Food cost and availability in a rural setting in Australia

Introduction: The burden of chronic diseases is rapidly increasing worldwide. In  Australia rural populations have a greater burden of disease. Chronic diseases are largely preventable with diet as a key risk factor. With respect to diet-related chronic disease, dietary risk may be due to poor food access, namely, poor availability and/or the high cost of healthy food. It is likely that poor food access is an issue in rural areas. Objective: To assess food access in rural south-west (SW) Victoria, Australia.

Methods: A total of 53 supermarkets and grocery stores in 42 towns participated in a survey of food cost and availability in the rural area of SW Victoria. The survey assessed availability and cost of a Healthy Food Access Basket (HFAB) which was designed to meet the nutritional needs of a family of 6 for 2 weeks.

Results: Seventy-two percent of the eligible shops in SW Victoria were surveyed. The study found that the complete HFAB was significantly more likely to be available in a town with a chain-owned store (p<0.00). The complete HFAB was less likely to be available from an independently owned store in a town with only one grocery shop (p<0.004). The average cost of the HFAB across SW Victoria was AU$380.30 ± $25.10 (mean ± SD). There was a mean range in difference of cost of the HFAB of $36.92. In particular, high variability was found in the cost of fruits and vegetables.

Conclusions: Cost and availability of healthy food may be compromised in rural areas. Implications: Improvements in food access in rural areas could reduce the high burden of disease suffered by rural communities.

The availability of snack food displays that may trigger impulse purchases in Melbourne supermarkets

Background

Supermarkets play a major role in influencing the food purchasing behaviours of most households. Snack food exposures within these stores may contribute to higher levels of consumption and ultimately to increasing levels of obesity, particularly within socioeconomically disadvantaged neighbourhoods. We aimed to examine the availability of snack food displays at checkouts, end-of-aisle displays and island displays in major supermarket chains in the least and most socioeconomically disadvantaged neighbourhoods of Melbourne.
Methods

Within-store audits of 35 Melbourne supermarkets. Supermarkets were sampled from the least and most socioeconomically disadvantaged suburbs within 30 km of the Melbourne CBD. We measured the availability of crisps, chocolate, confectionery, and soft drinks (diet and regular) at the checkouts, in end-of-aisle displays, and in island bin displays.
Results

Snack food displays were most prominent at checkouts with only five stores not having snack foods at 100% of their checkouts. Snack foods were also present at a number of end-of-aisle displays (at both the front (median 38%) and back (median 33%) of store), and in island bin displays (median number of island displays: 7; median total circumference of island displays: 19.4 metres). Chocolate items were the most common snack food item on display. There was no difference in the availability of these snack food displays by neighbourhood disadvantage.
Conclusions

As a result of the high availability of snack food displays, exposure to snack foods is almost unavoidable in Melbourne supermarkets, regardless of levels of neighbourhood socioeconomic disadvantage. Results of this study could promote awareness of the prominence of unhealthy food items in chain-brand supermarkets outlets.

Perceived quality and availability of fruit and vegetables are associated with perceptions of fruit and vegetable affordability among socio-economically disadvantaged women

Objective Perceptions that fruit and vegetables are expensive have been found to be associated with lower consumption of fruit and vegetables among disadvantaged women; however, the determinants of these perceptions are relatively unknown. The purpose of the current paper is to examine whether perceived availability and quality of fruit and vegetables, and social support for healthy eating, are associated with perceptions of fruit and vegetable affordability among women residing in disadvantaged neighbourhoods.

Design Cross-sectional self-report survey.

Setting The study was conducted in Melbourne, Australia.

Subjects An Australian sample of 4131 women, aged 18–45 years, residing in neighbourhoods ranked in the lowest Victorian tertile of relative disadvantage by the Australian Bureau of Statistics, an index that considers aspects of disadvantage such as residents’ income, education, motor vehicle access and employment.

Results Results showed that irrespective of education, income and other key covariates, women who perceived poor availability and quality of fruit and vegetables in their local neighbourhood were more likely to perceive fruit and vegetables as expensive.

Conclusions Our results suggest that perceptions of fruit and vegetable affordability are not driven exclusively by lack of financial or knowledge-related resources, but also by women's psychological response and interpretation of their local nutrition environment.

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial

OBJECTIVE: Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. DESIGN AND METHODS: Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. RESULTS: At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. CONCLUSIONS: A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901.

Access and attitude of rural allied health professionals to CPD and training

Continuing professional development (CPD) activities for allied health professionals are becoming mandatory as a means for professionals to maintain accreditation or skills. To access CPD activities, rural allied health professionals have the added costs of travel, accommodation and information technology access. It is assumed that health professionals in rural areas want access to training and CPD. In 2003, a survey of allied health professionals was carried out in Southwest Victoria, Australia, with the aim of identifying access and attitudes to CPD. Results showed that allied health professionals in Southwest Victoria were highly qualified, wished to access CPD more than four times a year and were prepared to spend a mean rate of $1000 (1300) per annum on CPD activities.

The influence of sodium on liking and consumption of salty food

Excessive sodium (Na) intake has been linked to development of hypertension and related pathologies. In this study, we assessed if the sodium chloride (NaCl) concentration in a prototypical food influences the liking and intake of that food. In study 1, detection and recognition thresholds for NaCl were assessed, and perceived salt intensity and liking for hash browns of varying sodium concentrations (40 mg, 120 mg, 170 mg, and 220 mg Na/100 g) were compared in a lab setting. In study 2, detection and recognition thresholds for NaCl were assessed in a lab setting, and lunches consisting of hash browns, basic salad, and beverages were consumed freely in a dining setting on 4 separate occasions. Intake and liking ratings for hash browns were recorded after the lunch. In both studies, detection and recognition thresholds for NaCl were not associated with perceived saltiness, liking, or intake of hash browns. Liking and perceived salt taste intensity of hash browns were correlated (r = 0.547 P < 0.01), and in study 1 the 220 mg sodium hash brown was most liked (P < 0.05). In study 2, there was no association between Na concentration and liking or consumption of hash browns. In summary, liking of hash browns were influenced by whether testing was in a lab or dining room environment. In a dining room environment, large decreases (>50%) of sodium content of food were achievable with only minor decrease in liking and no effect on consumption of the food.

Influence of stocking rate and mixed grazing of Angora goats and Merino sheep on animal and pasture production in southern Australia : 1 : botanical composition, sward characteristics and availability of components of annual temperate pastures

The effects of animal species (AS; Angora goats, Merino sheep or goats and sheep mixed grazed together at ratio 1:1) and stocking rate (SR; 7.5, 10 and 12.5 animals/ha) on the availability, botanical composition and sward characteristics of annual temperate pastures under continuous grazing were determined in a replicated experiment from 1981 to 1984. AS and SR had significant effects on pasture availability and composition and many AS SR interactions were detected. The pastures grazed by sheep had significantly reduced content and proportion of subterranean clover and more undesirable grasses compared with those grazed by goats. There were no differences in dry matter availabilities between goat- and sheep-grazed pastures at 7.5/ha, but at 10 and 12.5/ha goat pastures had significantly increased availabilities of green grass, dead and green clover and less weeds compared with sheep pastures. There was a significant AS SR interaction for the density of seedlings in May following pasture germination. Between July and January, the height of pastures was greater under goats than sheep but from January to March pasture height declined more on goat-grazed than on sheep-grazed pastures. There was an AS SR interaction for incidence of bare ground. Increasing the SR increased bare ground in pastures grazed by sheep but no change occurred on pastures grazed by goats. Changes in pasture characteristics due to increased SR were minimised on pastures grazed by goats but the grazing of sheep caused larger and faster changes and the pastures were damaged at the highest SR. Goats did not always select the same herbage material as sheep, changed their selection between seasons and were not less selective than sheep. Angora goats were flexible grazers and continually adapted their grazing behaviour to changing herbage conditions. Goat grazing led to an increase in subterranean clover, an accumulation of dead herbage at the base of the sward, reduced bare ground, taller pastures in spring and a more stable botanical composition. Mixed-grazed pasture characteristics were altered with SR. With careful management Angora goats on sheep farms may be used to manipulate pasture composition, to speed up establishment of subterranean clover, to decrease soil erosion and to reduce weed invasion.

Singaporean Parents’ Views of Their Young Children’s Access and Use of Technological Devices

Debates continue about the access young children have to technological devices, given the increasingly accessible and available technology in most developed countries. Concerns have been expressed by parents/caregivers and researchers, and questions have been raised about possible risks and benefits of these devices on young children who, in some instances, may be accessing these devices daily. Levin (2013) states that it is as if children are being remote controlled by the scripts of others (television, videos, electronic toys) which undermine children’s abilities to create their own learning scripts. This study investigated 1,058 parents’/caregivers’ views of their children’s (aged below 7 years) access and time spent on technology devices. Parents’/caregivers’ views on risks and benefits associated with the use of the emerging touch screen devices were also sought. The context for this research was Singapore which, according to a survey in 2012 by Ericsson, has one of the highest usage rates of smartphones and touchscreen devices in the world. The findings may help researchers, parents/caregivers and teachers to further their understanding of young children’s development in the twenty-first century.

Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

BACKGROUND: Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. OBJECTIVE: We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. DESIGN: The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. RESULTS: At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. CONCLUSIONS: A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.

Australian parents` views on their 5-6-year-old children's food choices

The home food environment is central to the development of healthy eating behaviours, but associations between the home food environment and children's food choices are not yet fully understood. The aims of this study were to explore parents' views regarding factors that influence children's food choices and parents' decision-making regarding the food they provide to their children. In-depth one-on-one interviews were conducted using a semi-structured interview schedule. Key concepts and themes were coded independently by two investigators. Participants include seventeen parents (16 mothers and 1 father) of children in their first year of formal schooling (aged 5–6 years). Five main themes emerged from the interviews: food marketing, food availability/food exposure, feeding strategies, modelling of eating and opportunities for food involvement. Parents believed that food marketing influenced their child's food preferences but differed in the ways they managed these influences. The food made available to children was also seen to influence what a child ate. Yet, although some parents believed it was the parents' role to determine what foods were made available to their child, others offered food on the basis of the child's tastes or preferences. The use of food as a reward was a feeding strategy employed by many parents. Family mealtimes were seen as an important opportunity for modelling of eating behaviour by parents. Peers were also seen to influence children's food preferences and eating behaviour. Finally, many parents believed that involving children in the preparation of food had a positive impact on children's food choices. Associations between the home food environment and children's food choices are complex and involve multiple mediators. Parents' views on the promoters and reinforcers of their decision-making regarding food and their child's food choices provide useful insights into these mediating factors. Increased understanding of these relationships is likely to enhance obesity prevention efforts.

Self-reported access to and quality of healthcare for diabetes : Do the severely obese experience equal access?

Background: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). Methods: 1795 respondents to the Diabetes MILES - Australia national survey had T2DM. Of these, 530 (30%) were severely obese (BMI ≥35 kg/m2) and these participants were matched with 530 controls (BMI <35 kg/m2). Data regarding participants' self-reported interactions with health practitioners and services were compared. Results: Over 70% of participants reported that their general practitioner was the professional they relied on most for diabetes care. There were no betweengroup differences in patient-reported availability of health services, quality of interaction with health practitioners, resources and support for selfmanagement, or access to almost all diabetes services. Discussion: Participants who were severely obese did not generally report greater difficulty in accessing diabetes care.

A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information.

Unhealthy diets represent one of the major risk factors for non-communicable diseases. There is currently a risk that the political influence of the food industry results in public health policies that do not adequately balance public and commercial interests. This paper aims to develop a framework for categorizing the corporate political activity of the food industry with respect to public health and proposes an approach to systematically identify and monitor it. The proposed framework includes six strategies used by the food industry to influence public health policies and outcomes: information and messaging; financial incentive; constituency building; legal; policy substitution; opposition fragmentation and destabilization. The corporate political activity of the food industry could be identified and monitored through publicly available data sourced from the industry itself, governments, the media and other sources. Steps for country-level monitoring include identification of key food industry actors and related sources of information, followed by systematic data collection and analysis of relevant documents, using the proposed framework as a basis for classification of results. The proposed monitoring approach should be pilot tested in different countries as part of efforts to increase the transparency and accountability of the food industry. This approach has the potential to help redress any imbalance of interests and thereby contribute to the prevention and control of non-communicable diseases.