Knowledge about folate and the contribution of nutrient supplements to the intake of folic acid and vitamin B12 in Australian adults in 1995 and 1996

The present paper reports knowledge about folate and the contribution of supplements to the intake of folic acid and vitamin B12 in Australian adults during 1995 and 1996. Data were obtained from two population survey monitor surveys conducted in a sample of 5422 adults in 1995-96. The surveys were designed to complement food intake data from the 1995 National Nutrition Survey and to provide an estimate of total folate intake prior to the implementation of voluntary fortification of foods with folic acid. The proportion with knowledge about folate increased with education level and socioeconomic status and was greater in women than men. It was also greater in those who were married, and in those residing in Western Australia and the Australian Capital Territory than in other states and territories. Five per cent of men and 10% of women had taken a supplement containing folio acid on the previous day. The equivalent figures for vitamin B12 were 7.5% for men and 12.5% for women. On average, intake of folic acid from supplements was 11 micro g per day for men and 28 micro g per day for women and intake of vitamin B12 was 2.6 micro g per day for men and 4.5 micro g per day for women. For individuals who consumed a supplement containing folic acid on the day before the survey the median folic acid contribution was 200 micro g. In 1995 and 1996 only one in two adult Australians had heard of folate and only one in ten women of child-bearing age had taken a supplement containing folic acid.

A practical approach to monitoring nutrient supplement intake of Australian adults

The adoption, in mid-1995, of the revised food Standard A9, which permits the more liberal addition of nutrients to a range of food products, highlighted the need to obtain information on nutrient intake from supplements to complement the i 995 National Nutrition Survey data on nutrient intake from food. This paper describes the method used to obtain quantitative information on nutrient supplement intake and reports on the prevalence of supplement use in different subgroups of the Australian population. Information on supplement intake was obtained in two Australian Bureau of Statistics Population Survey Monitor surveys in August 1995 and February 1996 using the Therapeutic Goods Administration (TGA) registration numbers to identify individual products. Approximately 18% of men and 29% of women aged 18 years and over reported consuming a nutrient supplement on the day before the survey and these proportions increased to 25% and 35% respectively for consumption during the two weeks before the survey. The prevalence of supplement intake increased with age, education level, socioeconomic status, employment status and with fruit and vegetable intake. The substantial proportion of Australian adults who consume nutrient supplements, and the rapidly changing composition of the Australian food supply in response to changes in food regulation, indicate that there is a need for regular monitoring of nutrient intake from supplements. The use of TGA registration numbers to identify supplements provides a practical way to address this need.

Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour?

The status and explanatory role of nutrition knowledge is uncertain in public health nutrition. Much of the uncertainty about this area has been generated by conceptual confusion about the nature of knowledge and behaviours, and, nutrition knowledge and food behaviours in particular. So the paper  describes several key concepts in some detail. The main argument is that 'nutrition knowledge' is a necessary but not sufficient factor for changes in consumers' food behaviours. Several classes of food behaviours and their causation are discussed. They are influenced by a number of environmental and intra-individual factors, including motivations. The interplay between motivational factors and information processing is important for nutrition promoters as is the distinction between declarative and procedural  knowledge. Consideration of the domains of nutrition knowledge shows that their utility is likely to be related to consumers' and nutritionists' particular goals and viewpoints. A brief survey of the recent literature shows that the evidence for the influence of nutrition knowledge on food behaviours is mixed. Nevertheless, recent work suggests that nutrition knowledge may play a small but pivotal role in the adoption of healthier food habits. The implications of this overview for public health nutrition are: (i) We need to pay greater attention to the development of children's and adults' knowledge frameworks (schema building); (ii) There is a need for a renewed proactive role for the education sector; (iii) We need to take account of consumers' personal food goals and their acquisition of procedural knowledge which will enable them to attain their goals; (iv) Finally, much more research into the ways people learn and use food-related knowledge is required in the form of experimental interventions and longitudinal studies.

Nutrition communication: do we need a new outlook?

The present paper will discuss the nature of nutrition communication and knowledge in relation to novel foods. The paper starts with an introduction to trends in present-day society, then focuses on the concepts of knowledge and information in relation to human needs and motivation. Next, the relevance of food and nutrition communication to consumer lifestyles is discussed. This is followed by consideration of consumer issues related to novel foods. The key conclusions are that nutrition communication is a minor part of most consumers' lifestyles and that the promotion of novel foods must be based on the dissemination of sound nutrition principles throughout the various values and lifestyles segments of the population.

Income differences in food consumption in the 1995 Australian national nutrition survey

Objective: To assess the relationships between an index of per capita income and the intake of a variety of individual foods as well as groups of food for men and women in different age groups. Design: Cross-sectional national survey of free-living men and women. Subjects: A sample of 5053 males and 5701 females aged 18 y and over who completed the Australian National Nutrition Survey 1995. Methods: Information about the frequency of consumption of 88 food items was obtained. On the basis of scores on the Food Frequency Questionnaire, regular and irregular consumers of single foods were identified. The relationships between regularity of consumption of individual foods and per capita income were analysed via contingency tables. Food variety scores were derived by assigning individual foods to conventional food group taxonomies, and then summing up the dichotomised intake scores for individual foods within each food group. Two-way ANOVA (income age group) were performed on the food variety scores for males and females, respectively. Results: Per capita income was extensively related to the reported consumption of individual foods and to total and food group variety indices. Generally, both men and women in low income households had less varied diets than those in higher-income households. However, several traditional foods were consumed less often by young high-income respondents, especially young women. Conclusions: Major income differentials in food variety occur in Australia but they are moderated by age and gender. Younger high-income women, in particular, appear to have rejected a number of traditional foods, possibly on the basis of health beliefs. The findings also suggest that data aggregation has marked effects on income and food consumption relationships.

The development of the nutrition and activity knowledge scale for use with people with an intellectual disability

Background Obesity is an increasing health problem for many Australians, no less so among people with an intellectual disability. Behaviour change aimed at improving nutritional intake and increasing levels of physical activity is a requirement for the reduction of obesity. An essential part of this process is to first ascertain the level of knowledge and beliefs people with an intellectual disability have about these behaviours.

Methods The aim of this study was to develop and psychometrically evaluate a scale to assess levels of nutritional and physical activity knowledge among people with an intellectual disability.

Results Seventy-three people with an intellectual disability completed the interview-rated scale at time 1 and 66 of them completed it again at a 3-week re-test.

Conclusions The scale demonstrated strong factorial construct validity, high internal consistency and good temporal stability. The applications of this scale in future research and in intervention programmes are discussed.

The relationship between education and food consumption in the 1995 Australian national nutrition survey

Objective: To assess the relationship between education and the intake of a variety of individual foods, as well as groups of foods, for Australian men and women in different age groups.

Design: Cross-sectional national survey of free-living men and women. Subjects: A sample of 2501 men and 2739 women aged 18 years and over who completed the National Nutrition Survey (NNS) 1995.

Methods: Information about the frequency of consumption of 88 food items was obtained using a food-frequency questionnaire in a nation-wide nutrition survey. Irregular and regular consumers of foods were identified according to whether they consumed individual foods less than or more than once per month. The relationship between single foods and an index of education (no post-school qualifications, vocational, university) was analysed via contingency table chi-square statistics for men and women. Food group variety scores were derived by assigning individual foods to conventional food group taxonomies, and then summing the dichotomised intake scores for individual foods within each food group. Two-way analyses of variance (education by age groups) were performed on food variety scores for men and women, separately.

Results: While university-educated men and women consumed many individual foods more regularly than less-educated people, they were less likely to be regular consumers of several meat products. The relationship between education and food consumption was less apparent when individual food scores were aggregated into food group scores. University-educated men and women exhibited higher scores on total food group variety than the other educational groups.

Conclusions: Higher education is associated with the regular consumption of a wider variety of foods. Aggregation of individual food consumption indices into food variety scores may mask the apparent effects of educational background on food consumption.

Diet, nutrition and the prevention of excess weight gain and obesity

Objective: To review the evidence on the diet and nutrition causes of obesity and to recommend strategies to reduce obesity prevalence.
Design: The evidence for potential aetiological factors and strategies to reduce obesity prevalence was reviewed, and recommendations for public health action, population nutrition goals and further research were made.
Results: Protective factors against obesity were considered to be: regular physical activity (convincing); a high intake of dietary non-starch polysaccharides (NSP)/fibre (convincing); supportive home and school environments for children (probable); and breastfeeding (probable). Risk factors for obesity were considered to be sedentary lifestyles (convincing); a high intake of energy-dense, micronutrient-poor foods (convincing); heavy marketing of energy-dense foods and fast food outlets (probable); sugar-sweetened soft drinks and fruit juices (probable); adverse social and economic conditions—developed countries, especially in women (probable).
A broad range of strategies were recommended to reduce obesity prevalence including: influencing the food supply to make healthy choices easier; reducing the marketing of energy dense foods and beverages to children; influencing urban environments and transport systems to promote physical activity; developing community-wide programmes in multiple settings; increased communications about healthy eating and physical activity; and improved health services to promote breastfeeding and manage currently overweight or obese people.
Conclusions: The increasing prevalence of obesity is a major health threat in both low- and high income countries. Comprehensive programmes will be needed to turn the epidemic around.

The medical provision of hydration and nutrition: Two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical
and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Scliiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.

Consumers' readiness to eat a plant-based diet

Objective: The aim of this study was to examine consumers' readiness to change to a plant-based diet. Design: Mail survey that included questions on readiness to change, eating habits and perceived benefits and barriers to the consumption of a plant-based diet. Setting: Victoria, Australia. Subjects: A total of 415 randomly selected adults. Results: In terms of their readiness to eat a plant-based diet, the majority (58%) of participants were in the precontemplation stage of change, while 14% were in contemplation/preparation, and 28% in action/maintenance. Those in the action/maintenance stage ate more fruit, vegetables, nuts, seeds, whole-meal bread, and cooked cereals than those in earlier stages. There were statistically significant differences in age and vegetarian status between the stages of change, but not for other demographic variables. There were strong differences across the stages of change with regard to perceived benefits and barriers to plant-based diets. For example, those in action/maintenance scored highest for benefit factors associated with well-being, weight, health, convenience and finances, whereas those in the precontemplation stage did not recognise such benefits. Conclusions: These findings can be utilised to help provide appropriate nutrition education and advertising, targeted at specific stages of change. For example, education about how it is possible to obtain iron and protein from a plant-based diet and on the benefits of change, in addition to tips on how to make a gradual, easy transition to a plant-based diet, could help progress precontemplators to later stages.

The effect of exercise and nutrition on the mechanostat

In this review, we discuss the effect of increased and decreased loading and nutrition deficiency on muscle and bone mass and strength (and bone length and architecture) independently and combined. Both exercise and nutrition are integral components of the mechanostat model but both have distinctly different roles. Mechanical strain imparted by muscle action is responsible for the development of the external size and shape of the bone and subsequently the bone strength. In contrast, immobilization during growth results in reduced growth in bone length and a loss of bone strength due to large losses in bone mass (a result of endosteal resorption in cortical bone and trabecular thinning) and changes in geometry (bone shafts do not develop their characteristic shape but rather develop a rounded default shape). The use of surrogate measures for peak muscle forces acting on bone (muscle strength, size, or mass) limits our ability to confirm a cause-and-effect relationship between peak muscle force acting on bone and changes in bone strength. However, the examples presented in this review support the notion that under adequate nutrition, exercise has the potential to increase peak muscle forces acting on bone and thus can lead to a proportional increase in bone strength. In contrast, nutrition alone does not influence muscle or bone in a dose-dependent manner. Muscle and bone are only influenced when there is nutritional deficiency – and in this case the effect is profound. Similar to immobilization, the immediate effect of malnutrition is a reduction in longitudinal growth. More specifically, protein and energy malnutrition results in massive bone loss due to endosteal resorption in cortical bone and trabecular thinning. Unlike loading however, there is indirect evidence that severe malnutrition when associated with menstrual dysfunction can shift the mechanostat set point upward, thus leading to less bone accrual for a given amount of bone strain.

Changes in attitudes to mothers working: evidence from Australian surveys

The aim of this article is to contribute to the development of our  understanding of two aspects of attitude change in Australia. First, both cohort and individual explanations for attitude change are tested empirically. Second, empirical evidence is provided about the nature and scope of change in gender role attitudes amongst males and females, and of different birth cohorts in Australia, as reported in two survey periods: 1994 and 2002. In particular, the question of whether there is empirical evidence of cohort differences in attitudes to gender roles in Australia is investigated. TheThe aim of this article is to contribute to the development of our understanding of two aspects of attitude change in Australia. First, both cohort and individual explanations for attitude change are tested empirically. Second, empirical evidence is provided about the nature and scope of change in gender role attitudes amongst males and females, and of different birth cohorts in Australia, as reported in two survey periods: 1994 and 2002. In particular, the question of whether there is empirical evidence of cohort differences in attitudes to gender roles in Australia is investigated. The findings show that birth cohorts display progressively more modern attitudes, but people tend not to change their attitudes as they get older. In addition, men and women have different attitudes to gender roles, with men displaying more traditional beliefs than women. Having more than one child makes women less inclined to express the belief that women should work.

Managing contactability in telephone surveys

The Australian market research industry relies on telephone interviewing as one of its major data collection methods. Through Its LIST initiative, the industry has committed to best practice In research methods in order to address various concerns, especially the decline in response rates for telephone interviews. Response rates are determined by the co-operation of eligible respondents and their degree of contactabllity. The reported study is concerned with the way the industry attempts to manage contactabiIity. A study of fieldwork managers responSible for over 75% of all phone interviews in Australia revealed a limited use of contact enhancing strategies such as longer fieldwork periods and more callbacks. Commercial imperatives for timely surveys and a lack of end-user concern for response rate issues, along with cost issues, were believed to be responsible.