Factors influencing food service provision decisions in centre-based early childhood education and care services: Cooks' perspective.

ISSUE ADDRESSED: Considerable public effort has been directed at centre-based childcare as an early childhood education and care (ECEC) setting to promote healthy food-related behaviours in young children. However, in the real-world setting, best practice, evidence-based guidelines are not always well-translated into usual, day-to-day routines. This study aims to understand what factors influence the centre-based childcare cooks' food and nutrition decisions for children aged 2-5 years. METHODS: Semi-structured qualitative interviews were conducted with cooks in centre-based childcare using purposeful maximum variation sampling and data analysed thematically. RESULTS: Fourteen cooks were interviewed from 14 services across South Australia. Central to providing a healthy food environment was expert-led knowledge and training gained through the workplace over several years and the embodiment of the service's healthy food and nutrition policy, evidenced through menu planning to maintain a focus on healthy eating. Threatening these positive, routine practices and decisions were pressures to modify menus in response to increasing food allergies and changing cultural and family preferences, in the absence of ongoing relevant training and expertise at the system-level. CONCLUSIONS: Children in ECEC benefit from cooks' commitment to providing nutritious foods; however, the requirements to extend their role to respond to increasing demands without relevant system-level support and training puts the children at risk of not being exposed to health-promoting menus and possible errors in providing dietary modifications. ECEC cooks urgently need access to system-level support and training. SO WHAT?: Understanding and addressing the barriers experienced by cooks and the complexity of factors that inform their food-related decision-making will sustain the implementation of effective, healthy eating guidelines and nutrition practices in ECEC.

A critical food system program in South Australia and the effects on consumer knowledge and attitudes.

ISSUE ADDRESSED: This study investigated the effects of food system literacy on knowledge and attitudes of food consumers. METHODS: A 2-week online course critically discussed the food system through three lenses of environmental sustainability, equity and health. Participants were randomly allocated into one Control and two Intervention groups (A & B). Data collection was by online questionnaire pre- and postintervention, addressing self-perceived food system knowledge, attitudes towards food purchasing behaviours, demographic characteristics and course evaluation. Differences in knowledge and attitude scores between Control and Intervention groups were assessed. Subjects were staff and students of Flinders University in South Australia. RESULTS: Forty-seven participants completed the course. The completion rate was 71.2%. Knowledge about the food system improved significantly for both Intervention groups when compared to the Control group (P ≤ 0.001). Although attitudes towards food purchasing behaviours also improved significantly for both Intervention groups (P < 0.001 and P = 0.005 for Interventions A and B respectively), the improvements were not significant when compared to the Control group (P = 0.065 and P = 0.43 for Interventions A and B respectively). The online methodology received positive feedback from participants. CONCLUSION: This 2-week online food system course showed that the pedagogy was appropriate and successful in improving self-perceived knowledge and attitudes towards food consumption. SO WHAT?: It provides encouraging indications of the potential of food system literacy to empower citizens to make healthier as well as, more environmentally and socially sustainable food choices.

Feeding the Australian family: challenges for mothers, nutrition and equity.

Australian women shoulder the bulk of household duties including family food provisioning, despite increasing participation in the workforce. This research aimed to understand employed mothers' daily-lived experience of family food provisioning, in particular, the intersection between family food provisioning, gender inequality and nutritional guidelines as they impact women's time and health. Semi-structured interviews were conducted with 22 employed mothers in South Australia. Participants had at least one child aged less than 13 years. Qualitative data was analysed using a thematic content approach. Time-scarcity was common and associated with stress in relation to family food provisioning; this relationship was particularly apparent among employed mothers who were also studying. Most mothers valued nutrition and strove to provide nutritious meals, although they tended to work from their own nutritional understandings, not the national nutrition guidelines; they saw the nutrition guidelines as unhelpful because of the time demands that were implied. The study invites policy makers, practitioners and researchers to consider time for family food provisioning as a social determinant of family as well as women's health, and structural strategies to address this health inequity for women.

Personal development, wellbeing and empowerment gains for nutrition peer educators: a South Australian perspective.

This study aimed to explore the experience of being a Community Foodies (CF) peer educator with respect to personal benefits, specifically, personal development, wellbeing and empowerment. Qualitative semi-structured telephone interviews conducted with metropolitan and country peer educators of the CF programme. The CF programme in South Australia (SA) delivers nutrition education to disadvantaged communities. Ten adult peer educators from the CF programme: seven from country SA and three from Adelaide. Phenomenon of interest is that peer educators' perceptions of personal growth and development from involvement in the CF programme. The interviews were audiotaped and analysed thematically. The experience of being a nutrition peer educator improved personal skills and knowledge, dietary habits, self-esteem, confidence, sense of belonging and civic engagement. Peer educators felt that the CF programme was run in a straightforward, easy to understand way, with a welcoming environment and abundant support from the coordinators. Apart from benefits to themselves, peer educators appeared to be most proud of their capacity to contribute to the nutritional health of the broader community. Peer education programmes in disadvantaged communities provide policy makers with valuable and cost-effective approaches to improve health, build self-efficacy, strengthen community engagement, and, foster active participation and trust.

Treats are a tool of the trade: an exploration of food treats among grandparents who provide informal childcare.

OBJECTIVE: Globally, grandparents are the main informal childcare providers with one-quarter of children aged ≤5 years regularly cared for by grandparents in Australia, the UK and USA. Research is conflicting; many studies claim grandparents provide excessive amounts of discretionary foods (e.g. high in fat/sugar/sodium) while others suggest grandparents can positively influence children's diet behaviours. The present study aimed to explore the meaning and role of food treats among grandparents who provide regular informal care of young grandchildren. DESIGN: Qualitative methodology utilising a grounded theory approach. Data were collected using semi-structured interviews and focus groups, then thematically analysed. SETTING: Participants were recruited through libraries, churches and playgroups in South Australia. PARTICIPANTS: Grandparents (n 12) caring for grandchild/ren aged 1-5 years for 10 h/week or more. RESULTS: Three themes emerged: (i) the functional role of treats (e.g. to reward good behaviour); (ii) grandparent role, responsibility and identity (e.g. the belief that grandparent and parent roles differ); and (iii) the rules regarding food treats (e.g. negotiating differences between own and parental rules). Grandparents favoured core-food over discretionary-food treats. They considered the risks (e.g. dental caries) and rewards (e.g. pleasure) of food treats and balanced their wishes with those of their grandchildren and parents. CONCLUSIONS: Food treats play an important role in the grandparent-grandchild relationship and are used judiciously by grandparents to differentiate their identity and relationship from parents and other family members. This research offers an alternative narrative to the dominant discourse regarding grandparents spoiling grandchildren with excessive amounts of discretionary foods.

Addressing nutrition and social connection through community gardening: A South Australian study.

BACKGROUND: This research aimed to evaluate the benefits of the community gardening program called ''Magic Harvest (MH)" with respect to its key elements: social interaction; gardening skills; and, healthier eating. The MH program supports community participants to grow food, share produce, prepare and preserve food. METHODS: Two focus groups were conducted with participants in MH programs in the south of Adelaide, South Australia. The MH programs were located in lower socio-economic areas. Focus group interviews were recorded, transcribed verbatim, coded and analysed thematically. RESULTS: Thirteen participants took part in the focus groups and reported gains in community connectedness and shared learning, skills for growing food and healthy eating and making more sustainable food choices. CONCLUSION: This study highlights the social and nutritional benefits that can be derived from a community gardening program in low-income communities. Health practitioners and policymakers should consider community gardening as an effective health promotion strategy that can address physical and social determinants of health and nutrition for low-income communities.

Eating occasions and the contribution of foods to sodium and potassium intakes in adults.

OBJECTIVE: To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions. DESIGN: Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011-2013). SETTING: Nationally representative survey in Australia. SUBJECTS: Male and female Australians aged 18-84 years (n 7818). RESULTS: Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes. CONCLUSIONS: Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.

The experiences and perceptions of food banks amongst users in high-income countries: An international scoping review.

PURPOSE: Food banks have become the main response to food insecurity in many high-income countries, but it has been argued that they lack the capacity to respond consistently and fully to the food needs of the people who use them. This literature review set out to answer the question 'how do food bank recipients experience food relief services and how does this impact their lives and wellbeing?' RESULTS: A comprehensive search of electronic databases yielded twenty qualitative studies, conducted in developed countries, exploring user perspectives of food banks. From the studies reviewed, there emerged three main categories that represented the different aspects of the food bank process from the food bank user's perspective: the user's perceptions about the idea of being fed from food banks, the user's perceptions about food bank offerings and operations, and the socio-psychological impact of receiving food from food banks. While participants of these studies spoke positively of the volunteers and were thankful for the service, they also consistently report limited food choice, poor quality, shame, stigma and embarrassment associated with food bank use. CONCLUSIONS: The food bank industry continues to expand despite there being little evidence that food banks are an appropriate response for those facing food insecurity. This is worrying as the results of this review indicate that although participants value the service provided by the food bank, the experience can be largely negative. These findings raise questions about the food bank model as a long-term strategy.

Does the presence of cardiovascular disease risk factors or established disease influence the dietary intake of affected adults and their children residing in the same household? A secondary analysis of the Australian Health Survey (2011-2013).

BACKGROUND: Diet is an important contributor to risk of cardiovascular disease (CVD) and integral in management and delaying progression. Little is known however about whether increased CVD risk or established CVD has any influence on dietary intakes of Australian adults or children residing in the same household. This study aimed to determine whether the presence of CVD or CVD risk factors influences dietary intake of Australian adults and if the presence of an adult with increased CVD risk influences the dietary intake of a child living in the same household. METHODS: Data were sourced from the 2011-2013 Australian Health Survey for: (1) adults ≥18 years with risk factors or established CVD and (2) children 2-17 years residing in the same household as adults with CVD risk factors or established CVD. Selected nutrient intakes (total fat, saturated fat plus trans fat, alpha-linolenic acid, total long chain omega 3 fatty acids, fibre and sodium) collected by repeated 24 h recalls were compared to national dietary recommendations and to the intakes of all other adults and children surveyed. Standard errors of the estimates were calculated using the replicate weights method, and an alpha value of <0.05 considered statistically significant. RESULTS: Six thousand two hundred sixty five of 9435 adults surveyed were identified as having CVD risk factors or established disease and of these 1609 had a child in the same household that also contributed data in this survey. No differences were observed in adjusted mean dietary intakes between those without risk factors or established CVD and those with, except for total energy and sodium which were significantly lower in the adults with CVD risk factors and/or established disease. However sodium intakes across both groups were higher than recommended targets. There were no differences for selected nutrients between children residing with affected adults and other children surveyed. CONCLUSIONS: While intakes of Australian adults with CVD risk factors or established disease were favourable for sodium, compared to unaffected adults, there is still scope for improvement as many Australian adults, despite CVD risk, are unable to achieve targets for selected nutrients. Effective dietary behaviour change strategies and resources are urgently needed.

Engaging South Australian local governments in the development of healthy eating policies.

Issue addressed Local governments are uniquely placed to influence the food environment of their communities through healthy eating policies (HEPs) but very few have done so. Methods Using a community-based participatory approach, Healthy Eating Local Policies and Programs built the capacity of South Australian local governments to develop and implement a HEP by leading the development of a HEP framework then mentoring local governments to develop their own local policy tailored to their community. Results Over a 2-year period, 31 of the 68 local governments worked towards developing a HEP, with 14 receiving endorsement by December 2013. Conclusions Local governments are ready to model healthy eating practices and adopt healthy eating policy that supports the health of their communities. A HEP developed using a participatory approach and with the flexibility to be tailored to local preferences and demographics appears feasible, although the process may be lengthy. This process and outcome appears applicable and transferable to other local governments. So what? As local governments take up their responsibilities in promoting health and wellbeing, HEPs provide important structural mechanisms to enable councils to facilitate healthy eating in their local communities.

Dietary intake of working women with children does not appear to be influenced by hours of employment: A secondary analysis of the Australian Health Survey (2011-2013).

UNLABELLED: Women with children often fulfil multiple roles of running a household, raising a family and working outside the home. Good nutrition during this time is important to optimise their performance and prevent lifestyle diseases. Women also act as nutritional gatekeepers for their family. The dual burden of paid employment and unpaid family work may be associated with time scarcity in mothers which can impact food preparation and therefore nutritional adequacy. The aim of this study was to examine the diet of women who lived with children by comparison of hours worked. METHODS: This was a secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12. Subjects were women aged 18-65 years who resided with ≥1 child (<18 years). Women were grouped according to hours of employment: not working; working <25 h a week; and working ≥25 hours a week. Data from two 24-h dietary recalls were used to compare differences between groups in nutrient intake and proportion of energy from discretionary foods. Covariates included were age, education, smoker status, Socio-Economic Indexes for Areas (SEIFA), number of persons in household, week or weekend day of the survey and the sequence of recalls. RESULTS: Analyses included 1869 women. Dietary intakes varied minimally between groups with intakes of fibre, vitamin C, and calcium lowest in the group not working. Overall diet quality was poor with >30% of energy coming from discretionary foods in all groups. CONCLUSIONS: Usual hours of employment per week have a minimal effect on diet quality in women with children. It is likely that different factors specific to each group contribute to the poor dietary intakes and should be further investigated.

A survey of the reformulation of Australian child-oriented food products.

BACKGROUND: Childhood obesity is one of the most pressing public health challenges of the 21st century. Reformulating commonly eaten food products is a key emerging strategy to improve the food supply and help address rising rates of obesity and chronic disease. This study aimed to monitor reformulation of Australian child-oriented food products (products marketed specifically to children) from 2009-2011. METHODS: In 2009, all child-oriented food products in a large supermarket in metropolitan Adelaide were identified. These baseline products were followed up in 2011 to identify products still available for sale. Nutrient content data were collected from Nutrient Information Panels in 2009 and 2011. Absolute and percentage change in nutrient content were calculated for energy, total fat, saturated fat, sugars, sodium and fibre. Data were descriptively analysed to examine reformulation in individual products, in key nutrients, within product categories and across all products. Two methods were used to assess the extent of reformulation; the first involved assessing percentage change in single nutrients over time, while the second involved a set of nutrient criteria to assess changes in overall healthiness of products over time. RESULTS: Of 120 products, 40 remained unchanged in nutrient composition from 2009-2011 and 80 underwent change. The proportions of positively and negatively reformulated products were similar for most nutrients surveyed, with the exception of sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess extent of reformulation, nearly half (n = 53) of all products were at least moderately reformulated and just over one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) that were positively reformulated and none that had undergone negative reformulation. CONCLUSION: Positive and negative reformulation was observed to a similar extent within the sample indicating little overall improvement in healthiness of the child-oriented food supply from 2009-2011. In the absence of agreed reformulation standards, the extent of reformulation was assessed against criteria developed specifically for this project. While arbitrary in nature, these criteria were based on reasonable assessment of the meaningfulness of reformulation and change in nutrient composition. As well as highlighting nutrient composition changes in a number of food products directed to children, this study emphasises the need to develop comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.

Marketing foods to children through product packaging: prolific, unhealthy and misleading.

OBJECTIVE: To investigate marketing techniques used on the packaging of child-oriented products sold through supermarkets. DESIGN: Food and beverage products which met criteria for 'marketed to children' were recorded as child-oriented. The products were analysed for food categories, nutritional value, and type and extent of marketing techniques used. SETTING: A major supermarket chain in Adelaide, South Australia. SUBJECTS: Child-oriented food and beverage products. RESULTS: One hundred and fifty-seven discrete products were marketed to children via product packaging; most (75·2 %) represented non-core foods, being high in fat or sugar. Many marketing techniques (more than sixteen unique marketing techniques) were used to promote child-oriented food products. Claims about health and nutrition were found on 55·5 % of non-core foods. A median of 6·43 marketing techniques per product was found. CONCLUSIONS: The high volume and power of marketing non-core foods to children via product packaging in supermarkets should be of concern to policy makers wanting to improve children's diet for their health and to tackle childhood obesity. Claims about health or nutrition on non-core foods deserve urgent attention owing to their potential to mislead and confuse child and adult consumers.

Television food advertising in Singapore: the nature and extent of children's exposure.

Television advertising is an effective medium for reaching young children and influencing their food choice. Studies have shown that messages conveyed by food advertisements are rarely consistent with healthy eating messages. With the increasing purchasing power of children, food companies are focusing on children as lucrative target audiences. Extensive marketing of energy-dense, nutrient-poor foods to children potentially contributes to the 'obesogenic' environment. This study aims to determine the degree and nature of food advertisements that Singaporean children are exposed to on television. Ninety-eight hours of children's television programmes broadcast by free-to-air stations were recorded and analysed. Advertisements with the intent of selling and sponsorships for programmes were included. Foods advertised were considered healthy if they met the criteria of the Healthier Choice Symbol in Singapore. Of the 1344 advertisements and sponsorships identified, 33% were for food. Of the food advertisements, 38% were considered healthy, while 57% were not. Candy, confectionery and fast food advertisements accounted for 46% of total food advertisements. Significantly more unhealthy food advertisements were screened on weekends compared with weekdays (p < 0.001). This is the first content analysis of television advertisements in Singapore and the results of this study provide background data on the extent of food advertising that children in Singapore are exposed to. Consistent with other countries, unhealthy food advertisements continue to dominate children's television programmes. This study suggests that Singaporean children are exposed to high levels of advertising for unhealthy foods. The study provides a baseline against which measures aimed at reducing children's exposure to television food advertising can be evaluated.

Food acculturation experiences of new Iranian skilled migrant mothers in South Australia.

AIM: This research aimed to investigate the food acculturation experiences of Iranian mothers who have migrated to Australia. METHODS: The study used qualitative methodology to interview seven mothers with children aged 5 to 15 years, who: carried primary responsibility for family food provisioning; arrived in Australia within the last 5 years; and spoke reasonably fluent English. RESULTS: Seven mothers were interviewed, and the findings revealed three broad themes: (a) adjusting to foods/foodways in Australia (b) sociocultural identity and (c) children and intergenerational conflict. The study highlighted psychosocial and economic stresses associated with food acculturation for this immigrant group. The impact of food acculturation on immigrant health is intricately linked to the complex balance between maintaining traditional cultural identity and practices, while at the same time adapting to the food culture and practices of the new home. CONCLUSIONS: Dietitians and healthcare professionals working with such immigrant groups need to consider food acculturation stress as a factor contributing to the health risks of new immigrants.

Food Charity, Shame/ing and the Enactment of Worth.

Food insecurity is a significant problem in many countries, including Australia. Consequently, food hubs, through which food is distributed using a supermarket style layout, have become an important new source of charity food provision. However, little is known about users' experiences. We draw on ethnographic research to understand the everyday experiences of people using South Australian food hubs. We suggest that attempts to produce a more dignified experience by creating a normalizing experience of shopping is not being achieved, because of the shame and stigma surrounding poverty, confusing operational processes, poor food quality, staff attitudes, and the disciplinary capacity of food hubs.

Australian children's views about food advertising on television.

This study explored children's views about food advertising on television in the light of recent public interest in childhood obesity and obesogenic environments. Thirty-seven children aged between 8 and 11 years, discussed their perceptions of food advertising, in focus groups. The children engaged as consumers of advertising, noticing technical aspects, and expressing their likes and dislikes of particular techniques. While they understood the persuasive intent of advertising, they nevertheless desired products and made purchase requests. They particularly desired energy-dense nutrient-poor foods. The children demonstrated sophisticated levels of advertising literacy through their articulation of problems such as deception, impacts on children's health and wellbeing, and family conflict. They revealed themselves as sentient beings, with the capacity to react, respond and reflect on their experience of advertising. This study makes a contribution to research on consumer socialisation by introducing the perspective of Australian children. As stakeholders in the childhood obesity problem, the views of children should also be of interest to health policymakers.

An investigation into the use of infant feeding tracker apps by breastfeeding mothers.

Sufficient information and support for breastfeeding mothers is vital to encourage optimal infant feeding practices. Infant feeding apps give breastfeeding instructions and access to information however, little is known about mothers' perceptions about these resources. This study investigated mothers' use and experiences of infant feeding apps with a feeding tracker component, including how information within these apps is used, initial reasons for downloading, the role of the app in infant feeding, and perceived benefits and disadvantages of infant feeding apps. In-depth interviews were conducted with nine Australian breastfeeding mothers who had used an infant feeding app in the last year. Interviews were recorded, transcribed verbatim and coded prior to thematic analysis. The findings revealed that infant feeding apps provide mothers with objective information to guide their breastfeeding decisions and other aspects of baby care. This objective approach to infant feeding gives mothers a perception of greater control, confidence and efficacy at a time of transition and stress in the early stages of parenting an infant. While, overall, the mothers were positive about infant feeding apps, they also expressed concerns regarding overreliance on the app, feeling overwhelmed with the data and questioning the credibility of the information.

Migration, Stress and the Challenges of Accessing Food: An Exploratory Study of the Experience of Recent Afghan Women Refugees in Adelaide, Australia.

This study explored the migration and food experiences of Afghani women refugees residing in Adelaide, South Australia for 2 years or less. In-depth semi-structured qualitative interviews were conducted with 10 women between May and September 2017. The data were thematically analysed, and the Social Determinants of Health Framework was used to discuss the findings. Five key themes emerged from the data. In the transition country (Iran/Pakistan), respondents experienced (i) trauma, discrimination and exclusion and (ii) familiar food culture, but food stress. In the destination country (Adelaide, Australia) respondents experienced (iii) a sense of precariousness, (iv) unfamiliar food culture and (v) challenges in accessing halal food. Afghani refugees experienced considerable stressors both in the transition and the final destination country but for different reasons. In the transition country, stresses related to the lack of social services and support, discrimination, racism and poverty seemed to have affected their ability to afford food. In Australia stressors pertaining to socioeconomic, housing and employment precariousness, as well as difficulties in accessing halal foods were identified as challenges. Furthermore, food stress in Australia was associated with the cultural appropriateness of food, the complexity of the food system, and the women's lack of skills and experiences in navigating the food system. With increasing refugee and immigration flows globally, it is necessary to acknowledge how food and social determinants intersect for refugee immigrants to ensure positive health outcomes.

Regulatory axes on food advertising to children on television.

This article describes and evaluates some of the criteria on the basis of which food advertising to children on television could be regulated, including controls that revolve around the type of television programme, the type of product, the target audience and the time of day. Each of these criteria potentially functions as a conceptual device or "axis" around which regulation rotates. The article considers examples from a variety of jurisdictions around the world, including Sweden and Quebec. The article argues that restrictions centring on the time of day when a substantial proportion of children are expected to be watching television are likely to be the easiest for consumers to understand, and the most effective in limiting children's exposure to advertising.