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McMahon E, Ferguson M, Wycherley T, Gunther A, Brimblecombe J. Development of a Tool for Reporting Key Dietary Indicators from Sales Data in Remote Australian Aboriginal and Torres Strait Islander Community Stores. Nutrients 2024; 16:1058. [PMID: 38613091 PMCID: PMC11013159 DOI: 10.3390/nu16071058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/20/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Reporting key dietary indicators from sales data can help us guide store decision makers in developing effective store policy to support healthier customer purchases. We aimed to develop a web-based reporting tool of key dietary indicators from sales data to support health-promoting policy and practice in stores in geographically remote Aboriginal and Torres Strait Islander communities. Tool development included identifying key dietary indicators (informed by sales data from 31 stores), community consultation (19 Aboriginal and Torres Strait Islander store directors and two store managers) and a web-build. Tool evaluation involved feedback interviews with stakeholders (25 store managers and two nutritionists). Key dietary indicators aligned with Australian Dietary Guideline food groupings and recommendations. An online portal for accessing and customising reports was built. Stakeholder feedback indicated that the strengths of the reports were the visuals, ease of interpretation, providing information that was not currently available and potential to increase capacity to support healthy food retailing. Difficulties were defining healthiness classification with alignment to other nutrition guidelines used and ensuring reports reached relevant store decision makers. This tool may be valuable to support store decision makers in identifying and prioritising nutrition issues and optimising the health-enabling attributes of stores.
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Affiliation(s)
- Emma McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia (A.G.)
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia
| | - Megan Ferguson
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia (A.G.)
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia
- School of Public Health, University of Queensland, Herston, QLD 4006, Australia
| | - Thomas Wycherley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
| | - Anthony Gunther
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia (A.G.)
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia (A.G.)
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia
- School of Public Health, University of Queensland, Herston, QLD 4006, Australia
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Dancey J, Reeve B, Jones A, Ferguson M, van Burgel E, Brimblecombe J. The use of private regulatory measures to create healthy food retail environments: a scoping review. Public Health Nutr 2024; 27:e88. [PMID: 38465376 PMCID: PMC11010160 DOI: 10.1017/s136898002400065x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/16/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these. DESIGN Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework. SETTING Food retail. PARTICIPANTS Food retail settings using private regulatory measures to create healthier food retail environments. RESULTS In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35). CONCLUSIONS We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.
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Affiliation(s)
- Jane Dancey
- Department of Nutrition, Dietetics and Food, Monash
University, Clayton, VIC,
Australia
| | - Belinda Reeve
- The University of Sydney Law School, Sydney,
NSW, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New
South Wales, UNSW, Sydney, NSW,
Australia
| | - Megan Ferguson
- School of Public Health, The University of
Queensland, Herston, QLD,
Australia
| | - Emma van Burgel
- Department of Nutrition, Dietetics and Food, Monash
University, Clayton, VIC,
Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash
University, Clayton, VIC,
Australia
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3
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Day G, Collins J, Twohig C, De Silva K, Brimblecombe J. Towards healthy food retail: An assessment of public health nutrition workforce capacity to work with stores. Aust N Z J Public Health 2023; 47:100056. [PMID: 37182502 DOI: 10.1016/j.anzjph.2023.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE This article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet. METHODS Convergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisations that provide a nutrition professional service to food retail stores in remote Australia. The study participants include 11 nutrition professionals and eight organisation representatives, including managers, organisation directors and policy officers. Systems-mapping and thematic analysis of the in-depth interviews were conducted using a capacity development framework. Descriptive analysis was applied to pre-interview survey and mapping data. RESULTS A gap between the aspirational work and current capacity of nutrition professionals to engage effectively with stores was identified. Engagement with stores to improve population health was valued by organisations. Dominance of the medical health model limited organisation strategic support for store work and created barriers. Key barriers included the limited access to training, decision-support tools, information, financial resources and organisational structures that directed store work. CONCLUSIONS Provision of adequate store-specific training, resources and organisational support may empower the nutrition professional workforce to be powerful leaders in co-design for healthy food retail. IMPLICATIONS FOR PUBLIC HEALTH Building capacity for this critical workforce to engage in food retail practice change must consider the influence of the broader health system and employer organisations and need for access to evidence-based decision-support tools.
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Affiliation(s)
- Georgia Day
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Cliona Twohig
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation (ALPA), 70 O'Sullivan Circuit, East Arm, Northern Territory, 0822, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia; Menzies School of Health Research, John Mathews Building (58), Royal Darwin Hospital Campus, 58 Rocklands Dr, Tiwi, NT, 0810, Australia.
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Yarning about Diet: The Applicability of Dietary Assessment Methods in Aboriginal and Torres Strait Islander Australians-A Scoping Review. Nutrients 2023; 15:nu15030787. [PMID: 36771491 PMCID: PMC9919225 DOI: 10.3390/nu15030787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Conventional dietary assessment methods are based predominately on Western models which lack Aboriginal and Torres Strait Islander knowledges, methodologies, and social and cultural contextualisation. This review considered dietary assessment methods used with Aboriginal and Torres Strait Islander populations and assessed their applicability. Four electronic databases and grey literature were searched with no time limit applied to the results. Screening, data extraction and quality appraisal were undertaken independently by two reviewers. Out of 22 studies, 20 were conducted in rural/remote settings, one in an urban setting, and one at the national population level. The most frequently used and applicable dietary assessment method involved store data. Weighed food records and food frequency questionnaires had low applicability. Modifications of conventional methods were commonly used to adapt to Indigenous practices, but few studies incorporated Indigenous research methodologies such as yarning. This highlights an opportunity for further investigation to validate the accuracy of methods that incorporate qualitative yarning-based approaches, or other Indigenous research methodologies, into quantitative data collection. The importance of developing validated dietary assessment methods that are appropriate for this population cannot be understated considering the high susceptibility to nutrition-related health conditions such as malnutrition, overweight or obesity, diabetes, and cardiovascular disease.
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Validation of the Thumbs food classification system as a tool to accurately identify the healthiness of foods. Br J Nutr 2022; 129:2001-2010. [PMID: 36038139 PMCID: PMC10167659 DOI: 10.1017/s0007114522002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess: (1) the Thumbs system’s alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying ‘unhealthy’ (contributing to discretionary energy and added sugars) and ‘healthy’ products against HSR and NTSCG; (3) areas for optimisation. Food and beverage products sold between 05/2018 and 05/2019 in fifty-one remote stores were classified in each system. System alignment was assessed by cross-tabulating percentages of products, discretionary energy and added sugars sold assigned to the same healthiness levels across the systems. The system/s capturing the highest percentage of discretionary energy and added sugars sold in ‘unhealthy’ products and the lowest levels in ‘healthy’ products were considered the best performing. Cohen’s κ was used to assess agreement between the Thumbs system and the NTSCG for classifying products as healthy. The Thumbs system classified product healthiness in line with the HSR and NTSCG, with Cohen’s κ showing moderate agreement between the Thumbs system and the NTSCG (κ = 0·60). The Thumbs system captured the most discretionary energy sold (92·2 %) and added sugar sold (90·6 %) in unhealthy products and the least discretionary energy sold (0 %) in healthy products. Modifications to optimise the Thumbs system include aligning several food categories to the NTSCG criteria and addressing core/discretionary classification discrepancies of fruit juice/drinks. The Thumbs system offers a classification algorithm that could strengthen the HSR system.
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Gilbert SZ, Morrison CL, Chen QJ, Punian J, Bernstein JT, Jessri M. Algorithm-based mapping of products in a branded Canadian food and beverage database to their equivalents in Health Canada's Canadian Nutrient File. Front Nutr 2022; 9:1013516. [PMID: 36873256 PMCID: PMC9980422 DOI: 10.3389/fnut.2022.1013516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/13/2022] [Indexed: 02/18/2023] Open
Abstract
Introduction There is increasing recognition of the value of linking food sales databases to national food composition tables for population nutrition research. Objectives Expanding upon automated and manual database mapping approaches in the literature, our aim was to match 1,179 food products in the Canadian data subset of Euromonitor International's Passport Nutrition to their closest respective equivalents in Health Canada's Canadian Nutrient File (CNF). Methods Matching took place in two major steps. First, an algorithm based on thresholds of maximal nutrient difference (between Euromonitor and CNF foods) and fuzzy matching was executed to offer match options. If a nutritionally appropriate match was available among the algorithm suggestions, it was selected. When the suggested set contained no nutritionally sound matches, the Euromonitor product was instead manually matched to a CNF food or deemed unmatchable, with the unique addition of expert validation to maximize meticulousness in matching. Both steps were independently performed by at least two team members with dietetics expertise. Results Of 1,111 Euromonitor products run through the algorithm, an accurate CNF match was offered for 65% of them; missing or zero-calorie data precluded 68 products from being run in the algorithm. Products with 2 or more algorithm-suggested CNF matches had higher match accuracy than those with one (71 vs. 50%, respectively). Overall, inter-rater agreement (reliability) rates were robust for matches chosen among algorithm options (51%) and even higher regarding whether manual selection would be required (71%); among manually selected CNF matches, reliability was 33%. Ultimately, 1,152 (98%) Euromonitor products were matched to a CNF equivalent. Conclusion Our reported matching process successfully bridged a food sales database's products to their respective CNF matches for use in future nutritional epidemiological studies of branded foods sold in Canada. Our team's novel utilization of dietetics expertise aided in match validation at both steps, ensuring rigor and quality of resulting match selections.
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Affiliation(s)
- Sappho Z Gilbert
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.,Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Conor L Morrison
- Department of Statistics, Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Qiuyu J Chen
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Jesman Punian
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Jodi T Bernstein
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Mahsa Jessri
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Services and Policy Research (CHSPR) and Health Services and Policy (HSP), Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Effects of Nutritional Interventions on Cardiovascular Disease Health Outcomes in Aboriginal and Torres Strait Islander Australians: A Scoping Review. Nutrients 2021; 13:nu13114084. [PMID: 34836337 PMCID: PMC8620344 DOI: 10.3390/nu13114084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022] Open
Abstract
Nutrition interventions can support Aboriginal and Torres Strait Islander peoples to reduce their risk of cardiovascular disease (CVD). This review examines nutritional interventions aiming to improve CVD outcomes and appraises peer-reviewed interventions using an Aboriginal and Torres Strait Islander Quality Appraisal Tool. Five electronic databases and grey literature were searched, applying no time limit. Two reviewers completed the screening, data extraction and quality assessment independently. The study quality was assessed using the South Australian Health and Medical Research Institute and the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Twenty-one nutrition programs were included in this review. Twelve reported on anthropometric measurements, ten on biochemical and/or hematological measurements and sixteen on other outcome domains. Most programs reported improvements in measurable CVD risk factors, including reduced body mass index (BMI), waist circumference (WC), weight, blood pressure and improved lipid profiles. Most programs performed well at community engagement and capacity strengthening, but many lacked the inclusion of Indigenous research paradigms, governance and strengths-based approaches. This review highlights the need for contemporary nutrition programs aimed at improving cardiovascular health outcomes to include additional key cultural components.
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8
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Hunt W, Bedoya‐Perez M, Geesink G, Van Den Heuvel A, Mullen J, Frost D. Harvesting Agile Wallabies for human consumption in the Northern Territory of Australia. ECOLOGICAL MANAGEMENT & RESTORATION 2021. [DOI: 10.1111/emr.12495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Contributions of Food Environments to Dietary Quality and Cardiovascular Disease Risk. Curr Atheroscler Rep 2021; 23:14. [PMID: 33594516 DOI: 10.1007/s11883-021-00912-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW To evaluate the multidimensional influence of food environments on food choice, dietary quality, and diet-related health and identify critical gaps necessary to develop effective population interventions that influence food choice. RECENT FINDINGS Multicomponent interventions that interact with multiple layers of the food environment show limited but consistent effects on dietary behaviors and may have wider and substantive population-level reach with greater incorporation of validated, holistic measurement tools. Opportunities to use smartphone technology to measure multiple components of the food environment will facilitate future interventions, particularly as food environments expand into online settings and interact with consumers in novel ways to shape food choice. While studies suggest that all dimensions of the food environment influence diet and health outcomes, robust and consistent measurements of food environments that integrate objective and subjective components are essential for developing stronger evidence needed to shift public policies.
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Kenny TA, Little M, Lemieux T, Griffin PJ, Wesche SD, Ota Y, Batal M, Chan HM, Lemire M. The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238818. [PMID: 33261090 PMCID: PMC7730644 DOI: 10.3390/ijerph17238818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.
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Affiliation(s)
- Tiff-Annie Kenny
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, QC G1V 0A6, Canada;
- Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC G1E 6W2, Canada
- Correspondence: or
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Tad Lemieux
- Department of English Language and Literature, Carleton University, Ottawa, ON K1S 5B6, Canada;
| | - P. Joshua Griffin
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA; (P.J.G.); (Y.O.)
- Department of American Indian Studies, University of Washington, Seattle, WA 98195, USA
| | - Sonia D. Wesche
- Department of Geography, Environment and Geomatics, Faculty of Arts, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Yoshitaka Ota
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA; (P.J.G.); (Y.O.)
- Nippon Foundation Ocean Nexus Center, EarthLab, University of Washington; Seattle, WA 98195, USA
| | - Malek Batal
- Département de nutrition, Faculté de médecine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, QC H3N 1X9, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, Ottawa, ON K1N 9A7, Canada;
| | - Melanie Lemire
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, QC G1V 0A6, Canada;
- Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC G1E 6W2, Canada
- Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Quebec, QC G1V 0A6, Canada
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Valluri S, French SA, Elbel B, Oakes JM, Rydell SA, Harnack LJ. Within- and Between-Household Variation in Food Expenditures Among Low-Income Households Using a Novel Simple Annotated Receipt Method. Front Nutr 2020; 7:582999. [PMID: 33195373 PMCID: PMC7642585 DOI: 10.3389/fnut.2020.582999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Household food purchasing behavior has gained interest as an intervention to improve nutrition and nutrition-associated outcomes. However, evaluating food expenditures is challenging in epidemiological studies. Assessment methods that are both valid and feasible for use among diverse, low-income populations are needed. We therefore developed a novel simple annotated receipt method to assess household food purchasing. First, we describe and evaluate the extent to which the method captures food purchasing information. We then evaluate within- and between-household variation in weekly food purchasing to determine sample sizes and the number of weeks of data needed to measure household food purchasing with adequate precision. Methods: Four weeks of food purchase receipt data were collected from 260 low-income households in the Minneapolis-St. Paul metropolitan area. The proportion of receipt line items that could not be coded into one of 11 food categories (unidentified) was calculated, and a zero-inflated negative binomial regression was used to evaluate the association between unidentified receipt items and participant characteristics and store type. Within- and between-household coefficients of variation were calculated for total food expenditures and several food categories. Results: A low proportion of receipt line items (1.6%) could not be coded into a food category and the incidence of unidentified items did not appreciably vary by participant characteristics. Weekly expenditures on foods high in added sugar had higher within- and between-household coefficients of variation than weekly fruit and vegetable expenditures. To estimate mean weekly food expenditures within 20% of the group's usual (“true”) expenditures, 72 households were required. Nine weeks of data were required to achieve an r = 0.90 between observed and usual weekly food expenditures. Conclusions: The simple annotated receipt method may be a feasible tool for use in assessing food expenditures of low-income, diverse populations. Within- and between-household coefficients of variation suggest that the number of weeks of data or group sizes required to precisely estimate usual household expenditures is higher for foods high in added sugar compared to fruits and vegetables.
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Affiliation(s)
- Sruthi Valluri
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States.,Medical Scientist Training Program, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Brian Elbel
- School of Medicine and Wagner School of Public Service, New York University, New York, NY, United States
| | - J Michael Oakes
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah A Rydell
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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12
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Brimblecombe J, McMahon E, Ferguson M, De Silva K, Peeters A, Miles E, Wycherley T, Minaker L, Greenacre L, Gunther A, Chappell E, Chatfield MD, Mah CL. Effect of restricted retail merchandising of discretionary food and beverages on population diet: a pragmatic randomised controlled trial. Lancet Planet Health 2020; 4:e463-e473. [PMID: 33038320 DOI: 10.1016/s2542-5196(20)30202-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contributing most to free sugar sales, on food and beverage sales. METHODS In this community-level pragmatic, partially randomised, parallel group trial, stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a co-designed strategy restricted merchandising of unhealthy food, or to a control group of usual retail practice. The trial was done in partnership with an organisation operating 25 stores in remote Australia. The primary analysis was based on difference in weekly sales with the strategy compared with no strategy in free sugar from all foods and beverages (g/total MJ; primary outcome), targeted food or beverages (weight and free sugars; g/total MJ), and gross profit (AU$) using mixed models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001588280. FINDINGS Between June 13 and Aug 15, 2018, 20 stores were recruited; ten stores were randomly assigned to the intervention group and ten stores to the control group. The trial was done between Sept 2 and Dec 2, 2018. The Healthy Stores 2020 strategy resulted in a reduction in sales of free sugar of 2·8% (95% CI -4·9 to -0·7). Targeted beverages were reduced by 8·4% (-12·3 to -4·3) and associated free sugar by 6·8% (-10·9 to -2·6), sugar-sweetened soft drinks by 13·2% (-18·5 to -7·6), and associated free sugar by 13·4% (-18·7 to -7·7). Reductions in sales of free sugar from confectionery of 7·5% (-14·3 to -0·2) and in weight sold (-4·6%, -11·1 to 2·3) resulted; however, the reduction in weight was not statistically significant. No differences in sales of table sugar and sweet biscuits were observed. Gross profit was not impacted adversely; a small increase resulted (5·3%, 0·3 to 10·5). INTERPRETATION Restricted merchandising of unhealthy foods and beverages, while allowing for complementary merchandising of healthier foods and beverages in a real-world store setting and co-designed with retailers, can achieve both public health and business relevant gains. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia; Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia.
| | - Emma McMahon
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Edward Miles
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Thomas Wycherley
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Leia Minaker
- School of Planning, University of Waterloo, Waterloo, ON, Canada
| | - Luke Greenacre
- Business School, Monash University, Melbourne, VIC, Australia
| | - Anthony Gunther
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Emma Chappell
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Catherine L Mah
- Faculty of Health, Dalhousie University, Halifax, NS, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Green MA, Watson AW, Brunstrom JM, Corfe BM, Johnstone AM, Williams EA, Stevenson E. Comparing supermarket loyalty card data with traditional diet survey data for understanding how protein is purchased and consumed in older adults for the UK, 2014-16. Nutr J 2020; 19:83. [PMID: 32791968 PMCID: PMC7427066 DOI: 10.1186/s12937-020-00602-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Our ability to understand population-level dietary intake patterns is dependent on having access to high quality data. Diet surveys are common diet assessment methods, but can be limited by bias associated with under-reporting. Food purchases tracked using supermarket loyalty card records may supplement traditional surveys, however they are rarely available to academics and policy makers. The aim of our study is to explore population level patterns of protein purchasing and consumption in ageing adults (40 years onwards). Methods We used diet survey data from the National Diet and Nutrition Survey (2014–16) on food consumption, and loyalty card records on food purchases from a major high street supermarket retailer (2016–17) covering the UK. We computed the percentage of total energy derived from protein, protein intake per kg of body mass, and percentage of protein acquired by food type. Results We found that protein consumption (as the percentage of total energy purchased) increased between ages 40–65 years, and declined thereafter. In comparison, protein purchased in supermarkets was roughly 2–2.5 percentage points lower at each year of age. The proportion of adults meeting recommended levels of protein was lowest in age groups 55–69 and 70+. The time of protein consumption was skewed towards evening meals, with low intakes during breakfast or between main meals. Meat, fish and poultry dominated as sources of protein purchased and consumed, although adults also acquired a large share of their protein from dairy and bread, with little from plant protein. Conclusions Our study provides novel insights into how protein is purchased and consumed by ageing adults in the UK. Supermarket loyalty card data can reveal patterns of protein purchasing that when combined with traditional sources of dietary intake may enhance our understanding of dietary behaviours.
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Affiliation(s)
- Mark A Green
- Geographic Data Science Lab, School of Environmental Sciences, University of Liverpool, Liverpool, UK.
| | - Anthony W Watson
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon-Tyne, UK
| | | | - Bernard M Corfe
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | | | | | - Emma Stevenson
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon-Tyne, UK
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14
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Fehring E, Ferguson M, Brown C, Murtha K, Laws C, Cuthbert K, Thompson K, Williams T, Hammond M, Brimblecombe J. Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community‐led supportive environment approach. Aust N Z J Public Health 2019; 43:551-557. [DOI: 10.1111/1753-6405.12950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Megan Ferguson
- School of Public Health, The University of Queensland
- Menzies School of Health Research, Northern Territory
| | - Clare Brown
- Apunipima Cape York Health Council, Queensland
| | - Kirby Murtha
- Menzies School of Health Research, Northern Territory
| | - Cara Laws
- Apunipima Cape York Health Council, Queensland
| | | | | | | | | | - Julie Brimblecombe
- Menzies School of Health Research, Northern Territory
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
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Wycherley TP, van der Pols JC, Daniel M, Howard NJ, O'Dea K, Brimblecombe JK. Associations between Community Environmental-Level Factors and Diet Quality in Geographically Isolated Australian Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111943. [PMID: 31159330 PMCID: PMC6603945 DOI: 10.3390/ijerph16111943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022]
Abstract
Remote Indigenous Australians experience disproportionately poor cardio-metabolic health, which is largely underpinned by adverse dietary intake related to social determinants. Little evidence exists about the community environmental-level factors that shape diet quality in this geographically isolated population group. This study aimed to explore the modifiable environmental-level factors associated with the features of dietary intake that underpin cardio-metabolic disease risk in this population group. Community-level dietary intake data were estimated from weekly store sales data collected throughout 2012 and linked with concurrent social, built, and physical environmental dimension data for 13 remote Indigenous Australian communities in the Northern Territory. Statistical analyses were performed to investigate associations. At the community level, store sales of discretionary foods were lower in communities with greater distance to a neighbouring store (r = −0.45 (p < 0.05)). Sales of sugar-sweetened beverages were lower in communities with higher levels of household crowding (r = −0.55 (p < 0.05)), higher levels of Indigenous unemployment (r = −0.62 (p = 0.02)), and greater distance to neighbouring stores (r = −0.61 (p = 0.004)). Modifiable environmental-level factors may be associated with adverse diet quality in remote Indigenous Australian communities and further investigations of these factors should be considered when developing policies to improve dietary intake quality in geographically isolated populations.
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Affiliation(s)
- Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity; University of South Australia, Adelaide 5000, Australia.
- Wellbeing and Preventable Chronic Diseases Division; Menzies School of Health Research, Darwin 0810, Australias Division.
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences; Queensland University of Technology, Brisbane 4001, Australia.
| | - Mark Daniel
- Health Research Institute; University of Canberra, Canberra 2617, Australia.
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy 3010, Australia.
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia.
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide 5000, Australia.
| | - Julie K Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division; Menzies School of Health Research, Darwin 0810, Australias Division.
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne 3800, Australia.
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16
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Wright KM, Dono J, Brownbill AL, Pearson Nee Gibson O, Bowden J, Wycherley TP, Keech W, O'Dea K, Roder D, Avery JC, Miller CL. Sugar-sweetened beverage (SSB) consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review. BMJ Open 2019; 9:e023630. [PMID: 30819702 PMCID: PMC6398687 DOI: 10.1136/bmjopen-2018-023630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. METHODS PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. DESIGN Systematic scoping review. RESULTS 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). CONCLUSIONS There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from an existing nationally representative survey of Aboriginal and Torres Strait Islander people could provide detailed information for demographic subgroups and benchmarks for future interventions. It is recommended that a consistent, culturally appropriate, set of consumption measures be developed.
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Affiliation(s)
- Kathleen M Wright
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Dono
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Aimee L Brownbill
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Odette Pearson Nee Gibson
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Jacqueline Bowden
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas P Wycherley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Wendy Keech
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Health Translation SA, Adelaide, South Australia, Australia
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - David Roder
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jodie C Avery
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Caroline L Miller
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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17
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Brown C, Laws C, Leonard D, Campbell S, Merone L, Hammond M, Thompson K, Canuto K, Brimblecombe J. Healthy Choice Rewards: A Feasibility Trial of Incentives to Influence Consumer Food Choices in a Remote Australian Aboriginal Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010112. [PMID: 30609836 PMCID: PMC6339254 DOI: 10.3390/ijerph16010112] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022]
Abstract
Poor diet including inadequate fruit and vegetable consumption is a major contributor to the global burden of disease. Aboriginal and Torres Strait Islander Australians experience a disproportionate level of preventable chronic disease and successful strategies to support Aboriginal and Torres Strait Islander people living in remote areas to consume more fruit and vegetables can help address health disadvantage. Healthy Choice Rewards was a mixed methods study to investigate the feasibility of a monetary incentive: store vouchers, to promote fruit and vegetable purchasing in a remote Australian Aboriginal community. Multiple challenges were identified in implementation, including limited nutrition workforce. Challenges related to the community store included frequent store closures and amended trading times, staffing issues and poor infrastructure to support fruit and vegetable promotion. No statistically significant increases in fruit or vegetable purchases were observed in the short time frame of this study. Despite this, community members reported high acceptability of the program, especially for women with children. Optimal implementation including, sufficient time and funding resources, with consideration of the most vulnerable could go some way to addressing inequities in food affordability for remote community residents.
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Affiliation(s)
- Clare Brown
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Cara Laws
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, 4870 Cairns, Australia.
| | - Sandy Campbell
- Centre for Indigenous Health Equity Research, Central Queensland University, 4870 Cairns, Australia.
| | - Lea Merone
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | | | - Kani Thompson
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Karla Canuto
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
- Wardliparingga Aboriginal Health, South Australian Health and Medical Research Institute, 5001 Adelaide, Australia.
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, 3168 Melbourne, Australia.
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18
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Pulker CE, Thornton LE, Trapp GSA. What is known about consumer nutrition environments in Australia? A scoping review of the literature. Obes Sci Pract 2018; 4:318-337. [PMID: 30151227 PMCID: PMC6105710 DOI: 10.1002/osp4.275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research. METHODS A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included. RESULTS Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66). CONCLUSIONS This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.
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Affiliation(s)
- C. E. Pulker
- School of Public HealthCurtin UniversityPerthWAAustralia
- Telethon Kids InstituteThe University of Western AustraliaPerthWAAustralia
| | - L. E. Thornton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityMelbourneVICAustralia
| | - G. S. A. Trapp
- Telethon Kids InstituteThe University of Western AustraliaPerthWAAustralia
- School of Population and Global HealthThe University of Western AustraliaCrawleyWAAustralia
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19
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Timmins KA, Green MA, Radley D, Morris MA, Pearce J. How has big data contributed to obesity research? A review of the literature. Int J Obes (Lond) 2018; 42:1951-1962. [PMID: 30022056 PMCID: PMC6291419 DOI: 10.1038/s41366-018-0153-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/30/2018] [Accepted: 02/25/2018] [Indexed: 02/02/2023]
Abstract
There has been growing interest in the potential of ‘big data’ to enhance our understanding in medicine and public health. Although there is no agreed definition of big data, accepted critical components include greater volume, complexity, coverage and speed of availability. Much of these data are ‘found’ (as opposed to ‘made’), in that they have been collected for non-research purposes, but could include valuable information for research. The aim of this paper is to review the contribution of ‘found’ data to obesity research to date, and describe the benefits and challenges encountered. A narrative review was conducted to identify and collate peer-reviewed research studies. Database searches conducted up to September 2017 found original studies using a variety of data types and sources. These included: retail sales, transport, geospatial, commercial weight management data, social media, and smartphones and wearable technologies. The narrative review highlights the variety of data uses in the literature: describing the built environment, exploring social networks, estimating nutrient purchases or assessing the impact of interventions. The examples demonstrate four significant ways in which ‘found’ data can complement conventional ‘made’ data: firstly, in moving beyond constraints in scope (coverage, size and temporality); secondly, in providing objective, quantitative measures; thirdly, in reaching hard-to-access population groups; and lastly in the potential for evaluating real-world interventions. Alongside these opportunities, ‘found’ data come with distinct challenges, such as: ethical and legal questions around access and ownership; commercial sensitivities; costs; lack of control over data acquisition; validity; representativeness; finding appropriate comparators; and complexities of data processing, management and linkage. Despite widespread recognition of the opportunities, the impact of ‘found’ data on academic obesity research has been limited. The merit of such data lies not in their novelty, but in the benefits they could add over and above, or in combination with, conventionally collected data.
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Affiliation(s)
- Kate A Timmins
- School of Sport and Exercise Science, University of Lincoln, Lincoln, NE, USA
| | - Mark A Green
- School of Environmental Sciences, University of Liverpool, Liverpool, UK.
| | - Duncan Radley
- School of Sport, Leeds Beckett University, Leeds, UK
| | - Michelle A Morris
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of Geosciences, University of Edinburgh, Edinburgh, UK
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20
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Abstract
Currently, an unhealthy diet is the largest modifiable factor in ill health and death globally. One of the important contributors to unhealthy diets is the pervasiveness of unhealthy food and drink in our daily food environments. Although efforts to build nutrition skills and education across communities are critical, they will be insufficient without substantial changes to the food environments themselves. Here, I discuss how we can improve our food environments by implementing a comprehensive, multilevel and multisetting approach. This approach needs to encompass the various policy contexts for improving population nutrition, from policy set by national governments to that introduced by local community organizations and food retailers. Clinicians can help implement and set healthy food policies across all our health-care settings, even in the absence of government action. To support a comprehensive suite of effective policies, we need to systematically develop and disseminate the evidence for the feasibility, effectiveness and sustainability of workable policies and to understand their role in the development of a healthier food system.
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Affiliation(s)
- Anna Peeters
- Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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21
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Friel S, Pescud M, Malbon E, Lee A, Carter R, Greenfield J, Cobcroft M, Potter J, Rychetnik L, Meertens B. Using systems science to understand the determinants of inequities in healthy eating. PLoS One 2017; 12:e0188872. [PMID: 29190662 PMCID: PMC5708780 DOI: 10.1371/journal.pone.0188872] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/14/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Systems thinking has emerged in recent years as a promising approach to understanding and acting on the prevention and amelioration of non-communicable disease. However, the evidence on inequities in non-communicable diseases and their risks factors, particularly diet, has not been examined from a systems perspective. We report on an approach to developing a system oriented policy actor perspective on the multiple causes of inequities in healthy eating. METHODS Collaborative conceptual modelling workshops were held in 2015 with an expert group of representatives from government, non-government health organisations and academia in Australia. The expert group built a systems model using a system dynamics theoretical perspective. The model developed from individual mind maps to pair blended maps, before being finalised as a causal loop diagram. RESULTS The work of the expert stakeholders generated a comprehensive causal loop diagram of the determinants of inequity in healthy eating (the HE2 Diagram). This complex dynamic system has seven sub-systems: (1) food supply and environment; (2) transport; (3) housing and the built environment; (4) employment; (5) social protection; (6) health literacy; and (7) food preferences. DISCUSSION The HE2 causal loop diagram illustrates the complexity of determinants of inequities in healthy eating. This approach, both the process of construction and the final visualisation, can provide the basis for planning the prevention and amelioration of inequities in healthy eating that engages with multiple levels of causes and existing policies and programs.
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Affiliation(s)
- Sharon Friel
- School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia
| | - Melanie Pescud
- School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia
| | - Eleanor Malbon
- School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia
| | | | | | | | | | - Jane Potter
- National Heart Foundation, Melbourne, Australia
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22
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McMahon E, Wycherley T, O'Dea K, Brimblecombe J. A comparison of dietary estimates from the National Aboriginal and Torres Strait Islander Health Survey to food and beverage purchase data. Aust N Z J Public Health 2017; 41:598-603. [PMID: 29044897 DOI: 10.1111/1753-6405.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 04/01/2017] [Accepted: 07/01/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We compared self-reported dietary intake from the very remote sample of the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (VR-NATSINPAS; n=1,363) to one year of food and beverage purchases from 20 very remote Indigenous Australian communities (servicing ∼8,500 individuals). METHODS Differences in food (% energy from food groups) and nutrients were analysed using t-test with unequal variance. RESULTS Per-capita energy estimates were not significantly different between the surveys (899 MJ/person/day [95% confidence interval -152,1950] p=0.094). Self-reported intakes of sugar, cereal products/dishes, beverages, fats/oils, milk products/dishes and confectionery were significantly lower than that purchased, while intakes of meat, vegetables, cereal-based dishes, fish, fruit and eggs were significantly higher (p<0.05). CONCLUSION Differences between methods are consistent with differential reporting bias seen in self-reported dietary data. Implications for public health: The NATSINPAS provides valuable, much-needed information about dietary intake; however, self-reported data is prone to energy under-reporting and reporting bias. Purchase data can be used to track population-level food and nutrient availability in this population longitudinally; however, further evidence is needed on approaches to estimate wastage and foods sourced outside the store. There is potential for these data to complement each other to inform nutrition policies and programs in this population.
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Affiliation(s)
- Emma McMahon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Hospital Campus, Northern Territory.,Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Thomas Wycherley
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Hospital Campus, Northern Territory.,Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Kerin O'Dea
- Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Hospital Campus, Northern Territory
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23
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Minaker LM, Lynch M, Cook BE, Mah CL. Exploring sales data during a healthy corner store intervention in Toronto: the Food Retail Environments Shaping Health (FRESH) project. Health Promot Chronic Dis Prev Can 2017; 37:342-349. [PMID: 29043761 PMCID: PMC5674765 DOI: 10.24095/hpcdp.37.10.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Population health interventions in the retail food environment, such as corner store interventions, aim to influence the kind of cues consumers receive so that they are more often directed toward healthier options. Research that addresses financial aspects of retail interventions, particularly using outcome measures such as store sales that are central to retail decision making, is limited. This study explored store sales over time and across product categories during a healthy corner store intervention in a lowincome neighbourhood in Toronto, Ontario. METHODS Sales data (from August 2014 to April 2015) were aggregated by product category and by day. We used Microsoft Excel pivot tables to summarize and visually present sales data. We conducted t-tests to examine differences in product category sales by "peak" versus "nonpeak" sales days. RESULTS Overall store sales peaked on the days at the end of each month, aligned with the issuing of social assistance payments. Revenue spikes on peak sales days were driven predominantly by transit pass sales. On peak sales days, mean sales of nonnutritious snacks and cigarettes were marginally higher than on other days of the month. Finally, creative strategies to increase sales of fresh vegetables and fruits seemed to substantially increase revenue from these product categories. CONCLUSION Store sales data is an important store-level metric of food environment intervention success. Furthermore, data-driven decision making by retailers can be important for tailoring interventions. Future interventions and research should consider partnerships and additional success metrics for retail food environment interventions in diverse Canadian contexts.
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Affiliation(s)
- Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Meghan Lynch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian E Cook
- Toronto Food Strategy, Toronto Public Health, Toronto, Ontario, Canada
| | - Catherine L Mah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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24
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Whalan S, Farnbach S, Volk L, Gwynn J, Lock M, Trieu K, Brimblecombe J, Webster J. What do we know about the diets of Aboriginal and Torres Strait Islander peoples in Australia? A systematic literature review. Aust N Z J Public Health 2017; 41:579-584. [PMID: 28898509 DOI: 10.1111/1753-6405.12721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide an overview of published research on the dietary intake of Aboriginal and Torres Strait Islander peoples. METHODS Peer-reviewed literature from 1990 to October 2016 was searched to identify studies that measured the dietary intake of Australian Aboriginal and Torres Strait Islander populations. Study quality was assessed using a purposely devised quality appraisal tool. Meta-analysis was not possible due to the heterogeneity in dietary intake assessment methods. A narrative synthesis of study findings, where key themes were compared and contrasted was completed. RESULTS Twenty-five articles from twenty studies with outcome measures related to dietary intake were included. Dietary intake was assessed by electronic store sales, store turnover method, 24-hour dietary recall, food frequency questionnaire and short questions. Consistent findings were low reported intakes of fruit and vegetables and high intakes of total sugar and energy-dense, nutrient-poor food and beverages. CONCLUSIONS While differences between studies and study quality limit the generalisability of the findings, most studies suggest that the diets of Aboriginal and Torres Strait Islander peoples are inadequate. Implications for public health: A more concerted approach to understanding dietary patterns of Aboriginal and Torres Strait Islander peoples is required to inform policy and practice to improve diet and nutrition.
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Affiliation(s)
- Sarah Whalan
- Menzies School of Health Research, Northern Territory
| | - Sara Farnbach
- The George Institute for Global Health, New South Wales
| | - Lena Volk
- The George Institute for Global Health, New South Wales
| | - Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, New South Wales
| | - Mark Lock
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Kathy Trieu
- The George Institute for Global Health, New South Wales
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Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities. SSM Popul Health 2017; 3:566-576. [PMID: 29349246 PMCID: PMC5769043 DOI: 10.1016/j.ssmph.2017.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/18/2017] [Accepted: 06/18/2017] [Indexed: 11/27/2022] Open
Abstract
Background Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia. Method A longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009–2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these. Results Engagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented. Conclusion A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative. A diverse group of stakeholders engaged in a continuous improvement process of community-led action to strengthen food security. Stakeholders collectively appraised the whole local food system and prioritised strategies to improve food security. Actions able to be directly implemented within available resources resulted from developing collaborative capacity. Positive shifts in community diet were associated with key areas where actions were implemented. Integrating the approach with higher level decision-making structures could further strengthen capacity for food system improvement.
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Ferguson M, Brown C, Georga C, Miles E, Wilson A, Brimblecombe J. Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia. Aust N Z J Public Health 2017; 41:294-298. [PMID: 28370899 DOI: 10.1111/1753-6405.12664] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia. METHODS Availability was assessed through repeated semi-structured interviews and consumption via a survey. Quantitative data were described and qualitative data classified. RESULTS Aboriginal and non-Indigenous key informants (n=30 in 2013; n=19 in 2014) from 20 Northern Territory (NT) communities participated in interviews. Aboriginal primary household shoppers (n=73 in 2014) in five of these communities participated in a survey. Traditional foods were reported to be available year-round in all 20 communities. Most participants (89%) reported consuming a variety of traditional foods at least fortnightly and 71% at least weekly. Seventy-six per cent reported being food insecure, with 40% obtaining traditional food during these times. CONCLUSIONS Traditional food is consumed frequently by Aboriginal people living in remote NT. Implications for public health: Quantifying dietary contribution of traditional food would complement estimated population dietary intake. It would contribute evidence of nutrition transition and differences in intakes across age groups and inform dietary, environmental and social interventions and policy. Designing and conducting assessment of traditional food intake in conjunction with Aboriginal leaders warrants consideration.
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Affiliation(s)
- Megan Ferguson
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Northern Territory.,School of Population Health, Division of Health Sciences, University of South Australia
| | - Clare Brown
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Northern Territory.,School of Population Health, Division of Health Sciences, University of South Australia
| | - Claire Georga
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Northern Territory
| | | | | | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Northern Territory
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Effect of 25% Sodium Reduction on Sales of a Top-Selling Bread in Remote Indigenous Australian Community Stores: A Controlled Intervention Trial. Nutrients 2017; 9:nu9030214. [PMID: 28264485 PMCID: PMC5372877 DOI: 10.3390/nu9030214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/21/2017] [Indexed: 01/25/2023] Open
Abstract
Reducing sodium in the food supply is key to achieving population salt targets, but maintaining sales is important to ensuring commercial viability and maximising clinical impact. We investigated whether 25% sodium reduction in a top-selling bread affected sales in 26 remote Indigenous community stores. After a 23-week baseline period, 11 control stores received the regular-salt bread (400 mg Na/100 g) and 15 intervention stores received the reduced-salt version (300 mg Na/100 g) for 12-weeks. Sales data were collected to examine difference between groups in change from baseline to follow-up (effect size) in sales (primary outcome) or sodium density, analysed using a mixed model. There was no significant effect on market share (-0.31%; 95% CI -0.68, 0.07; p = 0.11) or weekly dollars ($58; -149, 266; p = 0.58). Sodium density of all purchases was not significantly reduced (-8 mg Na/MJ; -18, 2; p = 0.14), but 25% reduction across all bread could significantly reduce sodium (-12; -23, -1; p = 0.03). We found 25% salt reduction in a top-selling bread did not affect sales in remote Indigenous community stores. If achieved across all breads, estimated salt intake in remote Indigenous Australian communities would be reduced by approximately 15% of the magnitude needed to achieve population salt targets, which could lead to significant health gains at the population-level.
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Fluctuations in money availability within an income cycle impacts diet quality of remote Indigenous Australians. Public Health Nutr 2017; 20:1431-1440. [PMID: 28069086 DOI: 10.1017/s1368980016003360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To consider the plausible nutritional impacts of fluctuations in money availability within an income cycle for remote Indigenous Australians. DESIGN Community-level dietary intake (energy, micro/macronutrients) and expenditure on foods and beverages (F&B) were estimated over one year for three remote Indigenous Australian communities (Northern Territory, Australia) using monthly F&B transaction data. F&B that were likely to be consumed during a period within an income cycle when money was relatively limited (low money period (LMP) foods) were identified by panel consensus and scenario modelling was conducted to simulate the nutritional outcomes of a range of F&B selection responses to having an LMP. RESULTS All scenarios resulted in reduced diet quality during the LMP relative to overall average diet values. Protein and fat energy percentages were reduced and carbohydrate energy percentage increased. Despite reduced expenditure, declines in energy intake were typically buffered due to the reduced energy cost ($AU/MJ) of the LMP diet. The micronutrient profile of the LMP diet was substantially poorer, such that additional key micronutrients dropped below population-weighted Estimated Average Requirements/Adequate Intakes. CONCLUSIONS The modelling undertaken herein suggests that even a short period of low money within an income cycle may noticeably contribute to the reduced diet quality of remote Indigenous Australians and exacerbate lifestyle disease risk. Dietary strategies that are designed to respond to diets and expenditure during different income cycle periods, rather than the overall average diet and expenditure, should be considered for improving diet quality and reducing cardiometabolic disease risk in remote Indigenous Australians.
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Ferguson M, O'Dea K, Holden S, Miles E, Brimblecombe J. Food and beverage price discounts to improve health in remote Aboriginal communities: mixed method evaluation of a natural experiment. Aust N Z J Public Health 2016; 41:32-37. [PMID: 27868342 DOI: 10.1111/1753-6405.12616] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 05/01/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Retrospectively evaluate food price discounts in remote Aboriginal community stores. METHODS Four price discount strategies of 10% were designed in 2010, aiming to influence grocery, fruit, vegetables and diet soft-drink sales. This natural experiment across a group of stores was evaluated using an explanatory, sequential mixed method design through analysis of store point-of-sale, document, observation and interview data. The outcome was measured by change in: 1) percentage of grocery sales to total food and beverage; 2) fruit and vegetable sales; and 3) diet soft-drink sales. Qualitative data enabled the interpretation of outcomes through understanding perceived success and benefits, and enablers and barriers to implementation. RESULTS Eighteen community stores and 54 informants participated. While targeted price discounts were considered important to improving health, no discernible effect was evident, due to inadequate design and communication of discount promotion, and probably inadequate magnitude of discount. CONCLUSIONS Strategy impact on food and beverage sales was limited by promotion and magnitude of discount. Implication for Public Health: This study demonstrates key factors and commitment required to design, communicate, implement and monitor strategies to improve health in this challenging remote retail context. Evaluation of natural experiments can contribute evidence to policy-making.
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Affiliation(s)
- Megan Ferguson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Northern Territory.,School of Population Health, Division of Health Sciences, University of South Australia
| | - Kerin O'Dea
- School of Population Health, Division of Health Sciences, University of South Australia
| | - Stacey Holden
- Department of Nutrition and Dietetics, Monash University, Victoria
| | | | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Northern Territory
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McMahon E, Webster J, O'Dea K, Brimblecombe J. Dietary sodium and iodine in remote Indigenous Australian communities: will salt-reduction strategies increase risk of iodine deficiency? A cross-sectional analysis and simulation study. BMC Public Health 2015; 15:1318. [PMID: 26714467 PMCID: PMC4696303 DOI: 10.1186/s12889-015-2686-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/24/2015] [Indexed: 11/25/2022] Open
Abstract
Background Excess salt intake is a global issue. Effective salt-reduction strategies are needed, however, as salt is a vehicle for iodine fortification, these strategies may also reduce iodine intake. This study examines the case of the remote Indigenous Australian population; we employed an innovative, objective method to assess sodium and iodine intakes against requirements and modelled the potential effects of salt-reduction strategies on estimated sodium and iodine intakes. Design Store-sales data were collected from 20 remote Indigenous community stores in 2012–14 representing the main source of food for 2 years for ~8300 individuals. Estimated average sodium and iodine intakes were compared against recommendations (nutrient reference values weighted to age and gender distribution). Linear programming was employed to simulate potential effects of salt-reduction strategies on estimated sodium and iodine intakes. Results Estimated average sodium intake was 2770 (range within communities 2410–3450) mg/day, far exceeding the population-weighted upper limit (2060 mg/day). Discretionary (added) salt, bread and processed meat were the biggest contributors providing 46 % of all sodium. Estimated average iodine intake was within recommendations at 206 (186–246) μg/day. The following scenarios enabled modelling of estimated average salt intake to within recommendations: 1) 67 % reduction in sodium content of bread and discretionary salt intake, 2) 38 % reduction in sodium content of all processed foods, 3) 30 % reduction in sodium content of all processed foods and discretionary salt intake. In all scenarios, simulated average iodine intakes remained within recommendations. Conclusions Salt intakes of the remote Indigenous Australian population are far above recommendations, likely contributing to the high prevalence of hypertension and cardiovascular mortality experienced by this population. Salt-reduction strategies could considerably reduce salt intake in this population without increasing risk of iodine deficiency at the population-level. These data add to the global evidence informing salt-reduction strategies and the evidence that these strategies can be synergistically implemented with iodine deficiency elimination programmes. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613000694718. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2686-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma McMahon
- Wellbeing and Preventable Disease Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia. .,Centre for Population Health Research, School of Health Sciences, University of South Australia, North Tce, Adelaide, SA, 5001, Australia.
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health, The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia.
| | - Kerin O'Dea
- Centre for Population Health Research, School of Health Sciences, University of South Australia, North Tce, Adelaide, SA, 5001, Australia. Kerin.O'
| | - Julie Brimblecombe
- Wellbeing and Preventable Disease Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia.
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Nutritional predictors of successful chronic disease prevention for a community cohort in Central Australia. Public Health Nutr 2015; 19:2475-83. [PMID: 26573342 DOI: 10.1017/s1368980015003262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate biomarkers of nutrition associated with chronic disease absence for an Aboriginal cohort. DESIGN Screening for nutritional biomarkers was completed at baseline (1995). Evidence of chronic disease (diabetes, CVD, chronic kidney disease or hypertension) was sought from primary health-care clinics, hospitals and death records over 10 years of follow-up. Principal components analysis was used to group baseline nutritional biomarkers and logistic regression modelling used to investigate associations between the principal components and chronic disease absence. SETTING Three Central Australian Aboriginal communities. SUBJECTS Aboriginal people (n 444, 286 of whom were without chronic disease at baseline) aged 15-82 years. RESULTS Principal components analysis grouped twelve nutritional biomarkers into four components: 'lipids'; 'adiposity'; 'dietary quality'; and 'habitus with inverse quality diet'. For the 286 individuals free of chronic disease at baseline, lower adiposity, lower lipids and better dietary quality components were each associated with the absence at follow-up of most chronic diseases examined, with the exception of chronic kidney disease. Low 'adiposity' component was associated with absence of diabetes, hypertension and CVD at follow-up. Low 'lipid' component was associated with absence of hypertension and CVD, and high 'dietary quality' component was associated with absence of CVD at follow-up. CONCLUSIONS Lowering or maintenance of the factors related to 'adiposity' and 'lipids' to healthy thresholds and increasing access to a healthy diet appear useful targets for chronic disease prevention for Aboriginal people in Central Australia.
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Lee A, Rainow S, Tregenza J, Tregenza L, Balmer L, Bryce S, Paddy M, Sheard J, Schomburgk D. Nutrition in remote Aboriginal communities: lessons from Mai Wiru and the Anangu Pitjantjatjara Yankunytjatjara Lands. Aust N Z J Public Health 2015; 40 Suppl 1:S81-8. [DOI: 10.1111/1753-6405.12419] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/01/2014] [Accepted: 03/01/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Amanda Lee
- School of Public Health and Social Work, Queensland University of Technology
- School of Exercise and Nutrition Sciences, Queensland University of Technology
| | | | | | | | | | | | | | - Jamie Sheard
- School of Exercise and Nutrition Sciences, Queensland University of Technology
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Brimblecombe J, Maypilama E, Colles S, Scarlett M, Dhurrkay JG, Ritchie J, O'Dea K. Factors influencing food choice in an Australian Aboriginal community. QUALITATIVE HEALTH RESEARCH 2014; 24:387-400. [PMID: 24549409 DOI: 10.1177/1049732314521901] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We explored with Aboriginal adults living in a remote Australian community the social context of food choice and factors perceived to shape food choice. An ethnographic approach of prolonged community engagement over 3 years was augmented by interviews. Our findings revealed that knowledge, health, and resources supporting food choice were considered "out of balance," and this imbalance was seen to manifest in a Western-imposed diet lacking variety and overrelying on familiar staples. Participants felt ill-equipped to emulate the traditional pattern of knowledge transfer through passing food-related wisdom to younger generations. The traditional food system was considered key to providing the framework for learning about the contemporary food environment. Practitioners seeking to improve diet and health outcomes for this population should attend to past and present contexts of food in nutrition education, support the educative role of caregivers, address the high cost of food, and support access to traditional foods.
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Brimblecombe J, Ferguson M, Liberato SC, O'Dea K, Riley M. Optimisation modelling to assess cost of dietary improvement in remote Aboriginal Australia. PLoS One 2013; 8:e83587. [PMID: 24391790 PMCID: PMC3877064 DOI: 10.1371/journal.pone.0083587] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/05/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations. OBJECTIVE We used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods. DESIGN A twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet. RESULTS Simultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B) met all nutrient targets except sodium (146.2% and 148.9% of the respective target) and saturated fat (12.0% and 11.7% of energy). Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day) and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (-90%) and refined cereals (-90%) and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals. CONCLUSION This modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure.
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Affiliation(s)
- Julie Brimblecombe
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Selma C. Liberato
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kerin O'Dea
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Health Sciences (School of Population Health), University of South Australia, Adelaide, South Australia, Australia
| | - Malcolm Riley
- Commonwealth Scientific Industrial Research Organisation (Animal, Food and Health Sciences), Parkville, Victoria, Australia
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Brimblecombe J, Ferguson M, Liberato SC, Ball K, Moodie ML, Magnus A, Miles E, Leach AJ, Chatfield MD, Ni Mhurchu C, O’Dea K, Bailie RS. Stores Healthy Options Project in Remote Indigenous Communities (SHOP@RIC): a protocol of a randomised trial promoting healthy food and beverage purchases through price discounts and in-store nutrition education. BMC Public Health 2013; 13:744. [PMID: 23938097 PMCID: PMC3751924 DOI: 10.1186/1471-2458-13-744] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/17/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts--much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions.This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities. METHODS/DESIGN We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed. DISCUSSION This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000694718.
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Affiliation(s)
- Julie Brimblecombe
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Selma C Liberato
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
- University of South Australia, Frome Rd, Adelaide, SA 5000, Australia
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood Hwy, Burwood 3125, Australia
| | - Marjory L Moodie
- Deakin Health Economics Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | - Anne Magnus
- Deakin Health Economics Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | - Edward Miles
- Indigenous Community Volunteers Level 1, 29 Cavanagh St, Darwin, NT 0801, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Kerin O’Dea
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- University of South Australia, Frome Rd, Adelaide, SA 5000, Australia
| | - Ross S Bailie
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
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