Search

In 2014, a fire at an open cut coalmine in regional Victoria, Australia burned for 6 weeks. Residents of the nearby town of Morwell were exposed to smoke, which included high levels of fine particulate matter (PM 2.5 ). We investigated whether the long-term effects of PM 2.5 on respiratory health were moderated by diet quality. A cross-sectional analysis was conducted of data collected 8.5 years after the mine fire from 282 residents of Morwell and 166 residents from the nearby unexposed town of Sale. Primary outcomes were respiratory symptoms. Exposure was coalmine fire-related PM 2.5 and diet quality was assessed as Australian Recommended Food Score (ARFS) derived using the Australian Eating Survey (AES). The moderating effect of diet quality on respiratory outcomes associated with PM 2.5 was assessed using logistic regression models, adjusting for potential confounders. Diet quality was poor in this sample, with 60% in the lowest category of overall diet quality. Overall diet quality and fruit and vegetable quality significantly attenuated the association between PM 2.5 and prevalence of chronic cough and phlegm. Sauce/condiment intake was associated with a greater effect of PM 2.5 on COPD prevalence. No other moderating effects were significant. The moderating effects of overall diet quality and vegetable and fruit intake aligned with a priori hypotheses, suggesting potential protective benefits. While more evidence is needed to confirm these findings, improving diets, especially fruit and vegetable intake, may provide some protection against the effects of smoke exposure from fire events., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Thara Govindaraju, Matthew Carroll, Brigitte M. Borg, Catherine L. Smith, Caroline X. Gao, David Brown, David Poland, Shantelle Allgood, Jillian F. Skin, Michael J. Abrasion, Tyler J. Lane reports financial support was provided by Victoria Department of Health. Michael J. Abramson reports a relationship with Pfizer, Boehringer-Ingelheim, Sanofi, GSK that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Local food systems which support affordable, equitable, accessible, and sustainable food are important to enhance food access and reduce food insecurity. Cardinia Shire Council, a local government in Victoria, Australia has developed and endorsed a 'Community Food Strategy' to support their local food system and food security. This study aimed to explore local government community member perspectives regarding food access within their local food environment, and suggested areas to be addressed to better support access., Methods: A sequential mixed methods photovoice methodology was implemented. Participants aged over 18 years, who resided in Cardinia Shire, completed an online quantitative survey to explore demographics, food access and food security status and severity (18-item USDA Household Food Security Survey Module). The qualitative photovoice method was used, whereby participants were asked to take photographs that represent their experiences of food access. These photographs were used as prompts in a semi-structured interview Interview data were thematically analysed., Results: Seventeen participants completed the study, of which five participants experienced varied severity levels of food insecurity. From the photovoice interviews four themes were developed: 1) Food: a connector to self, people and place, 2) Influencers of food access and triggers for food insecurity, 3) Savvy food literacy skills to support access to food, 4) Consequences of and struggles with food insecurity. Participants suggested recommendations for action to support future food access in their community., Conclusions: While food choice is influenced by a range of determinants, the local food environment greatly impacts both food access and food choice. A supportive local food system which promotes inclusion of a community voice, community connectedness, food literacy and physical and economic access to local produce is crucial to support food security., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia., Methods: Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method., Results: Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect., Conclusions: Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The present study aimed to qualitatively explore the food choice determinants of both Chinese immigrants living in Australia and Chinese people living in mainland China., Methods: Eight Chinese Australian participants (female, n = 5; male, n = 3) and ten mainland Chinese participants (female, n = 5; male, n = 5) were recruited from Australia (primarily in Melbourne, Victoria) and China (predominantly in Zhengzhou, Henan province) between June 2021 and March 2022. Participants were diverse in age, socio-economic background, occupation and health status. Semi-structured in-depth interviews were conducted in Mandarin either face-to-face or using online video/voice calls. Interviews were audio-recorded and transcribed verbatim. Investigator triangulation was used to enhance scientific rigour., Results: Four themes were identified: (1) food choice determinants were shaped by traditional and modern nutrition perceptions and personal food philosophy; (2) physiological responses to food provide direct feedback that impacts future food choices; (3) consideration of convenience was a predominant influencer of food choice; and (4) the differences in food environments between China and Australia promoted distinctive food choice determinants for Chinese people., Conclusions: Chinese Australian and mainland Chinese participants' food choices are shaped by traditional Chinese nutrition philosophy, modern Western nutrition science and the contemporary food environment. There are clear cultural characteristics in their food choice determinants that should be considered by health educators, nutrition professionals and nutrition policymakers when developing culturally appropriate health interventions for Chinese people., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.

Introduction: Shift workers are at an increased risk of developing obesity and type 2 diabetes. Eating and sleeping out of synchronisation with endogenous circadian rhythms causes weight gain, hyperglycaemia and insulin resistance. Interventions that promote weight loss and reduce the metabolic consequences of eating at night are needed for night shift workers. The aim of this study is to examine the effects of three weight loss strategies on weight loss and insulin resistance (HOMA-IR) in night shift workers., Methods and Analysis: A multisite 18-month, three-arm randomised controlled trial comparing three weight loss strategies; continuous energy restriction; and two intermittent fasting strategies whereby participants will fast for 2 days per week (5:2); either during the day (5:2D) or during the night shift (5:2N). Participants will be randomised to a weight loss strategy for 24 weeks (weight loss phase) and followed up 12 months later (maintenance phase). The primary outcomes are weight loss and a change in HOMA-IR. Secondary outcomes include changes in glucose, insulin, blood lipids, body composition, waist circumference, physical activity and quality of life. Assessments will be conducted at baseline, 24 weeks (primary endpoint) and 18 months (12-month follow-up). The intervention will be delivered by research dietitians via a combination of face-to-face and telehealth consultations. Mixed-effect models will be used to identify changes in dependent outcomes (weight and HOMA-IR) with predictor variables of outcomes of group, time and group-time interaction, following an intention-to-treat approach., Ethics and Dissemination: The study protocol was approved by Monash Health Human Research Ethics Committee (RES 19-0000-462A) and registered with Monash University Human Research Ethics Committee. Ethical approval has also been obtained from the University of South Australia (HREC ID: 202379) and Ambulance Victoria Research Committee (R19-037). Results from this trial will be disseminated via conference presentations, peer-reviewed journals and student theses., Trial Registration Number: Australian New Zealand Clinical Trials Registry (ACTRN-12619001035112)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Cost studies are increasingly popular given resource constraints. While scholars stress the context-dependent nature of cost, and the importance of theory, cost studies remain context-blind and atheoretical. However, realist economic evaluation (REE) privileges context and the testing/refinement of economic programme theory. This preliminary REE serves to test and refine economic programme theory for supervision training programmes of different durations to better inform future programme design/implementation., Methods: Our preliminary REE unpacked how short (half-day) and extended (12 week) supervision training programmes in Victoria, Australia, produced costs and outcomes. We employed mixed methods: qualitative realist and quantitative cost methods. Economically optimised programme models were developed guided by identified cost-sensitive mechanisms and contexts., Results: As part of identified context-mechanism-outcome configurations (CMOCs) for both training programmes, we found a wider diversity of positive outcomes but greater costs for the extended programme (11 outcomes; AU$3069/learner) compared with the short programme (7 outcomes; $385/learner). We identified four shared cost-sensitive mechanisms for both programmes (training duration, learner protected time, learner engagement, and facilitator competence) and one shared cost-sensitive context (learners' supervisory experience). We developed two economically optimised programme models: (1) short programme for experienced supervisors facilitated by senior educators ($406/learner); and (2) extended programme for inexperienced supervisors facilitated by junior educators ($2104/learner)., Discussion: Our initial economic programme theory was somewhat supported, refuted and refined. Results were partly consistent with previous research, but also extended it through unpacking cost-sensitive mechanisms and contexts. Although our preliminary REE fills a pressing gap in the methodology literature, conducting REE was challenging given our desire to integrate economic and realist analyses fully, and remain faithful to realist principles. Attention to training duration and experience levels of the facilitator-learner dyad may help to balance the cost and outcomes of training programmes., (© 2021 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background and Aims: Shift workers face an increased risk of cardiovascular disease (CVD), type-2 diabetes and obesity. Eating during the night is a likely contributing factor, as it coincides with the time at which postprandial metabolism is least efficient. In this pilot randomised crossover trial, we examine the effects of a short overnight fast on CVD risk markers (primarily postprandial triglyceride and glucose response) of night shift workers., Methods and Results: Night shift workers with abdominal obesity underwent 4-week intervention and control periods, separated by ≥ 2 weeks washout. In the intervention period, an overnight fast (0100 h-0600 h) was implemented, by redistributing 24-h energy intake. Usual dietary habits were followed in the control period. Outcomes between intervention and control were compared using mixed effects linear regression models. Nineteen adults completed the trial [13 females, mean (±SD) age 41 ± 10 years, BMI 30.7 ± 5.7 kg/m 2 ]. Postprandial triglyceride and glucose response post intervention were not different to post control. The overnight fast was well-tolerated by participants with an adherence rate of 95%, assessed by weekly 24-h dietary recalls. Exploratory analysis indicates lower mean body weight post intervention compared to post control (mean difference: -0.9 kg, 95% CI: -1.3 to -0.4)., Conclusions: Night shift workers who habitually ate during their night shifts were able to rearrange their meal times to maintain a small overnight fast, which may have promoted small weight changes. This warrants further investigation into the role of meal timing in mitigating the metabolic consequences of night shift work., Trial Registration: Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/) registered on the 30th May 2017 (ACTRN12617000791336)., Competing Interests: Declaration of competing interest None., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objective: To examine structured expert judgement (SEJ) elicitation as a method to provide robust, defensible data for three determinants of household food security (food cost, household disposable income and physical access) for quantifying a proof-of-concept integrating decision support system for food security., Design: SEJ elicitation is a validated method for obtaining unavailable data, but its use in household food security in high-income countries is novel. Investigate Discuss Estimate Aggregate (IDEA) elicitation protocol was implemented, including quantitative and qualitative elements. Using specific questions related to three determinants, food security experts were encouraged to Investigate - estimate individual first-round responses to these questions, Discuss - with each other evidence on the reasoning and logic of their estimates, Estimate - second-round responses, following which these judgements were combined using mathematical Aggregation., Setting: Victoria, Australia., Participants: Five experts with a range of expertise in the area of household food insecurity participated in the SEJ elicitation process., Results: The experts' ability to provide reliable estimates was tested and informed the aggregation of the collection of individual estimates into a single quantity of interest for use in decision support. The results of the quantitative elicitation show the impact of combinations of varying household income, food cost and physical access on household food security status and severity and is supported by the experts reasoning during elicitation., Conclusion: This research provides insight to the application of SEJ where elicited data can inform and support intervention decision-making specific to household food security, especially where evidence is absent or of poor quality.

This study aimed to pilot the feasibility, acceptability and effectiveness of three co-developed healthy food and beverage pricing interventions in a community retail setting. Aquatic and recreation centres in Victoria, Australia were recruited to co-develop and pilot pricing interventions within their onsite cafés, for 15 weeks from January 2019. A mixed method intervention evaluation was conducted. Interviews were conducted with food retail managers to understand the factors perceived to influence implementation, maintenance and effectiveness. Customer surveys assessed support for, and awareness of, interventions. Interrupted time series analysis estimated the impact of pricing interventions on food and beverage sales. Three centres each implemented a unique intervention: (i) discounted healthy bundles ('healthy combination deals'), (ii) offering deals at specific times of the day ('healthy happy hours') and (iii) increasing the prices of selected unhealthy options and reducing the prices of selected healthier options ('everyday pricing changes'). Café team leaders did not identify any significant challenges to implementation or maintenance of interventions, though low staff engagement was identified as potentially influencing the null effect on sales for healthy combination deals and healthy happy hours interventions. Customers reported low levels of awareness and high levels of support for interventions. Everyday pricing changes resulted in a significant decrease in sales of unhealthy items during the intervention period, though also resulted in a decrease in café revenue. Co-developed healthy food and beverage pricing interventions can be readily implemented with broad customer support. Everyday pricing changes have demonstrated potential effectiveness at reducing unhealthy purchases., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Retailers have the capacity to improve the food and beverage environment by making healthier options more affordable and attractive for their consumers. The perspectives of retailers on feasible and acceptable pricing strategies are not known. The aim of this study was to understand retailers' perceptions of factors that are relevant to feasible and acceptable health-promoting food and beverage pricing interventions. A convenience sample of 11 aquatic and recreation centre managers in Victoria, Australia was recruited to participate in semi-structured interviews. We took a pragmatic approach with the aim of understanding retailers' perceptions of factors that affect the feasibility and acceptability of pricing interventions within their facilities. Thematic analysis was used to synthesize and interpret retailers' perceptions of pricing interventions. Key themes identified were: structural and organizational characteristics (the internal and external characteristics of aquatic and recreation centres), characteristics of feasible pricing changes (type, magnitude and products targeted by pricing strategies) and business outcomes (profits and customer feedback). Results suggest that pricing interventions to promote healthy food and beverage choices can be feasible and acceptable to retailers, though contextual considerations are likely to be important. Future studies should use these findings to design interventions most likely to be acceptable to retailers, work with retailers to implement health-promoting food and beverage pricing interventions, evaluate the impact on business outcomes including customer perspectives and profitability, and test transferability to other retail settings., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Maternal lifestyle in the months leading up to conception and throughout pregnancy has both immediate and transgenerational impacts on offspring health., Aim: To explore how women's lifestyles change when they become pregnant, and their perspectives of the lifestyle advice they receive throughout pregnancy., Methods: A descriptive qualitative approach was used. Semi-structured interviews with 17 childbearing women (mean gestational age, 30.2 ± 2.0 weeks) recruited from a large hospital network in Victoria, Australia between July and October 2018 were transcribed and analysed using an inductive process of thematic analysis., Findings: Three themes and six sub-themes were identified. Lifestyle change during pregnancy was highly influenced by participants' preconception lifestyle, the physiological demands of pregnancy and the pressures of daily life. While participants proactively sought lifestyle advice from a range of sources, including the Internet, they were generally less proactive in seeking advice during routine maternity care visits. Participants appreciated the lifestyle advice they received from health professionals, including midwives, as part of their maternity care despite acknowledging that they often received it only if they asked. Overall, it seemed that the lifestyle advice received from health professionals was much less influential on maternal lifestyle behaviour change than the broader socio-ecological environment., Conclusion: Childbearing women want lifestyle advice that supports positive lifestyle change during pregnancy and health professionals, including midwives, must be proactive as they provide it. Other factors that impact on childbearing women's capability and opportunity to make lifestyle change should be considered when providing advice that supports positive lifestyle behaviour change., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Limited research has explored teachers' perceptions of the role that schools can play in supporting staff members' healthy eating and physical activity. We aimed to identify barriers to healthy eating and physical activity within the school context, and to conclude on potential strategies for supporting staff to pursue these healthier behaviours. A convenience sampling strategy was used to recruit eleven schools from across Victoria to participate in this study, through contacts known to the researchers. The researchers facilitated focus groups involving staff from schools. Focus groups ranged in size from 3 to 12 participants (total 82) and lasted between 40 and 75 min. Thematic analysis was used to identify themes and sub-themes which were identified by staff as being important for healthy eating and physical activity. Schools that were perceived by staff to support healthy eating and physical activity offered opportunities, through initiatives and the physical environment, to support staff in accessing environments and facilities that supported them in being healthy. Further supportive elements were identified as a culture of health behaviours amongst staff members and leadership which supported health behaviours. Workplace stressors were reported to impact many aspects of staff health and wellbeing. Potential actions by schools to better support staff to pursue healthy eating and physical activity were identified from the themes emerging from this study. Alignment between these themes and elements of the World Health Organisation's healthy workplace framework suggest it will be important for health promotion models to account for these themes., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The aim of this study is to identify if Victorian local governments prioritise Aboriginal health and wellbeing issues through policy and explore the key factors influencing policy and program development and implementation. A sequential explanatory mixed-methods study design utilised a survey to quantify commitment to Aboriginal health policy followed by in-depth interviews that explored how and why policy or programs were in place. Data were analysed separately and then interpreted together. Representatives from 39 of Victoria's 79 local governments (49%) responded to the survey and 14 were interviewed. Seventy-four per cent had policy and programs addressing Aboriginal health and wellbeing. The key factors influencing policy and program development were: (i) the process of policy and program development and implementation and the role of other policies; (ii) the influence of Aboriginal community characteristics; and (iii) advocacy for Aboriginal health and wellbeing. Underpinning these factors was that local government is 'working together (in partnership and through collaboration) towards reconciliation'. Victorian local governments that participated in this study appear to prioritise Aboriginal health and wellbeing, especially where collaboration with the Aboriginal community is strong. The effect of policies and their subsequent programs on the health of Aboriginal peoples warrants further exploration.

Issue Addressed: Affordability of a healthy diet is a determinant of nutritional intake and therefore health. This project aimed to measure the cost of healthy foods across a geographically defined region and examine factors related to changing food prices to assist in informing health promotion practice., Methods: The cost of a healthy food basket was measured using the Victorian Healthy Food Basket tool, in all eligible stores, across five rural local government areas in Western Victoria, Australia in 2014, 2015 and 2016. One-way analysis of variance was used to investigate differences in healthy food basket cost across years. Multivariable linear regression models were constructed to adjust for baseline (2014) cost to determine factors associated with cost., Results: Data were collected from 45 stores in 2014 and 2015 and 48 stores in 2016. The average cost of the healthy food basket was $459 in 2014, $437 in 2015 and $443 in 2016. The cost of the healthy food basket was the highest in stores >15 km from the major regional centre and in areas with only one supermarket (non-cluster) (P < 0.05). All food groups except fruit and vegetables decreased in price between 2014 and 2016., Conclusion: This project highlights distance from regional centres and competition as possible factors that influence the cost of healthy food. SO WHAT?: This is valuable insight for health promoters in designing both local level interventions aimed at improving access to healthy food and influencing regional food systems., (© 2018 Australian Health Promotion Association.)

There is limited evidence of how Australian low-to-middle income (AUD $40,000⁻$80,000) households maintain food security. Using a sequential explanatory mixed methods methodology, this study explored and compared the food security (FS) and insecurity (FIS) experiences of these households. An initial quantitative survey categorised participants according to food security status (the 18-item United States Department of Agriculture Household Food Security Survey Module) and income level to identify and purposefully select participants to qualitatively explore food insecurity and security experiences. Of the total number of survey participants ( n = 134), 42 were categorised as low-to-middle income. Of these, a subset of 16 participants (8 FIS and 8 FS) was selected, and each participant completed an in-depth interview. The interviews explored precursors, strategies to prevent or address food insecurity, and the implications of the experience. Interview data were analysed using a thematic analysis approach. Five themes emerged from the analysis: (i) food decision experiences, (ii) assets, (iii) triggers, (iv) activation of assets, and (v) consequences and emotion related to walking the food security tightrope. The leverage points across all themes were more volatile for FIS participants. Low-to-middle income Australians are facing the challenges of trying to maintain or improve their food security status, with similarities to those described in lower income groups, and should be included in approaches to prevent or address food insecurity.