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Zorbas C, Blake MR, Brown AD, Peeters A, Allender S, Brimblecombe J, Cameron AJ, Whelan J, Ferguson M, Alston L, Boelsen-Robinson T. A systems framework for implementing healthy food retail in grocery settings. BMC Public Health 2024; 24:137. [PMID: 38195419 PMCID: PMC10777568 DOI: 10.1186/s12889-023-17075-8] [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: 05/26/2023] [Accepted: 10/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Food retailers can be reluctant to initiate healthy food retail activities in the face of a complex set of interrelated drivers that impact the retail environment. The Systems Thinking Approach for Retail Transformation (START) is a determinants framework created using qualitative systems modelling to guide healthy food retail interventions in community-based, health-promoting settings. We aimed to test the applicability of the START map to a suite of distinct healthy food marketing and promotion activities that formed an intervention in a grocery setting in regional Victoria, Australia. METHODS A secondary analysis was undertaken of 16 previously completed semi-structured interviews with independent grocery retailers and stakeholders. Interviews were deductively coded against the existing START framework, whilst allowing for new grocery-setting specific factors to be identified. New factors and relationships were used to build causal loop diagrams and extend the original START systems map using Vensim. RESULTS A version of the START map including aspects relevant to the grocery setting was developed ("START-G"). In both health-promoting and grocery settings, it was important for retailers to 'Get Started' with healthy food retail interventions that were supported by a proof-of-concept and 'Focus on the customer' response (with grocery-settings focused on monitoring sales data). New factors and relationships described perceived difficulties associated with disrupting a grocery-setting 'Supply-side status quo' that promotes less healthy food and beverage options. Yet, most grocery retailers discussed relationships that highlighted the potential for 'Healthy food as innovation' and 'Supporting cultural change through corporate social responsibility and leadership'. CONCLUSIONS Several differences were found when implementing healthy food retail in grocery compared to health promotion settings. The START-G map offers preliminary guidance for identifying and addressing commercial interests in grocery settings that currently promote less healthy foods and beverages, including by starting to address business outcomes and supplier relationships.
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Affiliation(s)
- Christina Zorbas
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia.
| | - Miranda R Blake
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Andrew D Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Anna Peeters
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Steve Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Julie Brimblecombe
- Department of Nutrition and Dietetics, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC, Australia
| | - Adrian J Cameron
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Jill Whelan
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Megan Ferguson
- School of Public Health, The University of Queensland, St Lucia, QLD, Australia
| | - Laura Alston
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
- Deakin Rural Health, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Tara Boelsen-Robinson
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 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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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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Browne J, Becker D, Orellana L, Ryan J, Walker T, Whelan J, Alston L, Egan M, Johnson B, Rossignoli A, Crooks N, Brown AD, Bolton KA, Fraser P, Le H, Bell C, Hayward J, Sanigorski A, Backholer K, Allender S, Strugnell C. Healthy weight, health behaviours and quality of life among Aboriginal children living in regional Victoria. Aust N Z J Public Health 2022; 46:595-603. [DOI: 10.1111/1753-6405.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/01/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Denise Becker
- Biostatistics Unit, Faculty of Health Deakin University Geelong Victoria
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health Deakin University Geelong Victoria
| | - Joleen Ryan
- School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Troy Walker
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Jill Whelan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- School of Medicine, Faculty of Health Deakin University Geelong Victoria
| | - Laura Alston
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Deakin Rural Health, Faculty of Health Deakin University Warrnambool Victoria
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation Melbourne Victoria
| | - Brittney Johnson
- Victorian Aboriginal Community Controlled Health Organisation Melbourne Victoria
| | - Amy Rossignoli
- Victorian Aboriginal Community Controlled Health Organisation Melbourne Victoria
| | - Nicholas Crooks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Andrew D. Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Kristy A. Bolton
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Faculty of Health Deakin University Geelong Victoria
| | - Penny Fraser
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- School of Medicine, Faculty of Health Deakin University Geelong Victoria
| | - Ha Le
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Deakin Health Economics, Faculty of Health Deakin University Geelong Victoria
| | - Colin Bell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- School of Medicine, Faculty of Health Deakin University Geelong Victoria
| | - Josh Hayward
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Andrew Sanigorski
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Deakin Rural Health, Faculty of Health Deakin University Warrnambool Victoria
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
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O’Halloran S, Eksteen G, Gebremariam M, Alston L. Measurement Methods Used to Assess the School Food Environment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051623. [PMID: 32138232 PMCID: PMC7084932 DOI: 10.3390/ijerph17051623] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 01/15/2023]
Abstract
Children consume approximately half of their total daily amount of energy at school. Foods consumed are often energy-dense, nutrient-poor. The school food environment represents an effective setting to influence children’s food choices when dietary habits are established and continue to track into adulthood. The aim of this review was to: (1) group methods used for assessing the school food environment according to four food environment dimensions: Physical, economic, socio-cultural and policy and (2) assess the quality of the methods according to four criteria: Comprehensiveness, relevance, generalizability and feasibility. Three databases were searched, and studies were used to assess food and beverages provided at school canteens, tuck shops or cafeterias were included. The review identified 38 global studies (including 49 methods of measuring the food environment). The physical environment was the primary focus for 47% of articles, aspects of policy environment was assessed by 37% articles and a small number of studies assessed the economic (8%) and socio cultural (8%) environment. Three methods were rated ‘high’ quality and seven methods received ‘medium’ quality ratings. The review revealed there are no standardized methods used to measure the school food environment. Robust methods to monitor the school food environment across a range of diverse country contexts is required to provide an understanding of obesogenic school environments.
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Affiliation(s)
- Siobhan O’Halloran
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway;
- Correspondence:
| | - Gabriel Eksteen
- Division Human Nutrition, University of Cape Town, UCT Medical Campus, Cape Town 7925, South Africa;
| | - Mekdes Gebremariam
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway;
| | - Laura Alston
- Global Obesity Centre (GLOBE), Faculty of Health, Institute for Health Transformation, Deakin University, Geelong VIC 3217, Australia;
- Deakin Rural Health, School of Medicine, Deakin University, Geelong VIC 3217, Australia
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