The lasting impact of the Go for 2&5 campaign.

ISSUE ADDRESSED: Little is known about the executional techniques that are most likely to make healthy eating messages memorable over the longer term. The aim of this exploratory study was to identify factors contributing to the ongoing salience of the Go for 2&5 social marketing campaign among older audience members. METHODS: Interviews were conducted with 75 Western Australians aged 60+ years. A peer-interviewing method was used whereby eight older people recruited and interviewed members of their extended peer groups. The interview guide included questions about interviewees' recollections of healthy eating messages across their lifespans. RESULTS: Around one in five interviewees discussed the Go for 2&5 campaign that was on air in Western Australia between 2002 and 2011. These discussions focused on either specific advertisement features that were considered to be especially memorable (in particular, humour and the use of anthropomorphised depictions of produce) and/or their recollection of the number of daily servings of fruits and vegetables recommended in the campaign. Few were able to recall other healthy eating campaigns, and in some cases it was assumed that advertisements for specific food stores or products constituted health advice. CONCLUSIONS: Different campaign attributes may influence shorter-term attitudinal and behavioural responses versus longer-term recall. The characteristics of the Go for 2&5 campaign appear to have enabled it to achieve relatively high levels of recall among older people. SO WHAT?: The study results suggest that some advertising approaches that activate the peripheral route to persuasion may achieve recall over a longer period of time.

Dimensions of the diet-exercise relationship in later life: A qualitative study.

OBJECTIVE: Diet and physical activity are two lifestyle behaviours that are critical for healthy ageing. The aim of this study was to explore how older adults negotiate dietary and physical activity decisions to identify areas of intersection between these two behaviours and inform health promotion interventions targeting both diet and exercise. METHODS: This exploratory study utilised a novel data collection approach that involved lay interviewers recruiting their peers to (i) participate in two interviews over a period of six months and (ii) make notes on their thoughts relating to diet and physical activity. Participants were 75 adults aged 60+ years in Western Australia (n = 64 females). RESULTS: Three primary themes were identified: (i) the importance but difficulty of achieving energy balance; (ii) issues relating to managing food intake before, during, and after physical activity; and (iii) reciprocal opportunities for eating and physical activity. CONCLUSIONS: Diet and physical activity are linked in complex ways, highlighting the need for multi-factorial interventions. IMPLICATIONS FOR PUBLIC HEALTH: When developing communications strategies designed to encourage older people to both improve their diets and increase their physical activity, consideration could be given to leveraging existing perceived alignments between healthy eating and being active.

Health halo or genuine product development: Are better-for-you alcohol products actually healthier?

ISSUE ADDRESSED: Alcoholic products marketed as better-for-you is an emerging trend in Australia that has received limited research attention to date. This study aimed to examine the nutrient profiles of alcoholic products marketed as better-for-you that are available in the Australian market. METHODS: We extracted the details of alcoholic product announcements published on the Drinks Trade website in 2019 and 2020 containing at least one keyword used to promote better-for-you products. The alcohol, energy, carbohydrate and sugar content of each product was recorded and assessed against existing classifications for alcohol strength and sugar and carbohydrate content. RESULTS: We identified 144 products promoted as better-for-you. The majority of products (85%, n = 122) were classified as full-strength, and the median alcohol content across each alcohol product category was classified as full-strength. Most of the energy content came from alcohol, with 62% of products deriving at least 75% of their energy content from alcohol. CONCLUSIONS: Alcoholic products marketed as better-for-you appear to rely on an illusion of healthfulness, without addressing the ingredient of most concern to health, the alcohol content. SO WHAT?: Controls on alcohol marketing should be expanded to limit the use of health and nutrient claims. Mandatory labelling of alcoholic products with nutrition information would support consumers to be better informed about the contents of alcoholic products.

A Recipe for Success? A Nutrient Analysis of Recipes Promoted by Supermarkets.

Recipe use impacts eating habits, yet there is limited research investigating the nutritional quality of recipes. Supermarket recipe magazines command large readerships, with over 4 million readers for each of the two major Australian supermarket publications. Assessing the nutrient content of featured recipes is therefore of public health interest. The nutrient content of 312 main-meal recipes from Coles®Magazine and Woolworths Fresh® were analyzed and compared against a traffic-light system for classifying nutrients of concern in chronic disease. Nutrient content was compared across recipe type (standard, advertorial and celebrity) and between recipes with and without health or nutrient claims. Overall compliance with the traffic-light criteria was low, with less than half of recipes meeting the target. Advertorial recipes had a higher energy (p = 0.001), saturated fat (p = 0.045) and sodium (p ≤ 0.001) content per serve, and per 100 g for sodium (p ≤ 0.001) compared to standard and celebrity recipes. Recipes with claims had greater compliance to the nutrient criteria (p < 0.001) compared to those without. These findings support previous research highlighting the poor nutritional quality of published recipes from a variety of sources.

Objective assessment of compliance with a state-wide school food-service policy via menu audits.

OBJECTIVE: The Healthy Food and Drink Policy was implemented in Western Australian government schools in 2007. The aim of the present study was to assess the compliance of Western Australian school canteen menus with the policy a decade after its introduction. DESIGN: The traffic-light system that underpins the Healthy Food and Drink Policy categorises foods and drinks into three groups: 'green' healthy items, 'amber' items that should be selected carefully and 'red' items that lack nutritional value. Canteen menus were collected online and each menu item was coded as a green, amber or red choice. SETTING: Western Australia.ParticipantsOnline canteen menus from 136 primary and secondary government schools. RESULTS: The majority of audited school menus met policy requirements to include ≥60 % green items (84 %) and ≤40 % amber items (90 %), but only 52 % completely excluded red items. Overall, approximately half (48 %) of school canteen menus met all three traffic-light targets. On average, 70 % of the menu items were green, 28 % were amber and 2 % were red. Primary-school canteen menus were more likely than those from secondary schools to meet the requirements of the policy. CONCLUSIONS: While the sampled Western Australian government school canteen menus were highly compliant with most of the requirements of the Healthy Food and Drink Policy, many offered red foods and/or drinks. Providing all schools with further education about identifying red items and offering additional services to secondary schools may help improve compliance rates.

A process and outcome evaluation of an in-class vegetable promotion program.

OBJECTIVE: Nutrition interventions that target both fruits and vegetables are effective in increasing fruit consumption, but have been limited in their ability to improve vegetable intake. To address the low proportion of children meeting vegetable intake guidelines, approaches specifically targeting vegetables are needed. This paper reports on a mixed-method analysis of a 10-week vegetable promotion pilot project that aimed to increase vegetable intake as part of the existing Crunch&Sip in-class fruit and vegetable break program. DESIGN: The intervention was designed to promote vegetable consumption through the implementation of vegetable-focused resources, including curriculum resources and parent education materials. Teachers completed pre- and end-of-intervention surveys. Process measures related to the use of resources and teachers' perceptions of barriers to implementation. The outcome evaluation included measures of children's vegetable consumption during Crunch&Sip breaks and teachers' attitudes and confidence relating to educating students about the benefits of consuming vegetables. SUBJECTS: Twenty-one Western Australian primary schools already participating in the Crunch&Sip program participated in the pilot intervention and evaluation. Coverage included 35 primary school teachers representing 818 students aged 4-11 years. RESULTS: The proportion of children bringing vegetables for Crunch&Sip more than doubled over the 10-week intervention (21% vs 46%; p < 0.001). Improvements were observed in teachers' perceived knowledge about the nutritional benefits of vegetables (p = 0.001) and confidence to educate students about the benefits of vegetable consumption (p = 0.028). CONCLUSIONS: Preferentially promoting vegetable consumption as part of an existing school-based nutrition program may be an effective strategy to increase children's vegetable intake.

A qualitative exploration of the factors underlying seniors' receptiveness to entomophagy.

Entomophagy presents a novel approach to securing a nutritive and environmentally sustainable food source to meet the needs of a growing and ageing population. To date, research exploring the receptiveness of Western consumers towards entomophagy has focused on younger age groups and there has been little examination of the views of older adults. The aims of this study were to (i) explore the factors associated with older people's attitudes towards entomophagy and (ii) identify strategies to encourage seniors to adopt the practice. Interviews were conducted with 77 Western Australian seniors aged 60years and over. The average age of the interviewees was 73years and most were female (n=67). Reflecting the lack of promotion of entomophagy as a desirable eating behaviour, there were very low levels of awareness of the environmental and nutritional advantages of this practice. Most of the interviewed seniors saw entomophagy as a disgusting practice that was incompatible with their cultural beliefs and values, however a small group viewed it as a novel and potentially enjoyable experience. The findings suggest that strategies to target the former group could focus on overcoming the disgust reaction, such as by disguising insects in food and providing guarantees of food safety. Consumption in the latter group could be facilitated by improving knowledge and skills relating to the preparation of insect-based foods. Strategies to increase entomophagy in the Western world need to consider the unique views of different consumer groups towards the practice.

Assessing parents' receptiveness to a vegetable-focussed in-school nutrition intervention.

OBJECTIVE: Crunch&Sip is an Australian school-based initiative designed to increase the consumption of fruit, vegetables, and water among primary school children. To address the significant deficiencies in children's vegetable intake, the present study aimed to examine the responsiveness of parents (the main providers of food for Crunch&Sip) to a modified version of the program that focuses primarily on vegetable consumption. PARTICIPANTS: A total of 329 Western Australian parents completed an online questionnaire examining their support for a vegetable focus for Crunch&Sip and any perceived barriers, motivators, and facilitators. RESULTS: Most (80%) parents were supportive of a shift to a vegetable focus for Crunch&Sip. Belief in the effectiveness of Crunch&Sip at improving children's attitudes towards vegetables and increasing children's vegetable consumption was found to be significantly associated with levels of support. The most commonly nominated motivator was to improve their children's eating habits and the main facilitator was the perceived ability of teachers and peers to influence children's food consumption behaviours. Identified potential barriers included the difficulties associated with providing a variety of vegetables, maintaining freshness, and the preparation time required. The primary suggested strategy to overcome these barriers was for schools to conduct education sessions to provide information about vegetable provision options. CONCLUSIONS AND IMPLICATIONS: The results suggest that parents can be supportive of school-based nutrition programs that specifically encourage the consumption of vegetables but they may require guidance to reduce the identified barriers related to vegetable provision.

Tea and flavonoid intake predict osteoporotic fracture risk in elderly Australian women: a prospective study.

BACKGROUND: Observational studies have linked tea drinking, a major source of dietary flavonoids, with higher bone density. However, there is a paucity of prospective studies examining the association of tea drinking and flavonoid intake with fracture risk. OBJECTIVE: The objective of this study was to examine the associations of black tea drinking and flavonoid intake with fracture risk in a prospective cohort of women aged >75 y. DESIGN: A total of 1188 women were assessed for habitual dietary intake with a food-frequency and beverage questionnaire. Incidence of osteoporotic fracture requiring hospitalization was determined through the Western Australian Hospital Morbidity Data system. Multivariable adjusted Cox regression was used to examine the HRs for incident fracture. RESULTS: Over 10 y of follow-up, osteoporotic fractures were identified in 288 (24.2%) women; 212 (17.8%) were identified as a major osteoporotic fracture, and of these, 129 (10.9%) were a hip fracture. In comparison with the lowest tea intake category (≤1 cup/wk), consumption of ≥3 cups/d was associated with a 30% decrease in the risk of any osteoporotic fracture (HR: 0.70; 95% CI: 0.50, 0.96). Compared with women in the lowest tertile of total flavonoid intake (from tea and diet), women in the highest tertile had a lower risk of any osteoporotic fracture (HR: 0.65; 95% CI: 0.47, 0.88), major osteoporotic fracture (HR: 0.66; 95% CI: 0.45, 0.95), and hip fracture (HR: 0.58; 95% CI: 0.36, 0.95). For specific classes of flavonoids, statistically significant reductions in fracture risk were observed for higher intake of flavonols for any osteoporotic fracture and major osteoporotic fracture, as well as flavones for hip fracture (P < 0.05). CONCLUSION: Higher intake of black tea and particular classes of flavonoids were associated with lower risk of fracture-related hospitalizations in elderly women at high risk of fracture.