School lunchboxes as an opportunity for health and environmental considerations: a scoping review.

Very little research has focussed on children's school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children's lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes-particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children's health and sustainability behaviour, and mobilizing their pro-environmental agency.

School food environments play a key role in children's health and behaviour development. However, there are environmental implications of school food and this is not often considered in conjunction with schoolchildren's health based on their food consumption patterns. While wider environmental impacts of school food provision models have been studied, the more immediate and child-relevant outcomes (such as food and packaging waste) are also worth considering, especially in the context of school lunchboxes. This scoping review explored the existing literature for studies that focussed on school children's lunchbox contents and considered health attributes along with packaging and waste characteristics. Results from this review of 10 articles, which also describes the five interventions identified, pointed towards the merit of tapping into children's agency of change while also recognizing socio-ecological influences to drive sustainability practices for health co-benefits. The interconnectedness of nutritional quality and sustainability characteristics of school lunchboxes is an understudied phenomenon, but one with promising potential to promote and improve public health and planetary wellbeing.

'Alcohol causes cancer': a difficult message for Australians to swallow.

Alcohol is a modifiable risk factor for cancer. Public awareness of the link between alcohol and cancer risk is poor; thus, alcohol consumers may be unknowingly putting themselves at increased risk of cancer. One way to raise awareness of alcohol-related cancer is through placing labels warning of cancer risk on alcoholic beverage containers; however, little is known about the impact of such labels. We conducted seven focus groups, comprising participants who self-identified as low-to-moderate alcohol consumers, to gauge public attitudes towards the labels and messages relating to alcohol-related cancer risk. Transcripts of discussions were coded to identify emergent themes. Participants expressed a negative response to the alcohol warning labels, and their talk worked to challenge the legitimacy of alcohol-related cancer messages, and the entities responsible for disseminating the information. These responses functioned to counter any implied recommendation for reduction in speakers' alcohol consumption. These findings illustrate how the general population make sense of information about health risks, using this knowledge to make decisions about personal behaviour. In combination with other public health initiatives, alcohol-warning labels have the potential to increase awareness of cancer risk and help in the fight against cancer, but any messaging will need to account for probable consumer resistance.

Content analysis of school websites: policies and programs to support healthy eating and the environment.

Preschools and primary schools are important settings for the development of healthy eating habits and awareness of environmentally friendly practices. This study explored South Australian government schools' policies and programs in relation to healthy eating and environmentally friendly aspects of food choice (such as packaging), and whether any schools approached these issues in combination. Websites of 18 government preschools and primary schools in the Greater Adelaide region, stratified by low, medium and high socioeconomic status were reviewed for publicly available policies and other relevant content. A content analysis was undertaken, with policies and programs analysed deductively and thematically. Healthy eating (n = 8) and environment (n = 3) related policies were found on preschool websites only. The main themes observed across the three categories of interest (healthy eating, environmentally friendly practices and low-waste healthy foods) included the presence/absence of formal policy, promotional strategies and implementation. Expectations of children bringing healthy 'nude' foods that were environmentally friendly were mentioned informally on the websites but were not part of policy documents. Policies and programs around healthy eating and environmentally friendly practices (in combination) were lacking. There is scope to address this gap to improve health and sustainable outcomes within the school environment context.

A qualitative study of medication adherence amongst people with schizophrenia.

Non-adherence to antipsychotic medication is common among people with schizophrenia, and is associated with an increased risk of relapse. It is important to develop strategies to enhance medication adherence. Few qualitative studies have been undertaken to understand the consumer's perspective. The voice of people who are prescribed these medications is therefore missing from the research literature. Reasons for non-adherence were investigated by directly engaging with consumers and exploring their attitudes, beliefs and experiences concerning antipsychotic medications. Qualitative, semi- structured, one-to-one interviews were conducted with 25 community-dwelling people with schizophrenia from metropolitan Adelaide, Australia. Interviews were audio-recorded, transcribed and analysed, guided by a grounded theory approach. Codes identified in open coding were grouped into categories, reflective of the different aspects of consumers' attitudes and experiences with medication. Interviews continued until there was saturation of themes. Consumer-related factors, medication-related factors and service-related factors were reported to influence adherence behavior. These included poor insight, unpleasant medication side effects, inadequate efficacy and poor therapeutic alliance. Lessons gained during periods of non-adherence were the motivator for future adherence; such as worsening of symptoms if medication was not taken. Potential implications of future adherence described by Interviewees include greater involvement of peer workers, as they were considered to work more effectively with consumers to encourage adherence. Peer workers had more credibility than other service providers due to their lived experience. Multiple factors were identified that impact on antipsychotic medication adherence, providing opportunities for interventions and improvements in services that would enhance adherence.

Alcohol warning labels to reduce alcohol-related harm: a scoping review protocol.

OBJECTIVE: This scoping review aims to explore international literature relating to alcohol warning labels as a public health approach for reducing alcohol-related harm. INTRODUCTION: Alcohol-related harm is a global public health issue. More than 200 injuries, diseases and conditions are attributable to alcohol, and almost 6% of all global deaths are related to alcohol consumption.A common approach to raising public awareness of health hazards is product warning labels. Currently, 31 countries or territories have mandated the inclusion of alcohol warning labels on alcoholic beverages. However, research findings on the effectiveness of alcohol warning labeling to reduce alcohol-related harm are mixed and debatable. INCLUSION CRITERIA: This review will consider studies that focus on alcohol warning labeling (in the form of alcoholic beverage containers, simulated messages displayed on a computer screen or cards shown to participants that depict alcohol warning labels on beverage containers) as a strategy to reduce alcohol-related harm (e.g. drunk driving, violence, drinking while pregnant). METHODS: PubMed, Embase, Scopus, Cochrane Library, PsycINFO, Web of Science, CINAHL and JSTOR will be searched for relevant articles. The search for unpublished studies will utilise Trove and Google Scholar. Studies published in English from 1989 to the present will be considered. Retrieved papers will be screened for inclusion by at least two reviewers. Data will be extracted and presented in tabular form and a narrative summary that align with the review's objective.

"We Were Totally Supportive, of Course": How People Talk About Supporting a Significant Other to Stop or Reduce Their Drinking.

Despite the strong influence our significant others have on health behaviors such as alcohol consumption, little is known about when they are willing to provide support for changing such behaviors. We conducted interviews with 13 Australian adults who had a partner, friend, or family member who stopped or significantly reduced their alcohol consumption within the past 2 years, to understand how these significant others accounted for providing support for this behavior change as reasonable. Through thematic discourse analysis, we identified three types of accounts: (a) deontological, referring to duty or obligation to support others; (b) consequentialist, where costs for providing support were minimized or balanced; and (c) relational, attending to the importance of maintaining relationships. By identifying the principles people draw on to justify supporting a significant other who changes their alcohol consumption, this study enhances our understanding about when significant others are likely to support health behavior changes.

An examination of Australian newspaper coverage of the link between alcohol and cancer 2005 to 2013.

BACKGROUND: Alcohol is a Class-1 carcinogen but public awareness of the link between alcohol and cancer is low. The news media is a popular, readily-accessible source of health information and plays a key role in shaping public opinion and influencing policy-makers. Examination of how the link between alcohol and cancer is presented in Australian print media could inform public health advocacy efforts to raise awareness of this modifiable cancer risk factor. METHOD: This study provides a summative qualitative content analysis of 1502 articles that included information about a link between alcohol and cancer, as reported within Australian newspaper media (2005-2013). We use descriptive statistics to examine the prominence of reports, the nature and content of claims regarding the link between alcohol and cancer, and the source of information noted in each article. RESULTS: Articles were distributed throughout newspapers, most appearing within the main (first) section. The link between alcohol and cancer tended not to appear early in articles, and rarely featured in headlines. 95% of articles included a claim that alcohol causes cancer, 5% that alcohol prevented or did not cause cancer, 1% included both. Generally, the amount of alcohol that would cause or prevent cancer was unspecified or open to subjective interpretation. Coverage increased over time, primarily within community/free papers. The claim that alcohol causes cancer often named a specific cancer, did not name a specific alcohol, was infrequently the focus of articles (typically subsumed within an article on general health issues), and cited various health-promoting (including advocacy) organisations as information sources. Articles that included the converse also tended not to focus on that point, often named a specific type of alcohol, and most cited research institutions or generic 'research' as sources. Half of all articles involved repetition of materials, and most confirmed that alcohol caused cancer. CONCLUSIONS: Information about a link between alcohol and cancer is available in the Australian newsprint media, but may be hidden within and thus overshadowed by other health-related stories. Strategic collaboration between health promoting organisations, and exploitation of 'churnalism' and journalists' preferences for ready-made 'copy' may facilitate increased presence and accuracy of the alcohol-cancer message.

How have people who have stopped or reduced their alcohol consumption incorporated this into their social rituals?

OBJECTIVE: Limiting alcohol consumption is beneficial for health, but can be challenging given the role alcohol plays in the rituals of many social occasions. We examined how people who stopped or reduced their alcohol consumption incorporated this change within their social rituals. DESIGN: We conducted 16 semi-structured one-on-one interviews with adults aged 25-65 years, who lived in Australia and had stopped or significantly reduced their alcohol consumption in the previous year. RESULTS: Through thematic analysis, we identified four approaches to adapting drinking rituals: replacing alcohol with other drinks, replacing drinking with other social activities, changing the meaning of drinking rituals and replacing drinking occasions with activities that achieve different goals. These approaches varied in the extent to which they reflected a low or high change in the meanings and/or behaviours attached to the ritual. Approaches involving little change, such as using alternative drinks, were more readily accepted by participants' social companions than approaches involving more substantial changes such as replacing drinking with activities achieving different goals. CONCLUSIONS: Considering both the role and meaning alcohol carries in social interactions, and how else these might be achieved, may assist people to stop or reduce their drinking, without sacrificing their social lives.

"Males Don't Wanna Bring Anything Up To Their Doctor": Men's Discourses of Depression.

Men experiencing depression may present with externalizing behaviors including avoidance, getting angry, or finding distractions rather than seeking help. General practitioners report that depression is harder to diagnose in men than in women. Research has not typically focused on men's accounts of depression; thus, the current study uses an exploratory design to better understand men's subjectivities of depression. A thematic framework informed the analysis of interviews with 10 men who had experienced high levels of depressive symptoms at least once within the prior 5 years, with two overarching discourses of depression discussed. The first relates to links between depression and health, including comorbid illnesses. The second relates to social contexts in which depression is experienced. These findings extend upon previous research suggesting medical practitioners have difficulty with competing biomedical and social discourses of depression, highlighting the importance of continuing to improve understandings of men's depression discourses.

'Why can't I just not drink?' A qualitative study of adults' social experiences of stopping or reducing alcohol consumption.

INTRODUCTION AND AIMS: Alcohol is ingrained in Australian culture, playing an important role in many social occasions. This can make reducing or stopping alcohol consumption challenging, as one risks rejecting, not just a drink but also the valued social norms that drink represents. This study aimed to investigate the social experiences of adults who stop or reduce their alcohol consumption. DESIGN AND METHODS: Sixteen semi-structured interviews were conducted with people aged over 25 years who had stopped or significantly reduced their alcohol consumption for at least 3 months in the past year and were thematically analysed. RESULTS: Participants found themselves stigmatised for violating expectations around alcohol consumption when they tried to stop or reduce their own drinking. Although most were able to either conceal their change in alcohol consumption or present it so that it did not challenge norms around drinking, this approach was seen as a temporary measure and not one to employ with people with whom they socialised regularly. Instead, many participants sought to change their interactions with their social group to focus on activities with which alcohol consumption was not strongly associated. DISCUSSION AND CONCLUSIONS: Reducing or stopping alcohol consumption can have positive consequences for health, yet it can also raise social challenges that individuals need to negotiate in order to maintain their social well-being. This tension suggests a need for health promotion campaigns to address the social as well as health consequences of reducing alcohol consumption. [Bartram A, Eliott J, Crabb S. 'Why can't I just not drink?' A qualitative study of adults' social experiences of stopping or reducing alcohol consumption. Drug Alcohol Rev 2017;26:449-455].

Traffic-related air pollution and health co-benefits of alternative transport in Adelaide, South Australia.

BACKGROUND: Motor vehicle emissions contribute nearly a quarter of the world's energy-related greenhouse gases and cause non-negligible air pollution, primarily in urban areas. Changing people's travel behaviour towards alternative transport is an efficient approach to mitigate harmful environmental impacts caused by a large number of vehicles. Such a strategy also provides an opportunity to gain health co-benefits of improved air quality and enhanced physical activities. This study aimed at quantifying co-benefit effects of alternative transport use in Adelaide, South Australia. METHOD: We made projections for a business-as-usual scenario for 2030 with alternative transport scenarios. Separate models including air pollution models and comparative risk assessment health models were developed to link alternative transport scenarios with possible environmental and health benefits. RESULTS: In the study region with an estimated population of 1.4 million in 2030, by shifting 40% of vehicle kilometres travelled (VKT) by passenger vehicles to alternative transport, annual average urban PM2.5 would decline by approximately 0.4µg/m(3) compared to business-as-usual, resulting in net health benefits of an estimated 13deaths/year prevented and 118 disability-adjusted life years (DALYs) prevented per year due to improved air quality. Further health benefits would be obtained from improved physical fitness through active transport (508deaths/year prevented, 6569DALYs/year prevented), and changes in traffic injuries (21 deaths and, 960 DALYs prevented). CONCLUSION: Although uncertainties remain, our findings suggest that significant environmental and health benefits are possible if alternative transport replaces even a relatively small portion of car trips. The results may provide assistance to various government organisations and relevant service providers and promote collaboration in policy-making, city planning and infrastructure establishment.

"We've got to break down the shame": portrayals of men's depression.

News articles play a role in reproducing or challenging stigma. Stigma, in turn, can be a barrier to men's mental health help seeking. We used discursive analytic principles to analyze portrayals of men's communication about depression in news articles over a 5-year period. We found that news articles depicted men who were open about depression as experiencing positive outcomes such as recovery. Such depictions might challenge stigma associated with talking about mental health concerns. However, some articles problematically positioned depressed men as individually responsible for defying stigma and achieving recovery. We suggest that portraying depression as something that impacts a plurality of men is one way that media messages might dispel stigma. We drew recommendations from the findings about the language that could be used by media, mental health campaigns, and health service providers to mitigate the impact of stigma on men's mental health help seeking.

Barriers and facilitators to effective type 2 diabetes management in a rural context: a qualitative study with diabetic patients and health professionals.

Although effective type 2 diabetes management is essential for the prevention of complications, it is rarely carried out. Type 2 diabetes deaths in rural areas are higher than in metropolitan areas. A focus group (n = 8) and telephone interviews with patients (n = 10), and telephone interviews with health professionals (n = 18) in rural areas were conducted to examine this issue in a rural context. Inductive thematic analysis was used to generate 13 themes of barriers and facilitators to type 2 diabetes management at intrapersonal (denial of the illness, motivation, knowledge and skills and lack of time), interpersonal (stress and relationships), organisational (access to recommended foods, transport, health professionals, and exercise options) and societal (engagement and societal attitudes) levels of influence. Across all themes, participants highlighted the difficulty of maintaining management behaviours.

Cobenefits of replacing car trips with alternative transportation: a review of evidence and methodological issues.

It has been reported that motor vehicle emissions contribute nearly a quarter of world energy-related greenhouse gases and cause nonnegligible air pollution primarily in urban areas. Reducing car use and increasing ecofriendly alternative transport, such as public and active transport, are efficient approaches to mitigate harmful environmental impacts caused by a large amount of vehicle use. Besides the environmental benefits of promoting alternative transport, it can also induce other health and economic benefits. At present, a number of studies have been conducted to evaluate cobenefits from greenhouse gas mitigation policies. However, relatively few have focused specifically on the transport sector. A comprehensive understanding of the multiple benefits of alternative transport could assist with policy making in the areas of transport, health, and environment. However, there is no straightforward method which could estimate cobenefits effect at one time. In this paper, the links between vehicle emissions and air quality, as well as the health and economic benefits from alternative transport use, are considered, and methodological issues relating to the modelling of these cobenefits are discussed.

Accountability, monitoring and surveillance: body regulation in elite sport.

Regulation of athletes' bodies is commonplace in sporting environments, despite evidence that athletes have a higher risk of developing disordered eating than non-athletes. This article explores how athletes' bodies are regulated in practice, building on examinations of body surveillance in other contexts. Over 40 interactions occurring during body monitoring are analysed. Athletes, pre-emptively or following an explicit request, accounted for their body regulatory behaviours, also working to produce positive athlete identities. Failing to produce an account of improvement was interactionally problematic, making visible athletes' accountability to the institute to regulate their bodies. Implications of body regulatory practices are discussed.

Genetically modified food in the news: media representations of the GM debate in the UK.

This paper analyses a corpus of articles on GM crops and food which appeared in six UK newspapers in the first three months of 2004, the year following the GM Nation? debate (2003). Using the methods of critical discourse analysis we focus on how specific and pervasive representations of the major stakeholders in the national debate on GM--the British public, the British government, the science of GM, and biotechnology companies--served significant rhetorical functions in the controversy. Of particular significance was the pervasive representation of the British public as uniformly opposed to GM crops and food which served rhetorically to position the British government as undemocratic and as being beholden to powerful political and economic interests. Of significance also in our analysis, is how the science of GM farming itself became a highly contested arena. In short, our analysis demonstrates how the GM debate was represented in the newsprint media as a "battleground" of competing interests. We conclude by considering the possible implications of this representation given the increasing emphasis placed on the importance of deliberative and inclusive forms of science policy decision-making.

Contesting the 'national interest' and maintaining 'our lifestyle': a discursive analysis of political rhetoric around climate change.

The release of the fourth United Nations Intergovernmental Panel on Climate Change (IPCC) report in February 2007 prompted a flood of responses from political leaders around the globe. Perhaps nowhere was this more apparent than in Australia, where its release coincided with the first sitting week of the Australian Parliament, in an election year. The current study involves a discursive analysis of climate change rhetoric produced by politicians from the major Australian political parties in the period following the release of the IPCC leading up to the national election. Data include both transcripts of parliamentary debate and statements directly broadcast in the media. The analysis focuses on the various ways in which the issue of climate change was invoked and rhetorically managed by each of the two parties in the lead up to the election. In particular, it focuses on the ways in which appeals to the 'national interest' and 'lifestyle maintenance', both regular features of political rhetoric, were mobilized by both parties to discursively manage their positions on the climate change issue. Implications of the ways in which such appeals were constructed are discussed in relation to the discursive limits of the ways in which the issue of climate change is constructed in public debate.

Tracking depression-related mental health literacy across South Australia: a decade of change.

OBJECTIVE: The aim of the present study was to measure and compare levels of depression-related mental health literacy in South Australia across three points in time: 1998, 2004, and 2008. METHOD: Participants were those recruited for the 1998, 2004, and 2008 South Australian Health Omnibus Surveys. Comparisons were made across overall levels of depression-related mental health literacy as well as between responses to independent questionnaire items. RESULTS: A significant improvement was found in the overall measure of depression-related mental health literacy between 1998 and 2004 and this was consolidated in 2008. Some discrete changes in literacy were found between 2004 and 2008, with improvements recorded across some demographic groups and in participants' ability to accurately classify symptoms. Participants in 2008, however, were significantly less likely to endorse providers or treatments as 'helpful' than in 2004. CONCLUSIONS: Although knowledge and understanding of depression have improved significantly and stabilized since 1998, patient confidence in both mental health therapists and treatment options fell between 2004 and 2008, although it is still greater than in 1998.

Qualitative research: why psychiatrists are well-placed to contribute to the literature.

OBJECTIVE: The aim of this paper is to outline and review some of the qualitative approaches - specifically interviewing and case studies--that can contribute to psychiatric research, and to highlight the existing skills that psychiatrists can bring to such approaches. CONCLUSIONS: Qualitative research methods are currently under-utilized in psychiatric research. Psychiatrists are well placed to utilize qualitative methodologies by applying the skills that they acquire through training and clinical practice. Psychiatrists wishing to conduct research might wish to consider and adopt qualitative methods where appropriate.