Digital Apps to Improve Mobility in Adults with Neurological Conditions: A Health App-Focused Systematic Review.

The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review.

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment.

Background: An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation. Objective: A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential. Methods: A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms "vape"; "vaping"; "e-cigarette"; and "cessation," "quit," or "quitting" in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21. Results: An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user's willingness for behavior change and providing feedback on current actions in comparison to future goals. Conclusions: The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study.

BACKGROUND: Women referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AIMS: This study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. METHODS: A qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FINDINGS: Continuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. CONCLUSIONS: Continuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

Cross-cultural food practices and nutrition seeking behaviors among pregnant and postpartum Indian women living in Australia.

No research has explored the experiences of Indian women who become pregnant after they migrate to Australia, and how their existing traditions mix with their new environment and subsequently impact eating patterns. Semi-structured interviews were conducted with eleven women of Indian heritage who were living in Australia, and data were thematically analyzed. The researchers identified two main themes were identified (a) foods to eat and which to avoid, and (b) support networks and sources of health information during pregnancy. Women get advice and information from a range of sources and have diverse attitudes and beliefs about cultural food practices. that are both rigid and flexible, as well as traditional and contemporary.

Antenatal healthcare providers' knowledge, attitudes and practices regarding food insecurity in pregnancy: A qualitative investigation based at a specialist antenatal hospital in Melbourne, Australia.

BACKGROUND: Food insecurity exists when accessibility and availability of nutritious food is restricted, increasing the risk of adverse health outcomes. Pregnant women are especially vulnerable to food insecurity, which is concerning as optimal nutrition to support both their own health and the health and growth of their unborn child is critical. Antenatal healthcare providers (AHPs) are central to provision of pregnancy care. We aimed to assess AHPs' knowledge, attitudes and management of food insecurity. METHODS: Semi-structured interviews were conducted face-to-face, via telephone or online via Webex with 16 AHPs at the Royal Women's Hospital located in Melbourne, Australia. Interviews were thematically analysed according to Charmaz's constructivist grounded theory approach to ascertain AHPs' knowledge, attitudes and practices regarding food insecurity during pregnancy. RESULTS: AHPs had limited knowledge and awareness of food insecurity in pregnancy. Lack of experience in managing food insecurity and time constraints limit their capacity to support and deliver care to food-insecure women. There was a reported lack of structure and clarity surrounding referral pathways for effective management of food insecurity during pregnancy, as well as a lack of clarity regarding practitioner responsibility in managing this issue. CONCLUSIONS: Current assessment and management of food insecurity during pregnancy in the antenatal setting is suboptimal. Professional development strategies targeted to AHPs are urgently needed to assist optimal care of women who are food insecure during pregnancy to assist with supporting best maternal and child health.

How, why and for whom does a basic income contribute to health and wellbeing: a systematic review.

Ensuring that people have a sufficient income to meet their basic needs and that it keeps pace with costs of living are important when considering ways to reduce health inequities. Many have argued that providing a basic income is one way to do this. The aim of this review is to provide an overview of the existing peer reviewed evidence on the health and wellbeing impacts of basic income interventions. A systematic search of ten electronic databases was conducted in June 2022. Eligible publications examined any effect on health and wellbeing from unconditional cash transfers. All study designs were included, and no limitations were placed on duration of cash transfer trials, location of study, study population or on amount of money provided through the cash transfer. Ten studies were included in this review. Studies employed a range of methods. All studies reported on a trial of Universal Basic Income in either a region or a town. Studies explored a range of health and wellbeing related outcomes including crime, quality of life, employment, subjective wellbeing, tuberculosis and hospitalization. Basic income programs can mitigate poverty in a time of economic upheaval and have the potential to become a powerful policy tool to act upon the determinants of health and reduce health inequality. This review found a small number of trials indicating a positive impact on health and wellbeing. More trials which track recipients over a longer period are needed to provide more robust evidence for the impact of basic income programs.

Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study.

AIM: To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy. METHOD: Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand. RESULTS: Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand. CONCLUSIONS AND IMPLICATIONS: Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.

Measuring Food Insecurity in India: A Systematic Review of the Current Evidence.

PURPOSE OF REVIEW: India is home to an estimated 200 million malnourished people, suggesting widespread food insecurity. However, variations in the methods used for determining food insecurity status mean there is uncertainty in the data and severity of food insecurity across the country. This systematic review investigated the peer-reviewed literature examining food insecurity in India to identify both the breadth of research being conducted as well as the instruments used and the populations under study. RECENT FINDINGS: Nine databases were searched in March 2020. After excluding articles that did not meet the inclusion criteria, 53 articles were reviewed. The most common tool for measuring food insecurity was the Household Food Insecurity Access Scale (HFIAS), followed by the Household Food Security Survey Module (HFSSM), and the Food Insecurity Experience Scale (FIES). Reported food insecurity ranged from 8.7 to 99% depending on the measurement tool and population under investigation. This study found variations in methods for the assessment of food insecurity in India and the reliance on cross-sectional studies. Based on the findings of this review and the size and diversity of the Indian population, there is an opportunity for the development and implementation of an Indian-specific food security measure to allow researchers to collect better data on food insecurity. Considering India's widespread malnutrition and high prevalence of food insecurity, the development of such a tool will go part of way in addressing nutrition-related public health in India.

Food insecurity screening procedures used in reproductive healthcare settings.

CONTEXT: Food insecurity is an important determinant of health and should be identified by clinicians during routine reproductive healthcare. The procedures used in reproductive healthcare settings to identify people experiencing food insecurity have not been fully researched. OBJECTIVE: The objective of this study was to synthesize evidence from published studies that describe the procedures implemented by clinicians in healthcare settings to identify food insecurity in pregnant women, or women of reproductive age (15 years-49 years). DATA SOURCES: Four databases were searched in April 2022 to identify studies that met the eligibility criteria. DATA EXTRACTION: Studies that used tools that were both validated or newly developed were considered, as were studies that incorporated food insecurity screening as part of a multidomain screening tool. Two authors completed the screening, data extraction, and quality assessment independently. DATA ANALYSIS: There were 1075 studies identified; after screening, 7 studies were included in the narrative synthesis, including studies relating to women who were pregnant or in the postpartum period; none of the included studies related to women in the preconception stage. Four screening tools were identified: 2- and 6-item tools specifically focused on food insecurity, a 58-item multidomain tool incorporating 4 food insecurity items, and a modified version of the 2-item tool. Methods of implementing screening varied across studies. Three described subsequent processes that supported food-insecure patients once identified. CONCLUSION: Few published studies have investigated optimal screening tools and their implementation within reproductive healthcare settings to address food insecurity for this priority population group. Further research is required to determine: the optimal tool, preferable screening methods from the perspectives of both patients and clinicians, and potential strategies for implementation in countries outside of the United States. An additional evidence gap remains about referral pathways and appropriate supports for this population once food insecurity is identified. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022319687.

What's in a commercial meal kit? Structured review of Australian meal kits.

OBJECTIVE: The aim of this project is to review the products and recipes contained within popular subscription meal kits to determine if they are suitable for wider use among people who are food insecure. DESIGN: Across the 6-week period, weekly meal kits from both HelloFresh and Markey Spoon were purchased, resulting in thirty-six individual meals that were prepared and assessed. Meals were assessed based on the content included in the meal kit compared with the recipe card and the nutrition panel, the costs of the individual foods if purchased at one of two major supermarkets and the ease of preparation. SETTING: Australia. PARTICIPANTS: Households were comprised of two, 2-person households who were provided with 2 meals each week, and two, single-person households who were provided with one meal each week. RESULTS: The findings of this research suggest that while the meal kits are convenient and, in general, the recipes are easy to follow, and the meals would be made again, the high levels of salt and fat may preclude these kits from regular inclusion in a healthy diet. The meal kits were also found to be more costly than the same ingredients if purchased from a major supermarket. However, the convenience of having most of the foods needed to prepare a full meal with little to no wastage may counterbalance this cost. CONCLUSIONS: Meal kits may be a useful component of a healthy diet, that can increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation.

The coping continuum and acts reciprocity - a qualitative enquiry about household coping with food insecurity in Victoria, Australia.

OBJECTIVE: Food insecurity exists when a household has limited or uncertain access to food. This paper explores the strategies employed by households who are already accessing emergency and community food assistance to meet their food needs. METHOD: Interviews to explore strategies used to mitigate food insecurity of people living in Victoria, Australia, between June 2018 and January 2019. Data were analysed thematically. RESULTS: Seventy-eight interviews were conducted. Analysis resulted in two themes highlighting the range of coping strategies employed to mitigate the impacts of food insecurity; broadly described as 1) the coping continuum and 2) coping reciprocity. CONCLUSIONS: Food insecure households employ a range of strategies to secure food. Households that engage with the emergency and community food sector are described as in crisis or struggling, often skipping meals or reducing food consumed, or as coping and managing, characterised by bulking meals and growing food. IMPLICATIONS FOR PUBLIC HEALTH: Coping with food insecurity exists on a continuum from crisis to management and reciprocity. With the prevalence of food insecurity expected to increase, some of these coping strategies will need to be incorporated into the practice of emergency and community food providers to assist households to meet food needs.

Are mothers under lunchbox pressure? An exploration of the experiences of Victorian mothers preparing lunchboxes for their children.

ISSUE ADDRESSED: A healthy diet is particularly important during childhood. Research suggests that more than 95% of Australian primary school aged children do not eat a diet consistent with the Australian Dietary Guidelines, putting them at risk of poor health. Interventions to improve the quality of children's lunchboxes may help address this issue. However, there is limited understanding of the factors impacting lunchbox preparation. METHODS: This study explored the experiences of 10 mothers of Victorian primary school students. Mothers took part in semi-structured interviews exploring their views on lunchbox preparation and food choices. The study used a Constructivist Grounded Theory methodology and data were analysed using an inductive, thematic approach. RESULTS: Analysis of the interviews yielded four main themes. (i) Mothers experienced a range of non-nutritional barriers that impacted the food choices they made for their children. (ii) Children's preferences influenced parental food choices. (iii) Mothers experienced and/or perceived judgement about the food choices they make for their children. And (iv) Mothers identified a lack of support and information from schools about what was appropriate for school lunch. CONCLUSION: Findings of this study indicate that mothers are concerned with balancing nutrition and child preferences within the broader context of guidelines, perceived or real judgement and income constraints. SO WHAT?: The school environment may be an ideal setting to promote healthy eating but support for parents is needed. This is the first study in Victoria exploring mothers' perspectives on lunchbox preparation and provides initial information on which future research can build.

Screening Food Insecure during Pregnancy: Pilot Testing an Effective Brief Tool for Use in an Australian Antenatal Care Setting.

The purpose of this research is: (1) to determine the prevalence of food insecurity among pregnant people using the 10-, 6-, and 2-item iterations of the USA Household Food Security Survey Module (HFSSM) and the single item measure, and (2) identify an appropriate combination of questions that could be used to identify food insecurity in a clinical setting for a population of people who are pregnant in Australia. Cross-sectional survey collecting self-reported data from pregnant people in Australia (open May 2021 to March 2022). Survey included demographic characteristics, including income/welfare use, education, age, pregnancy information, household size and composition, and two measures of food insecurity. In total, 303 participants were included in the analysis. Sensitivity and specificity of the various combinations of questions were conducted. Food insecurity was estimated using the single item, and the 2-item, 6-item, and 10-item versions of the HFSSM, food insecurity was 6.2%, 11.4%, 11.7%, and 14.3% respectively. Respondents who were living in households that were food insecure answered affirmatively to question one, two, or three of the HFSSM, with the combination of questions one and three showing the best sensitivity and specificity for the whole sample, as well as for those who have characteristics likely to lead to food insecurity. Further testing of the 2-items, comprised of items one and three from the HFSSM, need to be conducted with a larger and more diverse sample to determine if this is an appropriate screening tool in an antenatal clinical setting to determine food insecurity during pregnancy.

Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study.

BACKGROUND: Food insecurity and hunger during pregnancy have significant implications for the health of the mother and baby. Assisting clinicians when they encounter women who are experiencing hunger or food insecurity during their pregnancy will increase the opportunity for better birth and pregnancy outcomes. At present there are no guidelines for Australian clinicians on how to do this. METHODS: This study uses a modified Delphi technique, allowing diverse participation in the process, to create consensus on the ways to address and respond to food insecurity during pregnancy. This modified Delphi collected data via two rounds of consensus. The opinions collected from the first round were thematically categorised and grouped. The topics were integrated into the survey for the second round and circulated to participants. During the second round, priorities were scored by giving five points to the topic considered most important, and one point to the least important. RESULTS: Through two rounds of consultation, the panel achieved consensus on how to identify food insecurity during pregnancy, with some clear items of consensus related to interventions that could be implemented to address food insecurity during pregnancy. Experts achieved consensus on items that have importance at the institution and policy level, as well as services that exist in the community. The consensus across the spectrum of opportunities for assistance, from the clinical, to community-provided assistance, and on to government policy and practice demonstrate the complexity of this issue, and the multipronged approach that will be required to address it. CONCLUSION: This is the first time such a consultation with experts on hunger and food insecurity during pregnancy has been conducted in Australia. Items that achieved consensus and the importance of the issue suggest several ways forward when working with pregnant women who are hungry and/or food insecure.

Development of a Comprehensive Household Food Security Tool for Families with Young Children and/or Pregnant Women in High Income Countries.

Despite increasing rates of food insecurity in high income countries, food insecurity and its related factors are inconsistently and inadequately assessed, especially among households with young children (0-6 years) and pregnant women. To fill this gap, researchers from the U.S. and Australia collaborated to develop a comprehensive household food security tool that includes the known determinants and outcomes of food insecurity among parents of young children and pregnant women. A five-stage mixed methods approach, including a scoping literature review, key informant interviews, establishing key measurement constructs, identifying items and scales to include, and conducting cognitive interviews, was taken to iteratively develop this new comprehensive tool. The resulting 78-item tool includes the four dimensions of food security (access, availability, utilization, and stability) along with known risk factors (economic, health, and social) and outcomes (mental and physical health and diet quality). The aim of this novel tool is to comprehensively characterize and assess the severity of determinants and outcomes of food insecurity experienced by households with young children and pregnant women.

Factors Associated with Food Insecurity among Pregnant Women and Caregivers of Children Aged 0-6 Years: A Scoping Review.

With a global focus on improving maternal and child nutrition through the 2030 Sustainable Development Goals, it is important to understand food insecurity in pregnant women and families with young children, as food insecurity at these life stages can have ongoing negative health consequences. However, factors that influence food insecurity among this population group are not well understood. This scoping review investigates the factors that influence food insecurity among pregnant women and households with young children aged 0-6 years living in high-income countries. A scoping literature review was conducted using four electronic databases. The search combined terms relevant to: food security, determinants, pregnancy and family and high-income countries. Only full text and English language articles were included. The search identified 657 titles and abstracts; 29 articles were included in the review. A majority (70%) of the studies were conducted in the United States and were mostly either cross-sectional or secondary data analysis of existing population data. Factors associated with food insecurity were identified and grouped into 13 constructs. These included social, economic and health risk factors, food access and utilization factors and health and dietary outcomes. This scoping review identifies the factors associated with food insecurity among pregnant women and families with young children that could be used to better measure and understand food insecurity, which could assist in developing program and policy responses. This review also highlights the lack of literature from high-income countries outside the US.

Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers.

PURPOSE OF THE REVIEW: Food insecurity can have a negative health impact for women during pregnancy and the postpartum period; however, there are a range of barriers to meeting nutritional guidelines during pregnancy. Food insecurity is associated with an increased risk of pregnancy complications and mental and physical health outcomes. This review aims to provide insight into programmes and interventions which have targeted food insecurity in pregnant and early postpartum women. The central research question for this review is as follows: What programmes and interventions have sought to address food insecurity among pregnant and postpartum women? A systematic search of five electronic databases including Medline, CINAHL, Global Health, Embase, and Cochrane was undertaken on August 2021. Key thematic areas searched were food insecurity, pregnancy, nutritional outcomes, and interventions or programmes. Only studies that were published since 2000 in English were considered. RECENT FINDINGS: Eleven studies were included in this review. Studies employed a range of methods and outcomes measures. They were conducted in mostly low- and middle-income countries, and in general, focused on nutritional supplementation, with some studies also incorporating nutrition education or counselling. The findings of this review suggest that while there are a range of possible interventions that seek to address food insecurity and hunger among pregnant and postpartum women, the limited number of robust evaluations or long-term interventions mean that evidence for any one intervention type is limited. Furthermore, the programmes and interventions that do exist are generally embedded within a single context or structure, and as such, may not be able to be widely implemented. (Prospero Registration CRD42022245787).

Experiences of Food-Insecure Pregnant Women and Factors Influencing Their Food Choices.

INTRODUCTION: Food insecurity (FI), an inadequate access to healthy, affordable food, is a public health concern primarily driven by material hardship. Optimal antenatal nutrition promotes best health outcomes for the mother and baby. Pregnant women experiencing FI are less able to access healthy foods, increasing the risk of complications such as gestational diabetes and preterm labour. Little is known about the experiences of food-insecure pregnant women in obtaining sufficient, nutritious food, their perceptions regarding antenatal nutrition and how this contributes to their food choices. METHODS: This qualitative study conducted from August to November 2020, during the COVID-19 pandemic, examined the experiences and coping strategies of food-insecure pregnant women, and the factors influencing their food choices. Seven English-speaking food-insecure pregnant women participated in semi-structured interviews. Interview transcripts were thematically analysed, informed by grounded theory methodology. RESULTS: Three themes were identified through analysis of the interviews related to strategies that managed household food supply, factors that influenced food choices, and experiences of pregnancy during the COVID-19 pandemic. As a result of a limited food budget, pregnancy symptoms, the cognitive overload that attends the FI experience, and the acute yet significant impact of the pandemic, food-insecure pregnant women in this study defaulted to cheap and convenient food choices despite acknowledging the importance of eating well for pregnancy. CONCLUSION: FI during pregnancy is burdensome, relentless and undermines women's wellbeing. Supportive strategies within antenatal healthcare settings are urgently required to deliver an equitable health response for vulnerable women.

Pre-exposure prophylaxis (PrEP) in Australia: are there challenges facing sexual health promotion?

Pre-exposure prophylaxis (PrEP) for HIV refers to the daily use of antiretroviral medications by HIV uninfected persons to block a potential HIV infection. There is evidence to show that as the use of PrEP increases, the use of other safer sex practices such as condoms decreases, which may lead to an increase in sexually transmitted infections (STIs). This study aimed to explore whether PrEP had caused any challenges for organizations undertaking sexual health promotion activities in Australia. In-depth, semi-structured interviews were conducted with 17 participants (15 males, 2 females) who were purposively sampled from a range of HIV advocacy and health promotion settings. These included publicly funded HIV/AIDS councils and organizations representing people living with HIV/AIDS. Guided by an exploratory, inductive approach, the interviews were analyzed using thematic analysis. Three themes were constructed from the data analysis. First, organizations in different jurisdictions came to support PrEP in different ways, and this influenced the way organizations engaged with PrEP and the messaging that they disseminated to their community. Second, organizations faced some barriers to promoting PrEP, with the most significant being overcoming decades of HIV prevention campaigns that focused on barrier methods only. Third, there were social benefits to PrEP, such as shifting the onus of preventing HIV transmission from HIV positive to HIV negative people. PrEP is a highly effective biomedical intervention to reduce HIV transmission, and future challenges include designing campaigns for those at risk for HIV transmission outside the MSM community.