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.

A critical food system program in South Australia and the effects on consumer knowledge and attitudes.

ISSUE ADDRESSED: This study investigated the effects of food system literacy on knowledge and attitudes of food consumers. METHODS: A 2-week online course critically discussed the food system through three lenses of environmental sustainability, equity and health. Participants were randomly allocated into one Control and two Intervention groups (A & B). Data collection was by online questionnaire pre- and postintervention, addressing self-perceived food system knowledge, attitudes towards food purchasing behaviours, demographic characteristics and course evaluation. Differences in knowledge and attitude scores between Control and Intervention groups were assessed. Subjects were staff and students of Flinders University in South Australia. RESULTS: Forty-seven participants completed the course. The completion rate was 71.2%. Knowledge about the food system improved significantly for both Intervention groups when compared to the Control group (P ≤ 0.001). Although attitudes towards food purchasing behaviours also improved significantly for both Intervention groups (P < 0.001 and P = 0.005 for Interventions A and B respectively), the improvements were not significant when compared to the Control group (P = 0.065 and P = 0.43 for Interventions A and B respectively). The online methodology received positive feedback from participants. CONCLUSION: This 2-week online food system course showed that the pedagogy was appropriate and successful in improving self-perceived knowledge and attitudes towards food consumption. SO WHAT?: It provides encouraging indications of the potential of food system literacy to empower citizens to make healthier as well as, more environmentally and socially sustainable food choices.

Feeding the Australian family: challenges for mothers, nutrition and equity.

Australian women shoulder the bulk of household duties including family food provisioning, despite increasing participation in the workforce. This research aimed to understand employed mothers' daily-lived experience of family food provisioning, in particular, the intersection between family food provisioning, gender inequality and nutritional guidelines as they impact women's time and health. Semi-structured interviews were conducted with 22 employed mothers in South Australia. Participants had at least one child aged less than 13 years. Qualitative data was analysed using a thematic content approach. Time-scarcity was common and associated with stress in relation to family food provisioning; this relationship was particularly apparent among employed mothers who were also studying. Most mothers valued nutrition and strove to provide nutritious meals, although they tended to work from their own nutritional understandings, not the national nutrition guidelines; they saw the nutrition guidelines as unhelpful because of the time demands that were implied. The study invites policy makers, practitioners and researchers to consider time for family food provisioning as a social determinant of family as well as women's health, and structural strategies to address this health inequity for women.

Personal development, wellbeing and empowerment gains for nutrition peer educators: a South Australian perspective.

This study aimed to explore the experience of being a Community Foodies (CF) peer educator with respect to personal benefits, specifically, personal development, wellbeing and empowerment. Qualitative semi-structured telephone interviews conducted with metropolitan and country peer educators of the CF programme. The CF programme in South Australia (SA) delivers nutrition education to disadvantaged communities. Ten adult peer educators from the CF programme: seven from country SA and three from Adelaide. Phenomenon of interest is that peer educators' perceptions of personal growth and development from involvement in the CF programme. The interviews were audiotaped and analysed thematically. The experience of being a nutrition peer educator improved personal skills and knowledge, dietary habits, self-esteem, confidence, sense of belonging and civic engagement. Peer educators felt that the CF programme was run in a straightforward, easy to understand way, with a welcoming environment and abundant support from the coordinators. Apart from benefits to themselves, peer educators appeared to be most proud of their capacity to contribute to the nutritional health of the broader community. Peer education programmes in disadvantaged communities provide policy makers with valuable and cost-effective approaches to improve health, build self-efficacy, strengthen community engagement, and, foster active participation and trust.

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.

The experiences and perceptions of food banks amongst users in high-income countries: An international scoping review.

PURPOSE: Food banks have become the main response to food insecurity in many high-income countries, but it has been argued that they lack the capacity to respond consistently and fully to the food needs of the people who use them. This literature review set out to answer the question 'how do food bank recipients experience food relief services and how does this impact their lives and wellbeing?' RESULTS: A comprehensive search of electronic databases yielded twenty qualitative studies, conducted in developed countries, exploring user perspectives of food banks. From the studies reviewed, there emerged three main categories that represented the different aspects of the food bank process from the food bank user's perspective: the user's perceptions about the idea of being fed from food banks, the user's perceptions about food bank offerings and operations, and the socio-psychological impact of receiving food from food banks. While participants of these studies spoke positively of the volunteers and were thankful for the service, they also consistently report limited food choice, poor quality, shame, stigma and embarrassment associated with food bank use. CONCLUSIONS: The food bank industry continues to expand despite there being little evidence that food banks are an appropriate response for those facing food insecurity. This is worrying as the results of this review indicate that although participants value the service provided by the food bank, the experience can be largely negative. These findings raise questions about the food bank model as a long-term strategy.

Public attitudes to government intervention to regulate food advertising, especially to children.

The World Health Organization has called on governments to implement recommendations on the marketing of foods and beverages to children. This study describes high public support for government intervention in marketing of unhealthy food to children and suggests more effort is needed to harness public opinion to influence policy development.

Are low-to-middle-income households experiencing food insecurity in Victoria, Australia? An examination of the Victorian Population Health Survey, 2006-2009.

Food insecurity affects health and wellbeing. Little is known about the relationship between food insecurity across income levels. This study aims to investigate the prevalence and frequency of food insecurity in low-to-middle-income Victorian households over time and identify factors associated with food insecurity in these households. Prevalence and frequency of food insecurity was analysed across household income levels using data from the cross-sectional 2006-09 Victorian Population Health Surveys (VPHS). Respondents were categorised as food insecure, if in the last 12 months they had run out of food and were unable to afford to buy more. Multivariable logistic regression was used to describe factors associated with food insecurity in low-to-middle-income households (A$40000-$80000 in 2008). Between 4.9 and 5.5% for total survey populations and 3.9-4.8% in low-to-middle-income respondents were food insecure. Food insecurity was associated with limited help from friends, home ownership status, inability to raise money in an emergency and cost of some foods. Food insecurity exists in households beyond those on a very low income. Understanding the extent and implications of household food insecurity across all income groups in Australia will inform effective and appropriate public health responses.

A snapshot of the scope of obesity prevention practice in Australia.

Community-based initiatives (CBIs) that build capacity and promote healthy environments hold promise for preventing obesity and non-communicable disease, however their characteristics remain poorly understood and lessons are learned in isolation. This limits understanding of likely effectiveness of CBIs; the potential for actively supporting practice; and the translation of community-based knowledge into policy. Building on an initial survey (2010), an online survey was launched (2013) with the aim to describe the reach and characteristics of Australian CBIs and identify and evaluate elements known to contribute to best practice, effectiveness and sustainability. Responses from 104 CBIs were received in 2013. Geographic location generally reflected population density in Australia. Duration of CBIs was short-term (median 3 years; range 0.2-21.0 years), delivered mostly by health departments and local governments. Median annual funding had more than doubled since the 2010 survey, but average staffing had not increased. CBIs used at least two strategy types, with a preference for individual behaviour change strategies. Targeting children was less common (31%) compared with the 2010 survey (57%). Logic models and theory were used in planning, but there was low use of research evidence and existing prevention frameworks. Nearly, all CBIs had an evaluation component (12% of budget), but dissemination was limited. This survey provides information on the scope and varied quality of the current obesity prevention investment in Australia. To boost the quality and effectiveness of CBIs, further support systems may be required to ensure that organizations adopt upstream, evidence-informed approaches; and integrate CBIs into systems, policies and environments.

Quantitative analysis of bariatric procedure trends 2001-13 in South Australia: implications for equity in access and public healthcare expenditure.

OBJECTIVES: The aims of the present study were to: (1) identify trends in bariatric surgery in South Australia (SA) from 2001 to 2013; and (2) compare public and private hospitals, and so discuss the implications of these trends as they relate to equity in access to bariatric procedures and public system healthcare expenditure. METHODS: An analysis of retrospective data of all bariatric procedures in public and private hospitals in SA was conducted using all SA public and private hospital administrative records between 2001 and 2013. RESULTS: Of all procedures conducted in SA, 22.6% were revisions or reversals. The number of revisions or reversals conducted in SA has increased at a rate higher than weight loss procedures (6.4- vs 3.8-fold increase). An increasing proportion of public surgeries are revisions or reversals of weight loss procedures that occurred outside of the SA public system (interstate or in the private system). CONCLUSION: Further investigation is necessary to identify the pathways patients navigate to access bariatric surgery, the utilisation of public services following private procedures and why rates of revisions or reversals of bariatric procedures are increasing in SA.

Socio-ecological factors that influence youth vaping: perspectives from Western Australian school professionals, parents and young people.

PURPOSE: To understand from the perspectives of school professionals, parents and young people the socio-ecological factors that may facilitate and prevent e-cigarette use among young people in Perth, Western Australia. METHODS: Purposive sampling was used to recruit school professionals, parents and young people for one-on-one (n = 35) or joint (n = 3) interviews (in-person n = 11 or online n = 27). Data were analysed using thematic analysis and classified into four domains based on the socio-ecological model: i) individual, ii) interpersonal, iii) organizational/community and iv) societal/policy. RESULTS: Factors that were found to support vaping among young people included sensation-seeking and risk-taking behaviour; a low-risk perception of vapes; attractive characteristics of vapes; ease of access; perception vaping is a social activity; and lack of knowledge about vaping among parents and school professionals. Vaping prevention messages originating from the familial, educational and community spheres are lacking but wanted by adults and young people. CONCLUSIONS: The pervasiveness of the e-cigarette trade and persistent challenges related to surveillance and enforcement need to be addressed to reduce exposure and access to e-cigarettes. A mixture of "hard" and "soft" public policy tools involving key stakeholders in a range of settings is needed to prevent e-cigarette access and uptake by young people.

Shifting the social determinants of food insecurity during the COVID-19 pandemic: the Australian experience.

We aimed to explore experiences of government-led actions on the social determinants of food insecurity during Australia's COVID-19 pandemic response (which included novel, yet temporary, social protection measures to support Australians facing hardship during state-wide lockdowns). During November-December 2020, we conducted in-depth interviews with 24 Victorians who received government income support (prior to COVID-19) and the temporary COVID-19 specific payments. Interviews were guided by a theoretical understanding of the social determinants of health and health inequities, which we aligned to the social policy context. Data were audio-recorded, transcribed, inductively coded, categorised and thematically analysed. Our sample included mostly women (n = 19) and single parents (n = 13). Interviews reflected four key themes. Firstly, participants described 'battles all around them' (i.e., competing financial, health and social stressors) that were not alleviated by temporary social policy changes and made healthy eating difficult to prioritise during the pandemic. Secondly, housing, income, job, and education priorities rendered food a lower and more flexible financial priority - even with 18 participants receiving temporary income increases from COVID-19 Supplements. Thirdly, given that food remained a lower and more flexible financial priority, families continued to purchase the cheapest and most affordable options (typically less healthful, more markedly price discounted). Finally, participants perceived the dominant public and policy rhetoric around income support policies and healthy eating to be inaccurate and shaming - often misrepresenting their lived experiences, both prior to and during COVID-19. Participants reported entrenched struggles with being able to afford basic living costs in a dignified manner during COVID-19, despite temporary social protection policy changes. To reduce inequities in population diets, a pre-requisite to health, all stakeholders must recognise an ongoing responsibility for adopting long-term food and social policies that genuinely improve lived experiences of food insecurity and poverty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-022-01318-4.

Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities.

This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020.

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

A Food Relief Charter for South Australia-Towards a Shared Vision for Pathways Out of Food Insecurity.

Chronic food insecurity persists in high-income countries, leading to an entrenched need for food relief. In Australia, food relief services primarily focus on providing food to meet immediate need. To date, there has been few examples of a vision in the sector towards client outcomes and pathways out of food insecurity. In 2016, the South Australian Government commissioned research and community sector engagement to identify potential policy actions to address food insecurity. This article describes the process of developing a co-designed South Australian Food Relief Charter, through policy-research-practice collaboration, and reflects on the role of the Charter as both a policy tool and a declaration of a shared vision. Methods used to develop the Charter, and resulting guiding principles, are discussed. This article reflects on the intentions of the Charter and suggests how its guiding principles may be used to guide collective actions for system improvement. Whilst a Charter alone may be insufficient to create an integrated food relief system that goes beyond the provision of food, it is a useful first step in enabling a culture where the sector can have a unified voice to advocate for the prevention of food insecurity.

Food Charity, Shame/ing and the Enactment of Worth.

Food insecurity is a significant problem in many countries, including Australia. Consequently, food hubs, through which food is distributed using a supermarket style layout, have become an important new source of charity food provision. However, little is known about users' experiences. We draw on ethnographic research to understand the everyday experiences of people using South Australian food hubs. We suggest that attempts to produce a more dignified experience by creating a normalizing experience of shopping is not being achieved, because of the shame and stigma surrounding poverty, confusing operational processes, poor food quality, staff attitudes, and the disciplinary capacity of food hubs.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children's own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children's firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children's perspectives. Eleven participants aged 10-13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of 'food' preparation. This study provides a child-centric analysis, demonstrating how children's agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

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.

Correction: Pollard, C.M.; Booth, S. Food Insecurity and Hunger in Rich Countries-It Is Time for Action against Inequality. Int. J. Environ. Res. Public Health 2019, 16, 1804.

The authors wish to make the following correction to their paper published in the International Journal of Environmental Research and Public Health [...].