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Wheaton N, Alston E, Versace VL, Field M, Wong Shee A, Jacobs J, Backholer K, Allender S, Nichols M, Needham C, Bolton KA, Blake MR, Stewart F, Close E, Alston L. Diet-Related Disease Prevention in a Rural Australian Setting: Understanding Barriers, Enablers, and the Role of Rural Health Services in Supporting Changes in Local Rural Food Environments. Nutrients 2023; 15:4979. [PMID: 38068837 PMCID: PMC10708407 DOI: 10.3390/nu15234979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders' perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included 'enablers to healthier food environments', 'barriers to healthier food environments', 'Rural health services are a leading broker of knowledge for healthy food environments', and 'characteristics of desirable healthy food environment interventions.'. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.
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Affiliation(s)
- Nikita Wheaton
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
| | - Emily Alston
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Vincent L. Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
| | - Michael Field
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
- Grampians Health, Ballarat, VIC 3350, Australia
| | - Jane Jacobs
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Cindy Needham
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Kristy A. Bolton
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Miranda R. Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Fletcher Stewart
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Evelyn Close
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
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Schumacher TL, Alderton CA, Brown LJ, Heaney S, Alston L, Kent K, Godrich SL. Development of a Scoring Tool for Australian Rural Food Retail Environments. Nutrients 2023; 15:4660. [PMID: 37960313 PMCID: PMC10648429 DOI: 10.3390/nu15214660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Current tools scoring the healthiness of food retail outlets do not reflect outlets found in rural locations. This study aimed to adapt pre-existing Australian scoring tools to represent non-metropolitan areas. Rural nutrition experts were identified, and a modified Delphi technique was used to adapt two pre-existing, food-scoring tools in five iterative stages. Stages included identifying all relevant outlets, providing a description and score for each, ensuring consistency between outlet scores and pre-existing, metro-centric tools, and providing instructions for correct use. Six rural nutrition experts were identified and engaged in the modified Delphi technique. The final tool consisted of 12 categories of food outlets and listed 35 individual outlets. Consistent with pre-existing Australian tools, scores ranged from +10 to -10 and included descriptions reflective of rural retail outlets. Scores were based on whether the majority of foods offered within the outlet were consistent with foods recommended in national health guidelines. The developed tool was designed to accommodate the diverse nature of food retail outlets found in non-metropolitan areas. This study assists in explaining the link between the food environment and health in populations living rurally.
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Affiliation(s)
- Tracy L. Schumacher
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; (C.A.A.); (L.J.B.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia;
| | - Carissa A. Alderton
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; (C.A.A.); (L.J.B.)
| | - Leanne J. Brown
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; (C.A.A.); (L.J.B.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia;
| | - Susan Heaney
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia;
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Port Macquarie, NSW 2444, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, VIC 3220, Australia;
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia
| | - Katherine Kent
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
| | - Stephanie Louise Godrich
- Centre for People, Place, and Planet, Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia;
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Hill A, Blake M, Alston LV, Nichols MS, Bell C, Fraser P, Le HN, Strugnell C, Allender S, Bolton KA. How healthy and affordable are foods and beverages sold in school canteens? A cross-sectional study comparing menus from Victorian primary schools. Public Health Nutr 2023; 26:2559-2572. [PMID: 37439210 DOI: 10.1017/s136898002300126x] [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] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Government policy guidance in Victoria, Australia, encourages schools to provide affordable, healthy foods in canteens. This study analysed the healthiness and price of items available in canteens in Victorian primary schools and associations with school characteristics. DESIGN Dietitians classified menu items (main, snack and beverage) using the red, amber and green traffic light system defined in the Victorian government's School Canteens and Other School Food Services Policy. This system also included a black category for confectionary and high sugar content soft drinks which should not be supplied. Descriptive statistics and regressions were used to analyse differences in the healthiness and price of main meals, snacks and beverages offered, according to school remoteness, sector (government and Catholic/independent) size, and socio-economic position. SETTING State of Victoria, Australia. PARTICIPANTS A convenience sample of canteen menus drawn from three previous obesity prevention studies in forty-eight primary schools between 2016 and 2019. RESULTS On average, school canteen menus were 21 % 'green' (most healthy - everyday), 53 % 'amber' (select carefully), 25 % 'red' (occasional) and 2 % 'black' (banned) items, demonstrating low adherence with government guidelines. 'Black' items were more common in schools in regional population centres. 'Red' main meal items were cheaper than 'green'% (mean difference -$0·48 (95 % CI -0·85, -0·10)) and 'amber' -$0·91 (-1·27, -0·57)) main meal items. In about 50 % of schools, the mean price of 'red' main meal, beverages and snack items were cheaper than 'green' items, or no 'green' alternative items were offered. CONCLUSION In this sample of Victorian canteen menus, there was no evidence of associations of healthiness and pricing by school characteristics except for regional centres having the highest proportion of 'black' (banned) items compared with all other remoteness categories examined. There was low adherence with state canteen menu guidelines. Many schools offered a high proportion of 'red' food options and 'black' (banned) options, particularly in regional centres. Unhealthier options were cheaper than healthy options. More needs to be done to bring Victorian primary school canteen menus in line with guidelines.
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Affiliation(s)
- Amy Hill
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
| | - Miranda Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
| | - Laura Veronica Alston
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
- Deakin Rural Health, Faculty of Health, Deakin University, Geelong3220, VIC, Australia
- Research Unit, Colac Area Health, Colac3250, VIC, Australia
| | - Melanie S Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
- GLOBE, Institute for Health Transformation, School of Medicine, Deakin University, Geelong3220, VIC, Australia
| | - Penny Fraser
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
- GLOBE, Institute for Health Transformation, School of Medicine, Deakin University, Geelong3220, VIC, Australia
| | - Ha Nd Le
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
| | - Claudia Strugnell
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
| | - Kristy A Bolton
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong3220, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong3220, VIC, Australia
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Alston L, Heaney S, Kent K, Godrich S, Kocanda L, Herbert J, Schumacher T, Brown LJ. Rural nutrition and dietetics research-Future directions. Aust J Rural Health 2023; 31:1027-1031. [PMID: 37723938 DOI: 10.1111/ajr.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
AIM The aim of this study was to summarise key evidence from recent Australian rural nutrition research and provide recommendations for future nutrition and dietetics research with rural communities. CONTEXT Clear evidence demonstrates that diet plays a role in the health gap between rural and metropolitan Australia. Despite the opportunity to address the health of rural Australians through better nutrition, alarmingly low investment in nutrition and dietetics research has occurred historically, and over the past decade. APPROACH A review of the evidence was undertaken by rural nutrition and dietetics leaders to provide a commentary piece to inform future rural nutrition research efforts. CONCLUSION Establishing strong, collaborative place-based nutrition and dietetics research teams are necessary to combat the significant gaps in the scientific knowledge of solutions to improve nutrition in rural Australia. Further, dieticians and nutritionists who live in and understand the rural contexts are yet to be fully harnessed in research, and better engaging with these professionals will have the best chance of successfully addressing the nutrition-related disease disparity between rural and metropolitan Australia.
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Affiliation(s)
- Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Victoria, Warrnambool, Australia
- Research Unit, Colac Area Health, Victoria, Colac, Australia
| | - Susan Heaney
- Department of Rural Health, University of Newcastle, New South Wales, Port Macquarie, Australia
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
| | - Katherine Kent
- School of Health Science, Western Sydney University, New South Wales, Campbelltown, Australia
- School of Health Sciences, University of Tasmania, Tasmania, Launceston, Australia
| | - Stephanie Godrich
- Centre for People, Place and Planet, Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Bunbury, Australia
| | - Lucy Kocanda
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
- Dietetics Department, Tamworth Rural Referral Hospital, New South Wales, Tamworth, Australia
| | - Jaimee Herbert
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Victoria, Warrnambool, Australia
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
| | - Tracy Schumacher
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
| | - Leanne J Brown
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
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Whelan J, Brimblecombe J, Christian M, Vargas C, Ferguson M, McMahon E, Lee A, Bell C, Boelsen-Robinson T, Blake MR, Lewis M, Alston L, Allender S. CO-Creation and Evaluation of Food Environments to Advance Community Health (COACH). AJPM FOCUS 2023; 2:100111. [PMID: 37790671 PMCID: PMC10546519 DOI: 10.1016/j.focus.2023.100111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Food environments are a key determinant of food intake and diet-related health. This paper describes the development of an iterative, adaptive, context-specific framework for health-enabling food environments embedded in cocreation theory. Methods A 3-stage multimethod framework for the coproduction and prototyping of public health interventions was followed in an iterative manner during the development of the framework. These 3 stages were (1) evidence review, including systematic review, consultation with experts, and observation of current work; (2) codesign of the framework prototype with multiple stakeholders; and (3) coproduction through refinement of the prototype through stakeholder workshops and expert reviews with incorporation of researcher notes and workshop evaluation. We use the term prototype during the development phase and the term framework to report on the final product. Results COACH (CO-creation and evaluation of food environments to Advance Community Health) is a process framework that describes what best practice application of cocreation in health-enabling food retail environments should involve. COACH consists of 10 interdependent factors within a 4-phase continuous quality improvement cycle. The 4 phases of the cycle are engagement and governance establishment, communication and policy alignment, codesign and implementation, and monitoring and evaluation. Conclusions Utilizing cocreation theory represents an innovative step in research and practice to improve the healthiness of food retail environments. COACH provides a specific, unique, and comprehensive guide to the utilization of cocreation to improve the healthiness of food environments in practice.
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Affiliation(s)
- Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Medicine, Deakin University, Geelong, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Science, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Meaghan Christian
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Science, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Megan Ferguson
- School of Public Health, The University of Queensland, Brisbane, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - Emma McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - Amanda Lee
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Medicine, Deakin University, Geelong, Australia
| | - Tara Boelsen-Robinson
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Miranda R. Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Meron Lewis
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Laura Alston
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
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Allender S, Munira SL, Bourke S, Lancsar E. Participatory systems science for enhancing health and wellbeing in the Indian Ocean territories. Front Public Health 2023; 11:1013869. [PMID: 37397744 PMCID: PMC10310353 DOI: 10.3389/fpubh.2023.1013869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 05/09/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives Co-creation of diabetes and obesity prevention with remote communities allows local contextual factors to be included in the design, delivery, and evaluation of disease prevention efforts. The Indian Ocean Territories (IOT) comprise the Christmas (CI) and Cocos Keeling Islands (CKI) and are remote Australian external territories located northwest of the mainland. We present results of a co-design process conducted with residents of IOT using realist inquiry and system mapping. Methods Interviews with 33 community members (17 CI, 14 CKI, 2 off Islands) on causes and outcomes of diabetes (2020/21) comprising community representatives, health services staff, dietitians, school principals and government administrators. Interviews were used to create causal loop diagrams representing the causes of diabetes in the IOT. These diagrams were used in a participatory process to identify existing actions to address diabetes, identify areas where more effort would be valuable in preventing diabetes, and to described and prioritize actions based on feasibility and likely impact. Findings Interviews identified 31 separate variables categorized into four themes (structural, food, knowledge, physical activity). Using causa loop diagrams, community members developed 32 intervention ideas that included strengthening healthy behaviors like physical activity, improving access to healthy and culturally appropriate foods, and overcoming the significant cost and availability limitations imposed by remoteness and freight costs. Interventions included relatively unique Island issues (e.g., freight costs, limited delivery timing), barriers to healthy food (e.g., limited fresh food availability), physical activity (e.g., transient workforce) and knowledge (e.g., multiple cultural backgrounds and language barriers, intergenerational knowledge).
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Affiliation(s)
- Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Syarifah Liza Munira
- Department of Health Services, Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Siobhan Bourke
- Department of Health Services, Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Lancsar
- Department of Health Services, Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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Alston L, Nichols M, Allender S, Versace V, Brown LJ, Schumacher T, Howard G, Shikany JM, Bolton KA, Livingstone K, Zorbas C, Judd SE. Dietary patterns in rural and metropolitan Australia: a cross-sectional study exploring dietary patterns, inflammation and association with cardiovascular disease risk factors. BMJ Open 2023; 13:e069475. [PMID: 37270193 DOI: 10.1136/bmjopen-2022-069475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES This study sought first to empirically define dietary patterns and to apply the novel Dietary Inflammation Score (DIS) in data from rural and metropolitan populations in Australia, and second to investigate associations with cardiovascular disease (CVD) risk factors. DESIGN Cross-sectional study. SETTING Rural and metropolitan Australia. PARTICIPANTS Adults over the age of 18 years living in rural or metropolitan Australia who participated in the Australian Health survey. PRIMARY OUTCOMES A posteriori dietary patterns for participants separated into rural and metropolitan populations using principal component analysis. SECONDARY OUTCOMES association of each dietary pattern and DIS with CVD risk factors was explored using logistic regression. RESULTS The sample included 713 rural and 1185 metropolitan participants. The rural sample was significantly older (mean age 52.7 compared with 48.6 years) and had a higher prevalence of CVD risk factors. Two primary dietary patterns were derived from each population (four in total), and dietary patterns were different between the rural and metropolitan areas. None of the identified patterns were associated with CVD risk factors in metropolitan or rural areas, aside diet pattern 2 being strongly associated with from self-reported ischaemic heart disease (OR 13.90 95% CI 2.29 to 84.3) in rural areas. There were no significant differences between the DIS and CVD risk factors across the two populations, except for a higher DIS being associated with overweight/obesity in rural areas. CONCLUSION Exploration of dietary patterns between rural and metropolitan Australia shows differences between the two populations, possibly reflective of distinct cultures, socioeconomic factors, geography, food access and/or food environments in the different areas. Our study provides evidence that action targeting healthier dietary intakes needs to be tailored to rurality in the Australian context.
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Affiliation(s)
- Laura Alston
- Deakin Rural Health, Deakin University, Warnambool, Victoria, Australia
- Research Unit, Colac Area Health, Colac, Victoria, Australia
| | - Melanie Nichols
- Global Centre for Preventative Health and Nutriton, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventative Health and Nutriton, Deakin University, Geelong, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Warnambool, Victoria, Australia
| | - Leanne J Brown
- Department of Rural Health, The University of Newcastle, Tamworth, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Tracy Schumacher
- Department of Rural Health, The University of Newcastle, Tamworth, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - George Howard
- Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, UK
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, UK
| | - James M Shikany
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, UK
| | - Kristy A Bolton
- Global Centre for Preventative Health and Nutriton, Deakin University, Geelong, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Katherine Livingstone
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Christina Zorbas
- Global Centre for Preventative Health and Nutriton, Deakin University, Geelong, Victoria, Australia
| | - Suzanne E Judd
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, UK
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Jacobs J, Strugnell C, Becker D, Whelan J, Hayward J, Nichols M, Brown A, Brown V, Allender S, Bell C, Sanigorski A, Orellana L, Alston L. Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study. Public Health Nutr 2023; 26:1185-1193. [PMID: 36710638 PMCID: PMC10346081 DOI: 10.1017/s1368980023000198] [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: 04/30/2022] [Revised: 10/18/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM). DESIGN A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake. SETTING Twelve regional and rural Local Government Areas in North-East Victoria, Australia. PARTICIPANTS Data were collected from 2456 grade 4 (approximately 9-10 years) and grade 6 (approximately 11-12 years) students. RESULTS The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)). CONCLUSIONS Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.
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Affiliation(s)
- Jane Jacobs
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Denise Becker
- Deakin University, Biostatistics Unit, Faculty of Health, Geelong, Australia
| | - Jill Whelan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Josh Hayward
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Andrew Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Victoria Brown
- Deakin University, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Colin Bell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Andrew Sanigorski
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
| | - Liliana Orellana
- Deakin University, Biostatistics Unit, Faculty of Health, Geelong, Australia
| | - Laura Alston
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Waterfront Campus, 1 Gheringhap St, Geelong, VIC3220, Australia
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
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9
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Pulker CE, Aberle LM, Butcher LM, Whitton C, Law KK, Large AL, Pollard CM, Trapp GSA. Development of the Menu Assessment Scoring Tool (MAST) to Assess the Nutritional Quality of Food Service Menus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3998. [PMID: 36901008 PMCID: PMC10001456 DOI: 10.3390/ijerph20053998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Preventing the rise in obesity is a global public health priority. Neighbourhood environments can help or undermine people's efforts to manage their weight, depending on availability of nutritious and nutrient-poor 'discretionary' foods. The proportion of household food budgets spent on eating outside the home is increasing. To inform nutrition policy at a local level, an objective assessment of the nutritional quality of foods and beverages on food service menus that is context-specific is needed. This study describes the development and piloting of the Menu Assessment Scoring Tool (MAST), used to assess the nutritional quality of food service menus in Australia. The MAST is a desk-based tool designed to objectively assess availability of nutrient-poor and absence of nutritious food and beverages on food service menus. A risk assessment approach was applied, using the best available evidence in an iterative way. MAST scores for 30 food service outlets in one Local Government Authority in Perth, Western Australia highlight opportunities for improvements. MAST is the first tool of its kind in Australia to assess the nutritional quality of food service menus. It was practical and feasible to use by public health nutritionists/dietitians and can be adapted to suit other settings or countries.
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Affiliation(s)
- Claire Elizabeth Pulker
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | | | - Lucy Meredith Butcher
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Clare Whitton
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Kristy Karying Law
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- The George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Amy Louise Large
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
| | - Christina Mary Pollard
- School of Population Health, Curtin University, Perth, WA 6845, Australia
- Enable Institute, Curtin University, Perth, WA 6845, Australia
| | - Georgina S. A. Trapp
- Telethon Kids Institute, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia
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10
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Alston L, Raeside R, Jia SS, Partridge SR. Underinvestment in nutrition research for at-risk populations: An analysis of research funding awarded in Australia from 2014 to 2021. Nutr Diet 2022; 79:438-446. [PMID: 35506173 PMCID: PMC9541268 DOI: 10.1111/1747-0080.12740] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/21/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
AIM To determine the proportion of research projects funded by the National Health and Medical Research Council and Australian Research Council research funding from 2014 to 2021 that aimed to understand or improve dietary behaviours for at-risk populations in Australia and estimate the proportion of total funding allocated during this period. METHODS Retrospective analysis of the publicly available National Health and Medical Research Council and Australian Research Council funding grants over the 8 years from 2014 to 2021 (n = 18 098). At-risk dietary populations included people living in rural and remote Australia, Aboriginal and Torres Strait Islander people, or people living in socioeconomically disadvantaged areas. Descriptive analysis was undertaken. RESULTS In total, 144 out of 18 098 (0.8%) individual grants totalling $96.8 million were identified relating to nutrition research from 2014 to 2021. Out of the 144, only 21 ($19.6 million; 0.1%) of all National Health and Medical Research Council grants were identified for nutritionally at-risk populations, with the majority focused on Aboriginal and Torres Strait Islander people (15/21). The National Health and Medical Research Council and Australian Research Council grants that aimed to improve human dietary behaviours increased by 0.66% and 0.58%, respectively, from 2014 to 2021. However, the National Health and Medical Research Council grants aiming to improve nutritional behaviours in at-risk populations decreased by 0.04% over the 8 years. CONCLUSIONS Despite slight increases in the proportions of funding to improve dietary behaviours over the past decade, nutrition research specifically targeting at-risk groups is scarce and appears to have decreased over time. Insufficient investment in research for these groups presents a risk for widening health disparities now and into the future. As such, they must be further supported and considered in the design of future funding schemes.
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Affiliation(s)
- Laura Alston
- The Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia.,Colac Area Health, Colac, Victoria, Australia
| | - Rebecca Raeside
- Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Si Si Jia
- Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie R Partridge
- Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School Public Health, The University of Sydney, Sydney, New South Wales, Australia
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11
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Kent K, Alston L, Murray S, Honeychurch B, Visentin D. The Impact of the COVID-19 Pandemic on Rural Food Security in High Income Countries: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3235. [PMID: 35328924 PMCID: PMC8954908 DOI: 10.3390/ijerph19063235] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023]
Abstract
Prior to the COVID-19 pandemic, rural-dwelling people in high-income countries were known to have greater challenges accessing healthy food than their urban counterparts. The COVID-19 pandemic has impacted food supplies across the world, and public health restrictions have changed the way people shop for food, potentially exacerbating food insecurity. This systematic literature review aimed to synthesize the available evidence on the impact of the COVID-19 pandemic on aspects of food insecurity in rural populations residing in high-income countries. Five electronic databases were searched, identifying 22 articles that assessed food insecurity prevalence or data on food availability, access, utilization and the stability of the food supply in rural populations during the COVID-19 pandemic. Ten studies examined the prevalence of food insecurity in rural populations, with the reported prevalence ranging from 15% to 95%. Where rural/urban comparisons were presented, most studies (n = 5; 71%) reported that food insecurity was significantly higher in rural regions. Five studies examined the availability of food and eight studies examined access to food, identifying that rural populations often had lower food availability and access to food during the pandemic. In contrast, two studies identified positive effects such as more gardening and increased online access to food. Rural populations experienced multiple changes to food utilization, such as reduced diet quality and food safety observed in eight studies, but this was not shown to be different from urban populations. Additionally, the food supply in rural regions was perceived to be affected in two studies. The results of this review may be used to inform region-specific mitigation strategies to decrease the impact of the current COVID-19 pandemic and future global events on food security. However, the lack of consistency in study outcomes in research on rural populations limits the identification of priority areas for intervention at a global-scale.
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Affiliation(s)
- Katherine Kent
- School of Health Sciences, Western Sydney University, Campbelltown 2560, Australia
- School of Health Sciences, University Tasmania Launceston, Tasmania 7250, Australia; (S.M.); (B.H.); (D.V.)
| | - Laura Alston
- Faculty of Health Deakin Rural Health, Deakin University, Warrnambool 3280, Australia;
- Institute for Health Transformation, The Global Obesity Centre Deakin University, Geelong 3220, Australia
| | - Sandra Murray
- School of Health Sciences, University Tasmania Launceston, Tasmania 7250, Australia; (S.M.); (B.H.); (D.V.)
| | - Bonnie Honeychurch
- School of Health Sciences, University Tasmania Launceston, Tasmania 7250, Australia; (S.M.); (B.H.); (D.V.)
| | - Denis Visentin
- School of Health Sciences, University Tasmania Launceston, Tasmania 7250, Australia; (S.M.); (B.H.); (D.V.)
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