Development of a survey tool to assess the environmental determinants of health-enabling food retail practice in Aboriginal and Torres Strait Islander communities of remote Australia.

BACKGROUND: Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail. METHODS: We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input. RESULTS: One-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store's health-enabling practice (n = 20) and frequency of occurrence (n = 6). CONCLUSIONS: The application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores.

An exploratory study to investigate alcohol consumption among breast-feeding mothers.

OBJECTIVE: We examined the likelihood of breast-feeding mothers consuming alcohol according to several socio-demographic factors. DESIGN: We carried out secondary data analyses using participant information obtained from a cross-sectional survey designed to capture the dietary habits of UK infants aged 4-18 months. SETTING: Data concerning breast-feeding mothers' social and domestic circumstances and alcohol consumption were drawn from the 2011 Diet and Nutrition Survey of Infants and Young Children. PARTICIPANTS: Complete data from 2683 breast-feeding mothers were included, and further analyses were carried out on those who continued to drink alcohol (n 227). RESULTS: Logistic regression enabled the identification of social factors associated with breast-feeding and continued alcohol consumption among mothers. Several social factors were found to influence the likelihood of breast-feeding mothers drinking alcohol. For example, older mothers, mothers with partners who drank alcohol, those with higher educational attainment and household income and those who consumed alcohol whilst pregnant were more likely to continue to drink alcohol. Mothers' breast-feeding infants older than 12 months were less likely to drink alcohol than those feeding infants aged 4-6 months. CONCLUSIONS: Evidence suggests that social circumstances influence the likelihood of alcohol use among mothers who are breast-feeding. Greater understanding of mothers' decision making with respect to the continuation or discontinuation of alcohol use whilst breast-feeding, according to the social context in which they live, is warranted.

Evaluation of the impact of a school gardening intervention on children's fruit and vegetable intake: a randomised controlled trial.

BACKGROUND: Current academic literature suggests that school gardening programmes can provide an interactive environment with the potential to change children's fruit and vegetable intake. This is the first cluster randomised controlled trial (RCT) designed to evaluate whether a school gardening programme can have an effect on children's fruit and vegetable intake. METHODS: The trial included children from 23 schools; these schools were randomised into two groups, one to receive the Royal Horticultural Society (RHS)-led intervention and the other to receive the less involved Teacher-led intervention. A 24-hour food diary (CADET) was used to collect baseline and follow-up dietary intake 18 months apart. Questionnaires were also administered to evaluate the intervention implementation. RESULTS: A total of 641 children completed the trial with a mean age of 8.1 years (95% CI: 8.0, 8.4). The unadjusted results from multilevel regression analysis revealed that for combined daily fruit and vegetable intake the Teacher-led group had a higher daily mean change of 8 g (95% CI: -19, 36) compared to the RHS-led group -32 g (95% CI: -60, -3). However, after adjusting for possible confounders this difference was not significant (intervention effect: -40 g, 95% CI: -88, 1; p = 0.06). The adjusted analysis of process measures identified that if schools improved their gardening score by 3 levels (a measure of school gardening involvement - the scale has 6 levels from 0 'no garden' to 5 'community involvement'), irrespective of group allocation, children had, on average, a daily increase of 81 g of fruit and vegetable intake (95% CI: 0, 163; p = 0.05) compared to schools that had no change in gardening score. CONCLUSIONS: This study is the first cluster randomised controlled trial designed to evaluate a school gardening intervention. The results have found very little evidence to support the claims that school gardening alone can improve children's daily fruit and vegetable intake. However, when a gardening intervention is implemented at a high level within the school it may improve children's daily fruit and vegetable intake by a portion. Improving children's fruit and vegetable intake remains a challenging task. TRIAL REGISTRATION: ISRCTN11396528.

Study protocol: can a school gardening intervention improve children's diets?

BACKGROUND: The current academic literature suggests there is a potential for using gardening as a tool to improve children's fruit and vegetable intake. This study is two parallel randomised controlled trials (RCT) devised to evaluate the school gardening programme of the Royal Horticultural Society (RHS) Campaign for School Gardening, to determine if it has an effect on children's fruit and vegetable intake. METHOD/DESIGN: Trial One will consist of 26 schools; these schools will be randomised into two groups, one to receive the intensive intervention as "Partner Schools" and the other to receive the less intensive intervention as "Associate Schools". Trial Two will consist of 32 schools; these schools will be randomised into either the less intensive intervention "Associate Schools" or a comparison group with delayed intervention. Baseline data collection will be collected using a 24-hour food diary (CADET) to collect data on dietary intake and a questionnaire exploring children's knowledge and attitudes towards fruit and vegetables. A process measures questionnaire will be used to assess each school's gardening activities. DISCUSSION: The results from these trials will provide information on the impact of the RHS Campaign for School Gardening on children's fruit and vegetable intake. The evaluation will provide valuable information for designing future research in primary school children's diets and school based interventions. TRIAL REGISTRATION: ISRCTN11396528.

Process evaluation of a cluster randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato.

OBJECTIVE: The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8-9 years. DESIGN: A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms. SETTING: Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group. SUBJECTS: A total of 311 children received the intervention. RESULTS: Implementation of the intervention was low, 21·3 % of school items and 56·0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3-7 nights/week on average consumed 37·6 (95 % CI 9·8, 65·4) g more fruit and vegetables than children who ate with their parents 0-2 times/week. CONCLUSIONS: Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on children's fruit and vegetable intake.