Public support for government regulatory interventions for overweight and obesity in Australia

Public support for obesity prevention policies in Western Australia from 2012 to 2020: Findings from cross-sectional surveys

ISSUE ADDRESSED

This study explored trends in public support for obesity prevention policies in Western Australia (WA).

METHODS

A series of cross-sectional surveys of a representative sample of WA adults aged 25-49 years (N = 11 534) were undertaken between 2012 and 2020 as part of an evaluation of the LiveLighter® mass media campaign, a component of a statewide healthy lifestyle education and promotion programme. Computer-assisted telephone interviews were used to gauge support for a range of obesity prevention initiatives that could be implemented by government.

RESULTS

A majority of respondents supported a range of obesity prevention policies, including taxes on sugary drinks, urban planning regulations, food labelling and packaging regulations, restrictions on advertising and sponsorship, bans on the sale and marketing of unhealthy food and drink in retail environments and support for education and campaigns. Obesity prevention policies were highly supported by women, people with a healthy weight, and those who had completed secondary school. Support for regulation was high compared to other studies. Notably, there were significant increases in support between baseline and 2020 for 'taxing soft drinks and using the money to reduce the cost of healthy food' (72% cf. 80%) and 'restricting junk food promotions/advertisements on public transport' (73% cf. 83%).

CONCLUSIONS

There is substantial public support for regulatory action on obesity prevention in WA, providing strong rationale for government interventions to improve nutrition and reduce obesity. The LiveLighter® programme may have contributed to increases in support for obesity prevention policies in WA. SO WHAT?: There is potential to implement robust obesity prevention policies in WA.

Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products

ISSUE ADDRESSED

This study assessed Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products.

METHODS

An online survey was undertaken by Australian adults aged 18-64 recruited via two national panels in December 2019 (N = 2044).

RESULTS

Most respondents (69%) agreed the Government should protect children from unhealthy food and drink marketing and advertising broadly. Those who agreed most commonly indicated children should be protected up to age 16 (34%) or 18 (24%). There was widespread support for government actions to stop unhealthy food and drink marketing on digital platforms (e.g., internet sites) (68%-69%) and various digital marketing techniques (e.g., advertising by brands on social media) (56%-71%). A total ban on targeting unhealthy food and drink marketing to children online received the highest level of support (76%). Most respondents (81%) disagreed unhealthy food and drink companies should be able to collect children's personal information for marketing purposes. Support for examined actions was generally higher among older adults, more educated adults and more frequent internet users, lower among males, and similar between parents and non-parents.

CONCLUSIONS

There is public perception that the government is responsible for protecting children, well into adolescence, from unhealthy food and drink marketing broadly. Widespread public support extends to specific actions to reduce children's exposure to digital marketing of unhealthy food and drink products. SO WHAT?: Implementation of policies to protect children from digital marketing of unhealthy food and drink products would be well received by the Australian public.

Components in downstream health promotions to reduce sugar intake among adults: a systematic review

Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.

The past as present in health promotion: the case for a 'public health humanities'

Health promotion is conceived as a unifying concept for improving the health of populations. This means addressing the socio-cultural, economic and commercial causes of ill-health, which are necessarily informed by past policies and socio-cultural contexts. However, historical scholarship has rarely figured in health promotion practice or scholarship. This gap resides in the determinants of health, and notably in the analyses of tobacco control and skin cancer prevention, two long-running campaigns that have shaped modern health promotion in Australia. Both highlight a need for understanding the profound impact of history on the present and the value of learning from past successes and failures. Doing so requires integrating historical analyses into existing health promotion scholarship. To achieve this aim, we present a new 'public health humanities' methodology. This novel interdisciplinary framework is conceived as a spectrum in which historical studies integrate with existing health promotion disciplines to solve complex health problems. We draw on the many calls for more interdisciplinarity in health promotion and derive this methodology from proposals in the medical humanities and cognate fields that have wrestled with combining history and present-focused disciplines. Using tobacco control and skin cancer prevention as case studies, we demonstrate how public health humanities uses interdisciplinary teams and shared research questions to generate valuable new knowledge unavailable with traditional methods. Furthermore, we show how it creates evaluation criteria to consider the powerful impact of issues like colonialism on current inequities that hinder health promotion strategies, and from which lessons may be derived for the future.

Public support for food policies in Mexican adults: Findings from the International Food Policy Study, 2017-2021

Deaths attributable to unhealthful eating underscore the need to improve dietary patterns through upstream, policy-led solutions. The approval and successful implementation of food policies is partly determined by their public acceptance. Little is known about public support for food policies in Mexico. We aimed to investigate the level of public support for 30 food policies, grouped into 5 domains, and their associated characteristics among Mexican adults. Data are from the 2017-2021 International Food Policy Study (IFPS), a cross-sectional web-based survey of adults. Differences in public support across years were estimated using linear regression models. The association between demographic characteristics and policy support was analyzed using multivariate logistic regression models. The highest mean support was for the subsidies and benefits domain, followed by the labelling and reformulation domain. The level of support varied across years and policy domains. Support was higher in 2019 compared to 2017 and 2018, and subsequently lower in 2020 and 2021 compared to previous years. Older age was associated with greater support across all domains (OR ranged from 0.002 to 0.004, p < 0.01). Female participants and those selfidentifying as indigenous showed greater support for certain policy domains, whereas higher income adequacy was associated with lower support for other policy domains. In Mexico, support for food policies varies across subpopulations. Our findings may serve as a guide to the development and promotion of food policies in Mexico, as well as to improve their feasibility and success.

Are Perceptions of Government Intervention Related to Support for Prevention? An Australian Survey Study

BACKGROUND

In Australia, despite the success of tobacco control policy interventions, policymakers remain resistant to policy-based approaches to diet, alcohol, physical inactivity and obesity, concerned about community perceptions of such interventions as "nanny-statist". We examined how people's general positions on government intervention related to their positions on different preventive policy options.

METHODS

Data were from a 2018 nationally representative cross-sectional telephone survey of 2601 Australian adults. Survey questions related to endorsement of different conceptualisations of government intervention (nanny state, paternalistic, shared responsibility and communitarian) and support for specific health interventions, using forced-choice questions about preferences for individual/treatment measures versus population/preventive health measures. We analysed associations between scores on different conceptualisations of government intervention and support of different policy options for tobacco and diet, and preferences for prevention over treatment.

RESULTS

The Nanny State Scale showed an inverse relationship with support for tobacco- and diet-related interventions, and alternative conceptualisations (paternalistic, shared responsibility and communitarian) showed a positive relationship. Effect sizes in all cases were small. Those aged 55+ demonstrated greater support for policy action on tobacco and diet, and greater preference for systemic rather than individual-level interventions.

CONCLUSION

General disposition towards government intervention, although correlated with support for specific policy actions, is not deterministic.

Gambling, fast food and alcohol sponsorship in elite sport - perspectives from Australian sporting fans

BACKGROUND

Public health bodies in Australia remain concerned about marketing of unhealthy commodities; namely unhealthy food, alcohol and gambling products. Children are particularly susceptible to the influence of unhealthy commodity marketing. This study explored adults' perceptions of unhealthy commodities sponsorship in elite sport and policies to restrict them.

METHODS

Four focus groups of 7-8 frequent sport spectators were recruited, including parents and non-parents, and located in inner and outer suburbs of Sydney, Australia. Results were analysed thematically.

RESULTS

Participants identified the contradictions of healthy messages of sport and unhealthy commodities, while highlighting the commercial value of sport sponsorship to sporting clubs. There is concern around children's exposure to effective and integrated marketing techniques when viewing sport, which encouraged unhealthy habits. Support for restricting sponsorship related to perceived product harm, with gambling viewed as having the greatest health impact. Participants were supportive of policies that reduced exposure of unhealthy commodities to children, but were concerned about the financial risk to sporting clubs. Governments and sports associations were identified as holding responsibility for enacting changes.

CONCLUSION

A number of options were identified for advocates to gain public and political traction to reduce unhealthy commodity sponsorship. There is potential for shifts away from unhealthy sponsorship by both governments and sports associations.

Public perception of the tax on sweetened beverages in France

OBJECTIVE

To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance.

DESIGN

A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling.

SETTINGS

NutriNet-Santé prospective cohort study.

PARTICIPANTS

Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France.

RESULTS

Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax.

CONCLUSION

The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.

Public Opinion on Food Policies to Combat Obesity in Spain

(1) Introduction: Poor diet is the fourth-leading cause of mortality in Spain, where adherence to the Mediterranean diet has declined in recent decades. To remedy this situation, a series of food policies have been proposed that would be easier to implement if they had public support. (2) Material and methods: Cross-sectional study covering a representative sample of the Spanish population (n = 1002), using telephone interviews that addressed nine food policies under four headings, namely, advertising, labeling, composition, and provision and sale. The sociodemographic determinants of support for these policies were analyzed using the chi-squared (χ²) test and Poisson multiple regression models with robust variance. (3) Results: All the proposed measures received more than 60% support. The policies that received greatest support were those targeting labeling at 96.6%, while the policies that received the least support were those directed at banning free refills at restaurants, at 63%. Support for policies was higher among women, older adults, and persons professing left-wing ideological affiliations. Compared with men, women’s support for advertising policies was 21% higher: similarly, compared with the youngest age group (18–29 years), support by the over-65 segment for provision and sale policies was 52% higher. Support for composition policies was 28% lower among persons with right-wing as opposed to left-wing political sympathies. (4) Conclusions: The authorities enjoy the support of the Spanish public as regards implementing food policies proposed by experts and overcoming the resistance of sectors opposed to such measures.

Policies to restrict unhealthy food and beverage advertising in outdoor spaces and on publicly owned assets: A scoping review of the literature

Unhealthy food marketing influences attitudes, preferences, and consumption of unhealthy foods, leading to excess weight gain. Outdoor advertising is highly visible (often displayed on publicly owned assets), but the evidence supporting regulation is unclear. This systematic scoping review of academic and grey literature aimed to (1) describe potential health and economic impacts of implementing government-led policies that restrict unhealthy food advertising in outdoor spaces or on public assets (including studies examining prevalence of advertising, associations with health outcomes and interventional studies); (2) identify and describe existing policies; and (3) identify factors perceived to have influenced policy implementation. Thirty-six academic studies were eligible for inclusion. Most reported on prevalence of unhealthy food advertising, demonstrating high prevalence around schools and in areas of lower socioeconomic position. None examined health and economic impacts of implemented policies. Four jurisdictions were identified with existing regulations; five had broader marketing or consumer protection policies that captured outdoor food marketing. Facilitators of policy implementation included collaboration, effective partnerships, and strong political leadership. Barriers included lobbying by food, media, and advertising industries. Implementation of food marketing policies in outdoor spaces and on public assets is feasible and warranted. Strong coalitions and leadership will be important to drive the policy agenda forward.

Community support for policy interventions targeting unhealthy food environments in public institutions

ISSUE ADDRESSED

Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions.

METHODS

An online cross-sectional survey was completed by 2,006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal, and behavioral characteristics.

RESULTS

Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n=7) initiatives. Support for food environment policies was highest for schools (76-82%) and hospitals (67-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support.

CONCLUSION

There is significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.

Perspectives of Adult Singaporeans toward Potential Policies to Reduce the Consumption of Sugar Sweetened Beverages-A Cross-Sectional Study

Excessive consumption of sugar sweetened beverages (SSB) is of growing concern, and several countries are implementing measures to reduce SSB consumption. Understanding perceptions towards SSB policies is crucial to prioritize policy actions and to effectively frame public communication. We conducted a cross-sectional study in a sample of 754 adult Singaporeans to examine support towards 10 hypothetical policies to reduce SSB consumption. Policy scenarios were presented to participants and support was assessed using a 5-point Likert scale. Opinions about policies were elicited by asking participants “What other thoughts do you have about this policy?”. We used logistic regression to examine determinants of policy support, and thematic analyses to understand opinions about policies. We observed good public support for a variety of SSB policies. In general, less restrictive policies such as traffic light labels (85.0% agreed/strongly agreed) and free access to water at eateries (77.1%) were better supported as compared to restrictive policies such as portion-size restrictions (64.5%) and taxation (55.0%). There was limited variation by age, ethnicity, income, physical activity and body mass index. Concerns about policies largely centered on loss of personal autonomy and economic implications for businesses. Nevertheless, participants also recognized that policies could support healthier beverage consumption by increasing awareness and enabling informed decision making. Findings from this study provide insights into consumer’s perceptions of SSB policies, and can inform public health advocacy and government action in this area.

Framing the nanny (state): an analysis of public submissions to a parliamentary inquiry on personal choice and community safety

OBJECTIVE

To examine public submissions to a parliamentary inquiry on personal choice and community safety, exploring framing used to support or oppose current public health regulatory approaches.

METHODS

Descriptive content analysis summarised the characteristics of electronic submissions. Framing analysis examined submissions according to the devices: problem and causes; principles and values; recommendations; data and evidence; and salience.

RESULTS

We categorised one hundred and five (n=105) submissions by source as Individual, Industry, Public Health and Other. Individuals made more than half the submissions. Overarching frames were choice and rights (Individuals); progress and freedom (Industry); protection and responsibility (Public Health). Most submissions opposed current regulations. Cycling, including mandatory helmet legislation, was most cited, with three-quarters of submissions opposing current legislation.

CONCLUSIONS

Framing analysis provided insights into policy actor agendas concerning government regulation. We found a high degree of resistance to public health regulation that curtails individual autonomy across various health issues. Investigating the influence of different frames on community perception of public health regulation is warranted. Implications for public health: Action is required to counteract 'nanny state' framing by industry and to problematise community understanding of the 'nanny state' in the context of balancing the public's liberties and the public's health.

Monitoring changes in community support for policies on obesity prevention

OBJECTIVE

To investigate the New South Wales (NSW) community's support for obesity prevention policies and concern for food marketing and promotion issues, and to determine any demographic differences or changes over time.

METHODS

In 2013 (n=2474), 2016 (n=1602) and 2019 (n=1613) a sample of adults who were representative of the NSW population for age, gender, education and location was asked about support for policy initiatives that influence the food environment. Analysis identified the characteristics of those who supported policies and variation in support over time.

RESULTS

There were limited changes in support over time; however, support for many policies was strong and sustained. In 2019, support was highest for regulation of claims about nutrition (77.2%), and health warning labels (75.7%). Support for a ban on unhealthy food advertising that targets children (64.6%) had decreased since 2013. Women, older people and those who were aware that obesity was a risk factor for cancer were generally more likely to support policies. Parents were more likely than non-parents to be concerned about positioning unhealthy food at supermarket checkouts (OR 1.32) and unhealthy outdoor advertisements (OR 1.22). Concern increased in 2019 for unhealthy marketing on the internet (OR 1.21).

CONCLUSIONS

This study shows public support for policy options at moderate to high levels but not increasing in the six-year study period. Implications for public health: These results form part of a package that, along with the well-established evidence, makes the case for policy action in Australia.

Adolescents report low opposition towards policy options to reduce consumption of sugary drinks

BACKGROUND

Policy makers benefit from insight into consumer perceptions of potential sugary drink policy measures. Adolescents are among the highest consumers in Australia, yet their perceptions are unknown.

OBJECTIVES

To determine adolescents' perceptions of potential policies aimed at reducing sugary drink consumption and explore variation in perceptions.

METHODS

Data were collected via a nationally representative survey of Australian secondary school students (aged 12-17) using a stratified two-stage probability design (n = 9102). Survey questions assessed receptiveness to five policy options, sugary drink consumption, perceptions of health effects and demographics.

RESULTS

Low proportions (13%-29%) were somewhat/strongly against policy options, 35% to 45% were neutral, and 27% to 52% were somewhat/strongly in favour. Highest support was observed for text warning labels on sugary drinks (52%), followed by tax with investment in healthy weight programmes (43%), standalone tax (36%), restricting school sales (30%) and restricting advertising to children (27%). Sex, sugary drink consumption and perceptions were significantly associated with most assessed policy options in bivariate analyses (P < .01). Significant associations between sex and consumption with selected policy options persisted in adjusted multilevel models.

CONCLUSIONS

Opposition towards policy options was low overall and neutrality was common. This creates opportunity for early intervention to increase public support for addressing specific health issues.

Promoting healthy eating in the community sport setting: a scoping review

Community sport organizations promote beneficial health outcomes such as social connection and physical activity, yet they can also facilitate the consumption of unhealthy food and beverages. To provide a foundation for future research and to inform intervention efforts in this context, this scoping review summarizes existing knowledge of the factors that contribute to unhealthy food and beverage consumption in the community sport setting and explores the interventions to promote healthier choices. Using a qualitative process aligned with the nature of our aims, 228 articles were initially identified and subjected to a systemized appraisal, resulting in 45 articles pertinent to the review. The findings identify that the two key factors contributing to unhealthy food choices are the limited availability of healthy options within the sport setting and the presence of unhealthy food and beverage sponsorship. These factors contribute to the normalization of unhealthy eating in this context and health promotion interventions have had limited success. Barriers to change primarily stem from the revenue implications of removing unhealthy food sponsors, lack of organizational capabilities and resources, and consumer preference for unhealthy options. Public health practitioners seeking to intervene in this setting should consider adopting practices used in other settings outside of the sport environment, including the use of technology, the role of peers and mentors and the co-production of impactful material. Community sport plays a vital role in delivering health benefits but must do more to stem its facilitation of a potentially unhealthy consumptive environment.

'Sweet talk': framing the merits of a sugar tax in Australia

Although rising rates of obesity are recognized as a major concern for Australian public health, debate on what (if any) responsive action should be undertaken is conceptually and normatively complex. It is shaped by diverse values and interests; different representations of the problem; and many options for action by government, the private sector or individuals. This paper presents research documenting arguments for and against implementing a sugar tax in Australia. It is based on semi-structured interviews with representatives from industry (n = 4), public health (n = 4), policy think tanks (n = 2); and document and media analyses. The research design was informed by framing and agenda setting theory with results reported under four main themes: framing economic impacts, framing equity, framing obesity and framing the 'nanny state' versus individual liberty argument. We found that proposals for a sugar tax as part of policy responses to the issue of overweight and obesity in Australia are framed very differently by actors who either support or oppose it. A conclusion is that policy makers and public health advocates involved in policy debates on a sugar tax need to understand the role of problem and 'solution' framing, and develop positions based on protecting the public interest as a basic ethical responsibility of governments and public agencies.

What do the Australian public think of regulatory nutrition policies? A scoping review

Effective government policies are crucial to creating healthy food environments. However, changing public policy is a slow and challenging process involving many competing factors. One cited factor is public opinion towards a proposed policy. This study aimed to systematically explore public opinion on regulatory nutrition policy issues in Australia from 2009 to 2019, to determine whether low levels of public opinion corresponded with the low levels of regulatory policy action in this country. We found that there was varying levels of public support in Australia for public health nutrition action. Regulatory- and legislative-based policies generally had moderate to high levels of support except for food and drink taxes, which had low to moderate support. Despite high levels of public support for certain policy initiatives, national public health nutrition policy in Australia has not evolved consistently with the level of public support nor the evidence base over the past decade indicating other more important factors at play in policymaking.

Are perceptions of government intervention for prevention different by gender and age? Results from the AUStralian Perceptions Of Prevention Survey (AUSPOPS)

OBJECTIVES

Understanding public opinion and community attitudes is needed to help the implementation of chronic disease prevention policies that are acceptable to the population. The AUStralian Perceptions Of Prevention Survey ('AUSPOPS') is a national survey designed to provide evidence on the views of Australians regarding government intervention for prevention. However there is limited evidence whether age and gender have modifying effects on attitudes about prevention.

METHODS

Using results from the 2018 AUSPOPS dataset, this study examines whether the effect of age on attitudes about prevention is modified by the effect of gender. Survey questions included views about statements for government intervention and whether government had gone far enough for thirteen different preventive interventions.

RESULTS

2601 Australian residents aged 18 years or older participated in the survey (response rate 16.7%). Results showed strong support for prevention framed as a shared responsibility between governments and individuals. Interventions where >50% of respondents felt the government had not gone far enough in prevention were restricting unhealthy food advertising for children and setting salt limits on processed food. There were significant age by gender interactions in a small number (n = 4) of questions examining support for government intervention for prevention, suggesting young men were least in favour of more action by government.

CONCLUSIONS

There is general support in the Australian community for government intervention for prevention. Policymakers could capitalize on this sentiment by prioritizing policies with high levels of support across all groups, and target population subgroups on issues where acceptability appears to be heterogenous.

Knowledge and acceptance of interventions aimed at reducing sugar intake in Portugal

OBJECTIVE

Governments worldwide have been implementing interventions aimed at improving citizens' dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population.

DESIGN

Online survey to assess which interventions are the most salient and receive greater public support.

SETTING

Portugal.

PARTICIPANTS

1010 (76·7 % female, MAge 36·33, sd 13·22).

RESULTS

Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex).

CONCLUSION

By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain.

The Acceptance of Key Public Health Interventions by the Polish Population Is Related to Health Literacy, But Not eHealth Literacy

Background: Public health and health promotion rely on many different interventions, which range from health education and communication, through community mobilisation and changes to environmental conditions, to legal and fiscal actions. The introduction of the increased tax on sugar-sweetened beverages (SSB), popularly called sugar tax (ST), and a mandatory programme of vaccinations are the strategies inciting the most vivid discussions in Polish society. The study was intended to assess the determinants of the attitudes of Polish society regarding the ST and to vaccinations. Methods: For the analysis, the data originating from the survey of a representative adult sample of Polish society (n = 1000) was used. The survey was based on computer-assisted telephone interviewing (CATI). The assessment of the relationships between the selected variables and the opinions about the introduction of the ST and the safety and effectiveness of vaccinations were carried out using the chi² test and univariate logistic regression models. Results: The acceptance of the ST and vaccination showed a significant relationship to the level of health literacy (HL) but not to eHealth literacy (eHL). Respondents having a higher rather than lower HL; older rather than younger; married rather than singles; retired, or on a disability pension, rather than vocationally active and nonusers of the Internet rather than users were more likely to show an acceptance for both interventions. Those more frequently using health care services and those with chronic diseases showed a greater belief in the safety and effectiveness of vaccinations. Conclusions: The relationship between the opinions of the two public health interventions analysed and the sociodemographic variables demonstrated similar patterns. Interestingly, the opinions were associated only with HL and not with eHL and users of the Internet were more sceptical about the interventions.

Attitudes of sports organisation members to junk food sponsorship

OBJECTIVES

To explore sports organisation members' attitudes to sponsorship of sport by energy-dense, nutrient-poor food and drink ('junk food') brands.

STUDY DESIGN

The study design is a cross-sectional study.

METHODS

An online survey of adult members of three sports organisations that did not accept junk food sponsorship in Victoria, Australia in 2018: one was responsible for an elite team in a national competition (5000-10,000 members); one managed a team sport competition across Victoria (50,000-100,000 registered junior and adult participants, referees and coaches); and one administered a junior team sport competition for boys and girls in a major city (10,000-15,000 participants).

RESULTS

Most (71%) of the 2224 respondents reported it was important/very important that their organisation did not accept junk food sponsorship. A higher proportion was concerned/very concerned about junk food companies sponsoring children's sport (60%) compared with such companies sponsoring elite (49%, P < 0.001) or community adult (39%, P < 0.001) sport. A higher proportion of respondents were likely/very likely to support a policy that restricted junk food sponsorship of children's sport (84%), compared with a policy restricting sponsorship of elite (76%, P > 0.001) and adult community (74%, P > 0.001) sport. Two-thirds of respondents supported restricting junk food companies from sponsoring sport, even if fees for children's (66%) and community adult (65%) sport increased, or if membership and attendance costs for elite sport supporters increased (63%).

CONCLUSIONS

In the Australian context of this study, junk food sponsorship of sport, particularly children's sport, is a concern to members of sports organisations. Although still high, support for restricting such sponsorship declines if members perceive it will lead to increases in participation costs and decreases in participation opportunities. Initiatives restricting junk food sponsorship of sport are likely to receive strong support from the sports community, particularly when the focus is on children's sport, and participation costs and opportunities are not negatively impacted.

Public acceptability of a sugar-sweetened beverage tax and its associated factors in the Netherlands

Objective:

To investigate the level of public acceptability of a sugar-sweetened beverage (SSB) tax and its associated factors.

Design:

Participants completed an online self-administered questionnaire. Acceptability of an SSB tax was measured on a seven-point Likert scale (strongly disagree to strongly agree). Associations between acceptability and sociodemographic factors, weight status, SSB consumption and beliefs about effectiveness (e.g., ‘An SSB tax would reduce people’s SSB consumption’), appropriateness, socioeconomic and economic benefit, implementation and trust were assessed using multivariable linear regression analyses.

Setting:

The Netherlands.

Participants:

Dutch adults aged ≥18 years representative of the Dutch population for age, sex, education level and location (n 500).

Results:

Of the participants, 40 % supported and 43 % opposed an SSB tax in general. Moreover, 42 % supported (43 % opposed) an SSB tax as a strategy to reduce overweight, and 55 % supported (32 % opposed) an SSB tax if revenue is used for health initiatives. Participants with a low education level (B = –0·82, 95 % CI –1·31, –0·32), overweight (B = –0·49, 95 % CI –0·89, –0·09), moderate or high SSB consumption (B = –0·86, 95 % CI –1·30, –0·43 and B = –1·01, 95 % CI –1·47, –0·56, respectively) and households with adolescents (B = –0·57, 95 % CI –1·09, –0·05) reported a lower acceptability of an SSB tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P < 0·001).

Conclusions:

Public acceptability of an SSB tax tends to be higher if revenue is used for health initiatives. The factors associated with acceptability should be taken into consideration.

Nutrition Policy and Individual Struggle to Eat Healthily: The Question of Public Support

The evidence for the effectiveness of nutrition policy interventions is growing. For the implementation of such interventions, social acceptability is crucial. Therefore, this study provides insight into public support for nutrition policy measures such as labelling and taxation. Further it analyses the level of acceptance in a quantitative segmentation approach. A new element to our approach is the comparison of different policy instruments, focusing on the interaction between policy acceptance and the perceived individual struggle to eat healthily. The survey was conducted in November 2017 and a total of 1035 German consumers are included in the data. The results indicate that the majority of German citizens accept nutrition policy interventions. Based on a cluster analysis, five different target groups according to the general acceptance of policy interventions and their own struggle to eat healthily are derived. The five-cluster solution reveals that both consumers who tend to eat a healthy diet as well as those who have problems with their diet support nutritional interventions. This shows that the perceived own struggle to eat healthily does not predict whether consumers accept nutrition policy interventions.

Should Australia tax sugar-sweetened beverages?

The implementation of a sugar tax in Australia has been discussed extensively as a way to combat rising rates of obesity and diabetes. We aim to review international efforts by governments to implement sugar tax initiatives. We summarise the different initiatives and investigate their pros and cons, evidence of impact and what the possibilities are for introducing a sugar tax in the Australian context. We conclude that government-imposed sugar taxes on production reduce sugar consumption in the general population. It remains unclear whether the reduction in sugar has generally led to a reduction in population obesity. Nonetheless, the fact that commercial actors have themselves begun to reduce sugar in their products indicates that they are aware of the benefits of reduced sugar consumption in the community, if only by way of changing consumer preferences.

Sports Sponsorship as a Cause of Obesity

PURPOSE OF REVIEW

This article investigates the role of food and beverage sponsorship of sports in influencing dietary behaviour, and ultimately obesity, focusing on research published in the past 5 years. A systematic strategy was used to search the health science, social science and marketing databases to identify peer-reviewed literature on food and non-alcoholic beverage company sponsorship of sport published in English from 2015 to 2019.

RECENT FINDINGS

Sixteen discrete studies were identified: six content analyses, two qualitative studies, four cross-sectional surveys and four experimental studies. Findings indicate sports sponsorship is widely used to promote unhealthy foods through professional and community sport, prompting increased awareness and preference for sponsor products. Most studies assessed self-reported responses to sponsorship, with a lack of behavioural data on food purchasing and consumption. Sports sponsorship by unhealthy food brands achieves vast population reach and exposure, promoting increased brand awareness and preference for sponsor products. Research is needed to improve our understanding of the relationship between food and beverage sponsorship and energy intake. Research evaluating the efficacy of strategies to reduce spectator's exposure to unhealthy sports sponsorship is also needed.

Insights on the Influence of Sugar Taxes on Obesity Prevention Efforts

PURPOSE OF REVIEW

This review will present the latest evidence on the impacts of sugar taxes on obesity with a focus on sugar-sweetened beverages (SSB).

RECENT FINDINGS

Evidence of direct impacts of SSB taxation policies on obesity prevalence continues to be limited. Natural experiments involving SSB taxation policies implemented in Mexico and Berkley, CA, indicate that this type of intervention alters beverage consumption patterns. Naturalistic evidence in combination with modeling studies suggests that SSB taxation is a viable anti-obesity policy. However, researchers and public health practitioners need to be vigilant of industry tactics to curtail SSB lowering efforts. To maximize the impacts of SSB taxation, it should be combined with interventions that increase access to non-sweetened beverages, educate consumers about alternative healthy beverages, and explore taxation of other non-nutritive foods and beverages. Furthermore, both intended and unintended consequences of interventions should be closely monitored.

Translation of a Mediterranean-Style Diet into the Australian Dietary Guidelines: A Nutritional, Ecological and Environmental Perspective

A Mediterranean diet (MedDiet) has been widely investigated and promoted as one of the 'healthiest' dietary patterns with respect to reductions in chronic disease risk and longevity. Moreover, it also emphasizes a plant-based dietary pattern consistent with an environmentally sustainable healthy reference diet conveyed by the EAT-Lancet Commission report. Nevertheless, the MedDiet does not exclude, but rather moderates consumption of animal-based foods, and therefore has emerged as a dietary pattern that could address both health and environmental concerns. However, whether non-Mediterranean countries such as Australia can adhere to such dietary principles is less clear. In this narrative review, we present evidence from eight randomized control trials conducted in Australia which demonstrates impressive and sustained adherence to a MedDiet intervention. However, we also report heterogeneity in the dietary protocols and prescriptive interpretation of a MedDiet across all studies presented in this review, making interpretations of the efficacy and adherence challenging. Based on the observable health benefits, translating key dietary elements of a Mediterranean-style diet within the Australian population remains attractive. However, adapting or modernizing traditional dietary patterns to satisfy the population's nutritional requirements and/or acceptability warrants further exploration.

Political and public acceptability of a sugar-sweetened beverages tax: a mixed-method systematic review and meta-analysis

BACKGROUND

Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax.

METHODS

Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions.

RESULTS

Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38-0.47) supports an SSBs tax, 39% (0.29-0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60-0.72) supports an SSBs tax if revenue is used for health initiatives.

CONCLUSIONS

Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.

A multi-country survey of public support for food policies to promote healthy diets: Findings from the International Food Policy Study

BACKGROUND

Poor diet is a significant contributor to the burden of global disease. There are numerous policies available to address poor diets; however, these policies often require public support to encourage policy action. The current study aimed to understand the level of public support for a range of food policies and the factors associated with policy support.

METHODS

An online survey measuring support for 13 food policies was completed by 19,857 adults in Australia, Canada, Mexico, the United Kingdom (UK) and the United States (US). The proportion of respondents that supported each policy was compared between countries, and the association between demographic characteristics and policy support was analysed using multivariate logistic regression.

RESULTS

The level of support varied between policies, with the highest support for policies that provided incentives (e.g., price subsidies) or information (e.g., calorie labelling on menus), and the lowest support for those that imposed restrictions (e.g., restrictions on sponsorship of sport events). This pattern of support was similar in all countries, but the level differed, with Mexico generally recording the highest support across policies, and the US the lowest. Several demographic characteristics were associated with policy support; however, these relationships varied between countries.

CONCLUSION

The results suggest that support for food policies is influenced by several factors related to the policy design, country, and individual demographic characteristics. Policymakers and advocates should consider these factors when developing and promoting policy options.

Are Australians ready for warning labels, marketing bans and sugary drink taxes? Two cross-sectional surveys measuring support for policy responses to sugar-sweetened beverages

OBJECTIVE

To assess public support for 10 potential policy initiatives to reduce sugar-sweetened beverage (SSB) consumption.

DESIGN

A 2014 historical data set, which employed a face-to-face survey in one Australian state (study 1), provided the basis for comparison with our 2017 nationally representative, cross-sectional, computer-assisted telephone interviewing population survey (study 2).

PARTICIPANTS

Study 1: South Australians, 15+ years (n=2732); study 2: Australians, 18+ years (n=3430).

PRIMARY OUTCOME MEASURES

levels of support for SSB-specific policy initiatives. For the 2017 national study (study 2), demographic characteristics, body mass index, knowledge of potential harms caused by consuming SSBs and SSB consumption were included in multivariable regression analyses.

RESULTS

In 2017, all 10 potential policy initiatives received majority support (60%-88% either 'somewhat' or 'strongly' in favour). Initiatives with educative elements or focused on children received high support (>70%), with highest support observed for text warning labels on drink containers (88%) and government campaigns warning of adverse health effects (87%). Higher support was observed for SSB tax paired with using funds for obesity prevention (77%) than a stand-alone tax (60%). Support for policy initiatives was generally greater among those who believed SSB daily consumption could cause health problems in adults (4%-18% absolute difference) and/or in children (8%-26% absolute difference) and lower among SSB high consumers (7+ drinks per week; 9%-29% absolute difference). State-specific data comparison indicated increased support from 2014 to 2017 for taxation (42%vs55%; χ²=15.7, p<0.001) and graphic health warnings (52%vs68%; χ²=23.4. p<0.001).

CONCLUSIONS

There is strong public support for government action, particularly regulatory and educational interventions, to reduce SSB consumption, which appears to have increased since 2014. The findings suggest that framing policies as protecting children, presenting taxation of SSBs in conjunction with other obesity prevention initiatives and education focused on the harms associated with SSB consumption will increase support.

Effective advocacy strategies for influencing government nutrition policy: a conceptual model

Influencing public policy change can be difficult and complex, particularly for those with limited power and resources. For any one issue there may be several groups, including the commercial sector and public health advocates advocating from different policy perspectives. However, much of the public health advocacy literature and tools available for those wanting to improve their practice is based on research from one specific perspective of an issue. This approach deprives advocates of potential insight into the most effective levers for this complex and difficult process. To provide a more comprehensive insight into effective levers for influencing public health policy change, a conceptual model for poorly-resourced advocates was developed. The model was developed through the integration and synthesis of policy process and network theories with the results from three studies conducted previously by the authors: a systematic literature review; a social network analysis of influential actors in Australian nutrition policy; plus in-depth interviews with a sample of these actors who had diverse perspectives on influencing nutrition policy. Through understanding the key steps in this model advocates will be better equipped to increase political and public will, and affect positive policy change.