Association of the LiveLighter mass media campaign with consumption of sugar-sweetened beverages: Cohort study.

ISSUE ADDRESSED: Evaluation of the behavioural impact of Western Australia's LiveLighter healthy weight and lifestyle campaign focussed on decreasing consumption of sugar-sweetened beverages (SSBs) using graphic imagery, as well as monitoring unintended consequences. METHODS: A cohort design with pre-campaign telephone survey of Western Australian adults aged 25-49 (Time 1 May/Jun 2013: N = 1504) undertaken and repeated following the campaign (Time 2 Aug/Sep 2013: N = 822). RESULTS: Post-campaign awareness was 67% with respondents in low socio-economic areas most likely to report viewing the campaign frequently. There was evidence of reduced SSB intake from baseline to follow-up among frequent (4+/week) SSB consumers (22% cf. 16%; P = 0.003) and some evidence among overweight (BMI 25+) weekly SSB consumers (56% cf. 48%; P = 0.013). There was also some evidence consumption of sweet food decreased (3+/week: 53% cf. 48%; P = 0.035) while fruit, vegetable and fast food consumption remained stable. Knowledge of potential health consequences of SSBs increased (70% cf. 82%; P < 0.001) with no change in knowledge of potential health consequences of overweight generally (86% cf. 89%). Importantly, there was no increase in endorsement of overweight stereotypes. CONCLUSIONS: The LiveLighter "Sugary Drinks" campaign positively impacted adults' knowledge and behaviour with regard to SSB consumption in a pattern specific to the campaign messaging and without adverse impact on weight-related stereotypes. SO WHAT?: Findings support the use of mass media for healthy lifestyle change. They suggest the public are receptive to undertaking the campaign's simple concrete lifestyle recommendation and provide an indication of the campaign dose required to achieve positive behaviour change.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults.

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

A process and outcome evaluation of an in-class vegetable promotion program.

OBJECTIVE: Nutrition interventions that target both fruits and vegetables are effective in increasing fruit consumption, but have been limited in their ability to improve vegetable intake. To address the low proportion of children meeting vegetable intake guidelines, approaches specifically targeting vegetables are needed. This paper reports on a mixed-method analysis of a 10-week vegetable promotion pilot project that aimed to increase vegetable intake as part of the existing Crunch&Sip in-class fruit and vegetable break program. DESIGN: The intervention was designed to promote vegetable consumption through the implementation of vegetable-focused resources, including curriculum resources and parent education materials. Teachers completed pre- and end-of-intervention surveys. Process measures related to the use of resources and teachers' perceptions of barriers to implementation. The outcome evaluation included measures of children's vegetable consumption during Crunch&Sip breaks and teachers' attitudes and confidence relating to educating students about the benefits of consuming vegetables. SUBJECTS: Twenty-one Western Australian primary schools already participating in the Crunch&Sip program participated in the pilot intervention and evaluation. Coverage included 35 primary school teachers representing 818 students aged 4-11 years. RESULTS: The proportion of children bringing vegetables for Crunch&Sip more than doubled over the 10-week intervention (21% vs 46%; p < 0.001). Improvements were observed in teachers' perceived knowledge about the nutritional benefits of vegetables (p = 0.001) and confidence to educate students about the benefits of vegetable consumption (p = 0.028). CONCLUSIONS: Preferentially promoting vegetable consumption as part of an existing school-based nutrition program may be an effective strategy to increase children's vegetable intake.

Factors associated with high consumption of soft drinks among Australian secondary-school students.

OBJECTIVE: To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility. DESIGN: Cross-sectional self-completion survey and height and weight measurements. SETTING: Australian secondary schools. SUBJECTS: Students aged 12-17 years participating in the 2012-13 National Secondary Students' Diet and Activity (NaSSDA) survey (n 7835). RESULTS: Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week ('high soft drink consumers'). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine. CONCLUSIONS: High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents' soft drink intake.

Whetting disadvantaged adults' appetite for nutrition education.

OBJECTIVE: To identify the features of a nutrition education programme for disadvantaged adults deemed most attractive and useful by participants. DESIGN: A two-year, multi-method, qualitative evaluation of pre and post data collected from programme participants. Data were imported into NVivo10 for coding to facilitate a thematic analysis. SETTING: Western Australia. Participants Individuals attending the Western Australian FOODcents nutrition education programme that is designed to provide knowledge and skills needed to consume a healthy diet on a budget. Focus groups were conducted several weeks after course completion (five groups, forty-seven participants), observations were conducted during FOODcents sessions (thirty-one observation episodes, 237 participants), and open-ended questions were asked in pre-post hard-copy surveys administered in sessions (n 927) and an online survey administered on average six weeks after course completion (n 114). RESULTS: The course attributes that were found to be especially important to participants were: (i) user-friendly, practical information that could be immediately translated to their daily lives; (ii) experiential learning that involved direct contact with food products; and (iii) opportunities for social interaction. These aspects of nutrition education were described as being highly influential in the decision to participate in the course, the application of the information in their subsequent food purchase and preparation activities, and their word-of-mouth communications with others about the course. CONCLUSIONS: Incorporating aspects of most importance to participants into nutrition education programme delivery and promotion may increase joining rates, enjoyment, satisfaction with course content and, ultimately, the uptake of recommended behaviours.

What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

OBJECTIVE: To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption. DESIGN: Cross-sectional survey of students' eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire. SETTING: Australian secondary schools across all states/territories. SUBJECTS: Secondary-school students aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey (n 12 188). RESULTS: Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week ('frequent snackers'). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m² were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers. CONCLUSIONS: Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Online advertising by three commercial breast imaging services: message takeout and effectiveness.

Mammography is widely acknowledged to be the most cost-effective technique for population screening for breast cancer. Recently in Australia, imaging modalities other than mammography, including thermography, electrical impedance, and computerised breast imaging, have been increasingly promoted as alternative methods of breast cancer screening. This study assessed the impact of three commercial breast imaging companies' promotional material upon consumers' beliefs about the effectiveness of the companies' technology in detecting breast cancer, and consumers' intentions to seek more information or consider having their breasts imaged by these modalities. Results showed 90% of respondents agreed that the companies' promotional material promoted the message that the advertised breast imaging method was effective in detecting breast cancer, and 80% agreed that the material promoted the message that the imaging method was equally or more effective than a mammogram. These findings have implications for women's preference for and uptake of alternative breast imaging services over mammography.

Prevalence and socio-demographic distribution of eating, physical activity and sedentary behaviours among Australian adolescents.

ISSUE ADDRESSED: To examine the prevalence and socio-demographic distribution of adherence to national dietary and physical activity recommendations among Australian secondary school students. METHODS: Cross-sectional survey of 12,188 students in Years 8 to 11 (aged 12-17 years). Students' self-reported eating, physical activity and sedentary behaviours were assessed using validated instruments administered via an online questionnaire. RESULTS: Less than one-quarter of students (24%) reported meeting the daily requirement of at least four serves of vegetables, while 41% reported consuming the recommended three or more daily serves of fruit. Just 15% of students reported engaging in at least 60 minutes of moderate-to-vigorous activity every day, and only one in five students met the recommendation of spending no more than two hours per day in small screen recreation. Males were performing better than females in terms of fruit intake and physical activity, but worse in relation to frequency of consumption of sugary drinks and fast food, and time spent using electronic media. The proportion of students meeting fruit and vegetable recommendations declined with advancing year level, while lower socio-economic position (SEP) students were faring less well than those from high SEP neighbourhoods, particularly with regards to healthy eating. CONCLUSIONS: There is considerable scope for improving young people's health behaviours in line with national dietary and physical activity recommendations.

'We're not told why--we're just told': qualitative reflections about the Western Australian Go for 2&5® fruit and vegetable campaign.

OBJECTIVE: To explore why there is a lack of acceptance among Western Australian (WA) adults of the Go for 2&5® fruit and vegetable social marketing message to consume at least five servings of vegetables per day. DESIGN: A series of focus group discussions comprised of homogeneous groups varied by sex and age, until saturation of themes was achieved, followed by thematic analysis. SETTING: Part of qualitative research for the Go for 2&5® fruit and vegetable social marketing campaign in WA (2009 population: 2.2 million). SUBJECTS: WA adults stratified by sex and age groups (18-29 and 30-55 years) drawn from the second and third quartiles of socio-economic disadvantage. RESULTS: Familiarity with the Go for 2&5® message was excellent. Understanding of what constitutes 'two servings of fruit' was excellent and regarded by participants as highly achievable. Understanding of what constitutes 'five servings of vegetables' was suboptimal with widespread overestimation contributing to the belief that it is unrealistic. Participants did not know how the 2&5 recommendation was formulated and believed that daily consumption of two servings of fruit and five of vegetables would confer no greater health benefit than one of fruit and three of vegetables. Participants assumed that the 2&5 recommendation was 'aspirational' in the sense that it was purposely exaggerated to simply encourage greater overall consumption. CONCLUSIONS: A convincing case needs to be presented to WA adults as to why they should consume five servings of vegetables per day. Continuing efforts to educate incorporating what constitutes a serving will assist perceptions that the recommendation is realistic.