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

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

Consumer perceptions of nutrient content claims in Australia: A qualitative study.

BACKGROUND: Nutrition and health claims influence consumer purchasing. Claims include content claims, which refer to the amount of a nutrient contained in a product, and health claims, which refer to health benefits of foods or nutrients in a product. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC). The present study aimed to explore consumer perceptions of content claims used on food and beverage labelling and advertisements. METHODS: Semi-structured focus groups were conducted with Australian consumers. Analysis involved an inductive, reflexive approach to thematic analysis. RESULTS: Six focus groups involving 26 participants were conducted. Four main interconnected themes were generated: (1) complex factors influence food choice; (2) content claim scepticism; (3) the difference between content and health claims is unclear; and (4) the regulation of content claims is not common knowledge. Content claims were used, although generally viewed through a lens of scepticism and mistrust, and seen as a promotional tool for the food industry. Product complexity appeared to increase content claim use as a result of consumer uncertainty of the content of complex products, such as ultraprocessed foods. Most participants were aware that content and health claims were in some way regulated. Overall, they did not know further detail, including the relevant regulatory body. CONCLUSIONS: For content claims to support the consumer they need to be accurate and their use limited to healthier foods. This can be achieved by requiring products with content claims to meet NPSC thresholds, as required for products making health claims.

Comparison of nutrition profiling models for food marketing regulation.

AIM: Regulation on food marketing to children is a recommended response to childhood obesity rates. Policy requires country-relevant criteria to determine which foods are eligible to be advertised. This study aims to compare six nutrition profiling models for use in food marketing regulation in Australia. METHODS: Advertisements on the outside of buses in five suburban Sydney transport hubs were photographed. Food and beverages advertised were analysed using the Health Star Rating; three models developed for food marketing regulation: the Australian Health Council guide and two World Health Organization models; the NOVA system; and the Nutrient Profiling Scoring Criterion used in Australian advertising industry codes. The proportion and types of products advertised on the buses that would be permitted by each of the six models were then analysed. RESULTS: A total of 603 advertisements were identified. Of those, over a quarter of the advertisements were for foods and beverages (n = 157, 26%) and 2.3% (n = 14) for alcohol. Among the food and non-alcoholic beverage advertisements, 84% were for unhealthy foods according to the Health Council guide. The Health Council guide would permit 31% unique foods to be advertised. The NOVA system would permit the least proportion of foods to be advertised (16%), while the Health Star Rating (40%), and Nutrient Profiling Scoring Criterion (38%) would permit the most. CONCLUSION: The Australian Health Council guide is the recommended model for food marketing regulation because it aligns with dietary guidelines by excluding discretionary foods from advertising. Australian governments can use the Health Council guide to develop policy in the National Obesity Strategy to protect children from marketing of unhealthy food.

Perceptions of adequacy of fruit and vegetable intake as a barrier to increasing consumption.

AIM: To investigate New South Wales adults' perceived adequacy of their fruit and vegetable consumption and to identify the barriers to consumption. METHOD: An online cross-sectional survey of a sample of adults in New South Wales (n = 1603) in February 2019 measured self-reported fruit and vegetable intakes, perception of consumption adequacy and barriers to consumption. Proportions of participants whose reported consumption met the daily recommended serves of fruit and vegetables per day were calculated. Chi-square and Fisher's exact tests were used to explore differences between demographic characteristics and meeting fruit and vegetable recommendations. For those not meeting recommendations, Chi-square and Fisher's exact tests were used to explore perceived adequacy of intake as a potential barrier to consumption. RESULTS: The sample included 52.7% women, 40.0% aged under 40 years and 28.6% over 59 years, 68.2% lived in a major city, and 32.6% were university educated. Overall, 64.8% of participants reported consuming adequate fruit and 12.4% reported consuming adequate vegetables. Of those consuming less than the guidelines, 21.3% perceived that they were eating enough fruit and 53.7% perceived they were eating enough vegetables. The most common barriers to eating more fruit were preference for other foods (29.6%), fruit spoiling too quickly (28.3%), and habit (27.0%). The most common barriers to eating more vegetables were the perception that they eat enough (26.8%), preference for other foods (21.9%), and habit (19.7%). CONCLUSIONS: Greater efforts are needed to support the public to eat adequate fruit and vegetables, consistent with dietary guidelines. Public education campaigns specifically targeting increasing vegetable consumption are required to address knowledge gaps, given a large proportion of our study population consumed inadequate levels of vegetables yet perceived their intake to be adequate.

Changes in public support for alcohol policies in NSW, Australia, 2013-2019.

OBJECTIVES: Alcohol contributes to significant health, social and economic burdens worldwide, but evidence-based policy options can reduce the harm associated with alcohol use. The aim of this paper is to understand factors influencing public support for various alcohol policies in New South Wales (NSW), Australia, and to determine any change over time. METHODS: An online survey of adults in NSW, in 2013 (n = 2482), 2016 (n = 1585) and 2019 (n = 1601), assessed support for alcohol policies. Multivariable logistic regression models examined the change in support over time, adjusting for demographics, alcohol consumption, smoking status and knowledge of alcohol as a risk factor for cancer. RESULTS: Most participants (68-72%) supported policies preventing underage internet users from exposure to alcohol advertising, and banning alcohol sponsorship of underage music and sporting events. Fiscal policies and restrictions on the number of alcohol outlets were the least supported policies (<40% support). Compared with 2013, participants in 2016 and 2019 were less likely to support policies increasing price, applying a volumetric tax and reducing the number of alcohol outlets. In 2019, more than 55% of respondents were aware that alcohol was a cancer risk factor, and knowledge of that relationship was associated with an increased likelihood of support for alcohol policies. CONCLUSIONS: Support was greatest for alcohol harm-reduction policies that had less impact on an individual's drinking. Overall, support for alcohol policies in NSW is not increasing. Initiatives to raise awareness about the health consequences of alcohol use, together with effective alcohol policies, are needed to counter industry influence on decision makers and negative public discourse.

An ecological study of obesity-related cancer incidence trends in Australia from 1983 to 2017.

Background: Overweight and obesity is a growing public health issue as it contributes to the future burden of obesity-related diseases, including cancer, especially in high-income countries. In Australia, 4.3% of all cancers diagnosed in 2013 were attributable to overweight and obesity. Our aim was to examine Australian age-specific incidence trends over the last 35 years for obesity-related cancers based on expert review (colorectal, liver, gallbladder, pancreas, breast in postmenopausal women, uterine, ovary, kidney, thyroid, and multiple myeloma) individually and pooled. Methods: Australian incidence data for 10 obesity-related cancers among people aged 25-84 years, diagnosed from 1983 to 2017, were obtained from the Australian Cancer Database. We used age-period-cohort modelling and joinpoint analysis to assess trends, estimating incidence rate ratios (IRR) by birth-cohort for each individual cancer and pooled, and the annual percentage change. The analyses were also conducted for non-obesity-related cancers over the same period. Findings: The total number of cancers where some proportion is obesity-related, diagnosed from 1983-2017, was 1,005,933. This grouping was 34.7% of cancers diagnosed. The IRR of obesity-related cancers increased from 0.77 (95% CI 0.73, 0.81) for the 1903 birth-cohort to 2.95 (95% CI 2.58, 3.38) for the recent 1988 cohort relative to the 1943 cohort. The IRRs of non-obesity related cancers were stable with non-significant decreases in younger cohorts. These trends were broadly similar across sex and age groups. Interpretation: The incidence of obesity-related cancers in Australia has increased by birth-cohort across all age-groups, which should be monitored. Obesity, a public health epidemic, needs to be addressed through increased awareness, policy support and evidence-based interventions. Funding: This research received no specific funding.

The Contribution of Nutrients of Concern to the Diets of 18-to-30-Year-Old Australians from Food Prepared Outside Home Differs by Food Outlet Types: The MYMeals Cross-Sectional Study.

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.

Monitoring complaints about food marketing to children under the Australian industry Codes 2015-20: a qualitative analysis.

OBJECTIVE: To analyse the case reports of complaints regarding food marketing to children over six years and compare Australian marketing Codes to best practice recommendations. METHODS: Case reports on complaints about food marketing to children under the five industry Codes - the Responsible Children's Marketing Initiative, the Quick Service Restaurant Initiative and the Australian Association of National Advertisers Code of Ethics, Code of Advertising and Marketing to Children and Food and Beverages Code - were qualitatively analysed. Reports on the Ad Standards website in the food/beverage groceries and food/beverage venues categories from 2015-2020 were investigated. The most common clauses from the Codes were identified and quotes from reports used to illustrate the determinations. Codes were compared with World Cancer Research Fund recommendations on policy to protect children. RESULTS: Only 14 of 119 complaints resulted in a reported breach of industry Codes. The most common reason for dismissing complaints involved clauses requiring advertisements to be 'primarily' directed to children. The Codes did not align with best practice recommendations. CONCLUSIONS: Complaints by the public show concern for food advertising to children but the Australian industry Codes fall short of addressing those concerns. Implications for public health: Government regulation is required to protect children from unhealthy food marketing.

Monitoring changes in community support for policies on obesity prevention.

OBJECTIVE: To investigate the New South Wales (NSW) community's support for obesity prevention policies and concern for food marketing and promotion issues, and to determine any demographic differences or changes over time. METHODS: In 2013 (n=2474), 2016 (n=1602) and 2019 (n=1613) a sample of adults who were representative of the NSW population for age, gender, education and location was asked about support for policy initiatives that influence the food environment. Analysis identified the characteristics of those who supported policies and variation in support over time. RESULTS: There were limited changes in support over time; however, support for many policies was strong and sustained. In 2019, support was highest for regulation of claims about nutrition (77.2%), and health warning labels (75.7%). Support for a ban on unhealthy food advertising that targets children (64.6%) had decreased since 2013. Women, older people and those who were aware that obesity was a risk factor for cancer were generally more likely to support policies. Parents were more likely than non-parents to be concerned about positioning unhealthy food at supermarket checkouts (OR 1.32) and unhealthy outdoor advertisements (OR 1.22). Concern increased in 2019 for unhealthy marketing on the internet (OR 1.21). CONCLUSIONS: This study shows public support for policy options at moderate to high levels but not increasing in the six-year study period. Implications for public health: These results form part of a package that, along with the well-established evidence, makes the case for policy action in Australia.

The Contribution of Foods Prepared Outside the Home to the Diets of 18- to 30-Year-Old Australians: The MYMeals Study.

Young adults are the highest consumers of food prepared outside home (FOH) and gain most weight among Australian adults. One strategy to address the obesogenic food environment is menu labelling legislation whereby outlets with >20 stores in one state and >50 Australia-wide must display energy content in kJ. The aim of this study was to assess the contribution of FOH to the energy and macronutrients, saturated fat, total sugars and sodium intakes of young Australians. One thousand and one 18 to 30-year-olds (57% female) residing in Australia's most populous state recorded all foods and beverages consumed and the location of preparation for three consecutive days using a purpose-designed smartphone application. Group means for the daily consumption of energy, percentage energy (%E) for protein, carbohydrate, total sugars, total and saturated fats, and sodium density (mg/1000 kJ) and proportions of nutrients from FOH from menu labelling and independent outlets were compared. Overall, participants consumed 42.4% of their energy intake from FOH with other nutrients ranging from 39.8% (sugars) to 47.3% (sodium). Independent outlets not required to label menus, contributed a greater percentage of energy (23.6%) than menu labelling outlets (18.7%, p < 0.001). Public health policy responses such as public education campaigns, extended menu labelling, more detailed nutrition information and reformulation targets are suggested to facilitate healthier choices.

Defining unhealthy food for regulating marketing to children-What are Australia's options?

AIM: To compare six nutrient profiling models for suitability in food marketing to children regulation. METHODS: Products (n = 220) advertised at transport hubs were classified as eligible/ineligible to be advertised to children using an Australian government developed guide (Council of Australian Governments), the Health Star Rating system before and after the modifications made in 2020, World Health Organization Western Pacific Region and Europe nutrient profile criterion and the NOVA food classification system. Agreement between models was determined using Cohen's Kappa. RESULTS: The Council of Australian Governments' guide was able to classify more products than the other models (n = 210) and was easy to use as it did not require nutrition information. It agreed most closely with NOVA (moderate agreement). The proportion of foods classified as eligible to be marketed (most strict) was lowest for NOVA (10%), similar for Council of Australian Governments and the World Health Organisation models (16%-17%) and highest for Health Star Rating models (26%-28%). CONCLUSIONS: The Council of Australian Governments' guide provides simple, easy to use profiling criteria aligned with Australian dietary advice. Political will is now required to incorporate a profiling model within government-endorsed food marketing regulation.

Changes in nutrition content and health claims post-implementation of regulation in Australia.

OBJECTIVE: To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code. DESIGN: Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016. SETTING: Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016. PARTICIPANTS: All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging. RESULTS: Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011-2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001). CONCLUSIONS: The proportion of products carrying claims that do not meet nutrient profiling and consumers' tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.

A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children's nutrition.

BACKGROUND: Globally children's diet quality is poor. Parents are primary gatekeepers to children's food intake; however, reaching and engaging parents in nutrition promotion can be challenging. With growth in internet and smartphone use, digital platforms provide potential to disseminate information rapidly to many people. The objectives of this review were to conduct a comprehensive and systematic evaluation of nutrition promotion via websites and apps supporting parents to influence children's nutrition, from three different perspectives: 1) current evidence base, 2) end user (parent) experience and 3) current commercial offerings. METHODS: Three systematic reviews were undertaken of (1) studies evaluating the effectiveness for digital platforms for improving nutrition in children and parents, (2) studies conducting user-testing of digital tools with parents, (3) websites and apps providing lunch-provision information to parents. Searches were conducted in five databases for reviews one and two, and systematic search of Google and App Store for review three. Randomised controlled trials, cohort and cross-sectional and qualitative studies (study two only) were included if published in English, from 2013, with the intervention targeted at parents and at least 50% of intervention content focused on nutrition. Search results were double screened, with data extracted into standardised spreadsheets and quality appraisal of included search results. RESULTS: Studies evaluating digital nutrition interventions targeting parents (n = 11) demonstrated effectiveness for improving nutrition outcomes, self-efficacy and knowledge. Six of the included randomised controlled trials reported digital interventions to be equal to, or better than comparison groups. User-testing studies (n = 9) identified that digital platforms should include both informative content and interactive features. Parents wanted evidence-based information from credible sources, practical tools, engaging content and connection with other users and health professionals. Websites targeting lunch provision (n = 15) were developed primarily by credible sources and included information-based content consistent with dietary guidelines and limited interactive features. Lunchbox apps (n = 6), developed mostly by commercial organisations, were more interactive but provided less credible information. CONCLUSIONS: Digital nutrition promotion interventions targeting parents can be effective for improving nutrition-related outcomes in children and parents. As demonstrated from the lunchbox context and user-testing with parents, they need to go beyond just providing information about positive dietary changes, to include the user-desired features supporting interactivity and personalisation.

Countering commercial interests: building advocacy campaigns to protect children from food marketing.

OBJECTIVES: To describe the strategies used by Cancer Council NSW (CCNSW) and Obesity Policy Coalition (OPC) to influence government policy on food marketing to children. Type of programs: Comprehensive advocacy campaigns. METHODS: We present the components of an advocacy campaign run by OPC and another campaign run by CCNSW to protect children from unhealthy food marketing. We look at the successes and challenges of the campaigns and discuss future directions. RESULTS: CCNSW has focused on a community-organising and mobilisation model, while OPC has invested in building relationships with key stakeholders such as decision makers. Both organisations have ensured that protecting children from unhealthy food marketing is highlighted through media advocacy and stakeholder engagement. The issue has remained a public health priority despite limited policy windows. LESSONS LEARNT: Creating a climate for change and facilitating policy action to protect children from unhealthy food marketing can be achieved with: 1) presentation of a clear, united public-health solution; 2) using earned (or unpaid) media to gain public attention; and 3) sustained community and political engagement.

The Role of Supportive Food Environments to Enable Healthier Choices When Eating Meals Prepared Outside the Home: Findings from Focus Groups of 18 to 30-Year-Olds.

Young adults are the highest consumers of food prepared outside home, which has been linked to weight gain. The aim of this qualitative research was to gather opinions from young adults about what influences their food choice when eating out and if they so desired, what might enable healthy choices. Thirty-one adults aged 18 to 30 years participated in four focus groups (females = 24). Predetermined questions were used to guide discussions which were audiotaped then transcribed. The content was organized into themes and sub-themes using NVivo software. Two broad groupings arose-personal behaviors and changes to physical and social food environments. For many, eating out was viewed as a special occasion so that healthy food was not a priority and despite understanding health consequences of poor diets this was not an immediate concern. Price discounts and menu-labelling were suggested and trust in credible organizations and peers' endorsement of meals and venues expressed. The role of smartphones in the modern food environment emerged as a tool to enable immediate access to many restaurants to order food and access reviews and social media as a source of persuasive food imagery. Current menu-labelling initiatives should continue, food pricing be explored and influence of smartphones on diet further researched. However, these findings may be limited by the high proportion of women and higher socioeconomic status and urban residence of many participants.

Nutrient composition of Australian fast-food and fast-casual children's meals available in 2016 and changes in fast-food meals between 2010 and 2016.

OBJECTIVE: A quarter of Australian children are overweight or obese. Research conducted in 2010 found that fast-food children's meals were energy-dense and nutrient-poor. Since then, menu labelling and self-regulation of marketing have been introduced in Australia. The present study aimed to: (i) investigate the nutrient composition of children's meals offered at fast-food chains; (ii) compare these with children's daily requirements and recommendations and the food industry's own criteria for healthier children's meals; and (iii) determine whether results have changed since last investigated in 2010. DESIGN: An audit of nutrition information for fast-food children's meals was conducted. Meals were compared with 30 % (recommended contribution for a meal) and 100 % of children's daily recommendations and requirements. A comparative analysis was conducted to determine if the proportion of meals that exceeded meal requirements and recommendations, and compliance with the food industry's own criteria, changed between 2010 and 2016. SETTING: Large Australian fast-food chains. PARTICIPANTS: All possible children's meal combinations. RESULTS: Overall, 289 children's meals were included. Most exceeded 30 % of daily recommendations and requirements for a 4-year-old's energy, saturated fat, sugars and Na. Results were also substantial for 8- and 13-year-olds, particularly for Na. When compared with mean energy and nutrient contents from 2010, there were minimal changes overall. CONCLUSIONS: Children's meals can provide excess energy, saturated fat, sugar and Na to children's diets. Systematic reformulation of energy, saturated fat, sugars and Na would improve the nutrient composition of the meals.

How effective is food industry self-substantiation of food-health relationships underpinning health claims on food labels in Australia?

OBJECTIVE: The Food Standards Code regulates health claims on Australian food labels. General-level health claims highlight food-health relationships, e.g. 'contains calcium for strong bones'. Food companies making claims must notify Food Standards Australia New Zealand (FSANZ) and certify that a systematic literature review (SLR) substantiating the food-health relationship has been conducted. There is no pre- or post-notification assessment of the SLR, potentially enabling the food industry to make claims based on poor-quality research. The present study assessed the rigour of self-substantiation. DESIGN: Food-health relationships notified to FSANZ were monitored monthly between 2013 and 2017. These relationships were assessed by scoping published literature. Where evidence was equivocal/insufficient, the relevant government food regulatory agency was asked to investigate. If not investigated, or the response was unsatisfactory, the project team conducted an independent SLR which was provided to the government agency. SETTING: Australia.ParticipantsSelf-substantiated food-health relationships. RESULTS: There were sixty-seven relationships notified by thirty-eight food companies. Of these, thirty-three relationships (52 %) from twenty companies were deemed to have sufficient published evidence. Four were excluded as they originated in New Zealand. Three relationships were removed before investigations were initiated. The project initiated twenty-seven food-health relationship investigations. Another six relationships were withdrawn, and three relationships were awaiting government assessment. CONCLUSIONS: To ensure that SLR underpinning food-health relationships are rigorous and reduce regulatory enforcement burden, pre-market approval of food-health relationships should be introduced. This will increase consumer and public health confidence in the regulatory process and prevent potentially misleading general-level health claims on food labels.

Examining the Frequency and Contribution of Foods Eaten Away From Home in the Diets of 18- to 30-Year-Old Australians Using Smartphone Dietary Assessment (MYMeals): Protocol for a Cross-Sectional Study.

BACKGROUND: Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes. OBJECTIVES: The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults' total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults. METHODS: A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns. RESULTS: Recruitment is underway, and results will be available in 2018. CONCLUSIONS: The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people's diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified.

Monitoring the changes to the nutrient composition of fast foods following the introduction of menu labelling in New South Wales, Australia: an observational study.

OBJECTIVE: The present study examined the energy (kilojoule) content of Australian fast-food menu items over seven years, before and after introduction of menu board labelling, to determine the impact of the introduction of the legislation. DESIGN: Analysis of the median energy contents per serving and per 100g of fast-food menu items. Change in energy content of menu items across the years surveyed and differences in energy content of standard and limited-time only menu items were analysed. SETTING: Five of Australia's largest fast food chains: Hungry Jack's, KFC, McDonald's, Oporto and Red Rooster. SUBJECTS: All standard and limited-time only menu items available at each fast-food chain, collected annually for seven years, 2009-2015. RESULTS: Although some fast-food chains/menu item categories had significant increases in the energy contents of their menus at some time points during the 7-year period, overall there were no significant or systematic decreases in energy following the introduction of menu labelling (P=0·19 by +17 kJ/100 g, P=0·83 by +8 kJ/serving). Limited-time only items were significantly higher in median energy content per 100 g than standard menu items (+74 kJ/100 g, P=0·002). CONCLUSIONS: While reformulation across the entire Australian fast-food supply has the potential to positively influence population nutrient intake, the introduction of menu labelling legislation in New South Wales, Australia did not lead to reduced energy contents across the five fast-food chains. To encourage widespread reformulation by the fast-food industry and enhance the impact of labelling legislation, the government should work with industry to set targets for reformulation of nutrient content.