Does the availability of snack foods in supermarkets vary internationally?

Background
Cross-country differences in dietary behaviours and obesity rates have been previously reported. Consumption of energy-dense snack foods and soft drinks are implicated as contributing to weight gain, however little is known about how the availability of these items within supermarkets varies internationally. This study assessed variations in the display of snack foods and soft drinks within a sample of supermarkets across eight countries.

Methods
Within-store audits were used to evaluate and compare the availability of potato chips (crisps), chocolate, confectionery and soft drinks. Displays measured included shelf length and the proportion of checkouts and end-of-aisle displays containing these products. Audits were conducted in a convenience sample of 170 supermarkets across eight developed nations (Australia, Canada, Denmark, Netherlands, New Zealand, Sweden, United Kingdom (UK), and United States of America (US)).

Results
The mean total aisle length of snack foods (adjusted for store size) was greatest in supermarkets from the UK (56.4 m) and lowest in New Zealand (21.7 m). When assessed by individual item, the greatest aisle length devoted to chips, chocolate and confectionery was found in UK supermarkets while the greatest aisle length dedicated to soft drinks was in Australian supermarkets. Only stores from the Netherlands (41%) had less than 70% of checkouts featuring displays of snack foods or soft drinks.

Conclusion
Whilst between-country variations were observed, overall results indicate high levels of snack food and soft drinks displays within supermarkets across the eight countries. Exposure to snack foods is largely unavoidable within supermarkets, increasing the likelihood of purchases and particularly those made impulsively.

What are grade 5 and 6 children buying from school canteens and what do parents and teachers think about it?

Objective: The foods sold in school canteens have a significant role to play in ensuring children consume a healthy balance of nutritious foods. However, no research to date has described the foods that Australian children are purchasing at school canteens, or the perceptions held about school canteens by students, teachers and parents.
Design: An exploratory cross-sectional survey was used to obtain information from students, parents and teachers through self completion questionnaires.
Subjects: There were 384 children aged nine to 12 years, 404 parents and 41 teachers involved.
Settings: The study was conducted in 12 primary schools in Victoria, Australia.
Main outcome measures: Types of foods purchased at school canteens, school canteen usage, parents' and teachers' perceptions of the role of the school and canteen in influencing children's eating habits.
Results: More than 50% of the children surveyed used the school canteen at least once per week. Children identified preference for unhealthy alternatives and availability as key barriers to choosing healthy foods at the canteen and suggested increased availability, advertisements and cost reductions as aids to purchasing healthy foods. Teachers placed more importance on the role of the canteen than parents did.
Statistical analyses: Frequencies, cross-tabulation analyses and chi square tests were undertaken using the SPSS 11 computer program.
Conclusions: These Victorian primary school children and their teachers, and to a lesser extent parents, had a clear understanding of healthy foods. Children and teachers identified barriers that prevent school canteens
from providing healthy foods. There is likely to be strong support from these stakeholders for novel health promoting policies.

Early life stress and child temperament style as predictors of childhood anxiety and depressive symptoms : findings from the longitudinal study of Australian children

Objective. The purpose of this study was to determine whether the relationship between stressful infant environments and later childhood anxiety and depressive symptoms varies as a function of individual differences in temperament style.

Methods. Data was drawn fromthe Longitudinal Study of Australian Children (LSAC). This study examined 3425 infants assessed at three time points, at 1-year, at 2/3 years and at 4/5 years. Temperament was measured using a 12-item version of Toddler Temperament Scale (TTS) and was scored for reactive, avoidant, and impulsive dimensions. Logistic regression was used to model direct relationships and additive interactions between early life stress, temperament, and emotional symptoms at 4 years of age. Analyses were adjusted for socioeconomic status, parental education, andmarital status.

Results. Stressful family environments experienced in the infant’s first year of life (high versus low) and high reactive, avoidant, and impulsive temperament styles directly and independently predicted anxiety and depressive problems in children at 4 years of age. There was no evidence of interaction between temperament and family stress exposure.

Conclusions. Both infant temperament and stress exposures are independent and notable predictors of later anxiety and depressive problems in childhood. The risk relationship between stress exposure in infancy and childhood emotion problems did not vary as a function of infant temperament. Implications for preventive intervention and future research directions are discussed.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

BackgroundChildren's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children are also at risk of exposure to ETS in child care or educational settings. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide.ObjectivesTo determine the effectiveness of interventions aiming to reduce exposure of children to ETS.Search methodsWe searched the Cochrane Tobacco Addiction Group Specialized Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, CINAHL, ERIC, and The Social Science Citation Index & Science Citation Index (Web of Knowledge). Date of the most recent search: September 2013.Selection criteriaControlled trials with or without random allocation. Interventions must have addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0 to 12 years). All mechanisms for reduction of children's ETS exposure, and smoking prevention, cessation, and control programmes were included. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions.Data collection and analysisTwo authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcome measures, no summary measures were possible and results were synthesised narratively.Main resultsFifty-seven studies met the inclusion criteria. Seven studies were judged to be at low risk of bias, 27 studies were judged to have unclear overall risk of bias and 23 studies were judged to have high risk of bias. Seven interventions were targeted at populations or community settings, 23 studies were conducted in the 'well child' healthcare setting and 24 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether the visits were to well or ill children, and another included both well and ill child visits. Thirty-six studies were from North America, 14 were in other high income countries and seven studies were from low- or middle-income countries. In only 14 of the 57 studies was there a statistically significant intervention effect for child ETS exposure reduction. Of these 14 studies, six used objective measures of children's ETS exposure. Eight of the studies had a high risk of bias, four had unclear risk of bias and two had a low risk of bias. The studies showing a significant effect used a range of interventions: seven used intensive counselling or motivational interviewing; a further study used telephone counselling; one used a school-based strategy; one used picture books; two used educational home visits; one used brief intervention and one study did not describe the intervention. Of the 42 studies that did not show a significant reduction in child ETS exposure, 14 used more intensive counselling or motivational interviewing, nine used brief advice or counselling, six used feedback of a biological measure of children's ETS exposure, one used feedback of maternal cotinine, two used telephone smoking cessation advice or support, eight used educational home visits, one used group sessions, one used an information kit and letter, one used a booklet and no smoking sign, and one used a school-based policy and health promotion. In 32 of the 57 studies, there was reduction of ETS exposure for children in the study irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure, but rather aimed to reduce symptoms of asthma, and found a significant reduction in symptoms in the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions.Authors' conclusionsWhile brief counselling interventions have been identified as successful for adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. Although several interventions, including parental education and counselling programmes, have been used to try to reduce children's tobacco smoke exposure, their effectiveness has not been clearly demonstrated. The review was unable to determine if any one intervention reduced parental smoking and child exposure more effectively than others, although seven studies were identified that reported motivational interviewing or intensive counselling provided in clinical settings was effective.

Socioeconomic variation in diet and activity-related behaviours of Australian children and adolescents aged 2–16 years

Background

Evidence for age-related variation in the relationship between obesity-related behaviours and socioeconomic position may assist in the targeting of dietary and physical activity interventions among children.
Objective

To investigate the relationship between different indicators of socioeconomic position and obesity-related behaviours across childhood and adolescence.
Methods

Data were from 4487 children aged 2 to 16 years participating in the cross-sectional 2007 Australian National Children's Nutrition and Physical Activity Survey. Socioeconomic position was defined by the highest education of the primary or secondary carer and parental income. Activity was assessed using recall methods with physical activity also assessed using pedometers. Intake of energy-dense drinks and snack foods, fruits and vegetables was assessed using 2 × 24-h dietary recalls.
Results

A socioeconomic gradient was evident for each dietary measure (although in age-specific analyses, not for energy-dense snacks in older children), as well as television viewing, but not physical activity. Whether each behaviour was most strongly related to parental income or education of the primary or secondary carer was age and sex dependent. The socioeconomic gradient was strongest for television viewing time and consumption of fruit and energy-dense drinks.
Conclusions

A strong socioeconomic gradient in eating behaviours and television viewing time was observed. Relationships for particular behaviours differed by age, sex and how socioeconomic position was defined. Socioeconomic indicators define different population groups and represent different components of socioeconomic position. These findings may provide insights into who should be targeted in preventive health efforts at different life stages.

Adolescent television viewing and unhealthy snack food consumption: the mediating role of home availability of unhealthy snack foods

Objective
To examine whether home availability of energy-dense snack foods mediates the association between television (TV) viewing and energy-dense snack consumption among adolescents.
Design
Cross-sectional.
Setting
Secondary schools in Victoria, Australia.
Subjects
Adolescents (n 2984) from Years 7 and 9 of secondary school completed a web-based survey, between September 2004 and July 2005, assessing their energy-dense snack food consumption, school-day and weekend-day TV viewing and home availability of energy-dense snack foods.
Results
School-day and weekend-day TV viewing were positively associated with energy-dense snack consumption among adolescent boys (β = 0·003, P < 0·001) and girls (β = 0·03, P < 0·001). Furthermore, TV viewing (school day and weekend day) were positively associated with home availability of energy-dense snack foods among adolescent boys and girls and home availability of energy-dense snack foods was positively associated with energy-dense snack food consumption among boys (β = 0·26, P < 0·001) and girls (β = 0·28, P < 0·001). Home availability partly mediated the association between TV viewing and energy-dense snack consumption.
Conclusions
The results of the present study suggest that TV viewing has a significant role to play in adolescent unhealthy eating behaviours. Future research should assess the efficacy of methods to reduce adolescent energy-dense snack food consumption by targeting parents to reduce home availability of energy-dense foods and by reducing TV viewing behaviours of adolescents.

VNTR polymorphism of the insulin gene and childhood overweight in a general population

Objective: The VNTR polymorphism 5' of the insulin gene has been related to obesity in a previous study on children with early onset of severe obesity. Our purpose was to analyze the association between this polymorphism and adiposity variability in an unselected population of children and adolescents in northern France.

Research Methods and Procedures: In 293 nuclear families from the Fleurbaix Laventie Ville Santé study, we genotyped the INS VNTR polymorphism in 431 children and adolescents (8 to 18 years of age) and their parents. Overweight was defined according to the international definition in both children and adults. A transmission disequilibrium test in families with an overweight offspring was performed. The prevalence of overweight was compared according to genotype. The effect of the genotype on BMI and waist circumference was tested with a linear regression model, adjusting for age, gender, and Tanner stage.

Results: There was an undertransmission of class III alleles from heterozygous parents to their overweight offspring (p < 0.002). Overweight was associated with class I alleles in children and adolescents (12% I/I, I/III vs. 3% III/III; p < 0.08). Those with a class III/III genotype had a 1 kg/m2 lower mean BMI (p = 0.04) and 3 cm lower waist circumference (p = 0.02) than those bearing one or two class I alleles. No association of adiposity or obesity with class I alleles was found in parents.

Discussion: INS VNTR polymorphism seems to contribute to differences in adiposity level in the general population of children and adolescents.

Access to a healthy diet and fast foods in the City of Casey

It is known that the consumption of fast food is associated with obesity (Binkley 2000). Relative ease of access to fast foods compared with healthy foods may contribute to the increasing prevalence of obesity. The aim of this study was to determine and compare the access by car to fast foods and a healthy diet. The study was located in the City of Casey, a municipality in South East Melbourne with a population of 220,000. We have previously shown that ease of access to a large chain supermarket ensures access to a basket of healthy foods adequate to meet the nutritional needs of a family of 6 (Burns 2004). The City of Casey council provided location details for major fast food outlets and supermarkets. Fast food was defined as food sourced from an outlet without table service. We included only those major fast food chain outlets which had more than 10 franchises within Australia. We included the 3 major supermarket chains that account for 87% total food retailing in Victoria. Geographic details from the City of Casey were used to map the location of these outlets. Then using these locations and road network a basic cost distance model was created for either the supermarket chains or fast food chains outlets. The cost unit is (time), it was to calculate by giving the roads in the network an average travel speed depending in the type of road (minor, major or highway) and then calculating how long it would take to reach the closest outlet. Access to supermarket and fast food outlets were determined relative to population density.
Our results indicate that in the City of Casey most (> 80%) people live within an 8-10 minute car journey of a major supermarket and a fast food outlet. Fifty percent of the fast food outlets are co-located with a supermarket. We conclude that access to both healthy food and fast food in the City of Casey is good if you own a car. The increasing demand for fast food is easily met in this municipality. Obesity prevention strategies in Casey should concentrate on the food choices available at fast food outlets and town planning to ensure a mix of food outlets to maximize the likelihood of healthy food choices.

Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia

Objective: This study examined trends in the price of healthy and less-healthy foods from 1989 to 2007 using the Australian Consumer Price Index (CPI).

Methods: CPI food expenditure classes were classified as 'core' or 'non-core'. Trends in the CPI were analysed to examine the rise in prices of core compared with non-core foods.

Results: On average, the CPI for core foods has risen at a slightly higher, though not statistically significant, rate than non-core foods. Furthermore, selected groupings reveal interesting patterns. 'Bread' has risen in price significantly more than 'cakes and biscuits', and 'milk' has risen in price significantly more than 'soft drinks, waters and juices'.

Conclusions and implications: This investigation of food price trends reveals notable differences between core and non-core foods. This should be investigated further to determine the extent to which this contributes to the higher prevalence of diet-related diseases in low socio-economic groups.

The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Minimising colonic fermentation of high fructan foods : using food processing techniques to reduce levels of fructans in onion and garlic

Background: Irritable Bowel Syndrome (IBS) is a chronic functional disorder of the bowel, affecting up to 15% of Australian adults. Dietary triggers need to be identified and controlled. Researchers have shown that short chain carbohydrates, fructans (high in onion and garlic) play a major role in triggering IBS symptoms. Current dietary management aims to limit the intake of fructans in the diet. Another approach may be to use simple food processing to reduce fructans in foods.

Objective: To investigate if pickling will reduce fructan levels in garlic and shallots, and if pickled garlic and shallots reduce colonic fermentation, and  abdominal symptoms in human volunteers.

Design: Fructan levels of the garlic and shallots were measured using the Megazyme fructan assay. 18 volunteers (13 healthy and 5 IBS) participated in a single blinded, randomised cross over study. Subjects were randomly assigned to receive a breakfast (potato and salmon patty) that was either high (unprocessed) or low (processed/pickled) in garlic and shallots. Breath hydrogen was measured every hour over a ten hour period, and abdominal symptoms were assessed using validated questionnaires.

Outcomes: Pickling over a 12 day period significantly reduced fructan levels in both garlic (p=.0.00) and shallots (p=0.00). Consumption of the low fructan breakfast resulted in significantly lower breath hydrogen (p=0.05), abdominal pain (p=0.032), and wind (p=0.04).

Conclusion: Pickling results in significantly lowered fructan levels in problem foods- shallots and garlic, and lowered colonic fermentation and abdominal symptoms in both healthy and IBS volunteers. This study provides another dietary strategy for dietetic counselling of patients with IBS.