The WHO and the European Union recognise that poor nutrition is a leading cause of the major non-communicable diseases, including CVD, type 2 diabetes, certain types of cancer, and contributes substantially to the global burden of disease, death and disability(Reference Robertson, Tirado and Lobstein1, 2). Therefore, it is no surprise that Rayner and Scarborough(Reference Rayner and Scarborough3) report that, in the UK, food-related ill health is responsible for approximately 10 % of morbidity and mortality and costs the National Health Service approximately £6 billion annually. In addition, the diets of those on low incomes may contribute significantly to health inequalities(Reference Mwatsama4), as they can fall considerably short of the latest nutritional recommendations(5).
Public health practitioners, therefore, need new strategies for targeting diet and nutrition health promotion at the populations that need it most. The Foresight Report(6) has found that creating an environment that supports people in developing and sustaining healthy eating is a challenge for policy makers but, if successful, can provide a valuable and essential channel for policy makers to make a direct impact on the health of individuals and communities. The place where people live their lives and the food they can access has a strong influence on health equity(7, 8). Further, the Ottawa Charter for Health Promotion(9) proposed a new approach to public health that highlights the role of environments in influencing health. This shift in orientation has found its expression in the settings approach, which moved health promotion away from focusing on individual behaviours to developing a strategy that encompasses a total population within a given setting(Reference Kickbusch10). This ‘whole settings’ approach, in which targeted changes are made to improve lifestyles where people live and work, is now familiar in settings such as hospitals and schools(11, Reference Tones12).
Thus, the potential for tackling health inequalities in specific environments can make health promotion more appropriate and accessible to communities. In 2004, two ‘Healthy Stadia’ programmes in North-West England began to explore how sports stadia(Reference Haig and Crabb13, Reference Ratinckx and Crabb14) could be used as settings to reach large numbers of people in order to promote and ultimately improve the health of local communities. Millions of people attend sports stadia each week, to support their team, to work or to use the stadium’s facilities. Stadia offer important opportunities for reaching large numbers of people and for improving public health and reducing inequalities(Reference Parker and Ireland15). However, the potential role of a stadium as a healthy setting has so far been under-researched and evaluated for the opportunities it may offer. In particular, while there has been growing awareness of the impact of a poor diet on health, there has been little attention given to the food available in sports stadia. Thus, as football stadia have been identified as potential settings for health promotion interventions, it is timely to consider the attitudes of supporters to the food served at the stadia they attend and the importance they attach to this food in terms of their own health.
A football club in the English Premier League in the north of England was identified as a case study. The club is a large, well-supported club with a loyal and strong fan base. They felt strongly about responding to the views of their fans and gave permission for the researchers to access their database and to use the club’s facilities to host the discussion groups.
The aim of the study was to explore football supporters’ perception of the food provided at the Citygrene Stadium, the home of Citygrene FC. This in turn will help to inform health promotion interventions that seek to improve the food served at sports stadia.
Methods
As football fans already have a clear collective identity through their allegiance to the football clubs they support(Reference Zillmann and Paulus16), it was felt that this identity would be ideal for a qualitative study using group discussions rather than through individual interviews.
The group discussions generated a great deal of interactive debate about supporters’ attitudes towards food and healthy lifestyles. It was essential to use the dynamics between supporters to explore this particular issue(Reference Morgan17–Reference Green and Thorogood19) and interviews would not have been able to capture this lively discourse.
A purposive sampling strategy was used to recruit participants from season ticket holders of the premiership club(Reference Coyne20). As it was assumed that gender may have considerable bearing on the views of football fans, the focus groups were divided into all male and all female groups. All women focus groups were used as there is a much lower female attendance at the Citygrene Stadium and hence a smaller sample size (the gender split for season ticket holders at Citygrene in the 2006/07 football season was 88 % male and 12 % female)(Reference Hodgson21). In order to access and recruit current supporters of Citygrene FC, consent was gained from the club to access their season ticket databases. Invitations were sent to the postal addresses of supporters with a local postcode inviting supporters to participate in a discussion group to be held in the stadium. To encourage participation, an inducement was offered of free entry into a prize draw for souvenirs from the club’s merchandise store for all those who participated.
From the start, recruitment was difficult. Initially, the research team wrote to ninety-two supporters from the database supplied by Citygrene. Only two reply slips confirming attendance were received from this first round of recruitment.
After a review of the recruitment strategy, more data were requested from the football club with a specific request for telephone numbers of supporters. This provided a much larger sample of supporters. Personal telephone calls were more effective in recruitment, although it was a problem getting hold of the named supporter at home.
The main reason people gave for not wishing to attend the focus groups was personal or work commitments, and it was much more difficult recruiting men than women. The combined recruitment strategies resulted in twenty-four participants being recruited into five focus groups. Efforts were made to ensure that groups were run on different evenings and times to accommodate as many people as possible.
The recruitment process and characteristics of the individual groups are outlined in Table 1.
Table 1 Recruitment process and attendance at focus groups
Group 1, men using stand A; Group 2, women using stand A; Group 3, men using stand B; Group 4, men using stand B; Group 5, women using stand B.
Data collection
All the participants in the focus groups were fully informed about the nature of the research and were asked to sign consent forms. They were also informed that they could withdraw from the study at any time(22).
The focus groups were held in rooms in Citygrene Stadium, where fans could enjoy the hospitality of the club in an informal, relaxed atmosphere. Football has a natural discourse of banter and fans need little encouragement to debate matters that concern their club, which proved helpful in the group discussions.
A question schedule was developed by the researchers prior to the focus groups; however, the discussions tended to be guided mainly by the views of the participants themselves, with little intervention required from the facilitator(Reference Green and Thorogood19, Reference Krueger and Casey23, Reference Litosseliti24).
All five focus groups were transcribed verbatim and the data were analysed using thematic analysis. Green and Thorogood(Reference Green and Thorogood19) describe thematic analysis as: ‘a useful approach for answering questions about the salient issues for particular groups of respondents’. A coding scheme was developed by the researchers from the words and phrases of the supporters themselves. By charting and mapping out the emerging themes, it was possible to look for associations and linkages between the data. The key findings are discussed below.
Results
Who are eating all the pies and drinking all the beer?
Female focus group participant aged 50
The findings showed consistent differences between the views of male and female participants attending the focus groups. This became an underlying theme throughout. Four other principal themes were identified: the quality of the food and drink; the food available to children; football fans as modern-day consumers; opportunities for improving the food and drink on offer at Citygrene.
Gender differences
The men and women who attended the focus groups had different expectations of a football stadium. Some of the men viewed attending matches as a treat; as an opportunity to behave differently. They attended football for a ‘release’ from their every day life and thus they would not expect to eat anything ‘healthy’. Healthy eating was not something they traditionally associated with football grounds:
I think when I’m not at the match, in general, I try and eat healthily, but coming to the games it’s a rare treat, so when I’m there I’m out for the day, I’m getting into the spirit of it, and have a pie…
Male (aged 28)
The female participants displayed very different views, not only about the catering but also about the ‘total football experience’. They were not always comfortable with attending a stadium, which to them represented an essentially male environment. The female participants also felt that the club did not consider their needs generally. They said many women were put off by the ‘masculine mentality’. They felt that football stadia were essentially male preserves – ‘a man’s game’ – and they were very clear that they wanted something different, where they were genuinely catered for across all aspects of the match day services:
…we want a different service to what’s being offered, to the masculine mentality of a pub, drinking, cigarette smoking, and pie and pint.
Female (aged in her 40s)
The type of food served at matches appeared to be more important to some women participants than the men. It was integral to their experience and expectations:
I don’t think food is just something to shove in your mouth and keep you occupied for the next hour, I think food is something you should enjoy, and it should be part and parcel of the event of the day.
Female (aged in her 40s)
One area where there was little disagreement between genders was in the quality of the food, nearly all the participants describing the food and drink as ‘awful’, ‘abysmal’ and ‘atrocious’:
I think the tea and coffee are these pre-prepared stuff and is the most atrocious thing that I’ve ever tasted. It’s horrible, the tea and coffee is abysmal.
Male (aged 51)
Well, I like pies, but the pies that I’ve sampled here and at football grounds are just awful, generally, really awful.
Female (aged 34)
Female participants complained about the alcohol choices, which they perceived as beer or nothing. They also noted that the food choice was so limited and it did not cater for people with special dietary needs, such as vegetarians.
Food for children
While many of the participants were unhappy about the food and drink on sale, of greater concern was the food available to children on match day. Female participants expressed real frustration about what was on offer at the Citygrene Stadium. They felt that the football stadium was a place of contradictory messages. While fizzy drinks and hot dogs were the principal catering options, out on the pitch – in stark contrast – were fit and active people, who represented the embodiment of healthy living.
The lack of choice in the food and drink was a concern to parents/carers who took their children to matches:
The thing is … if you’re taking children to the game with you … there’s nothing here for them, there wouldn’t be anything healthy for you to buy a child at all.
Female (aged 34)
Female participants felt there was a real opportunity for Citygrene to take a pro-active role by promoting healthier lifestyles to their young fans:
I think we should be educated now more for healthiness, I do, if this is what the Government are trying to influence into everybody at schools, I think we should be as a club going down that line as well, we should have more healthy options, we should be more conscious of young fans, being more healthy, … the players are very healthy on the pitch, they’re getting all the healthiness, why isn’t that implemented?…
Female (aged 45)
Football fans as modern-day consumers
It was frequently suggested that players could act as role models and promote healthier products. The more popular players could, for example, endorse products on the packaging. It was clear that these football supporters saw themselves as consumers who were entitled to be critical of services at football grounds as in other settings.
All the participants expressed varying degrees of dissatisfaction with the service they were offered at the Citygrene Stadium. They also all agreed that food and drink prices were too high, and expressed concern that the club ‘played on their loyalty’ to ensure their custom, whatever the prices. While some participants saw eating and drinking as a way of contributing directly to the club’s funds, they also felt that the club repaid their loyalty with a lack of consideration and respect.
…it’s just when they take the Mickey of it, with the pricing, that you don’t want to be made a fool of because you support the club.
Male (aged 28)
There was a sense that the participants understood their role as consumers and as such expected a better service. Their view was that times have changed and football supporters had become more sophisticated in their tastes. As such, they were prepared to challenge standards within the stadium:
…we’re a bit more sophisticated now, that’s the thing, and I don’t think football has caught up with this.
Male (aged 56)
All the participants recognised that the perceived poor quality of food and drink on offer, the low standard of service and the high prices affected catering sales at Citygrene. They felt that the club had missed a financial opportunity by not making the most of their custom:
I spend, of a match day, don’t quote me to my missus, I spend about £35 on a match, that’s besides paying for the season tickets. But I spend it away from C. The question that needs to be asked, is what plans has Citygrene got to take the £35 off me rather than me spending it in the pub?
Male (aged 55)
As consumers, the participants wanted change. This could be through a healthier, higher quality food service and certainly healthier products for their children. And they wanted their football club to be aware of and listen to their views.
Opportunities for improving the food and drink on offer at Citygrene FC
In general, the female participants recognised that there were often differences in what they like to eat and drink compared with their male counterparts, and their choices may be healthier. They did not want to deny the men their choice/s but they did feel that healthier options should be offered.
I think they should reach out to what the women want, and accept that it doesn’t really matter that there are differences in the needs of what they want, you know, because I wouldn’t want to deprive the men, or the boys, of their pies, because that’s part of their, what they want to do, but there should be alternatives, and it should be better.
Female (aged in her 40s)
Some of the women felt strongly that the club must make changes and indeed chose not to eat at the Citygrene Stadium because of the lack of a healthier choice. They either ate before coming to the game or brought food with them. Many said they simply wouldn’t dream of eating a pie at a match.
Maybe that’s the difference between men and women; I think women are more likely to kind of follow healthy eating and men … are more likely to have a pie.
Female (aged 30)
Finally, there was a difference observed between the attitudes and views of younger and older male participants. Some of the older men were beginning to experience health problems and thus had begun to develop concerns about what they ate and drank. Once again they felt there should be more choice and alternatives to pies:
I’m getting on a bit, and as such I’ve got various illnesses, I’m carrying baggage, my age and all that, it’s something I’m conscious of … and I basically, if I’ve got an alternative to pies, then I will take the alternative.
Male (aged 51)
Discussion
The present research was undertaken to ascertain football supporters’ views on the food and drink available at Citygrene. The culture and imagery of food at football grounds remains powerful. What is clear from the present study is that if food is to be improved and become healthier, the dominant association between pies and football will need to be considered more carefully. The feeling that the match is a place for an occasional unhealthy pie means it is unlikely that football fans will take easily to pies being removed from menus. However, the quality of the pies being served in stadia concourses could be improved considerably and by reducing the amount of saturated fats and salt used, the pie could be made healthier and with less calories. There are signs of changing standards in stadium kitchens(Reference James25, 26).
It would also appear from the present research that there are a number of contradictions operating in sports stadia. Whilst on a football pitch or arena there is the embodiment of health and fitness, the food provided contradicts this image and valuable opportunities for health promotion are lost. It also has the potential to undo the work of health promotion in other settings as this association between healthy eating and physical activity becomes blurred. The tensions that can be displayed between sport and health promotion have been noted elsewhere in the ‘incongruous partnerships’, where stadia and sports obtain sponsorships with corporations selling alcohol, fast food or sugary drinks, which can complicate their health equations(Reference Collin and MacKenzie27).
The UK government’s ‘Choosing Health’(28) includes a chapter on health in the consumer society. This suggests that by making healthy choices enjoyable and convenient, a stronger demand will be created for healthier products which will in turn influence industry to take into account health issues.
The study raises a number of issues important for health promotion. In particular, it is clear that gender is important and rather than being overlooked as it currently is, it should be mobilised for effective health promotion strategies. As the number of women football supporters increases, this may become the catalyst for improved services which can contribute to healthier food and potentially healthier stadia. However, at present, women football supporters remain close to invisible in the literature(29) and in stadia. Whilst some interest has been shown in women who play the game, those attending matches as spectators have been largely ignored. The female fan deserves much more attention by the researcher and the football industry alike. Their numbers are increasing and their ability to influence ‘football culture’ should be carefully considered.
Consumer choice is becoming a major issue in public health advocacy(28) and any move towards healthy stadia inevitably needs to engage with consumer choice. Crawford(Reference Crawford30) and others discussed the sports fan as a consumer and notes how sport venues have become increasingly geared towards creating an experience for the paying public to consume. There is a role here for public health advocacy in supporting consumers’ demands for healthier products. The latest Football League survey(31) shows a growing interest in the standard of the food and drink provided as a contributor to the match day experience.
The increasing commercialisation and commodification of sports venues inevitably affect the food and drink available and should be considered in future research. The increasing control consumers exercise over their own lifestyles demonstrates a move towards greater empowerment. The Government’s move towards greater individual choice in choosing healthier living(28) similarly indicates a cultural shift. However, it was noted by those attending the focus groups that their views were not usually sought by the football club and they welcomed the opportunity to have a voice. Public health discussions around community participation and genuine engagement focus on a lack of access to decision making(Reference Petersen and Lupton32) together with an opportunity for effective community consultation.
Giulianotti(Reference Giulianotti33) describes a ‘post-modern’ football environment where the football authorities seek to exercise control over what supporters may and may not do inside grounds. This control may be challenged, as supporters demand a louder voice in what they view as ‘their stadia’.
There is little research currently available on using sports stadia as settings for health promotion interventions, although a new European Sports Stadia and Community Health project(Reference Parker and Ireland15) will undoubtedly uncover new material.
The participants in the focus groups in the present study showed that many of those attending – women in particular – would welcome more awareness of health issues at the Citygrene Stadium. Further research both in the UK and internationally is necessary to determine the most effective way forward to deliver healthier choices in the food and drink available at sports stadia.
One of the main limitations of the present study was the problems with recruiting participants for the focus groups and the subsequent low attendance rate. The majority of contacts within the sample were, in terms of health needs, a hard-to-reach group: men in their 20s–40s, who often have a reluctance to engage with issues relating to their own health(Reference Robertson34). As the study showed, male supporters also associated attendance at football matches with escape from daily grind and, therefore, may not want to associate this with health. Conversely, the availability of contacts for women was significantly lower but women were much more proactive in responding and participating. The participants who did attend the focus groups were very engaged and active with participation levels high. It was clear amongst those who attended that the topic was important, yet was also a hidden issue. Future studies should take on board these problems with recruitment and develop a number of recruitment strategies that engage as many male supporters as possible. Greater incentives could also have been offered and help with travel expenses may have been more appealing.
Conclusion
The present research has shown that if public health practitioners are to implement the ‘healthy stadia’ initiative, the diverse views of both women and men need to be addressed.
Of key concern are the contradicting messages children receive. In school, the emphasis is on healthy eating, but in our football clubs – which remain possibly the biggest sporting influence on the lives of young people – the culture is anything but healthy as fans continue to consume fizzy drinks, burgers and hot dogs.
Public health practitioners can help clubs develop a key role in providing examples of good practice, particularly to young people, of the importance of healthy food and drink as part of a healthy lifestyle. This would help to balance the inconsistencies between the healthy lifestyles of the players and the food the clubs provide to their supporters.
Football clubs could be encouraged to reflect on their iconic status within their communities and demonstrate social responsibility in the food and drink supplied to their supporters. At the very least, greater consultation with their supporters is needed on the food and drink supplied in their stadia with a healthier choice of food and drink being made available.
Acknowledgements
No funding was received to support the present study. There are no conflicts of interest. Both authors contributed to the overall study design, the discussion of findings and conclusions. Collection of the data and initial coding was by R.I.
