Do video or telephone consultations impact attendance rates in an addiction medicine specialist outpatient clinic?

BACKGROUND: Effective alcohol and other drugs (AODs) treatment has been proven to increase productivity and reduce costs to the community. Telehealth has previously been proven effective at delivering AOD treatment in the right settings. Yet, Australia's current Medicare funding restricts telephone consultations. AIM: We hypothesise that treatment modality influences attendance rates. Specifically, telephone consultations can remove barriers to accessing treatment and, therefore, can increase attendance. METHODS: We conducted a retrospective audit on our addiction medicine specialist outpatient service from 1 July 2022 to 30 June 2023. A mixed-effects logistic regression model was used to analyse factors associated with attendance rates. RESULTS: There were 576 participants in the study, and 3354 appointments were booked over the 12-month study period. Of these, 2695 were face-to-face, 541 were telephone and 118 were video. The unadjusted raw attendance rate was highest in the telephone group (87.24%), followed by face-to-face (73.02%) and video (44.92%). After adjusting for covariates, telephone consultation was associated with significantly increased odds of attending compared to face-to-face (odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.90-3.54, P < 0.001). Video consultation was associated with a 69% reduction in the odds of attending compared to face-to-face (OR = 0.31, 95% CI = 0.019-0.49, P < 0.001). CONCLUSIONS: While physical attendance may be required for specific clinical care, telephone consultations are associated with increased attendance and can form an important adjunct to delivering addiction treatment. Given the substantial costs of substance use disorders, this could inform government policies and funding priorities to further improve access and treatment outcomes.

The role of adolescent social inclusion in educational attainment among vulnerable youth.

BACKGROUND: Completing high school enables access to educational and employment opportunities associated with better physical and mental health and improved quality of life. Identifying modifiable factors that promote optimal educational trajectories for youth experiencing disadvantage is an important research focus. Social inclusion has been theorised to play a role in promoting better educational outcomes for this priority population, however limited research has examined this relationship. METHOD: This study used three waves of data from the state-representative Australian arm of the International Youth Development Study (IYDS) (youngest cohort, N = 733; 54% female, 95% Australian born) to examine the extent to which vulnerability in primary school (Grade 5; Mage = 10.97, SD = 0.38) and social inclusion in mid-adolescence (Year 10; Mage = 15.50, SD = 0.53), were associated with school completion in young adulthood (post-secondary; Mage = 19.02, SD = 0.43). RESULTS: Regression models identified an interaction between social inclusion and vulnerability (OR = 1.37, 95% CI [1.06, 1.77], p = .016), indicating that the association between vulnerability and school completion varied as a student's level of social inclusion increased. Higher social inclusion was beneficial for youth with lower levels of vulnerability but did not appear to influence school completion for the most vulnerable students. CONCLUSIONS: For many young people, promoting social inclusion may support engagement in education and play a protective role. However, further research is needed to better understand the role of social inclusion for highly vulnerable youth, particularly the mechanisms via which social inclusion may have differential effects on school completion.

Depressive symptoms and social support among Australian men: A 7-year longitudinal study.

BACKGROUND: Mental health disorders are ranked globally as the single largest contributor to non-fatal ill-health. Social support can be a means of reducing and managing depression. However, depression can also impact on a person's level of social support. OBJECTIVE: As men typically have fewer sources of social support than females, this study investigated the bi-directional associations between depressive symptoms and perceived levels of social support among Australian males, aged 18-63. METHODS: Three waves of panel data from Ten to Men: The Australian Longitudinal Study on Male Health collected over 7 years (2013-2020) were used. A random intercept cross-lagged panel analysis with 5112 participants was undertaken. Mediating effects and indirect and total effects for lagged and cross-lagged pathways were also examined. RESULTS: Over time, greater social support was found to be associated with lower depression levels, and simultaneously greater levels of depression was found to be associated with lower levels of social support. Standardised cross-lagged effects between waves were mostly similar (ß = 0.10). However, mediation analyses identified that only the total effect size of the association for depression at wave 1 predicting social support at wave 3 (ß = -0.29) was significant. Mediated effects of social support at wave 1 predicting depression at wave 3 were not significant. LIMITATIONS: These include the number of years between each wave, and data were collected during the COVID pandemic. CONCLUSION: The study provides robust longitudinal evidence supporting the notion that social support and depression are both a cause and consequence of the other. However, the long-term effects of depression reducing social support were longer lasting than the effects of social support reducing depression.

Modeling Adolescent Social Inclusion to Improve School Completion.

Enhancing social inclusion in young people could increase engagement in education, yet few longitudinal studies have examined this relationship. This study aimed to identify whether social inclusion in an Australian adolescent sample predicted high school completion three years later. Using state-representative data from the International Youth Development Study, two waves of the youngest cohort (51.6% female and 94.6% Australian born) during mid-adolescence (n = 825, Mage = 15.99, SD = 0.39) and post-secondary school (n = 809, Mage = 19.03, SD = 0.44) were analyzed. Factor analysis identified a 4-factor structure that represented an overarching social inclusion construct: (1) Citizenship, (2) Connectedness to Community, (3) Connectedness to Family, and (4) Connectedness to and Participation in School. Multivariate regression analyses indicated higher social inclusion levels in mid-adolescence predicted an increased likelihood of high school completion three years later. The implementation of strategies that incorporate the enhancement of social inclusion may improve educational outcomes for young people.

Sexting Among Australian Adolescents: Risk and Protective Factors.

Although consensual sending of sexts between adolescents is considered developmentally appropriate, it may also entail a range of negative consequences. Current sexting research lacks a comprehensive theoretical framework identifying a range of risk and protective factors underpinning adolescent consensual sending of sexts across individual, interpersonal, and distal levels. Further, there is a lack of systematic evaluation of how the importance of these factors may vary across adolescent age. This study investigated the utility of the Social Development Model to predict a range of risk and protective factors across individual, family, peer, school, and community-level factors. The sample included 1302 teenagers from Victoria, Australia (Mage = 14.54, SD = 1.14, 50.8% girls). Results indicated that 146 (11.7%) participants sent a sext (76 boys and 70 girls). Logistic regression analyses revealed that the Social Development Model accounted for 45.8% of variance in sexting, with greater likelihood of sending sexts being associated with older age, prior sexual activity, school sector, physical activity, lifetime substance use, greater depressive symptoms, sensation seeking, and perceived substance availability in the community. Multigroup analyses revealed that lifetime substance use was associated with a greater likelihood of sending sexts among younger teens. Among older adolescents, adaptive coping was associated with reduced engagement in sexting, while higher parental overcontrol and family conflict increased the odds of sending sexts. Overall, sexting is associated with a range of modifiable factors potentially amenable to intervention.

School Influences on Adolescent Depression: A 6-Year Longitudinal Study Amongst Catholic, Government and Independent Schools, in Victoria, Australia.

This study examined associations between school sector (Government, Catholic or Independent) and depressive symptomology over the secondary school years. Six waves of data collected annually from a representative Australian sample were examined. Multilevel piecewise linear and logistic regression controlling for a variety of demographic variables and protective factors was undertaken. In all sectors, depressive symptomology decreased between 10 and 13 years of age, but significantly increased for girls at age 13. Adolescents in Catholic schools reported significantly fewer symptoms of depression compared to those in Government and Independent schools. Adolescents in Catholic schools were less likely to report clinical levels of depressed mood compared to adolescents in Government schools.

Adolescent Antecedents of Young Adult Homelessness: a Cross-national Path Analysis.

Adolescent and young adult health, development, and behavior lay a foundation for future population health. Increasing rates of young adult homelessness mean there is a need for research which generates evidence to support a stronger focus on population-level prevention. Using longitudinal data from a population-based sample of young adults participating in the cross-nationally matched International Youth Development Study, we examined adolescent antecedents of young adult homelessness in Washington State in the USA and in Victoria, Australia. Participants were surveyed using a modified version of the Communities That Care youth survey. Analyses of prospective, longitudinal data from 1945 participants, recruited as state-representative secondary school samples at grade 7 (average age 13, 2002) and longitudinally compared at young adulthood (average age 25, 2014), showed that young adults in Washington State reported higher rates of past year homelessness (5.24%) compared to those in Victoria (3.25%). Path modeling showed less positive family management strategies at age 13 uniquely increased risk for age 25 homelessness. This effect remained after accounting for age 15 antecedents in peer-group, school, and community environments. Friends' drug use, school suspension, academic failure, and low neighborhood attachment at age 15 mediated the association between less positive family management strategies at age 13 and age 25 homelessness. Despite observing some cross-national differences in levels of family, peer-group, school, and community antecedents, we found that these factors equally increased risk for age 25 homelessness in both states, suggesting similar cross-national influences for young adult homelessness. The findings indicate cross-nationally common adolescent antecedents for young adult homelessness that could be targeted by prevention strategies across international settings.

A Component Evaluation of a Randomised Control Community Intervention to Reduce Adolescent Alcohol Use in Australia.

Despite a decline in Australian adolescents reporting to have consumed alcohol, a high proportion of the adolescent population still consumes alcohol. Community-led prevention interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-behaviour change related to youth alcohol and drug use. This study evaluated the post-intervention effects of a multi-component community intervention in Australia. It comprised social marketing targeting adolescents and parents, and a community intervention to reduce underage alcohol sales. Structural equation modelling was used to examine direct and indirect effects of community intervention components on intention and consumption. Self-report surveys (N = 3377) and community sales data (27 communities) were analysed to evaluate the effect of the intervention components on intention and consumption before the age of 18. The intervention reduced alcohol sales to minors (OR = .82). Exposure to the social marketing was significantly associated with household no-alcohol rules (OR = 2.24) and parents not supplying alcohol (OR = .72). The intervention predicted intention not to consume alcohol before age 18; intention was associated with not consuming alcohol (OR = 5.70). Total indirect effects from the intervention through to intention were significant. However, parents setting a rule and not supplying alcohol were the only significant direct effects to intention. Parents setting a rule was directly associated with lower consumption. Overall, the intervention logic was supported by the data modelling. The study extends prior knowledge of community-based interventions to prevent adolescent alcohol use by identifying critical intervention components and effect mechanisms. ClinicalTrials.gov Identifier: ACTRN12612000384853.

Evaluation of Communities That Care-Effects on Municipal Youth Crime Rates in Victoria, Australia: 2010-2019.

Internationally, youth crime is a significant social problem. Violent youth crime has been rising over the past decade in the state of Victoria, Australia. Communities That Care (CTC) is a coalition training process designed to prevent youth crime. There has been limited evaluation outside the USA. Using a non-experimental design, this study employed official state crime statistics to evaluate the impact on crime as the five-phase CTC process was implemented between 2010 and 2019 across communities in Victoria. The standard five-phase CTC implementation cycle was supplemented with universal programs to reduce sales and supply of alcohol to underage youth (under 18 years). Growth models evaluated community trends in youth crime (all, person, property and deception and other), comparing communities that implemented CTC at phase 4 or greater with communities that had not implemented CTC. In accord with the hypotheses, the study found significant reductions in crimes associated with CTC over the period between 2010 and 2019. A 2% annual reduction in risk was observed for crimes against persons for all age groups (IRR = 0.98, 95% CI [0.96, 0.998]). A 5% annual reduction was observed for crimes of property and deception for adolescents aged between 10 and 17 years (IRR = 0.95, 95% CI [0.90, 0.99]). These findings support CTC as an intervention for preventing youth crime at a population level. Future studies should evaluate intervention mechanisms and economic benefits.

Returning to the nest: Emerging adults living with parents during the COVID-19 pandemic.

Changes in the working, study and social lives of emerging adults due to the COVID-19 pandemic have led to greater need for external supports. Many who lived independently may have sought that support by returning to live with parents. This study identifies factors associated with returns made between 2019 and 2020. It describes supports needed and obtained, relationships between parents and their resident emerging adults and identifies correlates of poor coping and high psychological distress. Data from the Longitudinal Surveys of Australian Youth and the Longitudinal Study of Australian Children were used and showed half of the emerging adults who moved did so due to COVID-19 restrictions. Loss of work and increased need for emotional and financial support were key drivers of moves. Nineteen per cent who returned found spending more time with family difficult and over half did not have their support needs fully met, increasing their odds of poor coping at that time (OR = 2.9, 4.3, respectively) and subsequent psychological distress (OR = 6.0). Families were an important source of support but could not necessarily mitigate all challenges; for some emerging adults, returning to live with parents gave rise to additional difficulties which negatively affected mental health.

A Cross-National Comparison of the Development of Adolescent Problem Behavior: a 1-Year Longitudinal Study in India, the Netherlands, the USA, and Australia.

The world youth population is the largest ever and the levels of problem behavior will influence future global health. Recognition of these issues raises questions as to whether adolescent development knowledge can be internationally applied. To date, most research examining adolescent problem behavior has been completed in the United States (USA) and there has been neglected analysis of health inequalities. The aim of the present study was to compare the structure and predictors of problem behavior in representative samples from the USA, Australia, India, and the Netherlands. Two timepoints of longitudinal data were analyzed from the International Youth Development Study that originally recruited state-representative student cohorts in 2002 in Washington State, USA (analytic sample N = 1942) and Victoria, Australia (N = 1957). Similar aged samples were recruited in Mumbai, India, in 2010 (N = 3.923) and the Netherlands in 2008 (N = 682). Surveys were matched and follow-up occurred over 1-year (average baseline ages 12 to 13). CFA identified a latent problem behavior construct comprised of substance use and antisocial behavior indicators. There were cross-national differences in the indicators for this construct. Factor loadings and items were similar between Australia and the USA; however, different items loaded on the construct for the Indian and Netherlands sample. SEM identified that problem behavior at time 2 was predicted by time 1 behavior, with cross-national differences evident. Low parent education was predictive in the USA and India. The number of risk factors present was predictive of problem behavior in all four nations. The findings suggest that evaluated preventative strategies to reduce adolescent problem behavior may have international applications. The analysis of cross-nationally matched longitudinal data appears feasible for identifying prevalence and predictor differences that may signify policy and cultural contexts, to be considered in adapting prevention programs.

Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001-2017.

BACKGROUND: Injuries are one of the three leading causes of morbidity and mortality for young people internationally. Although community risk factors are modifiable causes of youth injury, there has been limited evaluation of community interventions. Communities That Care (CTC) offers a coalition training process to increase evidence-based practices that reduce youth injury risk factors. METHOD: Using a non-experimental design, this study made use of population-based hospital admissions data to evaluate the impact on injuries for 15 communities that implemented CTC between 2001 and 2017 in Victoria, Australia. Negative binomial regression models evaluated trends in injury admissions (all, unintentional and transport), comparing CTC and non-CTC communities across different age groups. RESULTS: Statistically significant relative reductions in all hospital injury admissions in 0-4 year olds were associated with communities completing the CTC process and in 0-19 year olds when communities began their second cycle of CTC. When analysed by subgroup, a similar pattern was observed with unintentional injuries but not with transport injuries. CONCLUSION: The findings support CTC coalition training as an intervention strategy for preventing youth hospital injury admissions. However, future studies should consider stronger research designs, confirm findings in different community contexts, use other data sources and evaluate intervention mechanisms.

Delinquency, School Context, and Risk Factors in India, Australia, and the United States: Implications for Prevention.

There is a dearth of research on delinquency, school context, and risk factors across developed and developing nations. Using representative samples and matched surveys, we examined delinquency among cohorts in Mumbai, India (N = 3,717); Victoria, Australia (N = 1,842); and Washington State (WA), United States (N = 1,828). We used multivariate Poisson hierarchical linear modeling. Risk factor and delinquency levels varied across sites. Delinquency clustered within certain schools, particularly in Mumbai. Community disorganization exhibited an association with delinquency as a school-level context effect in Mumbai and Victoria. Peer delinquency, sensation seeking, and poor family management exhibited cross-nationally consistent associations with delinquency. Programs that target schools, the clustering of problem behaviors, and cross-nationally consistent risk factors should be considered internationally.

Longitudinal Associations Between Early-Mid Adolescent Risk and Protective Factors and Young Adult Homelessness in Australia and the United States.

Homelessness is associated with a range of negative health and behavioral outcomes, yet life-course pathways to homelessness from adolescence to early adulthood are not well-documented. This study asks to what extent do early-mid adolescent risk and protective factors predict young adult homelessness, and whether the predictive nature of these factors is similar in Victoria, Australia, and Washington State in the USA. As part of the International Youth Development Study, adolescents were recruited as state representative secondary school samples at grade 7 (age 13, 2002) and longitudinally compared at average age 25. Higher rates of past year homelessness were reported by Washington State (5.24%), compared to Victorian young adults (3.25%). Although some cross-state differences in levels of adolescent demographic, individual, family, peer group, school, and community predictors were found, cross-state comparisons showed these factors were equally predictive of young adult homelessness in both states. In univariate analyses, most adolescent risk and protective factors were significant predictors. Unique multivariate adolescent predictors associated with young adult homelessness included school suspension (adjusted odds ratio [AOR] = 2.76) and academic failure (AOR = 1.94). No significant unique protective effects were found. Prevention and intervention efforts that support adolescents' academic engagement may help in addressing young adult homelessness. The similar cross-state profile of adolescent predictors suggests that programs seeking to support academic engagement may influence risk for homelessness into young adulthood in both states. The similarity in life-course pathways to homelessness suggests that the USA and Australia can profitably translate prevention and intervention efforts to reduce homelessness while continuing to identify modifiable predictors.

Prevalence of homelessness and co-occurring problems: A comparison of young adults in Victoria, Australia and Washington State, United States.

Homelessness is associated with various co-occurring health and social problems yet; few contemporary international studies have examined these problems in young adulthood. This descriptive study presents cross-state comparison of the prevalence of young adult homelessness in Washington State, USA and Victoria, Australia using state representative samples from the International Youth Development Study (IYDS; n = 1,945, 53% female). Associations between young adult homelessness and a range of co-occurring problems were examined using a modified version of the Communities That Care youth survey. Results showed significantly higher rates of past year homelessness were reported by young adults in Washington State (5.24% vs. 3.25% in Victoria). Cross-state differences were evident in levels of friends' drug use, antisocial behavior, weekly income and support from peers. Unemployment (Adjusted Odds Ratio [AOR] = 2.67), antisocial behavior (AOR = 3.54) and victimization (AOR = 3.37) were more likely among young adults reporting homelessness in both states. Young adults with higher weekly income were less likely to report homelessness (AOR = .69) in both states. No significant association between mental health problem symptoms, substance use, family conflict or interaction with antisocial peers and homelessness were found in either state. Rates of violent behavior were more strongly related to young adult homelessness in Washington State than Victoria. The current findings suggest that programs that enable young adults to pursue income and employment, reduce antisocial behavior and include services for those who have been victimized, may help to mitigate harm among young adults experiencing homelessness.

Sustaining the implementation of alcohol management practices by community sports clubs: a randomised control trial.

BACKGROUND: Risky alcohol consumption is responsible for a variety of chronic and acute harms. Individuals involved in organised sport have been identified as one population group who consume risky amounts of alcohol both at the elite and the non-elite level. 'Good Sports', an alcohol management intervention focused on the community sports setting has been successful in addressing risky alcohol use and alcohol-related harm amongst players and sports fans. Sustaining such implementation effects is a common challenge across a variety of community settings. The primary aim of this trial was to assess the effectiveness of a web-based program in sustaining the implementation of best-practice alcohol management practices by community football clubs, relative to usual program care (i.e. control clubs). METHODS: Non-elite, community football clubs in the Australian states of New South Wales and Victoria, that were participating in an alcohol management program (Good Sports) were recruited for the study. Consenting clubs were randomised into intervention (N = 92) or control (N = 96) groups. A web-based sustainability intervention was delivered to intervention clubs over three consecutive Australian winter sports seasons (April-September 2015-2017). The intervention was designed to support continued (sustained) implementation of alcohol management practices at clubs consistent with the program. Control group clubs received usual support from the national Good Sports Program. Primary outcome data was collected through observational audits of club venues and grounds. RESULTS: A total of 92 intervention clubs (574 members) and 96 control clubs (612 members) were included in the final analysis. At follow-up, sustained implementation of alcohol management practices was high in both groups and there was no significant difference between intervention or control clubs at follow-up for both the proportion of clubs implementing 10 or more practices (OR 0.53, 95%CI 0.04-7.2; p = 0.63) or for the mean number of practices being implemented (mean difference 0.10, 95%CI -0.23-0.42; p = 0.55). There were also no significant differences between groups on measures of alcohol consumption by club members. CONCLUSIONS: The findings suggest that sustained implementation of alcohol management practices was high, and similar, between clubs receiving web-based implementation support or usual program support. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000746639. Prospectively registered 14/7/2014.

Social marketing and community mobilisation to reduce underage alcohol consumption in Australia: A cluster randomised community trial.

BACKGROUND AND AIMS: In many countries adolescent alcohol use is a major health problem. To supplement national policies, it is important to trial community interventions as a potential strategy to prevent adolescent alcohol use. METHODS: This study evaluated a multicomponent community intervention that included community mobilisation, social marketing, and the monitoring of alcohol sales to minors. Evaluation was a clustered randomised trial design with 14 intervention and 14 control communities. Prior to randomisation, communities were matched on socioeconomic status and location. Intervention communities were not blinded. PARTICIPANTS: 3545 Year 8 students (M = 12 years) were surveyed at baseline from 75 schools; 3377 students were surveyed post intervention in 2013 from 54 schools. OUTCOMES: It was hypothesised that the primary outcome, individual alcohol consumption in last 30 days, after the intervention would be 15% lower in intervention communities. Secondary outcomes were consumption in the past year and intention not to drink before age 18. RESULTS: The intervention communities showed larger relative reductions compared to the controls in last 30-day consumption and past year (10%), but not significantly different. A significantly lower proportion of participants in the intervention community (63%), compared to the controls (71%), reported intending to drink before 18 years old. Subgroup analysis identified regional and state differences for some secondary measures. CONCLUSIONS: Intervention assignment was associated with lower adolescent intention to drink before the age of 18. However, more intensive and longer-term intervention may be required to measure significant differences in behaviour change. TRIAL REGISTRATION: ACTRN12612000384853. PROTOCOL: Rowland B, Toumbourou JW, Osborn A, et al. BMJ Open 2013;3:e002423. doi:10.1136/bmjopen-2012-002423.

Underage purchasing of alcohol from packaged liquor outlets: an Australian study.

Access to the supply of alcohol is an important factor influencing adolescent alcohol consumption. Although alcohol sales outlets are prohibited from selling alcohol to underage youth, there has been limited research investigating compliance. The present study sought to estimate the extent to which adolescents that appeared underage were successfully able to purchase alcohol from packaged liquor outlets in Australia; and to identify store and sales characteristics associated with illegal purchasing. In 2012, purchase surveys were conducted (n= 310) at packaged liquor outlets in 28 urban and rural communities across three states of Australia: Western Australia, Queensland and Victoria. Confederates successfully purchased alcohol at 60% (95% CI: 55-66) of outlets. The density of general alcohol outlets in the surrounding area and the type of liquor outlet were predictors of successful alcohol purchases; however, this was moderated by the state in which the purchase was made. Regional geographical location was also found to predict underage alcohol purchase. The majority of alcohol sales outlets in Australia breach regulations prohibiting sales to underage youth. Consistent enforcement of policies across the states of Australia, and reducing the number of alcohol outlets, will help prevent alcohol outlets illegally selling alcohol to underage adolescents.

Improving availability, promotion and purchase of fruit and vegetable and non sugar-sweetened drink products at community sporting clubs: a randomised trial.

BACKGROUND: Amateur sporting clubs represent an attractive setting for health promotion. This study assesses the impact of a multi-component intervention on the availability, promotion and purchase of fruit and vegetable and non sugar -sweetened drink products from community sporting club canteens. We also assessed the impact the intervention on sporting club revenue from the sale of food and beverages. METHOD: A repeat cross-sectional, parallel group, cluster randomized controlled trial was undertaken with amateur community football clubs in New South Wales, Australia. The intervention was conducted over 2.5 winter sporting seasons and sought to improve the availability and promotion of fruit and vegetables and non sugar-sweetened drinks in sporting club canteens. Trial outcomes were assessed via telephone surveys of sporting club representatives and members. RESULTS: Eighty five sporting clubs and 1143 club members participated in the study. Relative to the control group, at follow-up, clubs allocated to the intervention were significantly more likely to have fruit and vegetable products available at the club canteen (OR = 5.13; 95% CI 1.70-15.38), were more likely to promote fruit and vegetable selection using reduced pricing and meal deals (OR = 34.48; 95% CI 4.18-250.00) and members of intervention clubs were more likely to report purchase of fruit and vegetable (OR = 2.58 95% CI; 1.08-6.18) and non sugar -sweetened drink (OR = 1.56; 95% CI 1.09-2.25) products. There was no significant difference between groups in the annual club revenue from food and non-alcoholic beverage sales. CONCLUSION: The findings demonstrate that the intervention can improve the nutrition environment of sporting clubs and the purchasing behaviour of members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12609000224224 .