The new normal for food insecurity? A repeated cross-sectional survey over 1 year during the COVID-19 pandemic in Australia.

BACKGROUND: Food insecurity during the COVID-19 pandemic has been impacted by necessary public health restrictions. Tasmania, an island state south of the Australian mainland, recorded no community transmission of COVID-19 between May 2020 to November 2021 due to strong border restrictions. This study aimed to determine the changes in prevalence and sociodemographic predictors of food insecurity throughout the COVID-19 pandemic in Tasmania, Australia. METHODS: In May 2020 (survey 1: during lockdown), September 2020 (survey 2: eased restrictions) and May 2021 (survey 3: 1-year post-lockdown), cross-sectional, online surveys using convenience sampling methods determined food insecurity in Tasmanian adults using the USDA Household Food Security Survey Module: Six-Item Short Form, in addition to key sociodemographic questions. Crude and age-adjusted prevalence of food insecurity was calculated, and binary logistic regression determined at-risk groups and changes in prevalence over time. RESULTS: The age-adjusted prevalence of food insecurity was 27.9% during lockdown (n = 1168), 19.5% when restrictions had eased (n = 1097) and 22.6% 1-year post-lockdown (n = 1100). Young adults, Aboriginal and/or Torres Strait Islander people, individuals with disabilities, families with dependents and temporary residents were at highest risk across all time points. CONCLUSIONS: The prevalence of food insecurity was higher than pre-pandemic levels across all three time points. Our results indicate the potential long-term impacts of the COVID-19 pandemic on food security in Australia, where despite easing social distancing restrictions and a lack of COVID-19 transmission, the prevalence of food insecurity reduced, but did not recover to pre-pandemic levels 1-year following a lockdown.

Stakeholder insights into implementing a systems-based suicide prevention program in regional and rural tasmanian communities.

PURPOSE: With emerging evidence indicating that systems-based approaches help optimise suicide prevention efforts, the National Suicide Prevention Trial sought to gather evidence on the appropriateness of these approaches to prevent suicide among at-risk populations, in regional and rural communities throughout Australia. The Tasmanian component of the Trial implemented the LifeSpan systems framework across three distinct rural areas with priority populations of men aged 40-64 and people 65 and over. The University of Tasmania's Centre for Rural Health undertook a local-level evaluation of the Trial. AIMS: To explore key stakeholder perceptions of implementing a systems-based suicide prevention program in regional and rural communities in Tasmania, Australia. METHOD: This study utilised qualitative methods to explore in depth, stakeholder perspectives. Focus groups and interviews were conducted with 46 participants, comprising Trial Site Working Group members (n = 25), Tasmania's Primary Health Network employees (n = 7), and other key stakeholders (n = 14). Approximately half of participants had a lived experience of suicide. Data were thematically analysed using NVivo. RESULTS: Key themes centred on factors impacting implementation of the Trial. These included how the Trial was established in Tasmania; Working Group governance structures and processes; communication and engagement processes; reaching priority population groups; the LifeSpan model and activity development; and the effectiveness, reach and sustainability of activities. DISCUSSION: Communities were acutely aware of the need to address suicide in their communities, with the Trial providing resources and coordination needed for community engagement and action. Strict adherence to the Lifespan model was challenging at the community level, with planning and time needed to focus on strategies influencing whole or multiple systems, for example health system changes, means restriction. Perceived limitations around implementation concerned varied community buy-in and stakeholder engagement and involvement, with lack of role clarity cited as a barrier to implementation within Working Groups. Barriers delivering activities to priority population groups centred around socio-cultural and technological factors, literacy, and levels of public awareness. Working Groups preferred activities which build on available capital and resources and which meet the perceived needs within the whole community. Approaches sought to increase awareness of suicide and its prevention, relationships and partnerships, and the lived experience capacity in Working Groups and communities. CONCLUSION: Stakeholder insights of implementing the National Suicide Prevention Trial in regional and rural Tasmanian from this study can help guide future community-based suicide prevention efforts, in similar geographic areas and with high-risk groups.

Consumer-driven strategies towards a resilient and sustainable food system following the COVID-19 pandemic in Australia.

BACKGROUND: The COVID-19 pandemic and associated public health restrictions temporarily disrupted food supply chains around the world and changed the way people shopped for food, highlighting issues with food systems resilience and sustainability. The aim of this study was to explore consumer-driven strategies towards a more resilient and sustainable food system in Australia, learning from experiences during the beginning of the COVID-19 pandemic. METHODS: During May-June 2020, a cross-sectional, online survey was conducted in Tasmania, Australia in a non-random sample of adults aged 18 years and over. The survey collected demographic data and posted the open-ended question: "How could Tasmania's food system be better prepared for a disaster in the future?" Descriptive statistics were used to analyse the demographic data and thematic analysis was employed to analyse the qualitative data. RESULTS: Survey respondents (n = 698) were predominantly female (79%), over 55 years of age (48%), university educated (70%) and living with dependents (45%). Seven key themes were identified: (i) balance food exports with local needs; (ii) strengthen local food systems; (iii) increase consumer awareness of food supply chains; (iv) build collaboration and connection in the food system; (v) embed clear contingency arrangements; (vi) support community capacity building and individual self-sufficiency; and (vii) the food system coped well. CONCLUSIONS: The consumer-driven strategies identified indicate multiple opportunities to increase resilience and sustainability in the food system to avoid future supply disruptions. Our findings indicate that considerable popular support for more resilient, local and sustainable food systems may be emerging from the COVID-19 pandemic.

Food insecure households faced greater challenges putting healthy food on the table during the COVID-19 pandemic in Australia.

The COVID-19 pandemic negatively affected the Australian food supply. However, it has remained unclear how food access, food availability and consumption were impacted, especially for households experiencing food insecurity. This study aimed to determine the association between food security and cooking and eating habits, food access and availability, self-sufficiency and perceptions of the food supply at the beginning of the COVID-19 pandemic in Tasmania, Australia. Throughout May-June 2020 during strict social distancing restrictions, a cross-sectional survey was conducted including the U.S. Household Food Security Survey Module Six-Item Short Form, twenty Likert scale questions on cooking and eating habits, food access, self-sufficiency and perceptions of the food supply (responses from 1 = strongly agree to 5 = strongly disagree), two questions on food availability and eleven socio-demographic questions. Survey data (n = 1067) were analysed using multivariate linear regression, and binary logistic regression. Food insecure households were significantly more likely to agree they were consuming less fresh food compared with food secure households (Mean difference between scale responses (MD) = 0.66; 95%CI:0.36-0.66; p < 0.001), and significantly more food insecure households agreed it was more difficult to get to the shops (MD = 0.49; 95%CI:0.34-0.64; p < 0.001) and they had less money available for food than prior to the COVID-19 pandemic (MD = 0.95; 95%CI:0.79-1.10; p < 0.001). Compared to food secure households, food insecure households were at significantly greater risk of foods being unavailable to them (OR:1.75; 95%CI:1.33-2.35; p < 0.001) and were less likely to have sufficient food stored in their homes (OR:0.48; 95%CI: 0.33-0.687; p < 0.001). This study indicates there was a disproportionate impact of the COVID-19 pandemic on food insecure households, related to food availability and access, with effects on cooking and eating habits.

A systematic review of the health and health care of rural sexual and gender minorities in the UK, USA, Canada, Australia and New Zealand.

INTRODUCTION: Lesbian, gay, bisexual, transgender, intersex, queer, and people with a diversity of sexual and gender identities (LGBTIQ+) residing in rural contexts may face additional challenges to attaining wellbeing, yet a comprehensive understanding of these experiences is lacking. The purpose of the systematic review is to address this knowledge gap. The aims of the review are to progress understanding about rural LGBTIQ+ communities with regard to wellbeing, healthcare access and experience, and barriers and facilitators to health care. METHODS: Peer-reviewed literature was searched in PubMed, Academic Search Premier, CINAHL, and PsychInfo databases, while grey literature was searched using Google Advanced Search. Documents produced between 2015 and 2020 in the USA, Canada, Australia, New Zealand, and UK were eligible and reference lists were screened. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Relevant data were extracted and synthesized. The quality of the peer-reviewed literature and grey literature was assessed using the Mixed Methods Appraisal Tool and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist, respectively. At each stage of the study selection process, a second author reviewed a sample of 10% of the articles and documents to ensure consistent application of the inclusion criteria. Consultation within the team was used to resolve any discrepancies encountered. RESULTS: The 297 unique peer-reviewed returned records were screened, with 69 full texts assessed for eligibility, resulting in the inclusion of 42 articles. The initial result of 2785 grey documents were similarly screened, resulting in the inclusion of 12 documents. Overall, the included literature was deemed to be of good quality. Synthesis of data resulted in the reporting of findings concerning mental, physical, and sexual wellbeing; healthcare access and experiences with care; and barriers and facilitators to health care for various communities in rural areas. The findings showed rural LGBTIQ+ communities shared many of the health concerns of non-rural LGBTIQ+ communities, as well as encountering similar issues and barriers to the receipt of high-quality appropriate care. However, the evidence also indicates an array of nuanced challenges for communities in rural areas such as a lack of available appropriate providers, and financial and practical barriers concerning the need to travel to obtain the services needed. The intersection of rurality and LGBTIQ+ identity was especially pronounced for rural LGBTIQ+ elders facing potential isolation in the context of declining mobility, service providers experiencing high demand and isolation from professional networks, and for LGBTIQ+ populations negotiating the complexities of disclosure in interactions with health professionals. The latter three findings in particular extend on the existing knowledge base. CONCLUSION: Investment is needed in the design, trialling, and evaluation of tailored models of care, which account for the specific challenges encountered in providing services to rural LGBTIQ+ communities. Such models, should also harness identified facilitators for rural LGBTIQ+ wellbeing, including the use of online technologies. Dedicated study is merited to inform policy and practice for aged care services in rural areas. Further, the development and implementation of strategies to support rural health service providers is warranted.

The prevalence and correlates of symptoms of post-traumatic stress disorder (PTSD) among resettled Afghan refugees in a regional area of Australia.

BACKGROUND: Post-traumatic stress disorder (PTSD) is common among resettled refugee populations and may be particularly problematic for refugees who have resettled in rural and regional areas. AIMS: The aim of this study was to examine the occurrence and correlates of PTSD among Afghan refugees resettled in a regional area of Australia, namely, Launceston, Tasmania. METHODS: A cross-sectional survey was conducted with 66 resettled Afghan refugees living in Launceston using the Post Migration Living Difficulties Scale (PMLD) and Impact of Event Scale-Revised (IES-R). Descriptive statistics and multivariable analysis of variables associated with a probable diagnosis of PTSD were conducted. RESULTS: Approximately half of participants 48.8% (95% CI: 36.0-61.1%) met an operational definition of probable PTSD diagnosis according to the IES-R. In multivariable logistic regression analysis, communication difficulties (OR = 14.6, 95% CI: 1.7-124.7), separation from family (OR = 9.9, 95% CI: 1.8-55.5), and self-recognition of a mental health problem (OR = 13.8, 95% CI: 2.4-80.0) were strongly and independently associated with probable PTSD diagnosis. While most participants (81.2%) with a probable PTSD diagnosis recognised that they had a mental health problem, less than half (46.9%) had sought professional help for such a problem. CONCLUSIONS: The findings suggest that there are high rates of PTSD, and relatively low uptake of mental health care by sufferers, among resettled Afghan refugees in the regional area of Launceston, Australia. Factors that might usefully be targeted in health promotion, prevention and early intervention program include communication difficulties, issues of family separation and isolation and aspects of "mental health literacy" likely to detract from help-seeking.

Local evaluation of the Tasmanian component of the National Suicide Prevention Trial-Preliminary learnings.

OBJECTIVE: Tasmania is one of the 12 Australian sites chosen to participate in the National Suicide Prevention Trial. The Centre for Rural Health, University of Tasmania, was contracted to conduct a local-level, process evaluation of this initiative using a Participatory Action Research approach, with the objective of this article to summarise progress and key learnings from the local evaluation to date. DESIGN: Empowerment and Utilisation-Focus Evaluation theoretical approaches informed the conduct of process evaluation activities, within an overarching participatory action research approach. SETTING: Three participating regions in Tasmania were included as follows: Launceston, the North-West and Break O'Day. PARTICIPANTS: Working group members, service providers and other relevant stakeholders. INTERVENTIONS: Mixed-methods surveys, field observations and content analysis were conducted. RESULTS: Survey results indicated that most working group members understood the concept of a "systems-based" approach to suicide prevention. Most participants believed that working group structures/functions engaged community members with lived experience, while around half believed that these structures/functions facilitated relationships with local services and that working group action plans adequately addressed issues of capacity building and sustainability. Preliminary field data suggested that awareness raising, engagement and face-to-face capacity-building activities focused on the wider community were preferred to activities targeting specific populations. CONCLUSION: These preliminary findings suggest ambivalence among key stakeholders concerning the application of a systems-based approach to suicide prevention in regional areas of Tasmania. Consistent with a participatory action research approach, the findings will inform the evolution of trial site activity for the remainder of the trial and, in due course, the implementation of future such initiatives.

The mental health of former refugees in regional Australia: A qualitative study.

OBJECTIVE: To examine the resettlement experiences of former refugees living in regional Australia, focusing on mental health and mental health and support services, including barriers to access. DESIGN: A phenomenological approach utilising a combination of six qualitative, semi-structured, face-to-face focus groups (n = 24) and seven individual interviews. Data were analysed thematically using NVivo 10 software. SETTING: Launceston, Tasmania. PARTICIPANTS: Adult and youth former refugees from Afghanistan, Bhutan, Burma, Sierra Leone, Sudan and Iran, and essential service providers, residing in Launceston. MAIN OUTCOME MEASURES: Participants were asked about experiences of resettlement and mental health. RESULTS: Participants reported that their mental health had improved since resettlement; however, major stressors impacted mental health and resettlement included employment and housing access and mastering the English language. Past experiences continued to impact current functioning, with trauma commonly experienced intergenerationally through parenting and attachment and ongoing trauma and feelings of guilt and responsibility experienced with families left behind. Participants noted barriers to accessing services: (a) Language difficulties including lack of interpreters; and (b) lack of culturally sensitive and trauma-informed practices. Discrimination was experienced through the inconsistent provision of interpreters and lack of due consideration of cultural and religious differences. The use of children as interpreters enhanced a number of risk including miscommunication of medical information, exposure to age-inappropriate information and the resulting increased risk of trauma for the child. CONCLUSION: Culturally sensitive, trauma-informed and discrimination-free practices should be employed across services, where Western-views surrounding this medical model are not imposed, cultural differences are respected, and timely access to interpreters was provided.

Exploring Community-Based Suicide Prevention in the Context of Rural Australia: A Qualitative Study.

Suicide rates in rural communities are higher than in urban areas, and communities play a crucial role in suicide prevention. This study explores community-based suicide prevention using a qualitative research design. Semi-structured interviews and focus groups asked participants to explore community-based suicide prevention in the context of rural Australia. Participants recruited ((n = 37; ages 29-72, Mean = 46, SD = 9.56); female 62.2%; lived experience 48.6%) were self-identified experts, working in rural community-based suicide prevention (community services, program providers, research, and policy development) around Australia. Data were thematically analysed, identifying three themes relating to community-based suicide prevention: (i) Community led initiatives; (ii) Meeting community needs; and (iii) Programs to improve health and suicidality. Implementing community-based suicide prevention needs community-level engagement and partnerships, including with community leaders; gatekeepers; community members; people with lived experience; services; and professionals, to "get stuff done". Available resources and social capital are utilised, with co-created interventions reflecting diverse lifestyles, beliefs, norms, and cultures. The definition of "community", community needs, issues, and solutions need to be identified by communities themselves. Primarily non-clinical programs address determinants of health and suicidality and increase community awareness of suicide and its prevention, and the capacity to recognise and support people at risk. This study shows how community-based suicide prevention presents as a social innovation approach, seeing suicide as a social phenomenon, with community-based programs as the potential driver of social change, equipping communities with the "know how" to implement, monitor, and adjust community-based programs to fit community needs.

Occurrence and correlates of depressive symptoms among the resettled Afghan refugees in a regional area of Australia.

AIMS: Refugees and asylum seekers are at high risk of mental health problems such as post-traumatic stress disorder (PTSD) and depression. Elucidating the occurrence and correlates of these problems in specific resettled refugee populations may be helpful in informing tailored prevention and health promotion programs. We sought to elucidate the occurrence and correlates of depressive symptoms among Afghan refugees resettled in Launceston, a regional town of Australia. METHODS: We conducted a cross-sectional survey of 66 resettled Afghan refugees residing in Launceston in April 2019. We used the Hopkins symptoms checklist (HSCL-25) and the post migration living difficulties scale (PMLD) to measure depression symptoms and post-migration variables, respectively. Demographic characteristics and levels of physical activity were also assessed. Multivariate analysis was used to examine factors associated with depressive symptoms. RESULTS: High levels of depressive symptoms were reported by 21.2% of participants (95% CI: 12.1%-33.0%) and were more common among female participants (41.2%, 95% CI: 18.4%-67.1%) than male participants (14.3%, 95% CI: 5.9%-27.2%). Isolation (loneliness, being or feeling alone) (OR = 19.5, 95% CI: 1.9-203.5) and physical inactivity (OR = 9.2, 95% CI: 1.8-45.8) were the only variables independently associated with depressive symptoms. CONCLUSIONS: Depressive symptoms were common among Afghan refugees living in Launceston, particularly women, and were associated with isolation and physical inactivity. Hence these factors might usefully be targeted in local health promotion and prevention programs.

Prevalence and Socio-Demographic Predictors of Food Insecurity in Australia during the COVID-19 Pandemic.

The COVID-19 pandemic has exacerbated economic vulnerabilities and disrupted the Australian food supply, with potential implications for food insecurity. This study aims to describe the prevalence and socio-demographic associations of food insecurity in Tasmania, Australia, during the COVID-19 pandemic. A cross-sectional survey (deployed late May to early June 2020) incorporated the U.S. Household Food Security Survey Module: Six-Item Short Form, and fifteen demographic and COVID-related income questions. Survey data (n = 1170) were analyzed using univariate and multivariate binary logistic regression. The prevalence of food insecurity was 26%. The adjusted odds of food insecurity were higher among respondents with a disability, from a rural area, and living with dependents. Increasing age, a university education, and income above $80,000/year were protective against food insecurity. Food insecurity more than doubled with a loss of household income above 25% (Adjusted Odds Ratio (AOR): 2.02; 95% CI: 1.11, 3.71; p = 0.022), and the odds further increased with loss of income above 75% (AOR: 7.14; 95% CI: 2.01, 24.83; p = 0.002). Our results suggest that the prevalence of food insecurity may have increased during the COVID-19 pandemic, particularly among economically vulnerable households and people who lost income. Policies that support disadvantaged households and ensure adequate employment opportunities are important to support Australians throughout and post the COVID-19 pandemic.

Definitions, Sources and Self-Reported Consumption of Regionally Grown Fruits and Vegetables in Two Regions of Australia.

Regional food systems are complex networks, with numerous retail sources that underpin a local economy. However, evidence is limited regarding how consumers define, identify, and source regionally grown fresh fruits and vegetables (RGFFV). A cross-sectional study was conducted in Tasmania (TAS) and South Western Australia (SWA) to compare how RGFFV are defined, identified and sourced by consumers, including self-reported consumption of selected RGFFV. Survey data were analyzed using the Chi-square test and t-tests. Results (TAS n = 120, SWA n = 123) identified that consumers had mixed perceptions of how RGFFV are defined, including produce sold at farmers markets, or grown within their region (TAS/SWA). RGFFV were commonly identified using product labelling (55% TAS, 69% SWA; p > 0.05). Respondents reported frequently shopping for RGFFV at major supermarkets, with more TAS respondents shopping weekly in comparison to SWA respondents (67% vs. 38%; p < 0.001). Supermarkets offered convenience and consumers enjoyed the experience of farmers' markets, especially in TAS (42%) in comparison to SWA (21%; p = 0.012). The major RGFFV consumed were root vegetables and apples/pears, but consumers were frequently unsure about the produce's provenance. Our findings indicate multiple opportunities to improve consumption of fresh, regional produce in TAS and SWA, which may positively impact regional economic growth and community health.

Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia.

Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. Four study communities were selected based on population size, rurality, access to local support services, history of suicide within the community, and maturity of the mental health promotion program. Data from self-report questionnaires (n = 245), including items of Communities Advancing Resilience Toolkit (CART) assessment, and qualitative (focus group and interview) data from key local stakeholders (n = 24), were pooled to explore the factors perceived to be influencing program implementation. Survey results indicate the primary community resilience strengths across the four sites were related to the 'Connection and Caring' domain. The primary community resilience challenges related to resources. Qualitative findings suggested lack of communication and leadership are key barriers to effective program delivery and identified a need to provide ongoing support for program staff. Assessment of perceived community resilience may be helpful in informing the implementation of mental health promotion programs in rural areas and, in turn, improve the likelihood of their success and sustainability.

Factors Shaping the Lived Experience of Resettlement for Former Refugees in Regional Australia.

Refugees experience traumatic life events with impacts amplified in regional and rural areas due to barriers accessing services. This study examined the factors influencing the lived experience of resettlement for former refugees in regional Launceston, Australia, including environmental, social, and health-related factors. Qualitative interviews and focus groups were conducted with adult and youth community members from Burma, Bhutan, Sierra Leone, Afghanistan, Iran, and Sudan, and essential service providers (n = 31). Thematic analysis revealed four factors as primarily influencing resettlement: English language proficiency; employment, education and housing environments and opportunities; health status and service access; and broader social factors and experiences. Participants suggested strategies to overcome barriers associated with these factors and improve overall quality of life throughout resettlement. These included flexible English language program delivery and employment support, including industry-specific language courses; the provision of interpreters; community events fostering cultural sharing, inclusivity and promoting well-being; and routine inclusion of nondiscriminatory, culturally sensitive, trauma-informed practices throughout a former refugee's environment, including within education, employment, housing and service settings.

Australian Consumer Perceptions of Regionally Grown Fruits and Vegetables: Importance, Enablers, and Barriers.

Fresh fruits and vegetables are a cornerstone of a balanced diet; their consumption has health, environmental, ethical, and economic implications. This pilot study aimed to: (i) measure fruit and vegetable consumption; (ii) understand consumer perceptions of the perceived importance of regionally grown fresh fruit and vegetables (RGFFV); and (iii) identify the barriers and enablers of access and consumption of RGFFV. The study took place in Tasmania (TAS) and South Western Australia (SWA). A 54-item survey included questions relating to purchasing and consumption patterns; barriers and enablers related to access and consumption of RGFFV; and sociodemographic information. Survey data were analyzed using Chi-square test and binary logistic regression. A total of n = 120 TAS and n = 123 SWA adult respondents participated. SWA respondents had higher intakes of fruit (p < 0.001) and vegetables (p < 0.001). Almost all respondents (97%) rated purchasing of RGFFV as important. Top enablers included produce freshness (97%), and to financially support local farmers (94%) and the local community (91%). Barriers included limited seasonal availability of the produce (26%), the belief that RGFFV were expensive (12%) and food budgetary constraints (10%). Recommendations include broader marketing and labelling of seasonal RGFFV; increasing 'buy local' campaigns; consumer information about how RGFFV benefits producers and communities; and pricing produce according to quality.