rather than grounded in evidence.

A statutory ban is the most likely measure to ensure that children and young people are effectively protected from the many harmful effects of energy drink consumption.


About the authors:

• Professor Amandine Garde, Professor of Law and Director of the Law & Non-Communicable Diseases Unit at the University of Liverpool. 
• Dr Amelia Lake, Associate Director of Fuse - the Centre for Translational Research in Public Health and Reader in Public Health Nutrition at Teesside University. Amelia is a Dietitian and registered Public Health Nutritionist. 
• Dr Shelina Visram, Programme Lead of the Complex Systems Research Programme for Fuse - the Centre for Translational Research in Public Health and Senior Lecturer in Public Health at Newcastle University.

The views expressed here are those of the authors and do not necessarily reflect those of the author's employer or organisation.

References:

1. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence?
2. Short Communication: In vitro assessment of Erosive Potential of Energy Drinks
3. Systematic review of the literature on the effectiveness of product reformulation measures to reduce the sugar content of food and drink on the population's sugar consumption and health: a study protocol
4. Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes
5. Alcohol Mixed With Energy Drinks and Risk of Injury: A Systematic Review
6. Alcohol mixed with energy drink use among U.S. 12th-grade students: Prevalence, correlates, and associations with unsafe driving

The Age of Bubble-gum Gin?

In a post for Alcohol Awareness Week, John Mooney, Fuse Associate and University of Sunderland Senior Public Health Lecturer, ponders how the alcohol industry will respond to declines in youth drinking. 

1990s alcopops on display at the Museum of Brands

There is no doubt about the current trend: youths and young adults are clearly drinking less alcohol. In what seems to run counter to the traditional image of “irresponsible teenagers” drinking to excess and partying the night away, a number of recently published studies and reports have confirmed an increasing indifference to the “charms of the demon drink” on the part of young people that extends across all age groups. In their recent report for example, University of Sheffield alcohol research group (SARG) in a Wellcome Trust funded study [1], highlighted that:

“Among 16-17 year-olds, the proportion who reported drinking nowadays fell from 88% in 2001 to 65% in 2016 and the decline over the same time period for 16-24 year-olds was from 90% to 78%...”

Similarly in a nearly 10,000 strong sample of participants aged 16 to 24 years using a ten year analysis of Health Survey for England datasets, rates of non-drinking increased from 18% in 2005 to 29% in 2015 (largely attributable to increases in lifetime abstention) [2]. In the same study for the same period, “not drinking in the past week” increased from 35% to 50%. The SARG Wellcome Trust report noted that younger drinkers were also consuming alcohol less often and in smaller quantities: Between 2003 and 2016, for example, the proportion of 11-15 year-old drinkers who “had consumed alcohol in the last week” fell from 41% to 19%. Among 16-17 year-old drinkers, the decline was from 58% to 39%, while for 16-24 year-olds it was from 75% to 60%.

As the Sheffield report also notes, these declines in alcohol consumption are by no means confined to the UK with similar reductions in youth drinking being seen across many European nations, North America and Australasia.

Declines in drinking would be expected of course to be accompanied by public health benefits and therefore alcohol-related hospital admission rates in England have been falling in line with consumption, as have the numbers of under 18s referred to specialist alcohol services. This has a particular resonance for North East England, where the rates of alcohol-related hospital admissions for under 18s have been among the highest in the country [3] and which in recent years have been falling more sharply than for England as a whole (though of course, the starting point was higher).

While the reasons behind these regional, national and international declines in youth drinking are as yet not particularly well understood, it is probably worth noting that we have been here before, with the early 1990s seeing international declines in youth drinking. Many experts on alcohol consumption trends at that time also noted that this decline was accompanied by a robust ‘product diversification’ response by the alcohol industry, most notably the rise of ‘alcoholic soft drinks’ or ‘alcopops’. In an article published in the Independent in 2003 [4], the then chair of Alcohol Concern, Eric Appleby commented:

"The whole alcopops thing came about because at that stage the industry had realised that they weren't getting the normal flow of drinkers coming through. Young people were more independent and drugs had taken over for a lot of young people as a recreational high instead of drink. The industry knew it had to do something. They will always deny it but it is pretty clear that the whole alcopops thing was about recruiting young drinkers and getting them at an early stage. Young people don't have a natural affinity for the taste of alcohol – this was a crash course, cutting out the middle man."

Consumption data confirmed these suspicions, with figures released by the UK Department of Health in 2002 revealing the average alcohol consumption of children aged 11 to 15 who were drinkers had rocketed from 5.3 units a week in 1990 to 9.8: ‘Alcopops’ or ready to drink mixes (RTD’s) of spirits and soft drinks were blamed.

This previous experience and the industry response does of course beg the question if there will be a similar response this time around and the format that this might take. As the Sheffield report also notes, drinking habits formed when young, have a major influence on lifetime alcohol consumption patterns, so these trends will not have escaped industry analysts and those who might be concerned about maintaining “medium to long-term consumption and sales forecasts”.

For a number of commentators, the industry responses are already clearly in evidence, most notably perhaps being a proliferation in novelty gin varieties, perhaps the most blatant ‘cross-over’ with confectionary style marketing being ‘bubble-gum gin’ or ‘marshmallow flavoured vodka’.

Of course, there is also a ready-made consumer base among young adults for energy drinks, which have been the focus of much publicised research by Fuse colleagues and there is a long established practice of these drinks as alcoholic mixers, to say nothing of the fortified caffeine and sugar enriched wine of choice, most popular in my native Scotland and the product of serene ‘Buckfast Abbey’ surroundings in South West England.

Current downward trends in alcohol consumption therefore might already be seeing a familiar  marketing response… but the extent to which that will succeed is still guesswork, given the as yet lack of clear understanding around what might be behind current trends.

From a North East public health perspective of course, long may these trends continue, since the medium to long-term population health benefits in this part of the world in particular are likely to be considerable!


#AlcoholAwarenessWeek

#AlcoholChange 

References: 

1. Oldham M, Holmes J, Whitaker V, Fairbrother H, Curtis P: Youth Drinking in Decline. University of Sheffield Alcohol Research Group & Wellcome Trust; 2018. 
2. Ng Fat L, Shelton N, Cable N: Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005–2015. BMC Public Health 2018, 18(1):1090. 
3. Public Health England: Local Alcohol Profiles for England In.: https://www.gov.uk/government/collections/local-alcohol-profiles-for-england-lape; 2017.
4. Harding N: The Demonised Drink: How Has Youth Drinking Evolved 20 years Since The Launch of Alcopops? Independent. London; 2013.

Image: "1990s alcopops on display at the Museum of Brands, west London" by Ben Sutherland via Flickr.com, copyright © 2017: https://www.flickr.com/photos/bensutherland/37299742285

Young people in the UK drink more energy drinks than any other countries in Europe

Posted by Amelia Lake, Associate Director of Fuse and Reader in Public Health Nutrition at Teesside University and Shelina Visram, Senior lecturer in public health at Newcastle University

It would be a bit shocking to see children and teenagers drinking espressos, yet it’s socially acceptable for young people to reach for energy drinks to give them a quick “boost”.

Energy drink sales in the UK are now worth more than £2 billion a year

Unaffected by the economic crisis, energy drinks are the fastest growing sector of the soft drinks market. Between 2006 and 2012 consumption of energy drinks in the UK increased by 12.8% – from 235m to 475m litres.

These drinks are very popular with young people – despite coming with a warning (in small letters on the back) that they are “not recommended for children”. A survey conducted across 16 European countries found that young people between the ages of ten and 18 in the UK consume more energy drinks on average than young people in other countries – just over three litres a month, compared to around two litres in other places.

More than two-thirds of young people surveyed in the UK had consumed energy drinks in the past year. And 13% identified as high chronic consumers – drinking them four to five times a week or more. Research also suggests that these drinks are more popular with boys and young men.

What goes into energy drinks?

Energy drinks are usually non-alcoholic and contain ingredients known to have stimulant properties. They are marketed as a way to relieve fatigue and improve performance: “Red Bull gives you wings”.

They contain high levels of caffeine and sugar in combination with other ingredients, such as guarana, taurine, vitamins, minerals or herbal substances. A 500ml can of energy drink for example, can contain 20 teaspoons of sugar and the same amount of caffeine as two cups of coffee.

Caffeine stimulates the central and peripheral nervous system. Consumed in larger doses, it can cause anxiety, agitation, sleeplessness, gastrointestinal problems and heart arrhythmias.

In the UK, there are no clear recommendations for caffeine intake for adults or children, although both the Food Standards Agency and the British Soft Drinks Association recommend that children should only consume caffeine in “moderation” and that caffeine content over [150mg/l] should be declared on the packaging. The current scientific consensus is that [less than 2.5 mg a day] in children and adolescents is not associated with adverse effects.

Should we be worried?

The evidence indicates that these drinks do not give you wings – or any other positive benefits. In fact their intake in young people, is associated with adverse health outcomes. There is growing evidence of the harmful effects of these drinks. Teachers are concerned about the detrimental impact these drinks have on pupils in their classrooms. There is also a known association between soft drink intake, dental erosion and obesity.

Lesser known are the effects of the cocktail of stimulant ingredients – such as guarana and taurine – contained within these drinks.

Our recent review of the scientific literature set out to look for any evidence of associations between children and young people’s consumption of energy drinks and their health and well-being – as well as their social, behavioural or educational outcomes.

We found that for young people, drinking energy drinks is associated with a range of adverse outcomes and risky behaviours. They are strongly and positively associated with higher rates of smoking, alcohol and other substance use – and linked to physical health symptoms such as headaches, stomach aches, hyperactivity and insomnia.

Why do young people buy them?

We also spoke with young people about their intake of these drinks. Discussions with our participants aged between ten and 14 indicated just how accessible and available these drinks are. They are also cheap – in some cases significantly cheaper than other soft drinks, as one of the girls we spoke to explained:

"I think it’s because like a normal can of Coke is like 70p, and [own brand energy drinks] are like 35p."

Our research found that energy drinks are often marketed on gaming sites and linked to sports and an athletic lifestyle – and are particularly aimed at boys. Taste, price, promotion, ease of access and peer influences were all identified as key factors in young people’s consumption choices.



Speaking with parents and teachers about these drinks there was confusion. Parents themselves identified the need for more information about energy drinks – and many admitted to not being fully aware of the contents and potential harmful effects on children.

Should they be banned?

Image used in a recent campaign led by Jamie Oliver
to ban the sale of energy drinks to under-16's

Recently there has been a move to restrict the sales of these drinks to under 16’s – an approach which has also been taken by other countries. This saw the self-imposed sales restriction by many larger retailers – including most supermarkets – to not sell to children under 16. But many places still continue to sell to young people – including convenience stores, which offer a wide range of brands, flavours and package sizes.

The Commons Science and Technology Committee’s enquiry into energy drinks called for submissions in April 2018 and will be reviewing in June 2018 – when we will also give oral evidence.

Of course, legislation to prevent the sales of energy drinks to under 16’s would be helpful. But the marketing of these drinks to young people through computer games and their association with sports is also a much wider issue. Far reaching discussions are needed about the direct and indirect marketing of these drinks (and other food and drinks) through multiple platforms other than TV – particularly through computer games.

This article was originally published on The Conversation. Read the original article.

Prevention by any other name would smell as sweet

Guest post by Tom Embury, Public Affairs Officer, British Dietetic Association

Next week, June 4th - 8th is Dietitians Week 2018, where the British Dietetic Association and its members and allies celebrate the work of dietitians. This year’s theme is “Dietitians Do Prevention”, which intends to highlight the important role that dietitians have to play in prevention and public health. We know nutrition and hydration underpin so much of our health and getting it right can reduce the impact of illness, aid recovery, or prevent some diseases and conditions altogether.

NHS England’s Five Year Forward View, in the most recent frameworks from NHS Scotland and the Northern Irish Health and Social Care Service and is embodied in the principles of the Wellbeing of Future Generations (Wales) Act.

It has been made clear by everyone from Marmot to the NHS Confederation that we need to strengthen prevention and that it should be everybody’s business. Despite this, many dietitians (and indeed healthcare staff in general) still don’t think of themselves as doing prevention or public health, especially as so many work in hospital settings, delivering acute care. Our recent 2018 member survey has shown that 40% of our members don’t feel that they do prevention or public health activity. This may be because they don’t have the time or resources, despite wishing to do so, but in some cases, it is because they don’t see public health as part of their remit.

Of course, we believe all our members “do prevention” and public health, but not everyone will call it by that name. Indeed, the term public health often seems to have quite a narrow definition, associated with the work of local government public health teams. This is important work, but by no means is that everything public health entails.

This is why, in preparation for Dietitians Week this year, we asked all our specialist groups for their view on how they do prevention. Our specialist groups cover pretty much all of the areas of dietetics - from paediatrics to older people, public health to critical care. What we found is that there are dozens of words and terms used to describe activity that is essentially a form of prevention.

Some were variations, like primary, secondary or tertiary prevention depending on where you work and what types of illnesses your patients have. Others, such as Making Every Contact Count or Healthy Conversations, relate to specific campaigns or initiatives. In areas like Mental Health or Paediatrics, a whole different language can exist. Even rehabilitation or recovery after acute illness is a form of prevention - preventing future episodes, further hospital visits or complications. One great example comes from Fuse itself – the research carried out into the impact of energy drink intake amongst young people has had an impact on national level policy making.

This is why we are trying to celebrate prevention in all its forms and with all its various names. Dietitians are and should to a greater extent be a core part of the public health workforce.

Our incoming Chairman, Caroline Bovey, highlighted this issue with terminology and understanding at our recent Annual General Meeting. She asked the crowd of over 100 dietitians to raise their hands if they were involved in public health. Some hands went up but they were definitely in the minority. She then asked who had a twitter account where they talked about diet and nutrition – far more hands shot up. “You are all”, she said, “doing public health dietetics”.

So, whether you’re having a healthy conversation or making every contact count, supporting rehabilitation or reducing hospital admissions, celebrate the way that you do prevention. We can’t let the terminology get in the way of sharing best practice or spreading good ideas. We’d love you to tell us about it as part of Dietitians Week! Get in touch via dietitiansweek@bda.uk.com

What should we do about children and young people’s consumption of energy drinks?

Guest post by Shelina Visram, Fuse Associate and Lecturer in the Centre for Public Policy & Health, Durham University

Did you know that cigarettes are the only product on the market that, when used exactly as intended by their manufacturers, will kill around half of their users? And yet you can buy them legally in every country of the world, with the exception of Bhutan? But you probably knew that already (except maybe the bit about Bhutan). It’s just one example of the type of paradoxical situation that occurs when public health evidence suggests we should do something and this is then contradicted by the actions of government and industry.

Here’s another example: did you know that energy drink consumption by school-age children is linked to hyperactivity, risky behaviours and health complaints such as headaches and stomach aches? And yet children of any age can buy these drinks in a variety of shops? You may have heard that the supermarket chain Morrisons banned sales of energy drinks to under 16s, but this was a trial that ended in early 2015. Some retailers choose not to sell energy drinks to younger children – often in response to pleas from teachers at nearby schools – but they do this on a voluntary basis and have to accept that they will probably lose revenue as a result.

Regular readers of this blog may be aware that Fuse members have been involved in conducting research on youth energy drink consumption over the past couple of years (you can read previous blog entries here and here). You may have read our Fuse brief, seen us present our findings at a seminar or conference, or downloaded our report from the HYPER! study website. So why the renewed call for action? At a time when the Government’s delayed childhood obesity strategy has been described as "pathetic", we need to take every opportunity to push for clear messages around food and health. We have worked with the Food Research Collaboration (FRC) to produce a briefing paper – published today – that clearly sets out the main ingredients of energy drinks, the current market situation, the scientific evidence base, and existing interventions, ranging from school-based educational activities to country-wide bans. The paper concludes with a series of recommendations on what could (and should) be done by policy-makers and others to address this issue.

To go back to the example of cigarettes, we know that sales and marketing restrictions are key factors in preventing uptake of smoking by children and young people, even if they do not eradicate the problem completely. Obviously energy drinks are nowhere near as harmful as cigarettes. They do not kill one in two consumers. But, like all sugar-sweetened beverages, they do contribute to increasing levels of childhood obesity and type 2 diabetes, as well as poor dental health. By law, energy drink labels must include the following warning: “High caffeine content. Not recommended for children or pregnant or breastfeeding women”. So isn’t it time we stopped sending out conflicting messages and made it clear that these drinks are not suitable for children and young people?

Download the briefing paper Energy Drinks: What’s the evidence? written by Shelina Visram (Durham University) and Kawther Hashem (Action on Sugar).


Illustration: Cathy Wilcox via http://www.essentialkids.com.au/food/nutrition/caffeine-concern-over-teens-and-energy-drinks-20130905-2t6hb

Not just a can of pop: the social meanings of energy drinks

Posted by Mandy Cheetham, Fuse Research Associate at Teesside University

Children and young people can sometimes be conspicuous by their absence in public debates about sugary drinks, so I’ve enjoyed reading the series of blogs posted since September, which describe research and activities involving young people. As children and young people are the predominant consumers of sugary drinks, it is claimed they are one of the groups whose health will benefit most from efforts to control or reduce their consumption (FPH 2015), such as the introduction of a duty on sugary drinks advocated by PHE (2015) and popularised by Jamie Oliver.

Our study on energy drinks showed that cost was one of the major influences on young people’s choices. The mapping exercise we did with Year 6 and Year 9 students in their local area showed walls of cheap, appealing, attractive displays of multiple flavoured energy drinks to tempt young people, with ‘buy one, get one free’ offers to share with friends. As important as the economic considerations are, the social meanings of energy drinks also have a major role to play. These are often misunderstood or ignored by adults planning public health interventions to reduce the risks of obesity.

Young people described the social spaces in which they drink energy drinks, whether consumed at weekend sleepovers, whilst gaming, hanging out with mates in the park, or on the way to or from school. Shared, swapped, and exchanged, energy drinks, and the sponsorship, branding and marketing associated with them, are woven in to the social fabric of young people’s lives. Energy drinks are part of the construction and maintenance of particular gendered identities, associated with extreme sports, alien elimination, looking hard, sophisticated and / or attractive. They offer young people opportunities to conform to certain ideas about what girls and boys like and do, and become part of the currency of young people’s daily interactions. In short, social meanings matter.

In Wendy Wills’ presentation at the Sweetness, Social Norms and Schools seminar in September, (CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices), I was struck by the similarities in young people’s comments about the importance of social relationships, interactions with friends, and the value of friendly respectful exchanges with local retailers, informing their lunchtime decision making. Young people were keen to be involved in efforts to improve the school food environment. Young people in our study were similarly fired up to make positive changes, and questioned why and how energy drinks companies can target young people under 16. They had ideas about what would make a difference and were realistic about the challenges of restricting sales of energy drinks to young people.

In September, Fuse welcomed Professor Helen Roberts, a self confessed fan of evidence informed public health advocacy, to deliver a knowledge exchange seminar prompting debates about our role as academics and advocates. Constrained by restrictions placed on us by funders, some appear nervous about compromising assumed notions of independence. If we want our research to have impact, should we not frame public health debates in ways which make sense to those who participate in our research? Rather than simply highlighting the health risks of energy drinks, this means understanding the social meanings of young people’s food and drink choices and more critical engagement with the industry that promotes them. Our efforts would be further strengthened by encouraging young people and colleagues to connect with other campaigns such as RRED and GULP.

To download the Fuse Energy Drinks report click here, or the Fuse Brief can be viewed here.

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Energy drinks: Don't believe the hype

Guest post by Shelina Visram, Lecturer in the Centre for Public Policy and Health, Durham University

When asked where the idea for our study on energy drinks came from, I usually say it was through discussions with colleagues as part of another project I’m leading on in County Durham. But that's not strictly true. The original spark came from my experience a few years ago of lecturing at Northumbria University in the dreaded Tuesday 9am slot (student night in Newcastle is on a Monday), where I noticed some students regularly downing a couple of energy drinks throughout the lecture. This was my first encounter with these drinks being consumed during daylight hours and I was fascinated by the idea that some people might have them for breakfast. So this got me wondering - why would young, seemingly healthy students feel the need to use an artificial source of energy to get them through the day? Or was it just my lectures sending them back to sleep? (That is if they had even been to sleep).

Over the years I noticed more and more of these drinks appearing in shops, on TV shows, in adverts and as litter on the streets, and assumed that they were used primarily by adults to stay awake. Most cans and bottles state that these products are not recommended for children, given that they contain high levels of caffeine which children are advised to consume in ‘moderation’ [1]. But then I overheard a couple of external partners discussing energy drinks in the context of them being seen as a growing 'problem' in primary and secondary schools in County Durham. They were looking for support in scoping the evidence base and exploring what types of interventions or educational materials could be developed locally. Around the same time, a call was circulated via Fuse for research proposals to The Children’s Foundation [2]. Colleagues from Fuse and the Wolfson Research Institute for Health and Wellbeing at Durham University [3] were keen to collaborate on an application. We developed our proposal, were awarded funding, and the HYPER! (Hearing Young People’s views on Energy drinks: Research) study was born [4]. 

Since June 2014, the HYPER! study team has been busy: reviewing the published literature on children and young people’s use of energy drinks; conducting a series of focus groups and interviews with students, parents and staff from four local schools; and involving young people in a mapping exercise, drawing on their knowledge of the area around their school to identify local energy drink vendors. Here are some of the things we’ve learned:

• If you come across a paper that says ‘energy drinks are good for you’, check to see if the work has been funded by Red Bull or conducted by someone with shares in PepsiCo.
• Most papers that say ‘energy drinks are bad for you’ are based on expert opinion, rather than robust research.
• Young people in the UK drink more energy drinks than those in other European countries, yet there are no published studies from the UK.
• Sales restrictions might seem like a sensible option; they would help to send a clear message but our study participants had concerns that they would be difficult to enforce.
• The strong influence of the marketing activities of energy drink companies should not be underestimated.
• Any interventions should ideally involve children and young people, as well as parents, schools, retailers and the industry.
• There is a lot of confusion around whether energy drinks are safe for children, and parents, teachers and young people need help to make more informed choices.  At least one young person in all but one of our focus groups thought that energy drinks contained bull or horse sperm [5]. They don’t.

There are still lots of unanswered questions. For example, if the government requires energy drinks to carry warnings stating that they are not recommended for children, why are manufacturers allowed to market them so obviously towards young people? What are the long-term health and other effects? Is there a link to health inequalities? And why would anyone knowingly drink something that they thought contained bull sperm? We’re hoping to answer some of these questions by conducting further research so please get in touch if you’d like to collaborate with us or if you’re already involved in work on energy drinks. We would love to hear from you.

You can find out more about this study by reading the new Fuse Brief here.

Shelina spoke about the HYPER! study at the CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices (9 September)

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Translating local action to national policy

Guest post by Robin Ireland, Chief Executive, Health Equalities Group and Director, Food Active

North West England (NWE) has some of the worst health statistics in the country calling for transformative and challenging approaches by its local public health community. Merseyside-based social enterprise, the Health Equalities Group (HEG) including heart health charity Heart of Mersey has worked with and supported NWE’s Directors of Public Health since 2003.

Obesity and maintaining a healthy weight present huge problems both now and in the future. Balancing the need for a population-based prevention approach whilst government policy focuses on targeting individuals with expensive weight management programmes is particularly difficult. At the same time individual stigmatisation is both unhelpful and particularly damaging. Somehow we have to work towards changing cultures so that junk food is less easily available, that healthier food is the popular choice and walking and cycling are positively encouraged.

The NWE Directors of Public Health asked HEG to develop a collaborative approach to healthy weight in 2012 and the Food Active campaign was eventually launched in November 2013. It calls for policies to:

• Control the marketing of junk food to children and young people
• Place a duty on sugar sweetened beverages
• Enforce 20mph speed limits in urban areas (lower traffic speeds make cycling, walking and play safer)

In the same way Liverpool and the NWE played an important role in the development of smoke free policies, Food Active hopes to bring local pressure to bear on government in calling for a more upstream approach to addressing obesity.

We began by building the evidence base around attitudes towards sugary drinks and modeling the effects a tax on such drinks may have on consumption. This in turn can be compared with the prevalence and cost of type 2 diabetes, and bariatric surgery etc. As data show teenagers are the highest consumers of sugary and ‘energy’ drinks, we established a media-friendly campaign called ‘Give Up Loving Pop’ to raise the debate and heighten the pressure for action. In the same way that regional tobacco control organisations have worked closely with national charities such as Action on Smoking and Health (ASH), Food Active has developed relationships with the Children’s Food Campaign and Action on Sugar.

In 2014, learning from ASH and the excellent work of local government on the Local Authority Declaration on Tobacco Control, Food Active started to develop a similar declaration on healthy weight. A regional meeting followed by workshops with three North West authorities showed that such a declaration could:

• Raise with elected representatives and the public that local authorities have a role to play in addressing obesity
• Help to show a wide range of policies (such as transport, planning and leisure) all have a part to play in promoting healthy weight

A Local Authority Declaration on Healthy Weight is more complex than its tobacco control equivalent and it is being developed in two parts; the first with some generic commitments (such as agreeing that obesity and overweight are a priority), the second more locally focused and aligning with local policies and priorities (for example Local Transport Plans).

As previously, the North West’s health needs will help to make the call for more concerted and resourced national action.

Robin will be speaking about the Food Active campaign tomorrow (9 September) at the CPPH Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices 

Robin Ireland

robin.ireland@hegroup.org.uk
@robinHEG

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Getting our hands greasy: The joys of researching food and drink sold near secondary schools

Guest post by Wendy Wills, Sociologist of Food and Public Health, University of Hertfordshire

Next Wednesday (9 September) I will be at Durham University to present and discuss the findings from a study which colleagues and I conducted that focused on exploring the reasons that young teenagers at secondary school buy food and drink outside school.

It was a busy project, with just two weeks at each of our seven selected case study schools to run an online survey in classes of 13-15 year olds, as well as asking them to take part in a written exercise and focus groups. We also conducted interviews with the young people, as well as the head teachers, school kitchen supervisors and local retailers. Over 600 young people took part. I had two brilliant early career researchers working full time collecting data in Scotland (the work was funded by the Food Standards Agency north of the border) plus some part time help from colleagues.

I love conducting fieldwork – there is nothing quite like getting your hands dirty (or greasy in this case but more on that later) during data collection and no better way to fully get to the heart of your research questions than being ‘in the field’ with your team. I particularly enjoy research with young people as they are often very happy to tell you exactly what they think and indeed, they are often pleased to be asked about matters that they are often not consulted about – such as the food and drink they have access to.

So, being in Scotland and racing from classroom to chip shop to follow young people (with their consent of course!) as they decide where to go on a particular day to buy their lunch was something of an adventure.

The young people had us salivating over their lunchtime purchases, though not for any health-related reason! For the most part it was the complete opposite. Part of our plan was to purchase the same edibles as the young people we accompanied so that we could weigh and record each item (to later conduct a nutritional analysis of the unpackaged food and drink they bought). We often had bags full of (extremely cheap) deep fried ‘chicken balls’ with luminous orange sweet and sour sauce from takeaway shops; warm sausage rolls with the grease oozing through their paper bags from bakeries and bottles of bright green, blue or orange ‘energy drinks’ from corner shops that sometimes had questionable hygiene and/or felt a little intimidating.

'Chicken balls'

As all this action happened over lunchtime you can imagine the team were often hungry by the time we left each school and so we sometimes resorted to trying some of the rapidly cooling food and drink that filled the boot of our car. The worst thing I tried was the battered and deep fried pizza slice – words cannot really describe it – the hard and tasteless pizza base, the smear of tomato paste, the greasy battered coating.

The fieldwork did not only provide us with greasy hands but also an appetite for supporting effective policies and interventions that promote healthy eating to secondary school pupils.

Wendy will be presenting this research at the CPPH seminar 'Sweetness, social norms and schools: factors influencing children and young people's food and drink practices' on Wednesday 9 September at Durham University. 

Bull sperm and ‘poor parents’: the role of myths in public health practice

Posted by Stephen Crossley, Research Assistant on the Fuse HYPER! Energy Drinks research project and a PhD student at Durham University

One of the most interesting themes, in my opinion, emerging from the current research into young people’s consumption of energy drinks, is the way that different messages about energy drinks – who (supposedly) consumes them and how – circulate and often deliver contradictory images and information. Not only are young people targeted by a range of clever advertising strategies from the companies that produce and sell these drinks, but they also receive information from teachers, parents, public health practitioners, media outlets (including social media) and their peers. Adults also receive information from similar sources.

By way of example, many people are aware that lots of energy drinks contain Taurine. Some people, no doubt helped by internet search engines, social media and classroom rumours, also believe that the taurine that is in energy drinks is extracted from bull sperm. This info lies firmly in the realm of ‘urban myth’, although you can perhaps understand where it originated from, given that taurine was first isolated from ox bile and it is present in bull sperm. It can also be found in fish and meat, and in breast milk, although we’ve yet to come across any young people who believe there is industrial scale maternal ‘pumping’ going on in an effort to give the population wings. Somewhat predictably, the taurine in energy drinks in synthetically produced in labs.

Urban myths, although they contain a degree of plausibility, are relatively easy to disprove due to a lack of robust evidence. But there are other types of myths which are sometimes harder to disprove, despite similarly lacking credible evidence bases. Christopher G. Flood (2002) identified ‘political myths’ as coherent narratives which orient discourses in the one ideological direction rather than another. He argued that political myths:

can be said to exist when accounts of a more or less common sequence of events, involving more or less the same principal actors, subject to more or less the same overall interpretation and implied meaning, circulate within a social group.

Contemporary political myths include there being ‘no alternative’ to austerity, the need to crackdown on ‘skivers’ who are ‘welfare dependent’ and the dangers posed by migrants acting as ‘benefits tourists’ or ‘health tourists’. The idea of a group of ‘poor parents’ (in both senses of the phrase) representing a major public health risk to their children as a result of problematic parenting behaviours is, I would argue, another such political myth. These parents are often marked out as being different from ‘us’ by virtue of their residence in ‘deprived’ areas and by their ‘inferior’ parenting practices. In Flood’s words, therefore, the same principal actors are subject to more or less the same overall interpretation and implied meanings.

During the course of our research, we have encountered a small number of stories about parents blending a MacDonald’s ‘Happy Meal’ or a ‘Sunday dinner’ and putting it in baby’s bottles or parents filling milk bottles with energy drinks or other inappropriate drinks/liquids. Previous experience within the research team suggests that similar stories will probably be familiar to many people working in public health and/or nutrition.

Views about ‘poor parents’ have a long and undistinguished history, stretching back to at least Victorian times when there was concern about a ‘social residuum’ (see John Welshman’s fascinating book Underclass for a comprehensive history). Public health practitioners also have a long history of involvement with these ideas and the roles of Chief Medical Officers in propagating ideas about a ‘social problem group’ in the 1930s and ‘problem families’ in the 1950s are particularly sobering, given that they were influenced and supported by The Eugenics Society. Despite over a century of social scientific research, there is no credible evidence of a large number of families with different cultural values or behavioural norms from ‘the rest of us’.

As noted above, many of these ideas originate from politicians, who are keen to differentiate between ‘skivers’ and ‘strivers’ or ‘troubled’ and ‘hard-working’ families and who would have us believe that there is an ‘underclass’ whose parenting deficiencies are ruining the lives of their children. Unfortunately, some public health practitioners do little more than repeat and embellish these political myths, giving them more credibility and potency than they perhaps deserve.

I am not denying that there may well be a parent - or maybe even parents - who have blended a Happy Meal or given their child an Energy Drink. What I do doubt is whether the potential, but as yet unfounded, actions of an extremely small number of parents is worthy of repetition from some - though not all - public health practitioners on the scale that we sometimes see. Shouldn’t we be setting the bar a little higher than second or third-hand anecdotes in terms of ‘evidence-based’ practice and policy making? Not believing, or at least questioning, some of things we read on the internet or that we are told by politicians and, in some cases, colleagues, would be a good place to start. Failure to challenge such stereotypes leaves the way clear for the wider political myth that, in the words of Stanley Cohen (1985), ‘the deprived are not much different from the depraved’.

Cohen, S. (1985) Visions of Social Control, Cambridge: Polity

Flood, C.G. (2002) Political Myth, Abingdon: Routledge

Welshman, J. (2013) Underclass: A history of the excluded since 1880, London: Bloomsbury

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