How healthy are Australian lunch box snacks with child-directed marketing?

ISSUE ADDRESSED: The diets of Australian children, including their lunch boxes have a disproportionate amount of discretionary foods. Packaged snacks have marketing directed to both children and parents. METHODS: Packaged school lunch box snacks were identified on supermarket websites. Nutrition information and child-directed and parent-directed marketing on the package were analysed. The "healthiness" of products was analysed using the Health Star Rating (HSR) (presently on packaging in Australia), two criteria designed for assessing food suitable for marketing to children (the Australian Health Council and the World Health Organization Western Pacific region) and Chilean criteria (used for broad food regulation). RESULTS: The average HSR of the 135 products was 2.2% and 79% had a HSR <3.5. About 39% of products had child-directed marketing. Child-directed marketing would be removed from 89% sweet snacks, and 91% savoury snacks if products with a HSR <3.5 were not allowed to carry that marketing. This is less than the proportion not allowed using criteria from Chile (100%), World Health Organization Western Pacific Region (99%) and the Australian Health Council (93%). CONCLUSIONS: A policy that disallows marketing tactics on unhealthy food based on any of the criteria studied would remove most of both child-directed and parent-directed marketing on packaged lunch box snacks. SO WHAT?: Removing child-directed marketing from unhealthy products would help parents when shopping and contribute to addressing the high proportion of discretionary foods eaten by children at school. Child-directed marketing on packaging should be a part of comprehensive regulation to protect children from the marketing of unhealthy foods.

Healthy Me, Healthy Planet: Evaluation of a pilot planetary health library program.

ISSUE ADDRESSED: The Healthy Me, Healthy Planet program was an evidence-informed pilot program conducted by a local libraries to promote the health co-benefits of action on climate change. BACKGROUND: An impact evaluation of the Healthy Me, Healthy Planet program was conducted using a mixed methods research design including pre-, during, and post-program surveys and online focus groups. METHODS: The evaluation included 136 participants aged 18+ years who were able to understand and communicate in English or simplified Chinese language. Descriptive analyses of the survey data were integrated with thematic analyses of focus group (N = 2) data to generate key themes. RESULTS: Key impacts included individual and organisational capacity building, personal and social well-being, and pro-environmental knowledge, attitudes, and behaviour. Impacts on program participants included increased confidence, motivation, positive feelings, and personal well-being after taking part in the Healthy Me, Healthy Planet program. Participants reported enhanced social connections, mental well-being, and environmental benefits such as engaging within the community on environmental issues and feeling inspired to make sustainable lifestyle changes. CONCLUSION: Libraries play a key role in promoting the health of people and planet in the community because they are a trusted, safe, and supportive community setting, a curator of credible and reliable evidence-based information on health and planetary topics and a local and free provider for skills and literacy development. SO WHAT: The evaluation of the pilot suggests that participants improved their capacity to practice sustainable living and it is recommended that this program be expanded to other library settings to enhance community connection and support local planetary health initiatives.

The emergence of e-cigarette retail shops in a regulated tobacco control environment.

ISSUE ADDRESSED: E-cigarettes are of growing concern. We aimed to determine the location and characteristics of retail shops selling e-cigarette products in Perth, Western Australia. METHODS: Two phase study: (i) identifying all e-cigarette retailers in the Greater Capital City Statistical Area of Perth; (ii) audit at the point-of-sale to assess products, promotions and shop characteristics (n = 41). RESULTS: Ninety-eight retailers selling e-cigarette products were identified: 43 tobacconists (44%), 21 vape shops (21% - up from one shop in 2017), 14 supermarkets (14%), 12 service stations (12%) and 8 smoke shops (8%). The most common e-cigarette product was non-nicotine e-liquid, available at 38 (93%) stores audited. Most stores sold parts of e-cigarette devices (n = 25, 61%). Front counter displays were the most frequent form of promotion (n = 40, 98%). Vape shops differed from other retailers, having bar-style layouts (n = 15, 71%), lounge areas (n = 7, 33%) and free e-liquid samples (n = 17, 89%). CONCLUSION: The availability of e-cigarette products from retail shops and particularly vape shops is increasing. E-cigarette retailers are using traditional promotional techniques including point-of-sale displays to market their products, while vape shops are extending their appeal through bar style, lounge layouts and free trials. IMPLICATIONS FOR PUBLIC HEALTH: Understanding the e-cigarette retail store environment is essential for identifying emergent trends, potential regulations and future research. SO WHAT?: The e-cigarette retail market in the Perth is growing, shops using traditional and new promotional techniques to market e-cigarette products. Our findings identify a need for public health surveillance, regulations and legislation.

Wellbeing and nature connectedness for emerging adult undergraduates after a short expedition: A small pilot study.

ISSUE ADDRESSED: Emerging adult university undergraduates are a vulnerable population due to various life stressors. Previous studies have reported a range of positive outcomes from outdoor expeditions for this population. This small pilot study aimed to investigate the impacts of an outdoor expedition on wellbeing and connectedness to nature and possible confounding by gender and living environment. METHODS: A sample of 54 Health and Physical Education emerging adult undergraduates in the second year of their four-year degree completed a 3-day/2-night immersion expedition. Pre-post differences and a repeated-measures analysis with confounders examined the expedition's impact on scores from the Warwick-Edinburgh Mental Well-being Scale and Connectedness to Nature Scale. RESULTS: Involvement in a short expedition resulted in improvements to wellbeing and connectedness to nature. Females reported a stronger connectedness to nature than males, while living environments may affect well-being. CONCLUSIONS/SO WHAT?: Incorporating regular contact with nature into the structure of undergraduate programs may improve wellbeing and protect this population's mental and emotional health. In a world adjusting to the effects of a global pandemic, opportunities for teaching in non-traditional classrooms (such as outdoors) may also protect physical health.

Considering ecological determinants of youth mental health in the era of COVID-19 and the Anthropocene: A call to action from young public health professionals.

In 2019, young Australians reported that two of their top concerns were 'climate change and the environment' and 'mental health'. The events of 2020/2021, such as the ongoing climate emergency, the Australian bushfires, and the COVID-19 pandemic, reflect the human-induced environmental issues young people are most worried about and have also exacerbated the mental health issues which they already reported to be at a crisis point back in 2019. Given experiences of mental illness in adolescence are associated with poorer mental health across the lifespan, it is becoming increasingly important to address ecological determinants of youth mental health in the Anthropocene. However, despite the inclusion of ecological determinants of health in seminal health promotion frameworks, health promotion has been described as 'ecologically blind', emphasising social determinants of health at the expense of ecological determinants of health. A socio-ecological model, which equally considers upstream social and ecological factors, should be applied to youth mental health issues. Using the Ottawa Charter for Health Promotion, we demonstrate how the ecological determinants of health may be incorporated into health promotion approaches targeting youth mental health. We also call for the health promotion sector to consider a number of actions to work towards achieving a transition to ecological determinants of health being at the forefront of health promotion activities. This commentary, written by young public health professionals, hopes to build on the momentum garnered by youth activists around the world and bring attention to the importance of ecological determinants of health for youth mental health promotion in the era of COVID-19 and the Anthropocene.

Towards healthier food choices for hospital staff and visitors: impacts of a healthy food and drink policy implemented at scale in Australia.

OBJECTIVE: To determine the impact of a healthy food and drink policy on hospital staff and visitors' food purchasing behaviours, and their awareness and support for the changes introduced. DESIGN: Two repeated cross-sectional surveys, consisting of intercept interviews and observations of food items purchased, were conducted before (March-July 2018) and after (April-June 2019) the target date for implementation of thirteen food and drink practices (31 December 2018). Food purchases were coded as 'Everyday' (healthy) or 'Occasional' (unhealthy). SETTING: Ten randomly selected New South Wales public hospitals, collection sites including hospital entrances and thirteen hospital cafés/cafeterias. PARTICIPANTS: Surveys were completed by 4808 hospital staff and visitors (response rate 85 %). The majority were female (63 %), spoke English at home (85 %) and just over half had completed tertiary education (55 %). RESULTS: Significant increases from before to after the implementation target date were found for policy awareness (23 to 42 %; P < 0·0001) and support (89 to 92 %; P = 0·01). The proportion of 'Everyday' food purchases increased, but not significantly (56 to 59 %; P = 0·22); with significant heterogeneity between outlets (P = 0·0008). Overall, younger, non-tertiary-educated adults, visitors and those that spoke English at home were significantly less likely to purchase 'Everyday' food items. Support was also significantly lower in males. CONCLUSIONS: The findings provide evidence of strong policy support, an increasing awareness of related changes and a trend towards increased 'Everyday' food purchasing. Given the relatively early phase of policy implementation, and the complexity of individual food purchasing decisions, longer-term follow-up of purchasing behaviour is recommended following ongoing implementation efforts.

Impact and acceptance of a state-wide policy to remove sugar-sweetened beverages in hospitals in New South Wales, Australia.

ISSUE ADDRESSED: Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. METHODS: A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. RESULTS: The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P < .001). The majority (79.5%) of the 2394 surveyed supported SSB removal, with nearly half (48.4%) reporting it would improve people's health. A minority (13.4%) did not support SSB removal, more than half (61.4%) of those said individuals should have free choice. More staff than visitors were aware of the change (61.9% vs 31.2%; P < .0001). CONCLUSIONS: Availability of SSBs in NSW hospitals was significantly reduced after implementation of a policy to remove them from sale. There was strong staff and visitor support for the initiative. SO WHAT?: This study provides clear evidence that a policy designed to provide a healthy hospital retail drink environment can be successfully implemented at scale with high levels of support from staff and visitors. SUMMARY: A state-wide policy initiative to remove SSBs from sale in NSW hospital food outlets in 2017 was successfully implemented, with a sample of outlets having nearly 100% compliance. The majority of staff and visitors (80%) supported the removal of SSBs, mostly because they believed it would improve individual and population health.

Is open defaecation in outdoor recreation and camping areas a public health issue in Australia? A literature review.

ISSUE ADDRESSED: In Australia, natural areas used for outdoor recreation activities or camping often have limited or no sanitation infrastructure. Recreationist and campers may use open defaecation practices where toilets are not provided. Contaminated soils and watercourses are associated with gastrointestinal illnesses. This review aims to determine if open defaecation is a public health issue in outdoor recreation and camping areas in Australia. METHOD: A literature review was conducted using the following search engines: CINAHL, Informit Database, Scopus, ProQuest Science & Technology, Medline (Ovid) and EBSCOhost. Inclusion criteria for this review were both experimental and observational research designs for studies describing the public health issues associated with open defaecation practice. RESULTS: Out of 12 147 papers identified, only three studies met the inclusion criteria, showing a lack of research into this area. Included were two studies that addressed human waste management practices in outdoor environments and the breakdown of human waste in alpine regions of Tasmania. The third study measured water contamination at a freshwater beach on K'gari-Fraser Island, Queensland. Visitors to natural areas are potentially at high risk of illness due to exposure to faecal contamination from other visitors using unsafe open defaecation practices in high-use camping areas. CONCLUSION: The limited number of studies addressing open defaecation in the outdoor recreation and camp areas in Australia indicates this review is a starting point to identify critical areas that may be of concern when managing visitors in an outdoor recreation setting. This review recommends investigating barriers and enablers motivating human disposal waste in these settings to help formulate health promotion content; environmental management policies related to sanitation and hygiene should be also underpinned by public health policy; and providing appropriate sanitation options depending on the ecological and visitor numbers to natural areas. SO WHAT-RELEVANCE OF FINDINGS: Outdoor recreation activities offer physical and mental health benefits for communities. The popularity of outdoor recreation activities is on the increase in Australia. With the rise in visitation to natural areas, management of human waste needs to be addressed to reduce the public health risk of illness.

Health promotion and food insecurity: Exploring environmental sustainability principles to guide practice within Australia.

ISSUE ADDRESSED: The Australian health promotion sector has made significant advances in food security over the years through recognition of social and economic factors. The incorporation of ecological determinants within health promotion practice to address food insecurity, however, is uncommon. This paper explores the potential of health promotion to use environmental sustainability principles to guide the development of health promotion food security programs in Australia. METHODS: A mixed-methods approach guided by a pragmatic framework was adopted for this study. A national online survey (n = 61) and semi-structured interviews (n = 16) targeting Australian health promotion practitioners was utilised. Triangulation involved seven stages to develop points of convergence and corroboration of the data. RESULTS: Practitioners were adopting principles of environmental sustainability such as ecological integrity and biodiversity protection to guide food security practice. The use of such principles demonstrates their compatibility within health promotion practice. This study, however, reveals that environmental sustainability principles were a relatively new area of practice for health promotion practitioners. CONCLUSION: The possibilities for integrating health promotion and environmental sustainability principles are promising for addressing multifaceted issues inherent within food security practice. At present, a lack of principles exist for guiding the sector to address food security that is cognisant of both human health and the environment. SO WHAT?: This study indicates a lack of integration between environmental sustainability and health promotion principles to guide food security practice. It would be pertinent for the sector to consider the development of a set of principles that considers both health promotion and environmental sustainability to ensure future food security and planetary health. Capacity building of current practitioners and pre-service graduates around the use of such principles to guide practice could assist the sector in this process.

An investigation of the cost of food in the Geelong region of rural Victoria: Essential data to support planning to improve access to nutritious food.

ISSUE ADDRESSED: Affordability of a healthy diet is a determinant of nutritional intake and therefore health. This project aimed to measure the cost of healthy foods across a geographically defined region and examine factors related to changing food prices to assist in informing health promotion practice. METHODS: The cost of a healthy food basket was measured using the Victorian Healthy Food Basket tool, in all eligible stores, across five rural local government areas in Western Victoria, Australia in 2014, 2015 and 2016. One-way analysis of variance was used to investigate differences in healthy food basket cost across years. Multivariable linear regression models were constructed to adjust for baseline (2014) cost to determine factors associated with cost. RESULTS: Data were collected from 45 stores in 2014 and 2015 and 48 stores in 2016. The average cost of the healthy food basket was $459 in 2014, $437 in 2015 and $443 in 2016. The cost of the healthy food basket was the highest in stores >15 km from the major regional centre and in areas with only one supermarket (non-cluster) (P < 0.05). All food groups except fruit and vegetables decreased in price between 2014 and 2016. CONCLUSION: This project highlights distance from regional centres and competition as possible factors that influence the cost of healthy food. SO WHAT?: This is valuable insight for health promoters in designing both local level interventions aimed at improving access to healthy food and influencing regional food systems.

New frontiers in community initiatives to increase vegetable consumption.

ISSUE ADDRESSED: Public health concerns about insufficient consumption of vegetables across all demographics in Australia have led to 20 years of behaviour change interventions ranging from social marketing to interactive small group programs, with modest results. To maximise health promotion intervention outcomes, practitioners need up-to-date information that helps them navigate the complexity of food systems and eating behaviours. METHODS: This scoping review of Australian and international research, including peer-reviewed and grey literature, provides a picture of health promotion nutrition interventions, as well as other initiatives that may promote increased vegetable consumption. Search terms related to nutrition and vegetable consumption, type of intervention or initiative, for example, campaign; and consumer values and behaviour. A wide range of data sources were used including scholarly papers, market research reports and publicly available websites of community organisations (eg, OOOOBY). A broad food systems typology was developed to provide a framework for the review. RESULTS: The review finds an emerging group of community-driven initiatives within local food systems that appear to have positive impacts on vegetable consumption. These initiatives sit within a multi-faceted approach to health and well-being that is consistent with the tenets of the Ottawa Charter for Health Promotion, including community engagement, social justice and sustainability goals. CONCLUSIONS: More research into the impact of these new frontiers is needed, but our preliminary findings point to the potential for health promotion practitioners to collaborate on local/community food system initiatives that are not motivated primarily by health goals, but have the potential to deliver multiple health and environmental outcomes. SO WHAT?: This review demonstrated community-driven initiatives around local food systems show the most promise in promoting vegetable consumption and addressing the determinants of health. Health promotion efforts to encourage food security and healthy eating could be strengthened through collaborations within these new frontiers.

Home away from home: Health and wellbeing benefits of men's sheds.

ISSUE ADDRESSED: Improving the health of men is a national policy priority. The Men's Shed program is one health promoting initiative that seeks to improve the health and wellbeing of men. This study assessed Men's Shed members' perceptions of the health and wellbeing benefits of Men's Shed activity in a large regional Queensland Men's Shed. METHODS: Data were collected via a self-administered questionnaire from 147 and three group interviews with 17 shedders. Wilcoxon signed-rank test was used to determine differences in shedders perceived health and wellbeing measures retrospectively just before joining the Men's Shed and currently. Thematic analysis was used to analyse qualitative data. RESULTS: There was no change in overall self-assessed health of shedders before and after joining the Men's Shed. Shedders expanded their social networks, and experienced less felt need for social interaction. Shedders' level of satisfaction with feeling part of the community and life as a whole increased. Health and wellbeing benefits of Men's Shed included fellowship, sense of belonging, access to equipment, and learning new and sharing their own skills. CONCLUSIONS: The Men's Shed appeared to provide social health and wellbeing benefits to its members, and an environment for quality social interaction. The Men's Shed is seen as a place for and about members - men. SO WHAT?: Men's Shed may have a unique role in supporting the social health and wellbeing of men beyond that already available from other community groups by providing an environment for the fellowship of men and activities of interest in an unstructured way.

Mobile device use when caring for children 0-5 years: A naturalistic playground study.

ISSUE ADDRESSED: Over the past decade, mobile device use has increased significantly. Adults are now using their mobile device whilst undertaking a range of work and social activities. This naturalistic study aimed to understand parents/carers' use of mobile devices and their associated beliefs about mobile device use whilst caring for children aged five and younger in playgrounds. METHODS: A mixed methods approach was used to collect quantitative and qualitative data from parents/carers. Data were collected by observations (n = 50) and interviews (n = 25) in playgrounds on the North Coast of New South Wales, Australia. RESULTS: Of the 50 observed parents/carers, 76% (n = 38) used their mobile device, with usage time extending to 17.2 minutes of the 20 minute observation period. Text-/type-related mobile device use was most often used (69.6%), followed by voice-related (23.7%) and camera-related mobile device use (6.7%). The 25 interviewed parents/carers beliefs on mobile device use were centred on three themes: diversity of mobile device use, child relationships and mobile device use and the physical environment and mobile device use. CONCLUSION: This study adds to the limited research into parent/carer mobile device use, which has become an integral part of peoples' lifestyle. However, research is required to better understand how parent/carer mobile device use may impact on child supervision and interaction. SO WHAT?: Mobile device use is increasing. We need to better understand its public health impact.

Injury prevention through employment as a priority for wellbeing among Aboriginal people in remote Australia.

ISSUE ADDRESSED: Injuries lead to more hospitalisations and lost years of healthy life for Aboriginal people than any other cause. However, they are often overlooked in discussion of relieving Aboriginal disadvantage. METHODS: Four Aboriginal communities with diverse geography, culture and service arrangements participated in the Interplay Wellbeing project. In each community, Aboriginal researchers conducted focus groups and interviews arranged through Aboriginal organisations to explore wellbeing. A total of 84 participants contributed to 14 focus groups and eight interviews, which were recorded, transcribed and coded. This article reports on injury and possibilities for prevention, unanticipated themes raised in discussions of wellbeing. RESULTS: Interpersonal violence, injury and imprisonment emerged as themes that were linked with employment and wellbeing. Employment in Aboriginal ranger programs provides meaningful activity, which strengthens people's identity and cultural integrity. This can avert interpersonal violence through empowering women and reducing alcohol access and consumption. CONCLUSION: Ranger programs may provide a much-needed opportunity to control escalating rates of injury for Aboriginal people in remote communities. SO WHAT?: The manifold benefits of Aboriginal ranger programs include reducing violence and its injury and criminal justice consequences.

Impactful co-design: Adult decision-makers' perspectives on actualising children's ideas for health-promoting neighbourhoods in Aotearoa New Zealand.

Our study sought to understand adult decision-makers' views on what was important for actualising children's ideas using co-design, towards creating health-promoting local environments. Ten adult decision-makers, experienced in co-design with children aged 5-13 years in Aotearoa New Zealand, participated in individual interviews. We generated three themes (Empowering children within co-design; Being intentional about children's influence; Curating who is involved) using reflexive thematic analysis. Our themes informed a novel framework of 'impactful co-design' accompanied by a practical checklist for adult decision-makers (practitioners, policy-makers, and researchers). Study findings affirm co-designing local neighbourhoods as an inherently social and technical endeavour, advocate for greater consideration of inclusivity and cultural context, and highlight the need for co-design with children to include safety, empowerment, and evaluation. We position impactful co-design as one useful process to enact children's meaningful participation.

Development and implementation of a municipal outdoor play policy for children and youth in Nova Scotia, Canada: a community case study.

Background: Children and youth benefit from outdoor play; however, environments and policies to support outdoor play are often limited. The purpose of this paper is to describe a case study of the development of a municipal outdoor play policy in Nova Scotia, Canada. The outdoor play policy was developed by the Town of Truro with support from the UpLift Partnership, a School-Community-University Partnership in Nova Scotia, Canada. UpLift supports the health and well-being of school-aged children and youth using a Health Promoting Schools approach which identifies the important role of municipal government in creating healthy school communities. The UpLift Partnership and the municipality hosted online workshops for municipal staff, community leaders and partners that included content about the importance of outdoor play, barriers and facilitators to outdoor play, best practices for youth engagement, the policy development process, and how policy actions can support outdoor play. Workshop participants developed policy actions for their community of Truro, Nova Scotia to increase opportunities for outdoor play for children and youth. Following the workshops, a small team from the municipality and UpLift drafted an outdoor play policy and submitted it to Truro town council for approval. The outdoor play policy was adopted in Fall 2021 and has since informed recreation and municipal planning decisions. By presenting a case study of the development of this outdoor play policy, we hope other communities may be inspired to develop and adopt their own outdoor play policies to benefit children and youth in their communities.

Update and validation of the Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS 2.0).

Aim: Understanding knowledge, attitudes and behaviors related to nutrition is crucial in developing effective intervention strategies to promote healthy eating habits. This study revised and updated the Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS) to align with the current Canada's Food Guide and dietary guidance and report on its reliability and validity with a new population. Method: Data from 167 early childhood educators were recruited to test the revised C-BANKS' reliability and validity. Reliability, as measured by internal consistency, was assessed using Cronbach's alpha, while concurrent validity was determined by correlating the C-BANKS 2.0 scores with the CHEERS (Creating Healthy Eating and Active Environments Survey) and Mindful Eating Questionnaire (MEQ). Responsiveness was assessed by comparing a baseline C-BANKS 2.0 score to a post-test score after completing an online healthy eating and physical activity educational intervention. Results: The adapted C-BANKS 2.0 questionnaire demonstrated good internal consistency (Cronbach's alpha >0.70) and construct validity with related measures CHEERS and MEQ (p < 0.05). The C-BANKS 2.0 demonstrated strong responsiveness. Specifically, C-BANKS 2.0 scores increased after the nutrition education intervention (p < 0.001). Additionally, there were no signs of floor or ceiling effects. Conclusion: The adapted C-BANKS 2.0 demonstrated satisfactory internal consistency, construct validity, and responsiveness to measure of nutrition knowledge, attitudes, and behaviors in an early childhood educator population. The revised C-BANKS 2.0 provides insight into the key factors that influence dietary habits thereby informing the design and evaluation of effective nutrition community intervention programs.

Community health workers' perspectives on integrating into school settings to support student health.

Introduction: While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health. Methods: This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes. Results: Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work. Discussion: This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.

Developing Co-Creation Research in Food Retail Environments: A Descriptive Case Study of a Healthy Supermarket Initiative in Regional Victoria, Australia.

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.

The Impact of Health Geography on Public Health Research, Policy, and Practice in Canada.

The link between geography and health means that the places we occupy-where we are born, where we live, where we work, and where we play-have a direct impact on our health, including our experiences of health. A subdiscipline of human geography, health geography studies the relationships between our environments and the impact of factors that operate within those environments on human health. Researchers have focused on the social and physical environments, including spatial location, patterns, causes of disease and related outcomes, and health service delivery. The work of health geographers has adopted various theories and philosophies (i.e., positivism, social interactionism, structuralism) and methods to collect and analyze data (i.e., quantitative, qualitative, spatial analysis) to examine our environments and their relationship to health. The field of public health is an organized effort to promote the health of its population and prevent disease, injury, and premature death. Public health agencies and practitioners develop programs, services, and policies to promote healthy environments to support and enable health. This commentary provides an overview of the recent landscape of health geography and makes a case for how health geography is critically important to the field of public health, including examples from the field to highlight these links in practice.