Indigenous Identity and Household Food Insecurity are Associated with Poor Health Outcomes in Canada.

Purpose: To examine whether Indigenous identity and food insecurity combined were associated with self-reported poor health.Methods: Data from the 2015-2016 Canadian Community Health Survey and multiple logistic regression were employed to evaluate the association between Indigenous identity, household food insecurity, and health outcomes, adjusted for individual and household covariates. The Alexander Research Committee in Alexander First Nation (Treaty 6) reviewed the manuscript and commented on the interpretation of study findings.Results: Data were from 59082 adults (3756 Indigenous). The prevalence of household food insecurity was 26.3% for Indigenous adults and 9.8% for non-Indigenous adults (weighted to the Canadian population). Food-secure Indigenous adults, food-insecure non-Indigenous adults, and food-insecure Indigenous adults had significantly (p < 0.001) greater odds of poor health outcomes than food-secure non-Indigenous adults (referent group). Food-insecure Indigenous adults had 1.96 [95% CI:1.53,2.52], 3.73 [95% CI: 2.95,4.72], 3.00 [95% CI:2.37,3.79], and 3.94 [95% CI:3.02,5.14] greater odds of a chronic health condition, a chronic mental health disorder, poor general health, and poor mental health, respectively, compared to food-secure non-Indigenous adults.Conclusions: Health policy decisions and programs should focus on food security initiatives for all Canadians, including addressing the unique challenges of Indigenous communities, irrespective of their food security status.

Determining the feasibility of a codesigned and personalised intervention (Veg4Me) to improve vegetable intake in young adults living in rural Australian communities: protocol for a randomised controlled trial.

INTRODUCTION: Diets low in vegetables are a main contributor to the health burden experienced by young adults in rural communities. Digital health interventions provide an accessible delivery model that can be personalised to meet the diverse preferences of young adults. A personalisable digital vegetable intake intervention (Veg4Me) was codesigned to meet the needs of young adults living in rural communities. This study will determine the feasibility of delivering a personalised Veg4Me programme and compare preliminary effects with a non-personalised Veg4Me (control). METHODS AND ANALYSIS: A 12-week assessor-blinded, two-arm, parallel randomised controlled trial will be undertaken from August 2023 until April 2024. A total of 150 eligible and consenting young adults (18-35 years; eat<5 serves of vegetables/day; have an internet connected mobile device/computer) living in Loddon Campaspe or Colac Otway Shire in Victoria, Australia, will be randomised to receive 12 weeks of personalised (intervention) or non-personalised (control) support to increase vegetable intake via a free web application (app; Veg4Me). The primary outcome is feasibility (recruitment, participation and retention rates). Secondary outcomes are user engagement, usability and experience, as well as vegetable intake, eating habits and digital health equity. Process evaluation will be conducted in a subsample of participants using semistructured interviews. Descriptive statistics will be presented for the personalised and non-personalised groups at baseline and 12 weeks. Generalised linear models will be used to evaluate group differences in outcomes. Interviews will be transcribed and analysed thematically. ETHICS AND DISSEMINATION: All procedures involving human subjects were approved by Deakin University's Human Ethics Advisory Group-Health (HEAG-H 06_2023) on 6 March 2023. Dissemination events will be held in the City of Greater Bendigo and the Colac Otway Shire. Summaries of the results will be disseminated to participants via email. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry, ACTRN12623000179639p, prospectively registered on 21 February 2023, according to the World Health Organizational Trial Registration Data Set. Universal Trial Number U1111-1284-9027.

A scoping review of the impact of Food Policy Groups on local food systems in high-income countries.

This scoping review aimed to explore international evidence on the impact of Food Policy Groups (FPGs) on local food systems, in urban and rural regions of high-income countries. Peer-reviewed and grey literature were searched to identify thirty-one documents published between 2002 and 2022 providing evidence on the impact of FPGs. Activities spanned domains including increasing food equity (e.g. strengthening school meals programmes); increasing knowledge and/or demand for healthy food (e.g. food literacy programmes with children and adults); increasing food access (e.g. enhancing local food procurement); environmental sustainability (e.g. promoting low-waste food items on café menus); economic development (e.g. ensuring local businesses are not outperformed by large food distributors); and increasing food system resiliency (e.g. establishment of local produce schemes). Most FPGs reported conducting activities that positively influenced multiple food system domains and reported activities in urban areas, and to a lesser extent in rural areas. Our study highlighted a range of qualitative and quantitative evaluation strategies used to measure FPGs' impact on local food systems. Our recommendations focus on regular and systematic evaluation and research surrounding the impact of FPG activities, to build the evidence base of their impact. Ideally, evaluation would utilise comprehensive and established tools. We recommend exploring the establishment of FPGs across more regions of high-income countries, particularly rural areas, and forming partnerships between FPGs, local government and universities to maximise implementation and evaluation of activities.

Rural nutrition and dietetics research-Future directions.

AIM: The aim of this study was to summarise key evidence from recent Australian rural nutrition research and provide recommendations for future nutrition and dietetics research with rural communities. CONTEXT: Clear evidence demonstrates that diet plays a role in the health gap between rural and metropolitan Australia. Despite the opportunity to address the health of rural Australians through better nutrition, alarmingly low investment in nutrition and dietetics research has occurred historically, and over the past decade. APPROACH: A review of the evidence was undertaken by rural nutrition and dietetics leaders to provide a commentary piece to inform future rural nutrition research efforts. CONCLUSION: Establishing strong, collaborative place-based nutrition and dietetics research teams are necessary to combat the significant gaps in the scientific knowledge of solutions to improve nutrition in rural Australia. Further, dieticians and nutritionists who live in and understand the rural contexts are yet to be fully harnessed in research, and better engaging with these professionals will have the best chance of successfully addressing the nutrition-related disease disparity between rural and metropolitan Australia.

Problems, policy and politics - perspectives of public health leaders on food insecurity and human rights in Australia.

BACKGROUND: To achieve zero hunger targets set within the United Nations' Agenda 2030, high-income countries such as Australia must reconsider current efforts to improve food security. This study aimed to; explore perspectives from public health nutrition experts on the usefulness of drawing on the international human right to food, and associated mechanisms, to address food insecurity; identify potential roles of key stakeholders in Australia to implement a rights-based approach; and examine barriers and enablers to achieving the right to food in Australia. METHODS: Qualitative in-depth interviews were conducted with key informants (> 10 years professional experience). Braun and Clarke's (2006) six-phase approach to thematic analysis was employed to analyse data, using Kingdon's multiple streams framework (1984) to examine interactive variables which affect policy-making processes. RESULTS: Thirty interviews took place, with most participants representing academia (n = 16), majority had 10-14 years of experience (n = 12) and almost one quarter (n = 7) were in senior leadership roles. Participants believed that framing food insecurity as a human rights issue could be effective when communicating with some audiences, however alternative rhetoric is more popular and potentially more effective. Citizens, government, food industry, non-profit sector, research/tertiary and legal institutions were described as playing critical roles. Barriers to progress were identified as lack of awareness and acknowledgement of the problem, prioritisation of the private sector, lack of political will and domestic laws, and an inefficient/ineffective charitable food sector. Participants identified various enablers and opportunities for implementing a rights-based approach such as grass-roots advocacy efforts to raise awareness of the issue, integrating human rights into government frameworks and community projects and the political will to support action aligned with sustainable development. CONCLUSIONS: Human rights language and mechanisms have the potential to trigger genuine commitment to addressing food insecurity however should be used with caution. Australia's public health workforce requires increased capacity to implement a human-rights approach and framing such efforts to align with sustainable development may achieve greater political action. TRIAL REGISTRATION: Ethics approval was received from the Deakin University Human Research Ethics committee (project ID HEAG 168_2018).

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.

South West Food Community: how government and community initiatives are supporting systemic change towards enhanced food security.

OBJECTIVE: Food security refers to adequate physical, social and economic access to food and is regarded as a complex, 'wicked' issue. This research aimed to understand the perspectives of initiative leaders (stakeholders), regarding their project relating to food security and its possession of characteristics associated with system change to enhance food security. METHODS: Stakeholders (n=51) participated in semi-structured interviews that evaluated initiatives (n=52) against 36 desirable characteristics for system change. Transcripts were analysed using QSR NVivo and Wicked Lab's Tool for Systemic Change. RESULTS: Community-based initiatives often harnessed the passion of local communities to enhance food security through awareness-raising activities and partnerships. Few initiatives created conflict to disrupt the current way of working. The largest 'window of opportunity' included better connection between government and community groups. CONCLUSIONS: This novel contribution provided in-depth understanding of individual initiatives and patterns of working among the food security system in the South West region of Western Australia. Implications for public health: Recommendations to better foster connection between the government and community initiatives include: ensuring government worker responsibilities include task and indicator-related measures; and strengthening understanding of food security among community groups of staff and elected member roles within local government and the ways local government could be supported to harness community knowledge.

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.

Local Challenges and Successes Associated with Transitioning to Sustainable Food System Practices for a West Australian Context: Multi-Sector Stakeholder Perceptions.

Large-scale food system practices have diminished soil and water quality and negatively impacted climate change. Yet, numerous opportunities exist to harness food system practices that will ensure better outcomes for human health and ecosystems. The objective of this study was to consider food Production, Processing, Access and Consumption domains, and for each determine the challenges and successes associated with progressing towards a sustainable food system. A workshop engaging 122 participants including producers, consultants, consumers, educators, funders, scientists, media, government and industry representatives, was conducted in Perth, Western Australia. A thematic analysis of statements (Successes (n = 170) or Challenges (n = 360)) captured, revealed issues of scale, knowledge and education, economics, consumerism, big food, environmental/sustainability, communication, policies and legislation, and technology and innovations. Policy recommendations included greater investment into research in sustainable agriculture (particularly the evidentiary basis for regenerative agriculture), land preservation, and supporting farmers to overcome high infrastructure costs and absorb labour costs. Policy, practice and research recommendations included focusing on an integrated food systems approach with multiple goals, food system actors working collaboratively to reduce challenges and undertaking more research to further the regenerative agriculture evidence.

Prevalence and socio-demographic predictors of food insecurity among regional and remote Western Australian children.

OBJECTIVE: Inequities can negatively impact the health outcomes of children. The aims of this study were to: i) ascertain the prevalence of food insecurity (FI) among regional and remote Western Australian (WA) children; and ii) determine which socio-demographic factors predicted child FI. METHODS: Caregiver-child dyads (n=219) completed cross-sectional surveys. Descriptive statistics and logistic regression analyses were conducted using IBM SPSS version 23. RESULTS: Overall, 20.1% of children were classified as FI. Children whose family received government financial assistance were more likely to be FI (OR 2.60; CI 1.15, 5.91; p=0.022), as were children living in a Medium disadvantage area (OR 2.60; CI 1.18, 5.72; p=0.017), compared to High or Low SEIFA ratings. CONCLUSIONS: Study findings are suggestive of the impact low income has on capacity to be food secure. The higher FI prevalence among children from families receiving financial assistance and living in medium disadvantage areas indicates more support for these families is required. Recommendations include: ensuring government plans and policies adequately support disadvantaged families; increasing employment opportunities; establishing evidence on the causes and the potential impact of FI on children's health. Implications for public health: One in five children were FI, demonstrating that FI is an issue in Western Australia.

What are the determinants of food security among regional and remote Western Australian children?

OBJECTIVE: To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. METHODS: The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi-structured interviews with 20 key informants. RESULTS: Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. CONCLUSIONS: Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills.

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads (n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007), promotion (p = 0.017), location of food outlets (p = 0.027), and price (p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.