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A growing gap between the production and consumption of food has led to a decline in consumer trust in food, and a desire for increased regulation of food. The aim of this study was to investigate the nature of consumer trust in food production and regulation in the wake of shifts in food technology, globalisation and production. Semi-structured interviews (n = 47) were conducted in 2009 with participants living in rural and metropolitan South Australia. Rural participants were more trusting of food production because of their direct experience with producing food than their metropolitan counterparts. Consumers’ proximity to food production impacts their trust in food. Increasing local food production and consumption may increase consumer trust in food, and decrease consumer dependence on government regulation.

A survey of the extent to which cost, taste and health considerations impact food purchasing practices in Australia was conducted. Data were gathered from a national computer assisted telephone survey of 1109 randomly sampled householders and analysed using multiple logistic regression analysis. 88% of respondents considered the taste of food before its price, with females and people on higher incomes more likely to do so. 52% of respondents said that they considered the price of food before its health and nutritional benefits, with males, younger people and people with lower educational qualifications more likely to do so. 49% said that they purchase organic food, with people with 1 child, full-time employed and people never married more likely to do so. Overall, gender, income, education, work status, age and family size are all important predictors of food purchasing practices in Australia.

This study compared public confidence in truth-telling by food chain actors in selected EU countries where there have been a number of food safety problems, with consumers in Australia where there have been fewer food crises. A computer-assisted telephone interviewing survey was used to address aspects of truth-telling at times of a food scandal with a random sample of 1109 participants across all Australian states (response rate 41.2%). Results were compared with a survey in six EU countries which had asked similar questions. Australians' trust in truth-telling by food chain actors was low, with 14.2% of the sample expecting various institutions and individuals to tell the whole truth during times of a food scandal. When compared with EU countries, Australia occupied a middle position in trust distribution, and was more similar to Great Britain in giving farmers the most trust in truth-telling. This study has demonstrated that in Australia, as in many EU countries, trust in truth-telling at a time of food scandal is low. The credibility of the food system is highly vulnerable under times of food crisis and once trust in broken, it is difficult to restore.

This paper presents theoretically informed qualitative research that investigates why young Australian females (aged 14–17) drink and how social and cultural context form the basis, rather than the periphery, of their drinking experience. We demonstrate the utility of Pierre Bourdieu's sociological framework for delving beyond the dichotomy of young people's drinking decisions as either a determination of their cultural environment or the singular result of a rational individual's independent decision-making. The paper is presented in two parts. First, we provide the interpretation, or ‘practise’, of Bourdieu's concepts through an outline and application of his complex theoretical constructs. Specifically, the concept of symbolic capital (or social power) is applied. Second, our explication of Bourdieu's ‘practice’, or epistemological contributions, offers a methodologically grounded example to other researchers seeking to attain more complete understandings of the social processes underpinning youth alcohol consumption.

The notion of developing resilience is becoming increasingly important as a way of responding to the social determinants of poor health, particularly in disadvantaged groups. It is hypothesized that resilient individuals and communities are able to ‘bounce back’ from the adversities they face. This paper explores the processes involved in building resilience as an outcome in relation to both quitting smoking and never smoking. The study involved 93 qualitative, oral-history interviews with participants from population groups with high and enduring smoking rates in Adelaide, Australia, and was essentially interested in how some people in these groups managed to quit or never start smoking in the face of adversities, in comparison to a group of smokers. Our key findings relate to what we call additive and subtractive resilience strategies, which focus on the practices, roles and activities that individuals either ‘took on’ or ‘left behind’ in order to quit smoking or remain abstinent. The theoretical lenses we use to understand these resilience strategies relate to biographical reinforcement and biographical reinvention, which situate the resilience strategies in a broader ‘project of the self’, often in relation to attempting to develop ‘healthy bodies’ and ‘healthy biographies’.

Single parent households experience periods of food insecurity more frequently than other Australian families. Despite elevated risk, many single parents achieve food security with limited means. This article applies and evaluates the utility of the livelihoods framework approach as a tool for understanding food insecurity in this population and generating relevant policy recommendations. The approach is adapted here to provide insight into the skills, strategies and resource individuals use to attain or strive for food security. The framework incorporates these individual capabilities into a model of the social, economic and political structures and processes through which individuals navigate to attain food security. Semi-structured interviews were conducted with single parents living in rural and urban South Australia. Transcripts were analysed in an effort to populate a food security livelihoods framework for single parents. The livelihoods framework is found to be capable of reproducing the types and levels of capabilities reported in previous findings. Furthermore, it provides novel insight into the relationships that form between classes of capabilities and between capabilities and the structures and processes in which they are utilised. These insights are considered in terms of relevance to policy.

In order to estimate the extent of food insecurity in South Australia and its relationship with a variety of socio-economic variables, Design Data collected routinely from 2002 to 2007 by SA Health were analysed. An ecological analysis of data collected by the South Australian Monitoring and Surveillance System (SAMSS) that collects data on key health indicators. Questions on food security are asked periodically from July 2002 to December 2007. Seven per cent (1342/19 037) of subjects reported running out of food during the previous year and not having enough money to buy food (food insecurity). Logistic regression analysis found food insecurity to be highest in households with low levels of education, limited capacity to save money, Aboriginal households, and households with three or more children. Conclusions The study confirms that food insecurity is strongly linked to economic disadvantage. Increasing cost of food is likely to exacerbate food insecurity. This is of concern given that food insecurity is associated with poor health, especially obesity and chronic disease. Comprehensive action at all levels is required to address root causes of food insecurity. Regular surveillance is required to continue to monitor levels of food security, but more in-depth understandings, via qualitative research, would be useful.

This study explored children's views about food advertising on television in the light of recent public interest in childhood obesity and obesogenic environments. Thirty-seven children, aged between 8 and 11 years, discussed their perceptions of food advertising in focus groups. The children engaged as consumers of advertising, noticing technical aspects, and expressing their likes and dislikes of particular techniques. While they understood the persuasive intent of advertising, they nevertheless desired products and made purchase requests. They particularly desired energy-dense nutrient-poor foods. The children demonstrated sophisticated levels of advertising literacy through their articulation of problems such as deception, impacts on children's health and wellbeing, and family conflict. They revealed themselves as sentient beings, with the capacity to react, respond and reflect on their experience of advertising. This study makes a contribution to research on consumer socialisation by introducing the perspective of Australian children. As stakeholders in the childhood obesity problem, the views of children should also be of interest to health policymakers.

In recent times, many developing countries have been going through a process of re-orienting health policy and services towards early detection and prevention, rather than solely on the treatment and on-going management, of illness and disease. For example, in the UK, the fundamental philosophy underpinning the approach to funding primary healthcare is analogous to the adage ‘prevention is better than cure’, with the NHS Improvement Plan stating that “If England is to secure world-class standards of health, the enormous human, financial and physical resources available to the NHS need to be focussed on the prevention of disease and not just its treatment”. Within Australia, there are similar shifts in thinking and policy, with the development of the National Preventative Health Taskforce, which has been tasked with developing a National Preventative Health Strategy.

Background Opportunities for cancer survivors' employment can both reflect and perpetuate health inequities, as employment is an important social determinant of health. Socio-economic and geographic disadvantage is associated with greater difficulty finding work, but little is known about work needs of Australian cancer survivors living with disadvantage. Objective This study examined survivor and health-care professional (HCP) perspectives on barriers experienced by Australian cancer survivors experiencing disadvantage when attempting to remain at or return to work. Method Focus groups and individual interviews were held with cancer survivors (N = 15) and oncology and primary HCPs (N = 41), focusing on communities at risk of disadvantage. Participants were asked about employment barriers and facilitators in general and in the context of disadvantage. Themes were identified using framework analysis. Results Geographic and socio-economic disadvantage resulted in specific individual- and system-level barriers. These related to distance from treatment and support services and limited availability and suitability of work for survivors living with geographic disadvantage, and limited availability, security, and flexibility of work and previous unemployment for survivors living with socio-economic disadvantage. Identified needs included system-level changes such as public and workplace-level education, legislative and policy changes, and better access to resources. Conclusions Cancer survivors living with disadvantage experience limited access to flexible employment opportunities and resources, further perpetuating their disadvantage. Promotion of health equity for cancer survivors living with disadvantage requires systemic changes to support attempts to remain at/return to work. Patient or public contribution This study included cancer survivors and HCPs as investigators, authors and participants.

Background: There is a growing evidence that resilience to stress can promote nonsmoking. However, few studies have undertaken quantitative research to investigate whether resilience, generated by internal and external factors, moderates the impact of stress on the likelihood of smoking. Objective: This study aims to help fill this knowledge gap in relation to smokers and ex-smokers, and those people who have never smoked. Methods: A large online cross-sectional survey was administered in Australia (2015–2016) to collect data on demographic variables, levels of internal and external resilience, and stress from current and past smokers (n = 400) and those who have never-smoked (n = 921). Logistic regressions were employed to test our hypotheses. Results: Most participants were female (82%) and ranged between 18 and 77 years. Higher levels of reported perceived stress and stress-related variables did significantly predict smoking. The combined impact of internal and external resilience factors predicted never-smoking and lessened the relationship between perceived stress and stress-related variables, and the likelihood of smoking. Conclusion: These results are important because they suggest that the social environment should be developed to augment social support and internal properties such as developing “a strong sense of purpose in life” to encourage people not to commence smoking, rather than focus on smoking cessation. Refereed/Peer-reviewed

Background: Disparities in health status occur between people with differing socioeconomic status and disadvantaged groups usually have the highest risk exposure and the worst health outcome. We sought to examine the social disparities in the population prevalence of diabetes and in the development of treated end stage renal disease due to type 1 diabetes which has not previously been studied in Australia and New Zealand in isolation from type 2 diabetes. Methods: This observational study examined the population prevalence of diabetes in a sample of the Australian population (7,434,492) using data from the National Diabetes Services Scheme and of treated end stage renal disease due to diabetes using data from the Australian and New Zealand Dialysis and Transplant Registry. The data were then correlated with the Australian Bureau of Statistics Socioeconomic Indexes for Areas for an examination of socioeconomic disparities. Results: There is a social gradient in the prevalence of diabetes in Australia with disease incidence decreasing incrementally with increasing affluence (Spearman's rho =.765 p < 0.001). There is a higher risk of developing end stage renal disease due to type 1 diabetes for males with low socioeconomic status (RR 1.20; CI 1.002-1.459) in comparison to females with low socioeconomic status. In Australia and New Zealand Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders appear to have a low risk of end stage renal disease due to type 1 diabetes but continue to carry a vastly disproportionate burden of end stage renal disease due to type 2 diabetes (RR 6.57 CI 6.04-7.14 & 6.48 CI 6.02-6.97 respectively p < 0.001) in comparison to other Australian and New Zealanders. Conclusion: Whilst low socioeconomic status is associated with a higher prevalence of diabetes the inverse social gradient seen in this study has not previously been reported. The social disparity seen in relation to treated end stage renal disease due to type 2 diabetes for Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders has changed very little in the past 20 years. Addressing the increasing incidence of diabetes in Australia requires consideration of the underlying social determinants of health. Refereed/Peer-reviewed

Objective To review published literature on the equity of participation in colorectal cancer screening amongst different population subgroups, in addition to identifying factors identified as barriers and facilitators to equitable screening. Studies were included in the review if they included FOBT as at least one of the screening tests. Method Relevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies of the association with colorectal cancer screening test participation, barriers to equitable participation in screening, and studies examining interventional actions to facilitate screening test participation were included. Data extraction and analysis was undertaken using an approach to the synthesis of qualitative and quantitative studies called Realist Review. Results Sixty-three articles were identified that met the inclusion criteria. SES status, ethnicity, age and gender have been found as predictors of colorectal cancer screening test participation. This review also found that the potential for equitable cancer screening test participation may be hindered by access barriers which vary amongst population sub-groups. Conclusion This review provides evidence of horizontal inequity in colorectal cancer screening test participation, but limited understanding of the mechanism by which it is sustained, and few evidence-based solutions.

Family food choice is complex with a number of people within the family sharing food choice and preparation responsibilities. Differences in dietary behaviours also exist between various ethnic groups worldwide, and are apparent within multicultural nations such as Australia. This study examined the intergenerational transmission of eating behaviour through semi-structured family interviews with 27 three generation families (Anglo-Australian: n = 11, Chinese-Australian: n = 8, Italian-Australian: n = 8; N = 114). The influence of generation (grandparent, parent, child), role (grandmother, grandfather, mother, father, daughter, son), and ethnic background were considered. Thematic analysis identified that regardless of ethnic background, grandmothers and mothers dominated family food choice decisions even in families where fathers were primarily responsible for the preparation of family meals. The women in each generation influenced fruit and vegetable intake by controlling purchasing decisions (e.g., by shopping for food or editing family grocery shopping lists), insisting on consumption, monitoring and reminding, utilizing food as a prerequisite for conditional treats (e.g., eating fruit before being allowed snacks), instigating and enforcing food rules (e.g., fast food only on weekends), and restricting others' food choices. Grandparents and children shared a relationship that skipped the parent generation and influenced dietary behaviours bi-directionally. These findings have implications for the delivery of dietary health messages used in disease prevention interventions designed to successfully reach culturally and linguistically diverse populations and all members of multigenerational families. Refereed/Peer-reviewed

Background: Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds. Methods: One hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10-18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members' disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members' roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds. Discussion: Results will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613001033730. Retrospectively registered: 17 September, 2013. Refereed/Peer-reviewed

Background: Smoking tobacco products is one of the largest preventable health risk factors for older people. Greek-Australians have the highest prevalence of cigarette use in Australia for older people, but there is a lack of knowledge about Greek-Australian's perspectives on smoking cessation. The purpose of this exploratory, qualitative study was to progress the knowledge base in this area. Methods: A qualitative study was designed to gather information on participants' perspectives about, and understanding of, their reasons for smoking and their attitudes to quitting. A snowball sampling technique was used to identify twenty Greek-Australian current smokers, aged ≥50 years. Semi-structured, face-to-face interviews were conducted with the assistance of a Greek translator. The audio-taped interviews were transcribed and then qualitative content analysis was used to categorise responses to the questions. Results: Participants' perspectives on three broad topics were identified in the interviews: perceived benefits of smoking, perceptions of smoking and its effect on health, and barriers to cessation. Smoking behaviour was described as contributing to tiredness, and stress, and yet also was also a source of enjoyment. Level of knowledge about smoking-related diseases and the risks of smoking was very low. The number of cigarettes smoked each day, type of smoking (i.e. pipe rather than cigarettes), and previous family history of smoking were identified as indicators that limited harm flows from smoking. Most participants had a positive attitude towards smoking and described their own life experience and cultural norms as supporting smoking acceptability. Low confidence in quitting was linked to advanced age. Conclusion: Smoking among older Greek-Australian smokers has been associated with a number of influences and these need to be addressed in smoking cessation efforts targeted at this group. Promoting knowledge about the health impacts of smoking, changing attitudes towards smoking, and ultimately, decreasing tobacco consumption are critical to the maintenance of health among older Greek Australians. Cultural and experiential influences may increase the difficulty associated with changing these outcomes, but may also serve as a framework from which to develop and implement an educational intervention tailored for older Greek-Australians. Refereed/Peer-reviewed

Food waste is a global problem. In Australia alone, it is estimated that households throw away AU$5.2 billion worth of food (AU$616 per household) each year. Developed countries have formal waste management systems that provide measures of food waste. However, much remains unknown about informal food waste disposal routes and volumes outside of the formal system. This article provides indicative metrics of informal food waste by identifying, in detail, five of the dominant informal food waste disposal routes used by Australian households: home composting, feeding scraps to pets, sewer disposal, giving to charity, and dumping or incineration. Informal waste generation rates are then calculated from three primary data sources, in addition to data from previous Australian and UK surveys, using a weighted average method in conjunction with a Monte-Carlo simulation. We find that the average Australian household disposes of 2.6 kgs of food waste per week through informal routes (1.7 kgs via household composting, 0.2 kgs via animals, and 0.6 kgs via sewage). This represents 20% of Australian household food waste flows. Our results highlight that informal food waste is a sizable food waste flow from Australian homes, deserving of greater research and government attention. Our examination of the full extent of food waste by disposal mode provides waste managers and policy makers with clear disposal routes to target for behaviour change and positive environmental outcomes. Refereed/Peer-reviewed

Background: There is little information on longitudinal patterns of participation in faecal occult blood test (FOBT) based colorectal cancer (CRC) screening or on demographic or behavioural factors associated with participation in re-screening. The lack of an agreed system for describing participatory behaviour over multiple rounds also hampers our ability to report, understand and make use of observed associations. Our aims were to develop a system for describing patterns of participatory behaviour in FOBT-based CRC screening programs and to identify factors associated with particular behavioural patterns. Methods: A descriptive framework was developed and applied to a data extract of screening invitation outcomes over two rounds of the NBCSP. The proportion of invitees in each behaviour category was determined and associations between behaviour patterns and demographic and program factors were identified using multivariate analyses. Results: We considered Re- Participants, Dropouts, Late Entrants and Never Participants to be the most appropriate labels for the four possible observed participatory categories after two invitation rounds. The screening participation rate of the South Australian cohort of the NBCSP remained stable over two rounds at 51%, with second round Dropouts (10.3%) being balanced by Late Entrants (10.5%). Non-Participants comprised 38.7% of invitees. Relative to Re-Participants, Dropouts were older, more likely to be female, of lower SES, had changed their place of residence between offers had a positive test result in the first round. Late Entrants tended to be in the youngest age band. Conclusions: Specific demographic characteristics are associated with behavioural sub-groups defined by responses to 2 offers of CRC screening. Targeted group-specific strategies could reduce dropout behaviour or encourage those who declined the first invitation to participate in the second round. It will be important to keep first round participants engaged in order to maximise the benefit of a CRC screening program., This study was part of a wider investigation of factors associated with re-screening for CRC funded by SA Health under its Strategic Health Research Program (SHRP).

Why people smoke despite the health risks is an important public health question. Equally important is why and how some people resist smoking in spite of circumstances that clearly place them at high risk of becoming smokers. This study used in-depth interviews to explore the narratives of 12 people diagnosed with mental illness, who had made conscious decisions not to smoke. This was despite most of them growing up in smoking families or being from population groups at high risk of smoking. A qualitative grounded theory methodology was used to analyse common themes around protective behaviours and attitudes within a model of resilience. Themes included strong negative reactions to smoking as children which have persisted into adulthood, strong lasting associations with smoking, a clear sense of 'self' separate from peers from an early age (internal resilience) and developing a range of coping strategies and external supports not related to smoking (external resilience). Understanding resilience holds potential lessons for health promotion and primary health care professionals supporting the prevention of smoking uptake and supporting smoking cessation by at risk groups. Refereed/Peer-reviewed

The notion of developing resilience is becoming increasingly important as a way of responding to the social determinants of poor health, particularly in disadvantaged groups. It is hypothesized that resilient individuals and communities are able to 'bounce back' from the adversities they face. This paper explores the processes involved in building resilience as an outcome in relation to both quitting smoking and never smoking. The study involved 93 qualitative, oral-history interviews with participants from population groups with high and enduring smoking rates in Adelaide, Australia, and was essentially interested in how some people in these groups managed to quit or never start smoking in the face of adversities, in comparison to a group of smokers. Our key findings relate to what we call additive and subtractive resilience strategies, which focus on the practices, roles and activities that individuals either 'took on' or 'left behind' in order to quit smoking or remain abstinent. The theoretical lenses we use to understand these resilience strategies relate to biographical reinforcement and biographical reinvention, which situate the resilience strategies in a broader 'project of the self', often in relation to attempting to develop 'healthy bodies' and 'healthy biographies'. Refereed/Peer-reviewed