Higher anthocyanin intake is associated with lower depressive symptoms in adults with and without major depressive disorder.

Background: Major depressive disorder (MDD) is a significant cause of disability globally and an emerging body of evidence suggests that dietary components, including flavonoids, may impact depression-related biochemical pathways. Further research that characterizes dietary intake of flavonoids in diverse population groups, including people with MDD and explores the relationship between flavonoid intake and depression is needed. This study aimed to determine dietary flavonoid and subclass intake and assess the association with depressive symptomatology in a sample of adults with and without MDD. Methodology: Participants with and without MDD (determined using DSM 5) completed the Depression, Anxiety, and Stress Scale-21 (DASS-21). Diet history interviews were analyzed using PhenolExplorer to quantify flavonoid subclasses (flavan-3-ols, flavonols, anthocyanins, flavones, flavanones, isoflavones), and total flavonoid intake. Independent t-tests and linear regression, adjusting for age, sex, and BMI were performed. Results: Participants (n = 93; 75% female) had a mean age of 26.0 ± 8.2 years. Participants with MDD had significantly higher DASS-depression scores (n = 44; DASS-depression 27.3 ± 9.8) compared to participants without MDD (n = 49; DASS-depression 3.1 ± 4.4; p < .001). Intakes of total flavonoids and subclasses were similar between groups, except for anthocyanins where participants with MDD reported lower intakes of anthocyanins compared to participants without MDD (median intake: 0.08 mg/day and 11.6 mg/day, respectively; p = .02). In the total sample, higher anthocyanin intake was associated with lower DASS-depression score (B = -4.1; SE = 1.8; 95% CI [-7.7, -0.4]; p = .029). Conclusion: Intake of total flavonoids and most subclasses were similar between people with and without MDD. However, a dietary deficit of anthocyanins (found in purple/red fruits and vegetables) was evident in participants with MDD, and higher anthocyanin intake was associated with lower depressive symptomatology in the total sample. Further research in larger samples is warranted to explore if the documented association is independent of MDD status.

Increasing food insecurity severity is associated with lower diet quality.

OBJECTIVE: Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity. DESIGN: A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0­73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted. SETTING: Tasmania, Australia. PARTICIPANTS: Community-dwelling adults (aged 18 years and over). RESULTS: The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = ­2·7; 95 % CI (­5·11, ­0·34); P = 0·03) and reduced by six points for moderately (B = ­5·6; 95 % CI (­7·26, ­3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = ­11·5; 95 % CI (­13·21, ­9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores. CONCLUSIONS: Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

Feeding Practices, Parent Perceptions, and Diet Diversity in a Sample of Children Aged 0-5 Years from Western Sydney, Australia: A Mixed Methods Study.

(1) Background: Sub-optimal feeding practices and dietary intakes in childhood are associated with poor health outcomes in adulthood. This mixed methods study aims to profile feeding practices, parent perceptions, and dietary diversity in a sample of children aged 0-5 years (n = 29) from Western Sydney, Australia. (2) Methods: In 2019, semi-structured interviews were conducted with parents, exploring their child's feeding practices. An online quantitative survey was used to assess children's feeding history. Nutrient intakes and dietary diversity scores were assessed using an online 24-h dietary recall. Quantitative data were analysed using descriptive statistics and one-way ANOVA, while qualitative data were analysed using inductive thematic analysis. (3) Results: The analysis showed that 27.6% of children were exclusively breastfed until 6 months of age and that 62.1% of children were introduced to solids before 6 months. Over 60% of children achieved minimum dietary diversity. The thematic analysis identified four themes, including mothers' feeding choices, mothers' perceptions of their children's diet, influences on feeding choices, and mothers' personal experiences. (4) Conclusions: The feeding history of over half the children in this sample indicated non-compliance with Australian and WHO infant feeding guidelines. The thematic analysis revealed various possible influences on parent feeding choices that can be used to inform targeted support.

Association between food insecurity status, campus food initiative use and diet quality in Australian university students.

AIMS: University students may experience food insecurity due to financial constraints, reducing the quality of their diet. This study aimed to identify students at higher risk of food insecurity, their engagement with on-campus food initiatives and evaluate the relationship between food insecurity and a validated index of diet quality. METHODS: A cross-sectional online survey used the six-item Household Food Security Survey Module to assess food insecurity. Total diet quality and subscale scores for eight food groups were measured using the Australian Recommended Food Score (range 0-73). Univariate and multivariate regression identified groups at risk of food insecurity, their engagement with campus food initiatives and relationship with diet quality scores. RESULTS: Of student respondents (n = 197), over half (54%) experienced food insecurity (14% mild, 23% moderate and 18% severe food insecurity). Male students and students not living with parents were at significantly higher risk. Food-insecure students were significantly more likely to use the campus food pantry (odds ratio = 2.3 [95% confidence interval = 1.286-4.142]; p = 0.005) but not a campus community garden. The mean diet quality score was 32.9 (standard deviation = 8.9). Food-insecure students reported a mean diet quality score over three points lower than food-secure respondents (B = -3.5 [95% confidence interval = -6.0 to -1.0]; p = 0.006), with significantly lower fruit and vegetable subscale scores. CONCLUSIONS: Results suggest a high occurrence of food insecurity and poor dietary quality in university students. Despite high levels of engagement with the campus food pantry, the poor diet quality of food-insecure students suggests an urgent need for greater university-led interventions to improve students' dietary intake.

The impact of community-based food access strategies in high-income countries: a systematic review of randomised controlled trials.

OBJECTIVES: Some geographic regions in high-income countries (HIC), including Australia, have poor healthy food access and a high burden of diet-related chronic disease. Scalable and sustainable strategies to strengthen community food systems have the potential to address these inequities. To inform future interventions in regions with poor healthy food access in Sydney, Australia, and beyond, we systematically reviewed randomised controlled trials of community-based food access interventions in HIC, to identify effects on dietary behaviours and health outcomes. METHODS: Four electronic databases were searched. Studies involving community-based healthy food access strategies (solely or combined with education/behaviour change) and measuring effects on dietary behaviours and/or health outcomes were identified. Data on dietary behaviours, health outcomes and intervention descriptions were extracted, and the risk of bias was assessed. RESULTS: Seven studies met inclusion criteria, with most conducted in the US (n = 6). Intervention strategies included food pantry-based interventions (n = 2), mobile produce markets (n = 2) and community farms (n = 3). Most interventions (n = 6, 85%) incorporated educational and/or behavioural change aspects. All studies measured fruit and vegetable (F&V) intake, with nearly all (n =6, 85%) reporting significant beneficial effects. CONCLUSION: Preliminary evidence in our synthesis demonstrates that multicomponent community-based food system interventions promise to improve F&V intake in regions of HICs. Recommendations for improving future evaluations are identified to build evidence for policymakers and urban planners to enact upstream and downstream strategies to strengthen community healthy food, particularly in geographic regions with the greatest health inequities.

Development of a Scoring Tool for Australian Rural Food Retail Environments.

Current tools scoring the healthiness of food retail outlets do not reflect outlets found in rural locations. This study aimed to adapt pre-existing Australian scoring tools to represent non-metropolitan areas. Rural nutrition experts were identified, and a modified Delphi technique was used to adapt two pre-existing, food-scoring tools in five iterative stages. Stages included identifying all relevant outlets, providing a description and score for each, ensuring consistency between outlet scores and pre-existing, metro-centric tools, and providing instructions for correct use. Six rural nutrition experts were identified and engaged in the modified Delphi technique. The final tool consisted of 12 categories of food outlets and listed 35 individual outlets. Consistent with pre-existing Australian tools, scores ranged from +10 to -10 and included descriptions reflective of rural retail outlets. Scores were based on whether the majority of foods offered within the outlet were consistent with foods recommended in national health guidelines. The developed tool was designed to accommodate the diverse nature of food retail outlets found in non-metropolitan areas. This study assists in explaining the link between the food environment and health in populations living rurally.

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

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

Rural nutrition and dietetics research-Future directions.

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

"I Always Buy the Purple Ones If I See Them": Socioecological Factors Influencing Anthocyanin-Rich Food Consumption for Cognitive Health in Older Adults.

Despite the positive relationship between anthocyanin-rich foods and cognitive health, a dietary deficit exists in older adults. Effective interventions require an understanding of people's dietary behaviors situated in social and cultural contexts. Therefore, the aim of this study was to explore older adults' perceptions about increasing their consumption of anthocyanin-rich foods for cognitive health. Following an educational session and the provision of a recipe and information book, an online survey and focus groups with Australian adults aged 65 years or older (n = 20) explored the barriers and enablers towards eating more anthocyanin-rich foods and potential strategies to achieve dietary change. An iterative, qualitative analysis identified the themes and classified the barriers, enablers and strategies onto the Social-Ecological model levels of influence (individual, interpersonal, community, society). Enabling factors included a desire to eat healthily, taste preference and familiarity of anthocyanin-rich foods (individual), social support (community), and the availability of some anthocyanin-rich foods (society). The barriers included budget, dietary preferences and motivation (individual), household influences (interpersonal), limited availability and access to some anthocyanin-rich foods (community) and the cost and the seasonal variability (society). The strategies included increasing individual-level knowledge, skills, and confidence in utilizing anthocyanin-rich foods, educational initiatives about the potential cognitive benefits, and advocating to increase access to anthocyanin-rich foods in the food supply. This study provides for the first time, insight into the various levels of influence impacting older adults' ability to consume an anthocyanin-rich diet for cognitive health. Future interventions should be tailored to reflect the barriers and enablers and to provide targeted education about anthocyanin-rich foods.

Severity of Food Insecurity among Australian University Students, Professional and Academic Staff.

Assessments of the severity of food insecurity within Australian university students are lacking, and the experience of food insecurity in Australian university staff is unknown. A cross-sectional online survey in March 2022 aimed to characterize the severity of food insecurity in students, professional and academic staff at the University of Tasmania (UTAS). The Household Food Security Survey Module six-item short form assessed food security status in addition to seven demographic and education characteristics for students and six demographic and employment characteristics for staff. Participants were categorized as having high, marginal, low, or very low food security. Multivariate binary logistic regression identified students and staff at higher risk of food insecurity. Among student respondents (n = 1257), the prevalence of food insecurity was 41.9% comprising 8.2% marginal, 16.5% low, and 17.3% very low food security. Younger, non-binary, first-year enrolled, on campus, and international students were at significantly higher risk of food insecurity. Among staff (n = 560), 16.3% were food insecure comprising 3.8% marginal, 5.5% low, and 7.0% very low food security. Professional staff, staff on casual contracts, and staff recently employed, were at significantly higher risk of food insecurity. Our findings suggest a high occurrence of food insecurity in UTAS students and staff, with a large proportion of food insecure staff and students experiencing very low food security. Our findings have implications for efforts towards reducing food insecurity at university campuses through a holistic and integrated approach, advocating for food systems that support healthy, sustainable, and equitable food procurement and provision for both university students and staff.

The new normal for food insecurity? A repeated cross-sectional survey over 1 year during the COVID-19 pandemic in Australia.

BACKGROUND: Food insecurity during the COVID-19 pandemic has been impacted by necessary public health restrictions. Tasmania, an island state south of the Australian mainland, recorded no community transmission of COVID-19 between May 2020 to November 2021 due to strong border restrictions. This study aimed to determine the changes in prevalence and sociodemographic predictors of food insecurity throughout the COVID-19 pandemic in Tasmania, Australia. METHODS: In May 2020 (survey 1: during lockdown), September 2020 (survey 2: eased restrictions) and May 2021 (survey 3: 1-year post-lockdown), cross-sectional, online surveys using convenience sampling methods determined food insecurity in Tasmanian adults using the USDA Household Food Security Survey Module: Six-Item Short Form, in addition to key sociodemographic questions. Crude and age-adjusted prevalence of food insecurity was calculated, and binary logistic regression determined at-risk groups and changes in prevalence over time. RESULTS: The age-adjusted prevalence of food insecurity was 27.9% during lockdown (n = 1168), 19.5% when restrictions had eased (n = 1097) and 22.6% 1-year post-lockdown (n = 1100). Young adults, Aboriginal and/or Torres Strait Islander people, individuals with disabilities, families with dependents and temporary residents were at highest risk across all time points. CONCLUSIONS: The prevalence of food insecurity was higher than pre-pandemic levels across all three time points. Our results indicate the potential long-term impacts of the COVID-19 pandemic on food security in Australia, where despite easing social distancing restrictions and a lack of COVID-19 transmission, the prevalence of food insecurity reduced, but did not recover to pre-pandemic levels 1-year following a lockdown.

Consumer-driven strategies towards a resilient and sustainable food system following the COVID-19 pandemic in Australia.

BACKGROUND: The COVID-19 pandemic and associated public health restrictions temporarily disrupted food supply chains around the world and changed the way people shopped for food, highlighting issues with food systems resilience and sustainability. The aim of this study was to explore consumer-driven strategies towards a more resilient and sustainable food system in Australia, learning from experiences during the beginning of the COVID-19 pandemic. METHODS: During May-June 2020, a cross-sectional, online survey was conducted in Tasmania, Australia in a non-random sample of adults aged 18 years and over. The survey collected demographic data and posted the open-ended question: "How could Tasmania's food system be better prepared for a disaster in the future?" Descriptive statistics were used to analyse the demographic data and thematic analysis was employed to analyse the qualitative data. RESULTS: Survey respondents (n = 698) were predominantly female (79%), over 55 years of age (48%), university educated (70%) and living with dependents (45%). Seven key themes were identified: (i) balance food exports with local needs; (ii) strengthen local food systems; (iii) increase consumer awareness of food supply chains; (iv) build collaboration and connection in the food system; (v) embed clear contingency arrangements; (vi) support community capacity building and individual self-sufficiency; and (vii) the food system coped well. CONCLUSIONS: The consumer-driven strategies identified indicate multiple opportunities to increase resilience and sustainability in the food system to avoid future supply disruptions. Our findings indicate that considerable popular support for more resilient, local and sustainable food systems may be emerging from the COVID-19 pandemic.

High occurrence of food insecurity in young people attending a youth mental health service in regional Australia.

AIM: Despite the relationship between food insecurity and poor mental health, food insecurity in young people attending mental health services in Australia remains understudied. This study aimed to determine the occurrence and predictors of food insecurity, and the relationship with dietary factors in young people attending a mental health service. METHODS: A cross-sectional online survey was conducted in a sample of young people (15-25 years) who attended a mental health service in Launceston, Australia. The survey utilised a single-item food insecurity screening tool and eight demographic, health and service use questions. Five questions determined self-reported intake of fruit, vegetables, breakfast, water, sugar-sweetened beverages and takeaway foods. Binary logistic regression determined predictors of food insecurity. Cross-tabulations determined differences in dietary intake according to food security. RESULTS: Of survey respondents (n = 48; 68% female), 40% (n = 19) were food insecure. Respondents living out of home or in unstable accommodation were at significantly higher risk of food insecurity (odds ratio [OR]: 4.43; SE: 0.696; 95% CI: 1.13-17.34; p = 0.032) compared to those living with their parents. Those receiving government financial assistance (OR: 5.00; SE: 0.676; 95% CI: 1.33-18.81; p = 0.017) were also at significantly higher risk of food insecurity. Regardless of food security status, self-reported intake of fruits, vegetables and breakfast were low, and respondents regularly consumed takeaway foods and sugar-sweetened beverages. CONCLUSIONS: There was a high occurrence of food insecurity and poor dietary intake in young people attending a youth mental health service demonstrating that initiatives to support access to healthy food in this group should be a priority, with potential benefits for mental health outcomes.

The knowledge, barriers and opportunities to improve nutrition and physical activity amongst young people attending an Australian youth mental health service: a mixed-methods study.

BACKGROUND: Mental illnesses are the leading cause of disability in young people, and lifestyle interventions in young people at risk of mental illness remain a priority. Opportunities to improve nutrition and physical activity among young people through youth mental health services remain unclear. This study aimed to determine the knowledge and behaviors towards nutrition and physical activity, the barriers and enablers to improving behaviors, and the preferred providers and sources of information for nutrition and physical activity among a sample of young people attending a youth mental health service. METHODS: A mixed-method study was conducted in regional Tasmania, Australia in a sample of young people (15-25 years) attending a youth mental health service (headspace). A quantitative survey (n = 48) determined young people's nutrition and physical activity knowledge, behaviors, barriers and enablers to achieving recommendations, and their preferred providers and sources of information. Structured interviews and a focus group further explored these concepts (n = 8), including the role of the mental health service as a provider of this support. RESULTS: The majority of participants did not meet national recommendations for nutrition and physical activity, despite possessing a high level of knowledge regarding their importance for mental health. Improving mental health was a common enabling factor for participants choosing to alter diet and physical activity habits, but also the leading barrier for participating in physical activity. Young people wanted to receive information from reputable health providers, ideally through social media sources. headspace was seen as an important potential provider of this information. CONCLUSIONS: Our results indicate that there is a clear need to improve diet and physical activity habits to enhance mental and physical health outcomes in this at-risk group, and youth mental health services could provide further interventions to support their clients. Specialized staff (e.g. dietitians and exercise physiologists) may provide additional benefits alongside existing mental health care support.

Anthocyanin intake is associated with improved memory in older adults with mild cognitive impairment.

Research on the role of dietary anthocyanins in preventing cognitive decline in older adults shows promise. This study investigated the association between usual anthocyanin intake and indices of memory and cognition in 40 older adults diagnosed with mild cognitive impairment that were recruited to a randomized clinical trial. It was hypothesized that daily anthocyanin intake would be similar to healthy older adults and that higher anthocyanin intake would be associated with better cognitive performance. Cognitive performance was assessed using a battery of tests including the Rey Auditory Verbal Learning Test (RAVLT). Dietary intake was assessed through 3-day food records and anthocyanin intake was quantified using the PhenolExplorer food composition database. Multivariate linear regression compared differences in cognitive performance between higher (>10 mg/d) and lower consumers (<10 mg/d). Overall, participants had low median intake of anthocyanins (5.3; interquartile range [IQR], 32.1 mg/d), with the lower consumer group eating negligible anthocyanins (median, 0.13; IQR, 1.5 mg/d), and the higher consumer group eating above the national average (median, 35.5; IQR, 71.5 mg/d). On the RAVLT, the higher anthocyanin consumer group recalled a greater number of words after a short delay and a distracter task (B, 2.07; standard error [SE], 0.93; 95% confidence interval [CI], 0.18-3.96; P = .03) and longer delay of 20 minutes (B, 2.68; SE, 1.11; 95% CI, 0.43-4.94; P = .02); and forgot less words after a long delay of 20 minutes (B, -2.63; SE, 0.63; 95% CI, -3.90 to -1.35; P< .001). Further investigation of the protective role of the usual consumption of dietary anthocyanins for memory and cognition in pathological and normal aging appears warranted. Trial registration: This cross-sectional study uses baseline data from a randomized controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001184268).

Food Supply Impacts and Solutions Associated with the COVID-19 Pandemic: A Regional Australian Case Study.

This study aimed to explore how food supply chains were impacted by COVID-19 and identify how the region could be better prepared for future crises. An online survey was completed by 107 consumers. In-depth interviews were conducted with 27 food supply stakeholders working in food production, distribution, retail, hospitality, institutions (i.e., childcare), logistics/freight and local government. Pre-COVID-19, farmer-direct distribution options and hospitality businesses comprised a substantial proportion of local food producer businesses. During the COVID-19 pandemic, consumers favoured local food supply options, farmers collaborated, and produce usually destined for export was redirected into local markets. Critical food supply actions included keeping borders open to food freight, enhancing social capital through real-time business communication, and business flexibility. Solutions included business adaptation, for example, farmers selling produce boxes and hospitality businesses selling excess stock, COVID-safe delivery, and collaboration through digital networks. To better prepare the region for future crises, actions to support communities could include a community approach to agriculture, increasing food supply diversity, facilitating transport to aid food distribution and purchasing, and more effective messaging to discourage panic buying. Actions to support retailers could include increasing access to wholesalers through online platforms. Actions to support producers could include improving infrastructure, such as more regional distribution facilities.

A mixed-methods study to determine the impact of COVID-19 on food security, food access and supply in regional Australia for consumers and food supply stakeholders.

BACKGROUND: The COVID-19 pandemic has impacted the Australian food supply through changed consumer purchasing patterns, and potentially, household food security. The aim of this study was to determine the impact of COVID-19 on the prevalence of food insecurity and food supply issues, and perspectives of food supply stakeholders in regional Australia. METHODS: A mixed-methods consumer survey and in-depth interviews with food supply stakeholders were conducted in regional Australia, more specifically South West Western Australia between May and July 2020, immediately after the 1st wave of the pandemic. RESULTS: The prevalence of food insecurity was 21% among consumers, and significantly more prevalent for those aged less than 30 years and living with a disability. Most consumers (73%) agreed that the COVID-19 pandemic had impacted the food supply. Food insecure respondents were more likely to report that food was more expensive, resulting in changes to the types and quantities of food bought. Food supply stakeholders perceived that consumers increased their intention to buy locally grown produce. Panic buying temporarily reduced the availability of food for both food suppliers and consumers, regardless of their food security status. CONCLUSIONS: This study provided novel insights from South West Australian consumer and food supply stakeholder perceptions. Food insecure consumers provided insights about the high cost of food and the subsequent adaptation of their shopping habits, namely type and amount of food purchased. Stakeholder perceptions largely focused on supply chain issues and corroborated consumer reports.

The Impact of the COVID-19 Pandemic on Rural Food Security in High Income Countries: A Systematic Literature Review.

Prior to the COVID-19 pandemic, rural-dwelling people in high-income countries were known to have greater challenges accessing healthy food than their urban counterparts. The COVID-19 pandemic has impacted food supplies across the world, and public health restrictions have changed the way people shop for food, potentially exacerbating food insecurity. This systematic literature review aimed to synthesize the available evidence on the impact of the COVID-19 pandemic on aspects of food insecurity in rural populations residing in high-income countries. Five electronic databases were searched, identifying 22 articles that assessed food insecurity prevalence or data on food availability, access, utilization and the stability of the food supply in rural populations during the COVID-19 pandemic. Ten studies examined the prevalence of food insecurity in rural populations, with the reported prevalence ranging from 15% to 95%. Where rural/urban comparisons were presented, most studies (n = 5; 71%) reported that food insecurity was significantly higher in rural regions. Five studies examined the availability of food and eight studies examined access to food, identifying that rural populations often had lower food availability and access to food during the pandemic. In contrast, two studies identified positive effects such as more gardening and increased online access to food. Rural populations experienced multiple changes to food utilization, such as reduced diet quality and food safety observed in eight studies, but this was not shown to be different from urban populations. Additionally, the food supply in rural regions was perceived to be affected in two studies. The results of this review may be used to inform region-specific mitigation strategies to decrease the impact of the current COVID-19 pandemic and future global events on food security. However, the lack of consistency in study outcomes in research on rural populations limits the identification of priority areas for intervention at a global-scale.

Food insecure households faced greater challenges putting healthy food on the table during the COVID-19 pandemic in Australia.

The COVID-19 pandemic negatively affected the Australian food supply. However, it has remained unclear how food access, food availability and consumption were impacted, especially for households experiencing food insecurity. This study aimed to determine the association between food security and cooking and eating habits, food access and availability, self-sufficiency and perceptions of the food supply at the beginning of the COVID-19 pandemic in Tasmania, Australia. Throughout May-June 2020 during strict social distancing restrictions, a cross-sectional survey was conducted including the U.S. Household Food Security Survey Module Six-Item Short Form, twenty Likert scale questions on cooking and eating habits, food access, self-sufficiency and perceptions of the food supply (responses from 1 = strongly agree to 5 = strongly disagree), two questions on food availability and eleven socio-demographic questions. Survey data (n = 1067) were analysed using multivariate linear regression, and binary logistic regression. Food insecure households were significantly more likely to agree they were consuming less fresh food compared with food secure households (Mean difference between scale responses (MD) = 0.66; 95%CI:0.36-0.66; p < 0.001), and significantly more food insecure households agreed it was more difficult to get to the shops (MD = 0.49; 95%CI:0.34-0.64; p < 0.001) and they had less money available for food than prior to the COVID-19 pandemic (MD = 0.95; 95%CI:0.79-1.10; p < 0.001). Compared to food secure households, food insecure households were at significantly greater risk of foods being unavailable to them (OR:1.75; 95%CI:1.33-2.35; p < 0.001) and were less likely to have sufficient food stored in their homes (OR:0.48; 95%CI: 0.33-0.687; p < 0.001). This study indicates there was a disproportionate impact of the COVID-19 pandemic on food insecure households, related to food availability and access, with effects on cooking and eating habits.

A Comparison of Diet Quality in a Sample of Rural and Urban Australian Adults.

The diet quality of rural Australians is under researched. Characterising disparities in diet quality between rural and urban populations may inform targeted interventions in at- risk groups. A cross-sectional study aimed to determine the relationship between diet quality, rurality and sociodemographic characteristics in a sample of Australian adults. Participants were recruited at rural and regional events between 2017 and 2020, in New South Wales, Australia. Diet quality was measured using the Healthy Eating Quiz or Australian Eating Survey to generate an Australian Recommended Food Score (ARFS). ARFS was compared by rurality and sociodemographic characteristics using multivariate regression. Participants (n = 247; 53% female) had a mean ± SD ARFS of 34.5 ± 9.0. There was no significant effect of rurality on ARFS (ß-coefficient = -0.4; 95%CI -3.0, 2.3). Compared to participants aged 18-30 years, higher ARFS was evident for those aged 31-50 (ß = 5.4; 95%CI 0.3, 10.4), 51-70 (ß = 4.4; 95%CI 0.3, 8.5) and >71 years (ß = 6.5; 95% CI 1.6-11.4). Compared to those living alone, participants living with a partner (ß = 5.2; 95%CI 2.0, 8.4) and families with children (ß = 5.6; 95%CI 1.4, 9.8) had significantly higher ARFS. ARFS was significantly lower with each additional self-reported chronic health condition (ß = -1.4; 95%CI -2.3, -0.4). Our results indicate that diet quality as defined by the ARFS was classified as 'getting there' and that age, living arrangements and chronic health conditions, but not rurality, influenced diet quality in a sample of Australian adults.