Accuracy of energy and nutrient intake estimation versus observed intake using four technology-assisted dietary assessment methods: a randomized crossover feeding study

BACKGROUND

Technology-assisted 24-hour dietary recalls (24HR) have been widely adopted in population nutrition surveillance. Evaluations of 24HR inform improvements but direct comparisons of 24HR methods for accuracy in reference to a measure of true intake are rarely undertaken in a single study population.

OBJECTIVE

To compare the accuracy of energy and nutrient intake estimation of four technology-assisted dietary assessment methods relative to true intake across breakfast, lunch, and dinner.

METHODS

In a controlled feeding study with a crossover design, 152 participants (55% women; mean age 32y (SD 11); mean BMI 26 kg/m2 (SD 5)) were randomized to one of three separate feeding days to consume breakfast, lunch, and dinner, with unobtrusive weighing of foods and beverages consumed. Participants undertook a 24HR the following day (Automated Self-Administered Dietary Assessment Tool-Australia© (ASA24); Intake24-Australia©; mobile Food Record™ - Trained Analyst (mFR-TA); or Image-Assisted Interviewer-Administered 24-hour recall (IA-24HR)). When assigned to IA-24HR, participants referred to images captured of their meals using the mobile Food Record™ app. True and estimated energy and nutrient intakes were compared, and differences among methods were assessed using linear mixed models.

RESULTS

The mean difference between true and estimated energy intake as a percentage of true intake was 5.4% (95% CI 0.6, 10.2) using ASA24, 1.7% (95% CI -2.9, 6.3) using Intake24, 1.3% (95% CI -1.1, 3.8) using mFR-TA, and 15.0% (95% CI 11.6, 18.3) using IA-24HR. The variances of estimated and true energy intakes were statistically significantly different for all methods (P<0.01), apart from Intake 24 (P=0.1). Differential accuracy in nutrient estimation was present among the methods.

CONCLUSIONS

Under controlled conditions, Intake24, ASA24, and mFR-TA estimated average energy and nutrient intakes with reasonable validity, but intake distributions were estimated accurately by Intake24 only (energy and protein). This study may inform considerations regarding instruments of choice in future population surveillance.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry Number ACTRN12621000209897; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381165&isReview=true.

Impact of low birth weight on academic attainment during adolescence: A comprehensive retrospective cohort study using linked data

BACKGROUND

This study addresses a critical knowledge gap by exploring the intricate relationship between low birth weight (LBW) and the heightened risk of suboptimal academic achievement during adolescence through a comprehensive retrospective cohort design.

METHODS

In this registry-based cohort study, meticulously linked health and curriculum-based test data for individuals born in New South Wales (NSW), Australia, between 2003 and 2005 were employed. Birth weight data were carefully sourced from the NSW perinatal data collection (PDC). The educational performance of offspring was thoroughly evaluated using the National Assessment Program for Literacy and Numeracy (NAPLAN) during grade 9, approximately at 14 years of age.

RESULTS

After rigorous adjustments for potential confounders, findings revealed a compelling narrative: LBW adolescents demonstrated an elevated susceptibility to not meeting national minimum standards across all domains, encompassing spelling [OR, 1.59 (95%CI 1.48-1.69)], writing [OR, 1.51 (95%CI 1.41-1.61)], reading [OR, 1.38 (95%CI 1.29-1.48)], and numeracy [OR, 1.52 (95%CI 1.40-1.63)]. Notably, LBW boys exhibited a more pronounced inclination towards diminished academic performance compared to their female counterparts.

CONCLUSIONS

This comprehensive retrospective cohort study, based on linked data, unequivocally establishes LBW as significantly associated with an increased vulnerability to substandard educational achievement during adolescence. Particularly robust effects were observed in females across all outcomes. Aimed at investigating whether LBW serves as a predictive factor for later academic difficulties, this study underscores the imperative for the adoption and fortification of preventative and early intervention strategies to curtail the prevalence of LBW-associated academic underachievement in later adolescence.

The Nutritional Quality of Food Donated to a Western Australian Food Bank

Food banks provide an indispensable service to people experiencing severe food insecurity. Food banks source donations from across the food system; however, the food redistributed to clients across the developed world is nutritionally poor. This, together with the increasing prevalence of diet-related diseases and food insecurity, has prompted a focus on nutritional quality. Despite more food being distributed via food banks in Australia, the nutritional quality of donated food remains unreported. This study analyzed all food (84,996 kg (1216 products)) donated to Foodbank WA over a 5-day period using diet-, food-, and nutrient-based nutrition classification schemes (NCSs). A total of 42% (27% of total weight) of donated food products were deemed 'unsuitable' and 19% (23% by weight) were 'suitable' according to all NCSs. There was no agreement on 39% of products (50% by weight). Overall, NOVA and the Healthy Eating Research Nutrition Guidelines (HERNG) (κ = 0.521) had the highest level of agreement and the ADGs and HERNGs the lowest (κ = 0.329). The findings confirm the poor nutritional quality of food donated to food banks and the need to work with donors to improve the food they donate. Fit-for-purpose nutrition guidelines are urgently needed for Australian food banks to support them in providing nutritious food to their vulnerable clients.

Promoting mental well-being in Western Australia: Act Belong Commit® mental health promotion campaign partners' perspectives

The Act Belong Commit® mental health promotion campaign aims to improve population mental well-being. Based on a social-franchising model, partnerships are sought with organizations offering 'mentally healthy activities' that foster social connectedness and mental well-being. There are four categories of partner organizations sought: Site (government agencies and health services), Associate (organizations with state-wide or national services), Community (local, grass-roots community groups) and Schools. This research explored organizational perceptions of the Act Belong Commit® Partnership Program. A purposive sample of 14 organizational representatives across all four partner categories participated in semi-structured interviews online or face-to-face between July and September 2021. Reflexive thematic analysis was used to identify three main themes: (a) A passion for promoting mental health; (b) Implementation, innovation, adaption and creation (e.g. the ability to adapt, create and deliver activities aligned with the campaign message; and (c) Future sustainability (e.g. recommendations for the sustainability of the programme). The use of reflexive thematic analysis enabled deeper insights into the complexity of the partnerships. Findings describe how the Act Belong Commit® Partnership Program supports mutually desirable objectives and extends the campaign reach. Embedded in a shared belief system that incorporates a passion for good mental health, the model supports the flexibility to adapt, create and deliver fit-for-purpose activities that promote mental well-being in the places where people live, work and play.

Policy approaches to nutrition-focused food banking in industrialized countries: a scoping review

OBJECTIVE

This review aims to synthesize the literature describing policy approaches to nutrition-focused food banking in industrialized countries, spanning the period 2000 to October 2021.

BACKGROUND

The charitable food system provides food assistance to increasing numbers of people experiencing food insecurity in industrialized countries. Calls to improve the nutrition quality of foods provided by foods banks, pantries, and shelves have increased, yet little is known about the challenges faced when initiating policy in this setting.

METHODS

A protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Guidelines was developed and registered with Open Science Framework. Four electronic databases (MEDLINE [Ovid], Global Health, ProQuest, and Scopus) were searched for peer-reviewed articles published in English. A gray literature search was conducted using Google Advanced Search.

RESULTS

Of 642 peer-reviewed articles screened, 15 were eligible for inclusion. In addition, 24 gray literature documents were included. These 39 papers were assessed against the Iron Triangle of Hunger Relief and the Campbell et al framework of organizational factors. Six themes were identified: (1) there is a moral imperative to take action to ensure the provision of appropriate and nutritious food for vulnerable clients; (2) nutrition policies are unlikely to be formalized; (3) the unpredictability of donated food is a barrier to providing healthy foods; (4) reliance on donations affects the sector's willingness to reduce the unhealthy inventory for fear of losing donors, and the challenges of managing donor relationships were emphasized; (5) organizational capacity (volunteer workforce, executive leadership support) must be considered; (6) the existing measure of success is a weight-based metric that does not support food banks' prioritizing of healthy foods. These, and other characteristics, were incorporated into an adapted framework.

CONCLUSION

There is a need and opportunity for nutrition-focused food banking. A priority action area is the adoption of an outcome metric that is based on nutritional quality, to reorient the charitable food system.

Local government venues' sponsorship and signage policies to limit the promotion of harmful products: A Western Australian public health audit

OBJECTIVE

Identify and assess publicly available local government sponsorship and signage policies related to harmful products in Western Australia (WA).

METHODS

An audit of WA Local Government Authority (LGAs) websites (n=139) was conducted. Sponsorship, signage, venue hire and community grants' policies were located and assessed against set criterion. Policies were scored for the inclusion of statements regarding the display and promotion of harmful commodities (alcohol, tobacco, gambling products, unhealthy food and beverages).

RESULTS

Across WA local governments, 477 relevant policies were identified. Six percent (n=28) included statements restricting the promotion of at least one harmful commodity via sponsorships, signage, venue hire, and sporting and/or community grants policy. Twenty-three local governments had at least one policy that restricted unhealthy signage or sponsorship.

CONCLUSIONS

Most WA local governments do not have publicly available policies that specifically limit the advertising and promotion of harmful commodities in their government-owned facilities.

IMPLICATIONS FOR PUBLIC HEALTH

There is a dearth of research identifying LGA interventions addressing advertising of harmful commodities within council-owned sporting venues. This research indicates opportunities for West Australian LGAs to develop and implement policy to protect public health by restricting the promotion of harmful commodities to their communities, improving the healthfulness of environments.

Dietary risk of donated food at an Australian food bank: an audit protocol

BACKGROUND

Sufficient, safe and nutritious food is unattainable for many people experiencing severe food insecurity, putting them at dietary risk. Food banks, a growing part of the charitable food system (CFS), are the main source of food relief in developed countries. Donations of surplus, unsalable food from supermarkets, producers and manufacturers is the main source of the food supply, and this can be unpredictable, insufficient and inappropriate. The universal performance indicator of food-banking success is a weight-based measure, complemented by various initiatives to track the nutritional quality of food provided. There is currently no method that assesses the dietary risk of donated food related to nutrition and food safety. This protocol describes a method developed to identify and assess the dietary risk of donated food at an Australian food bank including the type, amount, nutrition quality, and food safety.

METHODS

An audit of all food donated to a food bank servicing one Australian state was conducted over five consecutive days in May 2022. The audit process used a mobile device to take photographs of all incoming deliveries to the food bank. The images were manually annotated to document the type of food, product information (brand and product name, variety), the donor's name, weight (kilograms), and date-marking details. Data was extracted from the photographs and assessed against pre-determined dietary risk criterion for food safety (date marking, damaged packaging, visible food spoilage) and nutrition quality according to the principles of the Australian Guide to Healthy Eating, and the NOVA classification of level of processing.

DISCUSSION

Fifteen hundred images were required to assess the dietary risk of 86,050 kg of donated food. There were 72 separate donations, largely from supermarkets and food manufacturers. Data analysis will enable identification of dietary risk, particularly for nutrition quality and food safety. This is important given the absence of food regulation for CFS donations, and the vulnerability of the client group. This protocol highlights the need for more transparency and accountability from food donors, about the food they donate.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Australian Consumers' Attitudes towards Sustainable Diet Practices Regarding Food Waste, Food Processing, and the Health Aspects of Diet: A Cross Sectional Survey

Environmentally sustainable diets are increasingly aspired to in food-based dietary guidelines across the world. However, little is known about consumer attitudes toward these diets when making food decisions. This study aimed to identify the demographic characteristics of Australian adults based on the level of attention they paid to the healthfulness of their diet, their consideration of the level of food processing, and their concern about household food waste and sustainable packaging disposal. Adults aged from 18 to over 75 years (n = 540) were surveyed online. Thirty-seven percent were concerned about sustainable food waste, 28% considered the level of food processing when making food decisions, and 23% paid attention to the healthfulness of the food they ate. Adults who had higher educational attainment (above Year 12) were twice as likely to be concerned about food waste and sustainable packaging disposal (odds ratio (OR) = 2.10, 95% confidence interval (CI) 1.29-3.4), and processing levels (OR = 2.04, 95% CI 1.23-3.42) (controlling for age and gender). Those earning an income over AUD$100,000 were twice as likely to pay attention to the healthfulness of their food choices than those earning less than AUD$50,000 (OR = 2.19, 95% CI 1.28-3.74). Only 9% percent were concerned about or paid attention to all three of the components of healthy sustainable diets investigated, and 45% paid no attention and were not concerned about all three components. These findings suggest there is a need to educate the public to raise awareness of and concern for healthy, minimally processed, and sustainable food choices.

Intersection between health, health literacy and local government: a mixed methods approach to identifying ways to better connect people to place-based primary health care in western Australia

BACKGROUND

The aim of this year-long mixed methods research was to examine the intersection between health, health literacy and local government to identify ways to better connect people to place-based primary health care (PHC).

METHODS

Four local government areas located within the Perth metropolitan geographic area provided the setting for the current research. Researchers were co-located into the four local governments over a 10-month period to engage with community stakeholders and services. Two methodologies were used to achieve the objective: eight group model building (GMB) workshops were conducted with N = 148 participants to create causal loop diagrams of the barriers and enablers to people being healthy and well in each of the LGAs and develop potential action ideas from these. Surveys were used to collect health service use and health literacy, as measured using a validated Health Literacy Questionnaire (HLQ), across the four LGAs (N = 409, approximately 100 respondents/area).

RESULTS

The causal loop diagram themes common across LGAs included: (1) mental health; (2) access to services; (3) health system capacity; (4) economics; and (5) physical wellbeing. Health literacy was relatively high for all nine domains of the HLQ. In the five domains rated from one to four the lowest score was 2.8 for 'appraisal of information' and the highest was 3.2 for 'feeling understood and supported by healthcare providers'. In the four domains rated from one to five; the lowest score was 3.7 for 'navigating the healthcare system' and the highest was 4.1 for 'understand health information well enough to know what to do'.  Prioritised action ideas recommended increases in practitioners to meet local needs and training General Practitioners and other health staff in culturally sensitive and trauma informed health care. The survey findings and field notes from the GMB were used to construct personas embodied in vignettes highlighting general themes identified in the workshops including those relevant to local areas.

CONCLUSIONS

There are many possibilities for health care and local governments to work together to bring services to community members disengaged from the health system. Bringing together people from diverse backgrounds and organisations created synergies that resulted in novel and feasible potential strategies to improve community health.

Understanding Prevention Networks in a Local Government Area: Insights From a Social Network Analysis Among Western Australian Nutrition, Physical Activity, and Obesity Prevention Programs

This study aimed to use systems thinking tools to understand network relationships to inform discussions, policy, and practice to improve nutrition, physical activity, and overweight/obesity prevention activities in a Western Australian local government area. An audit of nutrition, physical activity, and obesity prevention activities was conducted, and identified organizations were invited to participate in an organizational network survey. Social network analysis (SNA) determined the extent to which organizations shared information, knowledge, and resources; engaged in joint program planning; applied for and shared funding; and identified operational barriers and contributors. SNA data were mapped and analyzed using UCINET 6 and Netdraw software. Five organizations within the network were identified as core; the remainder were periphery. The strongest networks were sharing information, and the weakest was funding. The connections were centralized to one organization, enabling them to readily influence other organizations and network operations. Remaining organizations indicated limited partnership across the networks. Strengthened collaborations and partnerships are essential to health promotion, as they extend reach and organizational capabilities. This study provides a process for undertaking network analysis, identifying leverage points to facilitate communication and information sharing, and reorienting of collaborations and partnerships to consolidate scarce resources and act strategically within a bounded area. There is a need for stronger relationships between organizations and a reorientation of partnerships to facilitate resource sharing within the local government area, to improve nutrition, physical activity, and obesity prevention practices. SNA can assist in understanding organizational prevention networks within a bounded area to support future planning of practices and policy.

Dietary assessment methods used in adult digital weight loss interventions: A systematic literature review

The effectiveness of the tailored feedback in digital interventions may be limited by the quality of the dietary assessment (DA) upon which it is based. This study systematically reviewed studies reporting the protocols for DA methods used to inform tailored feedback in digital weight loss interventions. The search included: PubMed - National Library of Medicine database, MEDLINE, Cochrane Library of Systematic Reviews, Web of Science, and ProQuest. Search terms were related to five groups: dietary assessment, weight loss, clinical trials, technology and tailoring. Thirteen articles were eligible for inclusion. The most common DA method was a digital dietary record linked to a food database that provided instant feedback on daily energy intake. Only four studies provided feedback on overall diet quality and intake of fruit, vegetables, and fibre. Dietary feedback was provided using text messages, email, mobile applications, and online intervention websites. Most digital dietary feedback focused on reducing energy intake without providing feedback to enhance diet quality. This review highlighted the heterogeneity in DA methods used in tailored weight loss interventions, which may account for the range of outcome results reported. Future interventions should publish the protocols describing how dietary data was collected and used to inform dietary feedback. This article is protected by copyright. All rights reserved.

The Diet Quality of Food-Insecure Australian Adults-A Nationally Representative Cross-Sectional Analysis

Poor diet quality exacerbates risks for acute and chronic conditions. People experiencing food insecurity have an increased likelihood of lower diet quality; however, this has not been investigated in the Australian context. The aim of this cross-sectional study was to examine whether the diet quality of Australian adults differed according to their household food security status. Data were analysed from a nationally representative sample (≥19 years; n = 9115) collected as part of the National Nutrition and Physical Activity Survey 2011-12. Household food security status and socio-demographic and health characteristics were assessed using data from an 18-module health interview. A 24 h dietary recall was used to estimate food and nutrient intakes and to calculate the Dietary Guidelines Index (DGI). DGI is a food-based score (0 to 130) that assesses adherence to the 2013 Australian Dietary Guidelines. Survey-weighted linear regression models, adjusted for age and sex, were used to examine diet quality (total DGI and component scores), and total energy and nutrient intake by food security status. Adults from food-insecure households had a mean total DGI score 3.5 points lower (95% CI −5.57, −1.46) than food-secure adults (p = 0.001). Adults from households experiencing food insecurity, when compared to those who were food-secure, had several lower DGI component scores including for dietary variety (1.6 vs. 2.3, p = 0.009), fruit (3.8 vs. 5.0, p = 0.001) and vegetables (3.7 vs. 4.4, p = 0.010). Adults from food-insecure households consumed on average more carbohydrates (45.6 vs. 43.3, p = 0.004) and total sugar (21.8 vs. 19.0, p = 0.003) as a percentage of daily energy and less protein (18.5 vs. 17.2, p = 0.004), mono-unsaturated fats (11.2 vs. 11.8, p = 0.026) as a percentage of daily energy, and fibre (20.1 vs. 23.0, p = 0.003), than food-secure adults. Sub-optimal diet may be one of the contributing factors to, or outcomes of, poorer health in food-insecure populations. Food security interventions are required to better address nutrition in food-insecure households and should be tailored to the health and socio-demographic characteristics of this population.

The Nutritional Quality of Kids’ Menus from Cafés and Restaurants: An Australian Cross-Sectional Study

Australian families increasingly rely on eating foods from outside the home, which increases intake of energy-dense nutrient-poor foods. ‘Kids’ Menus’ are designed to appeal to families and typically lack healthy options. However, the nutritional quality of Kids’ Menus from cafes and full-service restaurants (as opposed to fast-food outlets) has not been investigated in Australia. The aim of this study was to evaluate the nutritional quality of Kids’ Menus in restaurants and cafés in metropolitan Perth, Western Australia. All 787 cafes and restaurants located within the East Metropolitan Health Service area were contacted and 33% had a separate Kids’ Menu. The validated Kids’ Menu Healthy Score (KIMEHS) was used to assess the nutritional quality of the Kids’ Menus. Almost all Kids’ Menus (99%) were rated ‘unhealthy’ using KIMEHS. The mean KIMEHS score for all restaurants and cafés was −8.5 (range −14.5 to +3.5) which was lower (i.e., more unhealthy) than the mean KIMEHS score for the top 10 most frequented chain fast-food outlets (mean −3.5, range −6.5 to +3). The findings highlight the need for additional supports to make improvements in the nutritional quality of Kids’ Menus. Local Government Public Health Plans provide an opportunity for policy interventions, using locally relevant tools to guide decision making.

"I'm making a positive change in my life": a mixed method evaluation of a well-being tertiary education unit

ISSUE ADDRESSED

Mental health disorders (MHDs) are prevalent among university students with detrimental impacts for individual students, universities and the wider community. There is urgent need for proactive and preventative strategies to address the mental health crisis in the university population. This study evaluated the efficacy of a 13-week unit developed to directly educate university students about ways to improve and maintain well-being.

METHODS

Fifty-eight university students from five disciplines participated in a 13-week elective undergraduate unit "Well-Being Fundamentals for Success" as part of their degree. The Act Belong Commit mental health promotion campaign framework formed the basis of teaching materials. Outcome well-being measures were self-assessed at weeks 1, 6 and 12 using four scales: 1) Warwick-Edinburgh Mental Well-being Scale (WEMWBS); 2) Perceived Stress Scale (PSS); 3) Brief Resilience Scale (BRS); and 4) Mindful Attention Awareness Scale (MAAS). Post-unit group interviews (n = 11) were analysed for key themes.

RESULTS

Linear mixed models demonstrated a significant improvement in BRS over the semester; well-being (WEMBS) and mindful attention (MAAS) did increase but not significantly. There was a significant increase in stress (PSS) over the semester. Key themes that emerged from the group interviews were that 1) University life contributes to well-being; 2) University life contributes to stress; 3) The well-being unit helped students see and do things differently; 4) An overall endorsement of the unit.

CONCLUSION

University students' resilience increased over the semester following participation in curriculum focused on well-being which featured a combination of theoretical content and experiential workshops.

Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study

BACKGROUND

The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use.

OBJECTIVE

The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals.

METHODS

Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests.

RESULTS

Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021.

CONCLUSIONS

This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/32891.

Weight bias among health care professionals: A systematic review and meta-analysis

OBJECTIVE

Weight-biased attitudes and views held by health care professionals can have a negative impact on the patient-provider relationship and the provision of care, but studies have found mixed results about the extent and nature of bias, which warrants a review of the evidence.

METHODS

A systematic review and random-effects meta-analysis were conducted by including studies up to January 12, 2021.

RESULTS

A total of 41 studies met inclusion criteria, with 17 studies providing sufficient data to be meta-analyzed. A moderate pooled effect (standardized mean difference = 0.66; 95% CI: 0.37-0.96) showed that health care professionals demonstrate implicit weight bias. Health care professionals also report explicit weight bias on the Fat Phobia Scale, Antifat Attitudes Scale, and Attitudes Towards Obese Persons Scale. Findings show that medical doctors, nurses, dietitians, psychologists, physiotherapists, occupational therapists, speech pathologists, podiatrists, and exercise physiologists hold implicit and/or explicit weight-biased attitudes toward people with obesity. A total of 27 different outcomes were used to measure weight bias, and the overall quality of evidence was rated as very low.

CONCLUSIONS

Future research needs to adopt more robust research methods to improve the assessment of weight bias and to inform future interventions to address weight bias among health care professionals.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children’s own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children’s firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children’s perspectives. Eleven participants aged 10–13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of ‘food’ preparation. This study provides a child-centric analysis, demonstrating how children’s agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study

BACKGROUND

The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support.

OBJECTIVE

The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors.

METHODS

This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis.

RESULTS

Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence.

CONCLUSIONS

This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/12782.

Long-Term Food Insecurity, Hunger and Risky Food Acquisition Practices: A Cross-Sectional Study of Food Charity Recipients in an Australian Capital City

Inadequate social protection, stagnant wages, unemployment, and homelessness are associated with Australian household food insecurity. Little is known about the recipients of food charity and whether their needs are being met. This cross-sectional study of 101 food charity recipients in Perth, Western Australia, measured food security, weight status, sociodemographic characteristics and food acquisition practices. Seventy-nine percent were male, aged 21–79 years, 90% were unemployed, 87% received social assistance payments, and 38% were homeless. Ninety-one percent were food insecure, 80% with hunger, and 56% had gone a day or more without eating in the previous week. Fifty-seven percent had used food charity for ≥1 year, and, of those, 7.5 years was the mode. Charitable services were the main food source in the previous week, however 76% used multiple sources. Begging for money for food (36%), begging for food (32%), stealing food or beverages (34%), and taking food from bins (28%) was commonplace. The omnipresence and chronicity of food insecurity, reliance on social security payments, and risky food acquisition suggest that both the social protection and charitable food systems are failing. Urgent reforms are needed to address the determinants of food insecurity (e.g., increased social assistance payments, employment and housing support) and the adequacy, appropriateness and effectiveness of food charity.

Development of Australia's front-of-pack interpretative nutrition labelling Health Star Rating system: lessons for public health advocates

OBJECTIVES

To draw advocacy lessons from actions undertaken by public health groups to assist the development of Australia and New Zealand's Health Star Rating (HSR) front-of-pack nutrition labelling system.

METHODS

The advocacy approaches undertaken by the Public Health Association of Australia leading up to the time of the adoption of the HSR is examined using a 10 step advocacy framework. Key roles in advocacy planning and implementation are described, along with coordinating efforts by health and consumer groups during the HSR development processes.

RESULTS

HSR aims to support consumers to make informed choices to protect from diet-related diseases, including obesity. The HSR launched despite a number of major obstacles, owing to a strategic, coordinated advocacy effort undertaken by a guiding coalition.

CONCLUSIONS

Actions to improve nutrition are often highly contested, particularly if the desired outcome competes with commercial interests. However, by deploying a structured approach to public health advocacy it is possible to influence government despite opposition from commercial interests. Implications for public health: A shared vision and a coordinated effort by public health professionals enabled advocates to overcome undue commercial influence.

Food Insecurity and Hunger in Rich Countries-It Is Time for Action against Inequality

Household food insecurity is a serious public health concern in rich countries with developed economies closely associated with inequality. The prevalence of household food insecurity is relatively high in some developed countries, ranging from 8 to 20% of the population. Human rights approaches have the potential to address the structural causes, not just the symptoms of food insecurity. Despite most developed countries ratifying the Covenant on Economic, Social and Cultural Rights over 40 years ago, food insecurity rates suggest current social protections are inadequate. The contemporary framing of the solution to food insecurity in developed countries is that of diverting food waste to the hungry to meet the United Nations Sustainable Development Goals agenda (Goals 2 and 12.3). An estimated 60 million people or 7.2% of the population in high income countries used food banks in 2013. Although providing food assistance to those who are hungry is an important strategy, the current focus distracts attention away from the ineffectiveness of government policies in addressing the social determinants of food insecurity. Much of the action needed to improve household food security falls to actors outside the health sector. There is evidence of promising actions to address the social determinants of food insecurity in some developed countries. Learning from these, there is a strong case for government leadership, for action within and across government, and effective engagement with other sectors to deliver a coordinated, collaborative, and cooperative response to finding pathways out of food insecurity.

The Health Star Rating system - is its reductionist (nutrient) approach a benefit or risk for tackling dietary risk factors?

The Australian Government's voluntary Health Star Rating (HSR) system has potential to provide a user-friendly approach to help shoppers choose healthier packaged food options. However, despite evidence that it is dietary imbalances and excesses that are the predominant causes of diet-related noncommunicable diseases and obesity, the star-rating system's design is based on a reductionist (nutrient) world view of nutrition science which is not a fit-for-purpose solution to the cause of the problem. As a result, the HSR system frequently is inadvertently contradicting Australian Dietary Guidelines (ADG) recommendations, and promoting the marketing of discretionary and ultraprocessed foods. This perspective article looks at how the HSR system could be reformed to complement the ADG and stresses the overriding priority is to position it within, and not be a distraction from, a comprehensive national nutrition policy if dietary risk factors are to be effectively tackled.

Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial

BACKGROUND

Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed.

OBJECTIVE

This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter).

METHODS

All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness.

RESULTS

Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019.

CONCLUSIONS

Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/12782.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

Social Assistance Payments and Food Insecurity inAustralia: Evidence from the HouseholdExpenditure Survey

It is widely understood that households with low economic resources and poor labour market attachment are at considerable risk of food insecurity in Australia. However, little is known about variations in food insecurity by receipt of specific classes of social assistance payments that are made through the social security system. Using newly released data from the 2016 Household Expenditure Survey, this paper reports on variations in food insecurity prevalence across a range of payment types. We further investigated measures of financial wellbeing reported by food-insecure households in receipt of social assistance payments. Results showed that individuals in receipt of Newstart allowance (11%), Austudy/Abstudy (14%), the Disability Support Pension (12%), the Carer Payment (11%) and the Parenting Payment (9%) were at significantly higher risk of food insecurity compared to those in receipt of the Age Pension (<1%) or no payment at all (1.3%). Results further indicated that food-insecure households in receipt of social assistance payments endured significant financial stress, with a large proportion co-currently experiencing “fuel” or “energy” poverty. Our results support calls by a range of Australian non-government organisations, politicians, and academics for a comprehensive review of the Australian social security system.

Protocol for the Development of a Food Stress Index to Identify Households Most at Risk of Food Insecurity in Western Australia

Food stress, a similar concept to housing stress, occurs when a household needs to spend more than 25% of their disposable income on food. Households at risk of food stress are vulnerable to food insecurity as a result of inadequate income. A Food Stress Index (FSI) identifies at-risk households, in a particular geographic area, using a range of variables to create a single indicator. Candidate variables were identified using a multi-dimensional framework consisting of household demographics, household income, household expenses, financial stress indicators, food security, food affordability and food availability. The candidate variables were expressed as proportions, of either persons or households, in a geographic area. Principal Component Analysis was used to determine the final variables which resulted in a final set of weighted raw scores. These scores were then scaled to produce the index scores for the Food Stress Index for Western Australia. The results were compared with the Australian Bureau of Statistics’ Socio-Economic Indexes for Areas to determine suitability. The Food Stress Index was found to be a suitable indicator of the relative risk of food stress in Western Australian households. The FSI adds specificity to indices of relative disadvantage specifically related to food insecurity and provides a useful tool for prioritising policy and other responses to this important public health issue.

Healthy diets ASAP - Australian Standardised Affordability and Pricing methods protocol

BACKGROUND

This paper describes the rationale, development and final protocol of the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) method which aims to assess, compare and monitor the price, price differential and affordability of healthy (recommended) and current (unhealthy) diets in Australia. The protocol is consistent with the International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support's (INFORMAS) optimal approach to monitor food price and affordability globally.

METHODS

The Healthy Diets ASAP protocol was developed based on literature review, drafting, piloting and revising, with key stakeholder consultation at all stages, including at a national forum.

DISCUSSION

The protocol was developed in five parts. Firstly, for the healthy (recommended) and current (unhealthy) diet pricing tools; secondly for calculation of median and low-income household incomes; thirdly for store location and sampling; fourthly for price data collection, and; finally for analysis and reporting. The Healthy Diets ASAP protocol constitutes a standardised approach to assess diet price and affordability to inform development of nutrition policy actions to reduce rates of diet-related chronic disease in Australia. It demonstrates application of the INFORMAS optimum food price and affordability methods at country level. Its wide application would enhance monitoring and utility of dietary price and affordability data from a health perspective in Australia. The protocol could be adapted in other countries to monitor the price, price differential and affordability of current and healthy diets.

Charitable Food Systems' Capacity to Address Food Insecurity: An Australian Capital City Audit

Australian efforts to address food insecurity are delivered by a charitable food system (CFS) which fails to meet demand. The scope and nature of the CFS is unknown. This study audits the organisational capacity of the CFS within the 10.9 square kilometres of inner-city Perth, Western Australia. A desktop analysis of services and 12 face-to-face interviews with representatives from CFS organisations was conducted. All CFS organisations were not-for–profit and guided by humanitarian or faith-based values. The CFS comprised three indirect services (IS) sourcing, banking and/or distributing food to 15 direct services (DS) providing food to recipients. DS offered 30 different food services at 34 locations feeding over 5670 people/week via 16 models including mobile and seated meals, food parcels, supermarket vouchers, and food pantries. Volunteer to paid staff ratios were 33:1 (DS) and 19:1 (IS). System-wide, food was mainly donated and most funding was philanthropic. Only three organisations received government funds. No organisation had a nutrition policy. The organisational capacity of the CFS was precarious due to unreliable, insufficient and inappropriate financial, human and food resources and structures. System-wide reforms are needed to ensure adequate and appropriate food relief for Australians experiencing food insecurity.

Healthy and sustainable diets: Community concern about the effect of the future food environments and support for government regulating sustainable food supplies in Western Australia

OBJECTIVE

To determine the level of community concern about future food supplies and perception of the importance placed on government regulation over the supply of environmentally friendly food and identify dietary and other factors associated with these beliefs in Western Australia.

DESIGN

Data from the 2009 and 2012 Nutrition Monitoring Survey Series computer-assisted telephone interviews were pooled. Level of concern about the effect of the environment on future food supplies and importance of government regulating the supply of environmentally friendly food were measured. Multivariate regression analysed potential associations with sociodemographic variables, dietary health consciousness, weight status and self-reported intake of eight foods consistent with a sustainable diet.

SETTING

Western Australia.

SUBJECTS

Community-dwelling adults aged 18-64 years (n = 2832).

RESULTS

Seventy nine per cent of Western Australians were 'quite' or 'very' concerned about the effect of the environment on future food supplies. Respondents who paid less attention to the health aspects of their diet were less likely than those who were health conscious ('quite' or 'very' concerned) (OR = 0.53, 95% CI [0.35, 0.8] and 0.38 [0.17, 0.81] respectively). The majority of respondents (85.3%) thought it was 'quite' or 'very' important that government had regulatory control over an environmentally friendly food supply. Females were more likely than males to rate regulatory control as 'quite' or 'very' important' (OR = 1.63, 95% CI [1.09, 2.44], p = .02). Multiple regression modeling found that no other factors predicted concern or importance.

CONCLUSIONS

There is a high level of community concern about the impact of the environment on future food supplies and most people believe it is important that the government regulates the issue. These attitudes dominate regardless of sociodemographic characteristics, weight status or sustainable dietary behaviours.

What are the position and power of supermarkets in the Australian food system, and the implications for public health? A systematic scoping review

Supermarkets have been described as having unprecedented and disproportionate power in the food system. This scoping review synthesized the literature that describes the position and power of supermarkets in the Australian food system, and the implications for public health. A systematic search of peer-reviewed and grey literature identified 68 documents that described supermarket power. Implications for public health were also recorded. Data revealed that supermarkets hold a powerful position in the Australian food system, acting as the primary gatekeepers. Supermarkets have obtained instrumental, structural and discursive power from many sources that overlap and reinforce each other. Few positive public health impacts of supermarket power were identified, providing many opportunities for improvement in the domains of food governance, the food system and public health nutrition. There is very little public health research examining the impact of supermarket power in Australia. More research is needed, and examination of supermarket own brands is of particular importance owing to their pivotal role as a source of power and their potential to improve public health outcomes, such as obesity.

Removing the Australian tax exemption on healthy food adds food stress to families vulnerable to poor nutrition

OBJECTIVE

To assess the impact of changing the Australian Goods and Services Tax (GST) on household food stress, which occurs when >25% of disposable income needs to be spent on food.

METHODS

Weekly healthy meal plan costs for average-income (AI), low-income (LI) and welfare-dependent (WDI) families were calculated using the 2013 Western Australian (WA) Food Access and Costs Survey. Four GST scenarios were compared: 1) status quo; 2) increasing GST to 15%; 3) expanding base to include exempt foods at 10% GST; and 4) expanding base to include exempt foods and increasing the tax to 15%.

RESULTS

Single-parent families risk food stress regardless of their income or the GST scenario (requiring 24-42% of disposable income). The probability of food stress in Scenario 1 is 100% for WDI two-parent families and 36% for LI earners. In Scenarios 3 and 4, food stress probability is 60-72% for two-parent LI families and AI single-parent families, increasing to 88-94% if residing in very remote areas.

CONCLUSION

There is food stress risk among single-parent, LI and WDI families, particularly those residing in very remote areas. Implications for public health: Expanding GST places an additional burden on people who are already vulnerable to poor nutrition and chronic disease due to their socioeconomic circumstances.

BMI is Associated with the Willingness to Record Diet with a Mobile Food Record among Adults Participating in Dietary Interventions

Image-based dietary assessment methods have the potential to address respondent burden and improve engagement in the task of recording for dietary interventions. The aim of this study was to assess factors associated with the willingness of adults to take images of food and beverages using a mobile food record (mFR) application. A combined sample of 212 young adults and 73 overweight and obese adults completed a 4-day mobile food record on two occasions and a follow-up usability questionnaire. About 74% of participants stated they would record using the mFR for a longer period compared with a written record (29.4 ± 69.3 vs. 16.1 ± 42.6 days respectively; p < 0.0005). Multivariable logistic regression was used to identify those who were more likely to record mFR in the top tertile (≥14 days). After adjusting for age and gender, those with a BMI ≥ 25 were 1.68 times more likely (Odds Ratio 95% Confidence Interval: 1.02-2.77) than those with BMI < 25 to state a willingness to record with the mFR for ≥ 14 days. The greater willingness of overweight and obese individuals to record dietary intake using an mFR needs further examination to determine if this translates to more accurate estimates of energy intake.

The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults

BACKGROUND

Early adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18-30 years).

METHODS

A three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves.

RESULTS

Young adults (n = 247) were randomized to group A (n = 82), group B (n = 83), or group C (n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg (P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day (P = .02). Women who received dietary feedback only significantly reduced their intake of SSB (P = .04) by an average of 0.2 serves/day compared with controls.

CONCLUSIONS

Tailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults.

TRIAL REGISTRATION

Australian Clinical Trials Registry Registration number: ACTRN12612000250831 .

Parents' perception of their child's weight status and intention to intervene: a Western Australian cross-sectional population survey, 2009-12

OBJECTIVE

To report on parents' perceptions of their child's weight status and how the child's body mass index (BMI) is associated with parent intentions to change or maintain the child's weight.

METHODS

Estimates were derived via data collected from 4,437 parents from 2009 to 2012 as part of the Western Australian Health and Wellbeing Surveillance System. To measure weight perceptions, parents were asked, "Is your child underweight, normal weight, overweight or very overweight?" BMI values were also derived via parent-reported height and weight. Parent intentions were assessed by asking parents, "What are your intentions regarding your child's weight?"

RESULTS

Significantly fewer parents perceived their child as overweight (8.2%) or very overweight (0.2%) than was derived via parent-reported height and weight (16.3% and 5.8%, respectively). More than half the parents with children above or below the healthy BMI range reported an intention to "do nothing" about their child's weight (between 54.5% and 70.0%).

CONCLUSIONS

A large proportion of Western Australian parents misjudge their child's weight status and the majority express no intention to help their child achieve a healthy weight.

IMPLICATIONS

The results reinforce the importance of population-level, parent-focussed interventions targeting perceptions of children's weight and appropriate action.

A Novel Dietary Assessment Method to Measure a Healthy and Sustainable Diet Using the Mobile Food Record: Protocol and Methodology

The world-wide rise in obesity parallels growing concerns of global warming and depleting natural resources. These issues are often considered separately but there may be considerable benefit to raising awareness of the impact of dietary behaviours and practices on the food supply. Australians have diets inconsistent with recommendations, typically low in fruit and vegetables and high in energy-dense nutrient-poor foods and beverages (EDNP). These EDNP foods are often highly processed and packaged, negatively influencing both health and the environment. This paper describes a proposed dietary assessment method to measure healthy and sustainable dietary behaviours using 4-days of food and beverage images from the mobile food record (mFR) application. The mFR images will be assessed for serves of fruit and vegetables (including seasonality), dairy, eggs and red meat, poultry and fish, ultra-processed EDNP foods, individually packaged foods, and plate waste. A prediction model for a Healthy and Sustainable Diet Index will be developed and tested for validity and reliability. The use of the mFR to assess adherence to a healthy and sustainable diet is a novel and innovative approach to dietary assessment and will have application in population monitoring, guiding intervention development, educating consumers, health professionals and policy makers, and influencing dietary recommendations.

Eating out is associated with self-reported food poisoning: a Western Australia population perspective, 1998 to 2009

OBJECTIVE

To explore factors associated with self-reported food poisoning among Western Australian adults between 1998 and 2009.

DESIGN

Data were pooled from four Nutrition Monitoring Surveys Series which included information on suspected food poisoning among Western Australian adults. Descriptive statistics and multinomial regression analyses were used to describe factors associated with self-reported food poisoning, food safety knowledge and behaviours.

SETTING

Population of Western Australia estimated to be 2·5 million in 2009.

SUBJECTS

A representative sample of 4494 adults aged between 18 and 64 years.

RESULTS

There was no significant change in self-reported food poisoning over time, with about 18 % saying they had suspected food poisoning in the last 6 months. Overall, 2·1% said they had confirmed their food-borne illness with a nurse of doctor. People less than 34 years old, those with a university degree and people who ate meals out on the day prior to the survey (one meal: OR = 1·30, 95% CI 1·04, 1·62; two meals: OR = 2·21, 95% CI 1·30, 3·76) were the most likely to report food poisoning. Younger people were also more likely to have their food poisoning confirmed by a health professional. Use of refrigerator thermometers and cool bags for storing food increased significantly between 2004 and 2009.

CONCLUSIONS

Findings support the inclusion of food safety advice in dietary recommendations. Food safety and handling education and training is recommended for food businesses, particularly the takeaway food sector, and for consumers. Because food poisoning is reported more often by younger people, food safety education should begin during childhood.

Public say food regulatory policies to improve health in Western Australia are important: population survey results

OBJECTIVE

To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment.

METHODS

Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18-64 years collected in 2009 and 2012. Descriptive and logistic regression analyses were conducted using survey module of STATA 12.

RESULTS

The majority of adults believe it is important that government regulates food policy options under consideration: nutrition information on food labels (97% versus 2% who think it is not important); health rating on food labels (95% versus 3%); food advertising (83% versus 11%); and the supply of environmentally friendly food (86% versus 9%).

CONCLUSIONS

Community perception is that government control or regulation of food labelling, food advertising and the supply of environmentally friendly food is important.

IMPLICATIONS

Curbing excess weight gain and related disease burden is a public health priority. Australian governments are considering food regulatory interventions to assist the public to improve their dietary intake. These findings should provide reassurance to government officials considering these regulatory measures.

Connecting Health and Technology (CHAT): protocol of a randomized controlled trial to improve nutrition behaviours using mobile devices and tailored text messaging in young adults

BACKGROUND

Increasing intakes of fruits and vegetables intake, in tandem with reducing consumption of energy-dense and nutrient poor foods and beverages are dietary priorities to prevent chronic disease. Although most adults do not eat enough fruit and vegetables, teenagers and young adults tend to have the lowest intakes. Young adults typically consume a diet which is inconsistent with the dietary recommendations. Yet little is known about the best approaches to improve dietary intakes and behaviours among this group. This randomised controlled trial aims to evaluate the effectiveness of using a mobile device to assess dietary intake, provide tailored dietary feedback and text messages to motivate changes in fruit, vegetable and junk food consumption among young adults.

METHODS/DESIGN

The CHAT project will involve the development of the mobile device food record (MDFR), and evaluation of dietary feedback and implementation of a 6-month intervention in young adults aged 18 to 30 years. The participants will be randomly assigned to one of three groups (1) Intervention Group 1: MDFR + Text Messages + Dietary Feedback; (2) Intervention Group 2: MDFR + Dietary Feedback; (3) Control Group 3: MDFR, no feedback. All groups will undertake a 3-day dietary record using the MDFR but only the Intervention Groups 1 and 2 will receive tailored dietary feedback at baseline and at 6-months which will consist of assessment of serves of fruits, vegetables and junk food in comparison to dietary recommendations. Tailored nutrition text messages will be sent to Intervention Group 1 over the 6 months. Data will be collected at baseline and again at the 6-month completion.

DISCUSSION

This trial will test if applications running on mobile devices have potential to assess diet, provide tailored feedback and nutrition messages as an effective way of improving fruit and vegetable consumption and reducing energy-dense nutrient poor foods in young adults. The CHAT project will assess the impact of the intervention on behavioural intention to eat a more healthful diet. This innovative approach if successful may provide a means to deliver a low cost health promotion program that has the potential to reach large groups, particularly young adults.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12612000250831.

Translating government policy into recipes for success! Nutrition criteria promoting fruits and vegetables

OBJECTIVE

To develop nutrition criteria consistent with Australian dietary guidelines encouraging fruit and vegetable consumption for branding recipes with the Go for 2&5 campaign message.

DESIGN

Dietary policies, guidelines, food selection guides, nutrient targets, existing consumer education programs' nutrition criteria, food habits, and eating styles were reviewed to develop nutrition criteria, which were then used to assess 128 recipes.

SETTING

Perth, Australia.

ANALYSIS

Recipes were analyzed then assessed against criteria for fat, sodium, fiber, energy, added sugar, fruit, vegetables, cereal, and dairy content/per serving.

RESULTS

Recipe nutrition criteria were devised, and 128 contemporary industry recipes were evaluated according to developed nutrition criteria. Recipe categories included main meals; light meals (includes breakfast); soups; salads; side dishes; snacks (includes drinks); desserts; bakery; and basic ingredients (eg, stocks, dips, and sauces). Nearly three quarters failed. Excess fat (45%) and sodium (30%) and inadequate cereal (24%) were the main reasons. Only minor modifications were required to meet criteria.

CONCLUSIONS AND IMPLICATIONS

"Healthful" recipes promoting fruits and vegetables were often high in fat and sodium and low in cereal content. Nutrition criteria developed for this study provided a practical way of assessing specific meals and snacks according to the dietary guidelines, making them suitable for nutrition promotions.

Selecting interventions to promote fruit and vegetable consumption: from policy to action, a planning framework case study in Western Australia

Background

The Department of Health in Western Australia identified access to, and daily consumption of recommended amounts of fruit and vegetables, as priority health determinants. The numerous factors that influence supply and consumption of fruit and vegetables indicated that a comprehensive approach would be required.

A government and non-government sector steering group was set up to select priority interventions using the National Public Health Partnership's Framework for Implementing Public Health Strategies. This structured framework was used for developing strategies to improve fruit and vegetable consumption and supply, and to identify implementation priorities.

After one year a desktop audit of progress on framework interventions was undertaken.

Results

The structured framework led to a plan for defined actions, partners, costs, and performance indicators for strategies to improve fruit and vegetable consumption and supply. Lead agency custodians for management of the selected interventions were identified.

After one year there was significant progress in the implementation of a number of the high-ranking interventions. The exception was interventions that provide the infrastructure support such as research and development capacity, information systems.

Conclusion

A structured framework and stakeholder participation assisted in developing a fruit and vegetable implementation strategy. Engagement and commitment of influential and diverse stakeholders is needed, not just for program support, but particularly in the areas of food and nutrition policy development and providing the infrastructure support required. Further work is required to develop performance outcomes and cost effectiveness measures for many of the strategies that have been proposed to address portfolio objectives.

Increasing fruit and vegetable consumption: success of the Western Australian Go for 2&5 campaign

OBJECTIVE

The Western Australian Health Department's Go for 2&5 campaign aimed to increase adults' awareness of the need to eat more fruit and vegetables and encourage increased consumption of one serving over five years.

DESIGN

The multi-strategy fruit and vegetable social marketing campaign, conducted from 2002 to 2005, included mass media advertising (television, radio, press and point-of-sale), public relations events, publications, a website (www.gofor2and5.com), and school and community activities. Campaign development and the evaluation framework were designed using health promotion theory, and assessed values, beliefs, knowledge and behaviour. Two independent telephone surveys evaluated the campaign: the Campaign Tracking Survey interviewed 5032 adults monitoring fruit and vegetable attitudes, beliefs and consumption prior to, during and 12 months after the campaign; and the Health & Wellbeing Surveillance System surveyed 17,993 adults between 2001 and 2006, continuously monitoring consumption.

SETTING

Population public health intervention-social marketing campaign in Western Australia, population of 2,010,113 in 2005.

SUBJECTS

Adults in the Perth metropolitan area.

RESULTS

The campaign reached the target audience, increasing awareness of the recommended servings of fruit and vegetables. There was a population net increase of 0.8 in the mean number of servings of fruit and vegetables per day over three years (0.2 for fruit (1.6 in 2002 to 1.8 in 2005) and 0.6 for vegetables (2.6 in 2002 to 3.2 in 2005), significant at P < 0.05).

CONCLUSION

Sustained, well-executed social marketing is effective in improving nutrition knowledge, attitudes and consumption behaviour. The Go for 2&5 campaign provides guidance to future nutrition promotion through social marketing.

Food service in long day care centres--an opportunity for public health intervention

OBJECTIVE

To determine the characteristics of long day care centre operations, food service management practices, and nutrition resources use and needs.

METHOD

In October 1996, all 330 long day care centres in Western Australia were surveyed by telephone to gather information to help develop strategies for food service improvement.

RESULTS

The response rate was 85%. An accreditation committee directed operations in 76% of centres. Most centres employed a cook with limited or no cooking training. Coordinators identified training needs for cooks that are specific to the National Childcare Accreditation Council's Quality Improvement and Accreditation System (QIAS) guidelines: food hygiene; nutritional and food requirements of children; menu planning; and multicultural cooking.

CONCLUSIONS

National standards for the quantification of foods to meet children's nutritional requirements in long day care would allow for consistency in educating child care workers, training cooks, and establishing and assessing government regulations and the QIAS guidelines. Nine recommendations for strategies to improve food service in long day care are presented.

IMPLICATIONS

There are two main messages for public health practitioners working to improve the quality of food served to children in long day care: the strong influence of the QIAS guidelines, and the need for specific nutrition recommendations.

Food Cent$--implementing and evaluating a nutrition education project focusing on value for money

The Food Cent$ Project aimed to show low income earners a new way to allocate their food budget to obtain value for money and balance their diet. It also created an infrastructure for program delivery. Strategies included a recommended spending model, resources that addressed barriers to healthy eating, together with group activities to enhance knowledge and skills. Community volunteers, known as Food Cent$ Advisers, were trained to deliver the project by conducting budget and cooking sessions for people in their social networks. In 1992, the Food Cent$ Project was piloted in the Great Southern Health Region of Western Australia. It successfully reached its target group of low income earners who were identified as those holding Health Care Cards. Health Care Cards were held by 37% of the 150 trained advisers and 52% of the 373 people who attended the budget and cooking sessions. Evaluation results demonstrated positive changes in self-reported dietary, cooking and shopping behaviours.

Western Australian Health Department recommendations for fruit and vegetable consumption--how much is enough?

In 1989 the Nutrition Program of the Health Department of Western Australia determined a minimum recommended daily intake of fruit and vegetables for use in promotion of increased fruit and vegetable consumption. Considerations in the development of this recommendation included: a review of existing recommendations; the protective effects of fruit and vegetables; specification of fruit and vegetables separately or together; classification of fruit and vegetables; definition of a serve; and practical considerations for the implementation of the recommendation. This paper outlines the development of the recommendation to eat at least two average-sized (120-150 g) pieces of fruit and five average-sized (60-90 g) serves of vegetables daily.