Barriers and enablers to a healthy food environment in Australian childcare services: Exploring directors' perspectives.

ISSUE ADDRESSED: Early childhood education and care (ECEC) settings are ideal environments to optimise nutrition and positively influence children's food behaviours. However, recent research has identified the need to improve nutrition policies, food provision, and mealtime environments in Australian ECEC settings. This study explored the perceptions of ECEC directors regarding barriers and enablers to a health-promoting food environment within ECEC services. METHODS: Eleven directors from ECEC services in Nerang, Queensland, and surrounding areas, participated in qualitative interviews between March and May 2021. Transcripts were analysed using qualitative content analysis that followed a deductive-inductive approach employing nutrition-related domains from the Wellness Child Care Assessment Tool, these being: (i) nutrition policy; (ii) nutrition education; (iii) food provision; and (iv) mealtimes. Transcripts were coded independently by two researchers in NVivo and consensus for barriers and enablers was achieved through discussion. RESULTS: Barriers and enablers were reported across four domains (nutrition policy, nutrition education, food provision, and mealtimes). Comprehensive nutrition-related policies were an enabler to a healthy nutrition environment but were sometimes described as lacking detail or customisation to the service. Nutrition education for children was described as competing with other activities for time and resources in an already-crowded curriculum. Financial and time pressures faced by families were a barrier to healthy food provision in services where families provided food for children. The ability of staff to sit with children and engage in conversation during mealtimes was an enabler; however, competing demands on time and the unavailability of food for staff were cited as barriers to health-promoting mealtimes. CONCLUSIONS: Directors in ECEC services report both barriers and enablers to a healthy food environment. Nutrition policies were an enabler when comprehensive and relevant but a barrier when vague and not tailored to the service environment. ECEC services should be supported to develop and implement service-specific nutrition policies and practices by engaging with parents and staff. SO WHAT?: The barriers and enablers reported in this study should be considered when designing and implementing future evidence-based interventions to improve the nutrition environment in ECEC services.

Working together to increase Australian children's liking of vegetables: a position statement by the Vegetable Intake Strategic Alliance (VISA).

Children need to be repeatedly and consistently exposed to a variety of vegetables from an early age to achieve an increase in vegetable intake. A focus on enjoyment and learning to like eating vegetables at an early age is critical to forming favourable lifelong eating habits. Coordinated work is needed to ensure vegetables are available and promoted in a range of settings, using evidence-based initiatives, to create an environment that will support children's acceptance of vegetables. This will help to facilitate increased intake and ultimately realise the associated health benefits. The challenges and evidence base for a new approach are described.

Toddlers may be getting enough iron in long day-care services after all.

BACKGROUND: Previous research has suggested that toddlers are not provided with adequate dietary iron in long-day care (LDC) services. However, the iron bioavailability provided is unknown. The present study aimed to investigate the amount and bioavailability of iron provided to toddlers aged 2-3 years at LDC services. METHODS: A cross-sectional audit was conducted using a 2-day weighed food record of 30 LDC services. Iron provision (not child intake) in LDC services across Perth, Australia was compared with the estimated average requirements (EAR) and LDC services provision guidelines (50% of EAR = 2 mg/day based on a 14% bioavailability factor). Bioavailability was estimated per mealtime using haem and non-haem iron, ascorbic acid, animal protein, calcium, soy, eggs and phytates using two pre-existing algorithms (by A. P. Rickard and colleagues and H. Hallberg and H. Hulten). RESULTS: Median iron supplied (2.52 mg/day, interquartile range [IQR] = 2.43-3.17) was above the 50% of EAR of 2.0 mg/day (p < 0.001). Median bioavailable iron was 0.6 mg/day (IQR = 0.54-0.8) using the method of Rickard et al. and 0.51 mg/day (IQR = 0.43, 0.76 using that of Hallberg and Hulthen). The top three foods contributing to iron provision were bread, breakfast cereals and beef. CONCLUSIONS: Our results suggest that LDC services in Perth are meeting the minimum recommendation of provision of 50% of the iron EAR, and also that toddlers are provided with sufficient bioavailable iron. Future strategies should focus on promoting food combinations to maintain the iron bioavailability in meals currently served at LDC services.

Would you like fries with that? Investigating fast-food outlet availability near schools in Perth, Western Australia.

ISSUE ADDRESSED: Locating fast-food outlets near schools is a potential public health risk to schoolchildren, given the easy access and repeated exposure to energy-dense, nutrient-poor foods they provide. Fast-food outlet availability near schools has not been previously investigated in Perth, Western Australia. This study aimed to quantify fast-food outlet availability near Perth schools and determine whether differences in area-level disadvantage and school type exist. METHODS: Fast-food outlet locations were sourced from Perth Local Governments in 2018/2019. All Perth Primary (n = 454), Secondary (n = 107) and K-12 (n = 94) schools were assigned an area-level disadvantage decile ranking based on the Australian Bureau of Statistics Socio-Economic Index for Areas (SEIFA). Regression models assessed whether fast-food outlet availability within 400 m, 800 m and 1 km of schools differed by school type (ie, Primary/Secondary/K-12) or SEIFA. RESULTS: Secondary schools were significantly more likely than Primary and K-12 schools to have a higher presence and density of fast-food outlets and the "Top 4" fast-food outlet chains (McDonalds, Hungry Jacks, KFC and Red Rooster) nearby. Schools located in low socio-economic status (SES) areas had a significantly higher density of fast-food outlets within 400 m, and "Top 4" fast-food outlet chains within 400 m and 1 km, than schools located in high SES area. CONCLUSIONS: Perth schools are surrounded by fast-food outlets with densities significantly higher around secondary schools and schools located in lower SES areas. SO WHAT?: Policies and regulations aimed at reducing fast-food outlets near schools is an essential strategy to improve dietary intakes and reduce obesity in schoolchildren.

The Nutritional Quality of Kids' Menus from Cafés and Restaurants: An Australian Cross-Sectional Study.

Australian families increasingly rely on eating foods from outside the home, which increases intake of energy-dense nutrient-poor foods. 'Kids' Menus' are designed to appeal to families and typically lack healthy options. However, the nutritional quality of Kids' Menus from cafes and full-service restaurants (as opposed to fast-food outlets) has not been investigated in Australia. The aim of this study was to evaluate the nutritional quality of Kids' Menus in restaurants and cafés in metropolitan Perth, Western Australia. All 787 cafes and restaurants located within the East Metropolitan Health Service area were contacted and 33% had a separate Kids' Menu. The validated Kids' Menu Healthy Score (KIMEHS) was used to assess the nutritional quality of the Kids' Menus. Almost all Kids' Menus (99%) were rated 'unhealthy' using KIMEHS. The mean KIMEHS score for all restaurants and cafés was -8.5 (range -14.5 to +3.5) which was lower (i.e., more unhealthy) than the mean KIMEHS score for the top 10 most frequented chain fast-food outlets (mean -3.5, range -6.5 to +3). The findings highlight the need for additional supports to make improvements in the nutritional quality of Kids' Menus. Local Government Public Health Plans provide an opportunity for policy interventions, using locally relevant tools to guide decision making.

Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review.

BACKGROUND: Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools. METHODS: The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study. RESULTS: Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool. CONCLUSIONS: The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.

How a 7-Week Food Literacy Cooking Program Affects Cooking Confidence and Mental Health: Findings of a Quasi-Experimental Controlled Intervention Trial.

Obesity and mental health disorders are rising simultaneously with shifting dietary behavior away from home cooking, toward typically nutrition-poor and energy-dense convenience meals. Food literacy strongly influences nutrition choices. Community-based cooking interventions target barriers to healthy eating and facilitate development of food literacy skills, thereby potentially increasing preparation of home-cooked meals and positively influencing health. This study of 657 healthy Australian adults explored the efficacy of a 7-week cooking program in improving cooking confidence, whether this transferred to behavior surrounding food, and/or affected mental health. Significant post-program improvements in cooking confidence and satisfaction (all p < 0.001, η p 2 1.12 large), ability to change eating habits (p < 0.001) and overcome lifestyle barriers (p = 0.005) were observed for the intervention group but not control. Participation also improved mental and general health (all p < 0.05, η p 2 0.02 small). No changes were observed for acquisition and consumption of food, or nutrition knowledge in either group. This 7-week cooking program built cooking confidence and improved general and mental health but did not change dietary behavior. To further improve nutrition related behaviors associated with better mental health, more effort is needed to recruit those with below-average nutrition knowledge and interest in cooking.

A multifaceted approach increased staff confidence to develop outside of school hours care as a health promoting setting.

BACKGROUND: Outside-of-school-hours-care (OSHC) services are well positioned to influence the health behaviours of 489, 800 Australian children, and are an important setting for health promotion given the current rates of childhood overweight and obesity and associated health risks. OSHC Professionals are ideally placed to become positive influencers in this setting, although they may require training and support to confidently perform this role. This study piloted a multifaceted intervention strategy to increase OSHC Professional's confidence and competencies, to support a health promoting OSHC environment with a nutrition and physical activity focus. METHODS: A mixed methods approach was used. Nineteen OSHC Professionals participated in the study, including a face-to-face workshop, supported by a closed Facebook group and website. Role adequacy (self-confidence) and legitimacy (professional responsibility) were measured pre and post workshop and evaluated using non-parametric statistics. Facebook interactions were monitored, and four participants undertook qualitative exit interviews to discuss their experiences with the intervention. RESULTS: Pre-workshop 68% of participants had not received any OSHC-specific health promotion training. Post-workshop significant improvements in confidence about menu planning, accessing nutrition information, activities and recipes was observed (P < 0.05 for all). A significant improvement was observed in role support and role related training (P < 0.05). A high level of support and interaction was observed between participants on Facebook and the website was reported a useful repository of information. CONCLUSIONS: Health promotion training, combined with positive social connections, shared learning experiences, and a website improved OSHC Professionals confidence and capacity to provide a health promoting OSHC environment. Health promotion professional development for OSHC professionals should be mandated as a minimum requirement, and such learning opportunities should be scaffolded with support available through social media interactions and website access.

Childcare Food Provision Recommendations Vary across Australia: Jurisdictional Comparison and Nutrition Expert Perspectives.

Early childhood is a critical stage for nutrition promotion, and childcare settings have the potential for wide-reaching impact on food intake. There are currently no Australian national guidelines for childcare food provision, and the comparability of existing guidelines across jurisdictions is unknown. This project aimed to map and compare childcare food provision guidelines and to explore perspectives amongst early childhood nutrition experts for alignment of jurisdictional childcare food provision guidelines with the Australian Dietary Guidelines (ADG). A desktop review was conducted and formed the basis of an online survey. A national convenience sample of childhood nutrition experts was surveyed. Existing guideline recommendations for food group serving quantities were similar across jurisdictions but contained many minor differences. Of the 49 survey respondents, most (84-100%) agreed with aligning food group provision recommendations to provide at least 50% of the recommended ADG serves for children. Most (94%) agreed that discretionary foods should be offered less than once per month or never. Jurisdictional childcare food provision guidelines do not currently align, raising challenges for national accreditation and the provision of support and resources for services across jurisdictions. Childhood nutrition experts support national alignment of food provision guidelines with the ADG.

The study protocol for a pseudo-randomised pre-post designed controlled intervention trial to study the effects of a 7-week cooking program on self-efficacy and biomarkers of health: the ECU lifestyle and biomarkers get connected study (ECULABJMOF) including the Jamie's Ministry of Food WA participant experience.

BACKGROUND: Australia, like other nations, has experienced a shift in dietary patterns away from home cooking of nutritious foods, towards a reliance on pre-prepared convenience meals. These are typically energy-dense, nutrient-poor and contribute to the rising prevalence of obesity and chronic disease burden. The aims of this study were to evaluate whether a community-based cooking program instigated a change to participants' skills, attitudes, knowledge, enjoyment and satisfaction of cooking and cooking confidence (self-efficacy). METHODS: The pseudo-random, pre-post study design consisted of an intervention and a control group. Participant recruitment and group allocation was based on their program start dates. Intervention participants were surveyed three times (baseline, 7 weeks and 6 months) and the control group were surveyed at baseline and 5 weeks. All participants were registered via an online website and were 18 years or over. Upon consent, participants were offered four levels of commitment, defined by different assessments. The minimum participation level included an online survey and levels 2, 3 and 4 involved attendance at a clinic with increasing functional, anthropometric and biomarker measurements. Primary endpoints were participants' cooking confidence as a proxy for self-efficacy. Secondary endpoints were dietary intake, physical activity levels, body composition, anthropometry, blood, urine and faecal biomarkers of systemic, physical and mental health. DISCUSSION: The community cooking program provided participants with information and advice on food sourcing, preparation and nutrition to improve home cooking skills. The study was designed to explore whether food literacy programs are efficacious in improving participant physical health and well-being in order to combat the rise in obesity and diet-related disease. It will support future use of public health cooking program initiatives aimed at improving food literacy, self-efficacy and physical and mental health. The extensive data collected will inform future research into the relationship between diet, the gut-microbiota and human health. TRIAL REGISTRATION: Retrospectively registered on 16.08.2019 with the Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12619001144101 . Protocol version 4.

Increasing Food Expenditure in Long Day-care by an Extra $0.50 per Child/Day Would Improve Core Food Group Provision.

Early childhood education and care services are a significant feature of Australian family life, where nearly 1.4 million children attended a service in 2019. This paper reports on the cost of food provided to children in long day-care (LDC) services and extrapolates expenditure recommendations to support food provision compliance. A cross-sectional audit of LDC services in metropolitan Perth was conducted to determine food group provision by weighing raw ingredients of meal preparation-morning tea, lunch, and afternoon tea (MT, L, AT). Ingredients were costed at 2017 online metropolitan pricing from a large supermarket chain. Across participating services, 2 days of food expenditure per child/day ranged between $1.17 and $4.03 across MT, L, AT, and averaged $2.00 per child/day. Multivariable analysis suggests that an increase of $0.50 per child/day increases the odds of a LDC service meeting >50% of Australian Dietary Guideline (ADG) recommendations across ≥4 core food groups by fourfold (p = 0.03). Given the fact that the literature regarding food expenditure at LDC services is limited, this study provides information about food expenditure variation that impacts planning and provision of nutritionally balanced menus recommended for children. An average increase of food expenditure of $0.50 per child/day would increase food provision compliance.

Food allergy management in Early Childhood Education and Care Services in Australia.

AIM: To assess Australian Early Childhood Education and Care Services (ECEC) staff on their preparedness to manage children with food allergy (FA) and anaphylaxis. METHODS: An online survey addressing training, knowledge, skills and staff confidence to manage FA and anaphylaxis was emailed to 5956 ECEC services nationally (excluding Western Australia, where this survey had been previously implemented); 494 surveys were completed and analysed. RESULTS: One in 10 (9.5%) ECEC services did not require staff to undertake anaphylaxis training, indicating non-compliance with current legislation. Staff felt confident in managing FA and anaphylaxis, regardless of their level of training. Against recommendations, 37% of participating ECEC services stored adrenaline autoinjectors (AAI) in a locked location. Only 51.4% of ECEC services reported having an AAI trainer device. Victoria reported the highest level of anaphylaxis management training (P < 0.05), and staff were significantly less likely to store their AAI devices in a locked location compared to New South Wales and Queensland (P < 0.001). New South Wales and Queensland had a significantly lower proportion of services with AAI training devices than Victoria (P < 0.001). CONCLUSIONS: ECEC staff self-reported high levels of training, knowledge, skills and confidence in FA and anaphylaxis management. However, we identified gaps in staff knowledge and skills, particularly in how to correctly store and administer an AAI device. Compliance with appropriate FA and anaphylaxis policies and emergency response plans need to be prioritised.

Measuring food provision in Western Australian long day care (LDC) services: a weighed food record method/protocol at a service level.

BACKGROUND: There are currently 1.3 million children utilising Early Childhood Education and Care (ECEC) services in Australia. Long day care (LDC), family day care and out of school hours care currently provide this service in different environments. This research reports findings from a LDC perspective. Children can consume 40-67% of their food intake whilst at LDC services, this highlights the importance of monitoring food provision at a service level. There are several methods to measure food provision which typically focus on intake at an individual level. There is limited evidence of measuring food provision accurately at a service level and for young children. Accurate and consistent dietary assessment methods are required to determine compliance with dietary guidelines and to provide rigour for comparison between studies. METHODS: Convenience sampling was used to recruit 30 LDC services and food provision assessed over two consecutive days. To ensure consistency, trained researchers weighed raw food ingredients used in food preparation at each service. Food and food weights were allocated to food groups to determine average serves of food group provision at morning tea, lunch and afternoon tea per child. All data were entered into Foodworks for dietary analysis and compliance with dietary guidelines was assessed using Wilcoxon signed-rank and one-sample t-tests (SPSS). DISCUSSION: This paper outlines the process of data collection for the measurement and auditing of food provision and food waste at a service level. There is an urgent need to ensure that food provision at a service level complies with current dietary guidelines and is accurately assessed. Following a standard method of data collection will allow a more accurate comparison between studies and allow change to be monitored more accurately over time to guide decision makers. TRIAL REGISTRATION: As this research project is conducted at a service level and not a clinical trial, registration was not required.

Local Challenges and Successes Associated with Transitioning to Sustainable Food System Practices for a West Australian Context: Multi-Sector Stakeholder Perceptions.

Large-scale food system practices have diminished soil and water quality and negatively impacted climate change. Yet, numerous opportunities exist to harness food system practices that will ensure better outcomes for human health and ecosystems. The objective of this study was to consider food Production, Processing, Access and Consumption domains, and for each determine the challenges and successes associated with progressing towards a sustainable food system. A workshop engaging 122 participants including producers, consultants, consumers, educators, funders, scientists, media, government and industry representatives, was conducted in Perth, Western Australia. A thematic analysis of statements (Successes (n = 170) or Challenges (n = 360)) captured, revealed issues of scale, knowledge and education, economics, consumerism, big food, environmental/sustainability, communication, policies and legislation, and technology and innovations. Policy recommendations included greater investment into research in sustainable agriculture (particularly the evidentiary basis for regenerative agriculture), land preservation, and supporting farmers to overcome high infrastructure costs and absorb labour costs. Policy, practice and research recommendations included focusing on an integrated food systems approach with multiple goals, food system actors working collaboratively to reduce challenges and undertaking more research to further the regenerative agriculture evidence.

The Food Literacy Action Logic Model: A Tertiary Education Sector Innovative Strategy to Support the Charitable Food Sectors Need for Food Literacy Training.

Food literacy is seen as a key component in improving the increasing levels of food insecurity. While responsibility for providing training falls on the charitable service organizations, they may not have the capacity to adequately reach those in need. This paper proposes a tertiary education - (university or higher education) led model to support the food literacy training needs of the food charity sector. A cross-sectional study comprised of online surveys and discussions investigated food services offered by Western Australia (WA) and Australian Capital Territory (ACT) agencies, food literacy training needs for staff, volunteers and clients, and challenges to delivering food literacy training programs. Purposive sampling was used, and ACT and WA charitable service originations (survey: ACT n = 23, WA n = 32; interviews: ACT n = 3, WA n = 2) were invited to participate. Findings suggest organizations had limited financial and human resources to address the gap in food literacy training. Nutrition, food budgeting, and food safety education was delivered to paid staff only with limited capacity for knowledge transfer to clients. The Food Literacy Action Logic Model, underpinned by a tertiary education engagement strategy, is proposed to support and build capacity for organizations to address training gaps and extend the reach of food literacy to this under-resourced sector.