Food security definition, measures and advocacy priorities in high-income countries: a Delphi consensus study.

OBJECTIVE: To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries. DESIGN: A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked. SETTING: High-income countries. PARTICIPANTS: Household food security experts in academia, government and non-government organisations who had published in the last 5 years. RESULTS: Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem. CONCLUSIONS: This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

Measuring health promotion research impact - What researchers think?

ISSUES ADDRESSED: The significant investment in health research has resulted in an increased focus to determine suitable approaches to measure health promotion research impact. This research was undertaken at the request of a nationally competitive research organisation that funds health promotion research, to explore how Chief Investigators (CIs) on their funded projects understood research impact, its measurement and associated challenges. METHODS: Participants were required to be or have been a CI on an Australian competitive research (exploratory or intervention) grant focussed on health promotion. The qualitative study used thematic analysis from one-on-one interviews. Themes were created and descriptive quotes were selected to illustrate the main findings. RESULTS: The majority of participants were female (n = 13) working at a university (n = 13). Three themes emerged: a) defining health research impact; b) complexity and simplicity of measuring health research impact; c) challenges of measuring health research impact: i) differing language; ii) differing assessment; iii) attribution and timing; and iv) resourcing and skills. CONCLUSION: Researchers recognised that there are significant challenges in measuring the impact of health promotion research. The most significant factors identified by participants were the disciplinary background of the researchers undertaking the measurement, their skills and experience and the resources (including time) available to assess impact. SO WHAT?: Research impact assessment is complex, time consuming and requires specific skills to facilitate measurement of impact provision of funding for this activity in research grants and research impact training is required.

Food Outlets Dietary Risk (FODR) assessment tool: study protocol for assessing the public health nutrition risks of community food environments.

BACKGROUND: Availability and accessibility of nutritious foods can vary according to the food outlets present within a neighbourhood or community. There is increasing evidence that community food environments influence food choice, diet and the risk of diet-related chronic disease, however contemporary community food environments assessments (e.g. unhealthy fast food outlets versus healthy supermarkets or fruit and vegetable shops) may be too simplistic to accurately summarise the complexities of their impacts on food choice. This study protocol describes the development of the Food Outlets Dietary Risk (FODR) assessment tool for use by local government in Perth, Western Australia. METHODS: Similar to food safety risk assessment, the FODR assessment tool rates the potential harmful public health nutrition impact of food outlets by identifying and characterising the issues, and assessing the risk of exposure. Scores are attributed to six public health nutrition attributes: 1) availability of nutrient-poor foods; 2) availability of nutritious foods; 3) acceptability and appeal; 4) accessibility; 5) type of business operation; and 6) complex food outlet considerations. Food retail outlets are then classified as having a low, medium, high or very high dietary risk based on their total score. DISCUSSION: A local government administered tool to rate the public health nutrition risk of food outlets requires data which can be collected during routine assessments or sourced from the internet. The ongoing categorical classification of foods available within food outlets as either unhealthy or nutritious will require nutrition scientists' input. An objective risk assessment of the dietary impact of food retail outlets can guide local government planning, policies and interventions to create supportive community food environments. It is intended that locally relevant data can be sourced throughout Australia and in other countries to apply the local context to the FODR assessment tool. Utility and acceptability of the tool will be tested, and consultation with environmental health officers and public health practitioners will inform future iterations.

The nutritional quality of supermarket own brand chilled convenience foods: an Australian cross-sectional study reveals limitations of the Health Star Rating.

OBJECTIVE: To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts. DESIGN: Cross-sectional. SETTING: Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017. PARTICIPANTS: Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score. RESULTS: Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE. CONCLUSIONS: The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

Positioning food standards programmes to protect public health: current performance, future opportunities and necessary reforms.

OBJECTIVE: To assess current performance and identify opportunities and reforms necessary for positioning a food standards programme to help protect public health against dietary risk factors. DESIGN: A case study design in which a food standards programme's public health protection performance was analysed against an adapted Donabedian model for assessing health-care quality. The criteria were the food standards programme's structure (governance arrangements and membership of its decision-making committees), process (decision-making tools, public engagement and transparency) and food standards outcomes, which provided the information base on which performance quality was inferred. SETTING: The Australia and New Zealand food standards programme.ParticipantsThe structure, process and outcomes of the Programme. RESULTS: The Programme's structure and processes produce food standards outcomes that perform well in protecting public health from risks associated with nutrient intake excess or inadequacy. The Programme performs less well in protecting public health from the proliferation and marketing of 'discretionary' foods that can exacerbate dietary risks. Opportunities to set food standards to help protect public health against dietary risks are identified. CONCLUSIONS: The structures and decision-making processes used in food standards programmes need to be reformed so they are fit for purpose for helping combat dietary risks caused by dietary excess and imbalances. Priorities include reforming the risk analysis framework, including the nutrient profiling scoring criterion, by extending their nutrition science orientation from a nutrient (reductionist) paradigm to be more inclusive of a food/diet (holistic) paradigm.

The extent and nature of supermarket own brand foods in Australia: study protocol for describing the contribution of selected products to the healthfulness of food environments.

BACKGROUND: While public health experts have identified food environments as a driver of poor diet, they also hold great potential to reduce obesity, non-communicable diseases, and their inequalities. Supermarkets are the dominant retail food environment in many developed countries including Australia. The contribution of supermarket own brands to the healthfulness of retail food environments has not yet been explored. The aim of this protocol is to describe the methods developed to examine the availability, nutritional quality, price, placement and promotion of supermarket own brand foods within Australian supermarkets. METHODS: Photographic audits of all supermarket own brand foods present in three major food retail outlets were conducted. Two researchers conducted the supermarket audits in Perth, Western Australia in February 2017. Photographs showing the location of the in-store product display, location of products on shelves, use of display materials, and front-of-pack and shelf-edge labels were taken for each supermarket own brand food present. An electronic filing system was established for photographs from each of the supermarkets and an Excel database constructed. The following data were extracted from the photographs: front-of-pack product information (e.g. product and brand name, pack weight); packaging and label design attributes (e.g. country of origin; marketing techniques conveying value for money and convenience); shelf-edge label price and promotion information; placement and prominence of each product; and nutrition and health information (including supplementary nutrition information, nutrition and health claims, and marketing statements and claims). Nutritional quality of each product was assessed using the principles of the Australian Guide to Healthy Eating, the NOVA classification of level of food processing, and the Health Star Rating score displayed on the front-of-pack. DISCUSSION: Approximately 20,000 photographic images were collected for 3940 supermarket own brand foods present in this audit: 1812 in the Woolworths store, 1731 in the Coles store, and 397 in the IGA store. Analysis of findings will enable researchers to identify opportunities for interventions to improve the contribution of supermarket own brands to healthful retail food environments. This protocol is unique as it aims to investigate all aspects of retail food environments and address the contribution of supermarket own brands.

Global supermarkets' corporate social responsibility commitments to public health: a content analysis.

BACKGROUND: Supermarkets have unprecedented political and economic power in the food system and an inherent responsibility to demonstrate good corporate citizenship via corporate social responsibility (CSR). The aim of this study was to investigate the world's largest and most powerful supermarkets' publically available CSR commitments to determine their potential impact on public health. METHODS: The world's largest 100 retailers were identified using the Global Powers of Retailing report. Thirty-one supermarkets that published corporate reports referring to CSR or sustainability, in English, between 2013 and 2018, were included and thematically analysed. RESULTS: Although a large number of themes were identified (n = 79), and there were differences between each business, supermarket CSR commitments focused on five priorities: donating surplus food to charities for redistribution to feed the hungry; reducing and recovering food waste; sustainably sourcing specific ingredients including seafood, palm oil, soy and cocoa; governance of food safety; and growing the number of own brand foods available, that are made by suppliers to meet supermarkets' requirements. CONCLUSIONS: CSR commitments made by 31 of the world's largest supermarkets showed they appeared willing to take steps to improve sustainable sourcing of specific ingredients, but there was little action being taken to support health and nutrition. Although some supermarket CSR initiatives showed promise, the world's largest supermarkets could do more to use their power to support public health. It is recommended they should: (1) transparently report food waste encompassing the whole of the food system in their waste reduction efforts; (2) support healthful and sustainable diets by reducing production and consumption of discretionary foods, meat, and other ingredients with high social and environmental impacts; (3) remove unhealthful confectionery, snacks, and sweetened beverages from prominent in-store locations; (4) ensure a variety of minimally processed nutritious foods are widely available; and (5) introduce initiatives to make healthful foods more affordable, support consumers to select healthful and sustainable foods, and report healthful food sales as a proportion of total food sales, using transparent criteria for key terms.

Ultra-processed family foods in Australia: nutrition claims, health claims and marketing techniques.

OBJECTIVE: To objectively evaluate voluntary nutrition and health claims and marketing techniques present on packaging of high-market-share ultra-processed foods (UPF) in Australia for their potential impact on public health. DESIGN: Cross-sectional. SETTING: Packaging information from five high-market-share food manufacturers and one retailer were obtained from supermarket and manufacturers' websites. SUBJECTS: Ingredients lists for 215 UPF were examined for presence of added sugar. Packaging information was categorised using a taxonomy of nutrition and health information which included nutrition and health claims and five common food marketing techniques. Compliance of statements and claims with the Australia New Zealand Food Standards Code and with Health Star Ratings (HSR) were assessed for all products. RESULTS: Almost all UPF (95 %) contained added sugars described in thirty-four different ways; 55 % of UPF displayed a HSR; 56 % had nutrition claims (18 % were compliant with regulations); 25 % had health claims (79 % were compliant); and 97 % employed common food marketing techniques. Packaging of 47 % of UPF was designed to appeal to children. UPF carried a mean of 1·5 health and nutrition claims (range 0-10) and 2·6 marketing techniques (range 0-5), and 45 % had HSR≤3·0/5·0. CONCLUSIONS: Most UPF packaging featured nutrition and health statements or claims despite the high prevalence of added sugars and moderate HSR. The degree of inappropriate or inaccurate statements and claims present is concerning, particularly on packaging designed to appeal to children. Public policies to assist parents to select healthy family foods should address the quality and accuracy of information provided on UPF packaging.

Gratitude, resignation and the desire for dignity: lived experience of food charity recipients and their recommendations for improvement, Perth, Western Australia.

OBJECTIVE: The present study explored recipients' perceptions of food charity and their suggested improvements in inner-city Perth, Western Australia. DESIGN: In-depth interviews were conducted with charitable food service (CFS) recipients. Transcripts were thematically analysed using a phenomenological approach. SETTING: Interviews were conducted at two CFS in inner-city Perth. SUBJECTS: Fourteen adults. RESULTS: The recipients' journeys to a reliance on CFS were varied and multifactorial, with poverty, medical issues and homelessness common. The length of time recipients had relied on food charity ranged from 8 months to over 40 years. Most were 'grateful yet resigned', appreciative of any food and resigned to the poor quality, monotony and their unmet individual preferences. They wanted healthier food, more variety and better quality. Accessing services was described as a 'full-time job' fraught with unreliable information and transport difficulties. They called for improved information and assistance with transport. 'Eroded dignity' resulted from being fed without any choice and queuing for food in public places, often in a volatile environment. 'Food memories and inclusion' reflected a desire for commensality. Recipients suggested services offer choice and promote independence, focusing on their needs both physical and social. CONCLUSIONS: Although grateful, long-term CFS recipients described what constitutes a voluntary failure. Their service improvement recommendations can help meet their nutritional and social needs. A successful CFS provides a food service that prioritises nutritious, good-quality food and individual need, while promoting dignity and social inclusion, challenging in the current Australian context.

Consumer attitudes and misperceptions associated with trends in self-reported cereal foods consumption: cross-sectional study of Western Australian adults, 1995 to 2012.

BACKGROUND: The reasons for low adherence to cereal dietary guidelines are not well understood but may be related to knowledge, attitudes, beliefs and perceived barriers. This study aims to assess trends in cereal foods consumption, intention to change and factors associated with intake among Western Australian (WA) adults 18 to 64 years. METHOD: Cross-sectional data from the 1995, 1998, 2001, 2004, 2009, and 2012 Nutrition Monitoring Survey Series involving 7044 adults were pooled. OUTCOME VARIABLES: types and amount of cereals (bread, rice, pasta, and breakfast cereal) eaten the day prior. Attitudes, knowledge, intentions, weight status and sociodemographic characteristics were measured. Descriptive statistics, multiple binary logistic and multinomial logistic regressions assess factors associated with consumption. RESULTS: Bread (78%) was the most commonly consumed cereal food. The proportion eating bread decreased across survey years (Odds Ratio OR = 0.31; 95% Confidence Interval; 0.24-0.40 in 2012 versus 1995), as did the amount (4.1 slices of bread in 1995 to 2.4 in 2012). The odds of consuming whole-grain cereal foods increased since 2009 (OR = 1.27; 1.02-1.58 versus 1995 p < 0.05). The likelihood of trying to eat less cereal food in the past year was greater in 2012 compared to 1995 (Relative Risk Ratio RRR 10.88; 6.81-17.4). Knowledge of cereal recommendations decreased over time (OR = 0.20; 0.15-0.27 in 2012 versus 1995 p < 0.001). Overweight and obese respondents were more likely than healthy weight respondents to have tried to eat less cereals (RRR 1.65; 1.22-2.24 and 1.88; 1.35-2.63 respectively). 'I already eat enough' was the main barrier (75% in 1995 to 84% in 2012 (p < 0.001)). CONCLUSIONS: WA adults are actively reducing the amount of cereal foods they eat and intake is associated with a misperception of adequacy of intake. Nutrition intervention is needed to increase awareness of the health benefits of cereal foods, particularly whole-grains, and to address barriers to incorporating them daily. TRIAL REGISTRATION: Not applicable.

Workforce capacity to address obesity: a Western Australian cross-sectional study identifies the gap between health priority and human resources needed.

BACKGROUND: The disease burden due to poor nutrition, physical inactivity and obesity is high and increasing. An adequately sized and skilled workforce is required to respond to this issue. This study describes the public health nutrition and physical activity (NAPA) practice priorities and explores health managers and practitioner's beliefs regarding workforce capacity to deliver on these priorities. METHODS: A workforce audit was conducted including a telephone survey of all managers and a postal survey of practitioners working in the area of NAPA promotion in Western Australia in 2004. Managers gave their perspective on workforce priorities, current competencies and future needs, with a 70 % response rate. Practitioners reported on public health workforce priorities, qualifications and needs, with a 56 % response rate. RESULTS: The top practice priorities for managers were diabetes (35 %), alcohol and other drugs (33 %), and cardiovascular disease (27 %). Obesity (19 %), poor nutrition (15 %) and inadequate physical activity (10 %) were of lower priority. For nutrition, managers identified lack of staff (60.4 %), organisational and management factors (39.5 %) and insufficient financial resources (30.2 %) as the major barriers to adequate service delivery. For physical activity services, insufficient financial resources (41.7 %) and staffing (35.4 %) and a lack of specific physical activity service specifications (25.0 %) were the main barriers. Practitioners identified inadequate staffing as the main barrier to service delivery for nutrition (42.3 %) and physical activity (23.3 %). Ideally, managers said they required 152 % more specialist nutritionists in the workforce and 131 % specialists for physical activity services to meet health outcomes in addition to other generalist staff. CONCLUSION: Human and financial resources and organisational factors were the main barriers to meeting obesity, and public health nutrition and physical activity outcomes. Services were being delivered by generalists rather than specialists, which may reduce service effectiveness. Although conclusions from this research need to take into account the fact that the audit was conducted in 2004, the findings suggest that there was a need to equip health services with an adequately skilled workforce of sufficient capacity to deliver an effective public health response to the obesity epidemic, particularly addressing poor nutrition and physical inactivity.

Who Uses the Internet as a Source of Nutrition and Dietary Information? An Australian Population Perspective.

BACKGROUND: The Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information. OBJECTIVE: The aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs. METHODS: Data were pooled from the Western Australian Department of Health's 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected. RESULTS: The proportion of respondents using the Internet for nutrition information increased from <1% in 1995-2001 to 9.1% in 2004 and 33.7% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95% CI 2.07-3.88) and 2012 (OR 5.20, 95% CI 3.86-7.02, P<.001). Respondents using the Internet as a source were more likely to be female (OR 1.30, 95% CI 1.05-1.60, P=.02), live in a metropolitan area (OR 1.26, 95% CI 1.03-1.54, P=.03), born in countries other than Australia/UK/Ireland (OR 1.41, 95% CI 1.07-1.85, P=.02), more educated (university: OR 2.46, 95% CI 1.77-3.42, P<.001), and were less likely to be older (55-64 years: OR 0.38, 95% CI 0.25-0.57, P<.001). The majority of respondents agreed the following information would assist them to make healthier choices: more ways to prepare healthy foods (72.0%, 95% CI 70.7-73.3), quicker ways to prepare healthy foods (79.0%, 95% CI 77.8-80.1), how to choose healthy foods (68.8%, 95% CI 67.5-70.1), and knowing more about cooking (54.7%, 95% CI 53.3-56.1). Those using the Internet for nutrition information were more likely than nonusers to want to know quicker ways to prepare healthy foods (83.0% vs 78.1%, P=.005) and information on choosing healthy foods (76.3% vs 67.3%, P<.001). CONCLUSIONS: Use of the Internet as a main source of nutrition information has grown rapidly since 2004; one-third of Western Australian adults reported using the Internet for this purpose in 2012. Information on preparing healthy foods (ideas, quicker ways), choosing ingredients, and knowing more about cooking would make it easier to eat a healthy diet. For Internet users, emphasis should be on quicker ways and choosing ingredients. These finding have implications for policy makers and practitioners and suggest that traditional health promotion tactics should continue to be used to reach the broader population.

Development of the Menu Assessment Scoring Tool (MAST) to Assess the Nutritional Quality of Food Service Menus.

Preventing the rise in obesity is a global public health priority. Neighbourhood environments can help or undermine people's efforts to manage their weight, depending on availability of nutritious and nutrient-poor 'discretionary' foods. The proportion of household food budgets spent on eating outside the home is increasing. To inform nutrition policy at a local level, an objective assessment of the nutritional quality of foods and beverages on food service menus that is context-specific is needed. This study describes the development and piloting of the Menu Assessment Scoring Tool (MAST), used to assess the nutritional quality of food service menus in Australia. The MAST is a desk-based tool designed to objectively assess availability of nutrient-poor and absence of nutritious food and beverages on food service menus. A risk assessment approach was applied, using the best available evidence in an iterative way. MAST scores for 30 food service outlets in one Local Government Authority in Perth, Western Australia highlight opportunities for improvements. MAST is the first tool of its kind in Australia to assess the nutritional quality of food service menus. It was practical and feasible to use by public health nutritionists/dietitians and can be adapted to suit other settings or countries.

"Just So You Know, It Has Been Hard": Food Retailers' Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings.

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers' experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

Using the Food Stress Index for Emergency Food Assistance: An Australian Case Series Analysis during the COVID-19 Pandemic and Natural Disasters.

Food insecurity increases with human and natural disasters. Two tools were developed to assist effective food relief in Western Australia: the Food Stress Index (similar to rental stress, predicts the likelihood of household food insecurity by geographic location) and a basic and nutritious Food Basket Recommendation (that quantifies the types and amounts of food to meet dietary recommendations for different family types). This study aims to understand and compare the processes and impact of using these tools for organisations and their clients involved in emergency food assistance and/or disaster preparedness. A multiple case-study design analysed organisation's use of the tools to assist the response to COVID-19 pandemic restrictions and the catastrophic bushfires in Australia. Qualitative interviews were conducted by telephone and Zoom (a cloud-based video conferencing service) in July-August 2020. A purposeful sample of eight interviewees representing seven cases (government, food relief and community organisations involved in emergency food assistance and/or disaster preparedness). Three themes emerged from the analysis, (1) organisations are confident users of the tools; (2) Collaborations were "Ready to Go" and (3) Food Stress Index is a "game changer". Findings demonstrate the intrinsic value of the tools in the provision of emergency food relief under both normal circumstances and in times of increased need, i.e., COVID-19 pandemic. The study highlights the value and importance of ongoing intersectoral collaborations for food relief and food security (e.g., the Western Australian Food Relief Framework) and suggests that upscaling of the Food Stress Index and food baskets will increase the effectiveness of measures to address food insecurity in Australia.

Addressing Food and Nutrition Security in Developed Countries.

The guest editors of the special issue on Addressing Food and Nutrition Security in Developed Countries reflect on the 26 papers that were published as part of this issue and the scope of research contained therein. There is an extensive body of work, which focuses on topics ranging from the prevalence of food insecurity in developed countries, associations and determinants, measurement and monitoring, to reports of the lived experience and coping strategies of people who are living with food insecurity or and those who are a part of the charitable food sector. Very few solutions to address the problem of food insecurity in developed countries were offered, and many challenges highlighted. Further research is required to find the solutions to address the problem of food insecurity in developed countries, and important principles and values are proposed for those undertaking this work to embrace.

The Nature and Quality of Australian Supermarkets' Policies that can Impact Public Health Nutrition, and Evidence of their Practical Application: A Cross-Sectional Study.

Improving population diets is a public health priority, and calls have been made for corporations such as supermarkets to contribute. Supermarkets hold a powerful position within the food system, and one source of power is supermarket own brand foods (SOBFs). Many of the world's largest supermarkets have corporate social responsibility (CSR) policies that can impact public health, but little is known about their quality or practical application. This study examines the nature and quality of Australian supermarkets' CSR policies that can impact public health nutrition, and provides evidence of practical applications for SOBFs. A content analysis of CSR policies was conducted. Evidence of supermarkets putting CSR policies into practice was derived from observational audits of 3940 SOBFs in three large exemplar supermarkets (Coles, Woolworths, IGA) in Perth, Western Australia (WA). All supermarkets had some CSR policies that could impact public health nutrition; however, over half related to sustainability, and many lacked specificity. All supermarkets sold some nutritious SOBFs, using marketing techniques that made them visible. Findings suggest Australian supermarket CSR policies are not likely to adequately contribute to improving population diets or sustainability of food systems. Setting robust and meaningful targets, and improving transparency and specificity of CSR policies, would improve the nature and quality of supermarket CSR policies and increase the likelihood of a public health benefit.

The Impact of Voluntary Policies on Parents' Ability to Select Healthy Foods in Supermarkets: A Qualitative Study of Australian Parental Views.

Food packaging is used for marketing purposes, providing consumers with information about product attributes at the point-of-sale and thus influencing food choice. The Australian government focuses on voluntary policies to address inappropriate food marketing, including the Health Star Rating nutrition label. This research explored the way marketing via packaging information influences Australian parents' ability to select healthy foods for their children, and who parents believe should be responsible for helping them. Five 90-min focus groups were conducted by an experienced facilitator in Perth, Western Australia. Four fathers and 33 mothers of children aged 2-8 years participated. Group discussions were audio-recorded and transcribed verbatim and inductive thematic content analysis conducted using NVivo11. Seven themes were derived: (1) pressure of meeting multiple demands; (2) desire to speed up shopping; (3) feeding them well versus keeping them happy; (4) lack of certainty in packaging information; (5) government is trusted and should take charge; (6) food manufacturers' health messages are not trusted; (7) supermarkets should assist parents to select healthy foods. Food packaging information appears to be contributing to parents' uncertainty regarding healthy food choices. Supermarkets could respond to parents' trust in them by implementing structural policies, providing shopping environments that support and encourage healthy food choices.