The Nutritional Knowledge, Eating Habits, and Body Image of Adolescent Females

This mixed methods investigation examined the nutritional knowledge and habits of adolescent girls in grades 9 through 12 at a secondary school in southern Ontario. Through questionnaires, interviews, and the use of teaching and curriculum documents, this study attempted to understand whether the current nutrition curriculum is influential in developing students' nutritional knowledge, healthy eating habits, and a favourable body image. Data collection occurred over a 2-month period, involving 90 female participants, and the data analysis program SPSS was used for analysis of the quantitative questionnaire data. Interview data were organized into categories, and analysis of any emerging themes occurred. Teaching and curriculum documents were examined to determine any overlap and develop an understanding of the participants' exposure and experience within nutrition within the classroom setting. The findings of this study suggest that the current nutrition education did have an impact on the participants' nutrition knowledge. However, the impact on their eating habits and body image was limited in the context it was measured and tested. The knowledge learned within the classroom may not always be applied outside of the classroom. This study suggests that improvement in the current nutrition curriculum may be needed to have a bigger impact on adolescent females. The findings from the study shine light on areas of improvements for educators as well as development of future curriculum. Changes may need to be made not only in the specific curriculum content and expectations but also the delivery of it by the classroom teacher.

Under-reporting of energy intake is more prevalent in a healthy dietary pattern cluster

The aim of the present study was to determine whether under-reporting rates vary between dietary pattern Clusters. Subjects were sixty-five Brazilian women. During 3 weeks, anthropometric data were collected. total energy expenditure (TEE) was determined by the doubly labelled water method and diet Was Measured. Energy intake (El) and the daily frequency of consumption per 1000 kJ of twenty-two food groups were obtained from a FFQ. These frequencies were entered into a Cluster analysis procedure in order to obtain dietary patterns. Under-reporters were defined Lis those who did not lose more than 1 kg of body weight during the study and presented EI:TEE less than 0.82. Three dietary pattern clusters were identified and named according to their most recurrent food groups: sweet foods (SW). starchy foods (ST) and health), (H). Subjects from the healthy cluster had the lowest mean EI:TEE (SW = 0.86, ST = 0.71 and H = 0.58: P = 0.003) and EI - TEE (SW = -0.49 MJ, ST = - 3.20 MJ and H = -5.09 MJ; P = 0.008). The proportion of Under-reporters was 45.2 (95 % CI 35.5, 55.0) % in the SW Cluster: 58.3 (95 % CI 48.6, 68.0) % in the ST Cluster and 70.0 (95 % CI 61.0, 79) % in the H cluster (P=0.34). Thus, in Brazilian women, Under-reporting of El is not uniformly distributed among, dietary pattern clusters and tends to be more severe among subjects from the healthy cluster. This cluster is more consistent with both dietary guidelines and with what lay individuals usually consider `healthy eating`.

Policy interventions implemented through sporting organisations for promoting healthy behaviour change (review)

Background
Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination.

Objectives
To review all controlled evaluation studies of policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access).

Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. We identified further studies in the bibliographies of articles and by contacting authors of key articles in the area.

Selection criteria
We aimed to identify research that had used study designs that incorporated an evaluated intervention and comparison. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review.
Types of studies: Studies in which sporting organisations were allocated to a policy intervention or control/comparison group. No minimum follow-up required.
Types of participants: People of all ages.
Types of interventions: Any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g.. anti-vilification, anti-discrimination).
Types of outcome measures: Behaviour change, intention to change behaviour, change in attitudes, knowledge or awareness of healthy behaviour, and policy presence.

Data collection and analysis
We assessed whether identified citations were controlled evaluation studies and investigated the use of policy implemented in sporting settings. Abstracts were independently inspected by two reviewers and full papers were obtained where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented.

Main results
No rigorous studies were located to test the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or inclusion of health oriented policies within the organisarions.

Authors' conclusions
We were unable to find any controlled studies to guide the use of policy interventions used in sporting settings. The search process revealed a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely ro be effective in reducing harmful behaviours.

Social, cultural and environmental influences on child activity and eating in Australian migrant communities

Aim: This study set out to examine the socio-cultural, familial and environmental factors influencing health, eating habits and patterns of physical activity contributing to child and adolescent overweight and obesity. Methods: Semi-structured, community-based interviews were conducted with contrasting key informant three-generation families; and generation by generation focus groups of grandparents, parents and children from four cultural communities in the state of Victoria, Australia. Purposive sampling occurred from Turkish, Greek, Indian and Chinese communities that have migrated to Australia within the last three generations (n = 160, eight families, 47 children aged 5–15 years, 29 parents, 42 grandparents). Results: Evidence of two-way influences on eating and physical activity across three generations was evident, with children reporting the greatest cross-cultural diversity. A range of dietary restrictions was reported across all cultural groups. Efforts to foster healthy eating and lifestyle patterns within communities were evident. Parents, as a generation in particular, felt the need for more access to education and support regarding healthy limits for pre-puberty and puberty stages. Conclusion: There is a dynamic influence of culture on many aspects of family lifestyle across three generations. To achieve successful intervention design, childhood obesity researchers need to collaborate with diverse groups and communities. Considering the role and influence of extended family, a multigenerational, whole-of-community approach beyond that of parent and child populations ought to be considered.

Supermarkets as a setting to promote health eating : some lessons learnt in Victoria

Issue addressed: Supermarkets are a potential setting in which to deliver nutrition promotion to the community. A pilot project was able to examine the requirements for health authorities to form partnerships with other sectors and opportunities and limitations of using industry- based communication strategies to promote healthy eating messages. Methods: Pre-intervention interviews helped determine communication strategies. Post-intervention interviews were used to assess content and appropriateness of nutrition resources, collaboration between key participants, satisfaction with training and barriers/promoters to implementation. An intercept survey with consumers measured the impact of the intervention. Results: The survey of more than 1,120 women indicated only limited success. 12% of respondents from the intervention supermarkets had watched demonstrations and 20% had noticed the recipe leaflets, with only 5% able to name the promotion. Supermarket owners, representatives from participating food companies and demonstrators were supportive of the concept and content used in the promotion and qualitative analysis provides indicators for similar promotions. Conclusions: Health authorities considering 'partnerships' with the food/supermarket industry should recognise the diversity of roles and responsibilities of the organisations involved in the supply of food through the retail market and allow for long term planning when working with them. Head office of the supermarket group has a key coordinating role, however, individual supermarkets will be driven by financial returns. So what?: The recognition and trust in the name of health authorities by consumers means that organisations value an association with them.

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, β-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

Is a healthy diet affordable and accessible in the city of Yarra, Victoria Australia? An analysis of cost disparity and nutritional choices

This study aimed to examine cost disparity and nutritional choices within the
City of Yarra (Yarra), targeting three suburbs that have low- and high-rise
estates: Richmond, Fitzroy, and Collingwood. The healthy food basket
(HFB) was modeled on the Queensland Healthy Food Access Basket for a
six-person family for a fortnight and was constructed to include food items
that are common to ethnic groups living in Yarra. The HFB food item costs
were sampled across 29 food outlets in Yarra. The average cost of HFB per fortnight
for a family of six was significantly lower in Richmond (Mean = $419.26)
than in Collingwood (Mean = $519.28) and in Fitzroy (Mean = $433.98). While
costs for cereal groups, dairy, meats and alternatives, and non-core were
comparable across the suburbs, significant differences were noticed for fruit,
legumes and vegetables. Geographic location alone explained 54% of the
variance in HFB price (F_2,26 = 15.23, p < 0.001) and 32.7% in the variance of
fruit, vegetable and legumes (F_2,26 = 7.72, p < 0.001). The effect of geographic
location remained consistent after controlling for the type of food
outlets. The type of food outlets had a non-significant effect on the variance
of prices. Richmond had a greater number variety of fruit, vegetables, and
legumes (F_{2, 26} = 5.7, p < 0.01) and an overall lower number of missing items
(F_{2, 26} = 3.9, p < 0.05) than Collingwood and Fitzroy. The diversity of food
available in the three suburbs was more likely to reflect the Vietnamese,
Chinese and East-Timorese shopping pattern than the rest of other ethnic

‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts.

Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones.

Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be 'dangerous' and detrimental to their diabetes control. Respondents described such foods as 'strength-giving', and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines.

Conclusions. Perceptions that South Asian foodstuffs necessarily comprise 'risky' options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.

Evidence-informed process to identify policies that will promote a healthy food environment in the Pacific Islands

Objective: To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases.

Design: A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed.

Results: Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified.

Conclusions: Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.

Personal, social and environmental correlates of healthy weight status amongst mothers from socioeconomically disadvantaged neighborhoods : findings from the READI study

Background

Socioeconomically disadvantaged mothers are at high risk of obesity, yet the aetiology of obesity in this group remains poorly understood. The aim of this study was to examine the perceived personal, social and physical environmental factors associated with resilience to obesity among mothers from socioeconomically disadvantaged neighbourhoods.
Methods

Survey data were provided by a cohort of 1840 women aged 18-46 years with dependent children (aged 0-18 years) from 40 urban and 40 rural socioeconomically disadvantaged neighbourhoods across Victoria, Australia. Mothers responded to a number of questions relating to personal, social and environmental influences on their physical activity and eating habits. Mothers' weight status was classified as healthy weight (BMI: 18.5-24.99), overweight (BMI: 25-29.99) or obese (BMI: 30+).
Results

Mothers' weight status was bivariably associated with factors from all three domains (personal, social and physical environmental). In a multivariable model, mothers' perceived ability to make time for healthy eating (OR = 1.34) and physical activity (OR = 1.11) despite family commitments, and the frequency with which families ate healthy low-fat foods with mothers (OR = 1.28) remained significantly positively associated with healthy weight status. The frequency with which families encouraged eating healthy low-fat foods remained negatively associated (OR = 0.81) with weight status; ie greater encouragement was associated with less healthy weight status.
Conclusions

Drawing on the characteristics of mothers resilient to obesity might assist in developing intervention strategies to help other mothers in socioeconomically disadvantaged neighbourhoods to manage their weight. Such strategies might focus on planning for and prioritising time for healthy eating and physical activity behaviours, and including family members in and encouraging family mealtimes.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents’ eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12–15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents’ diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

Scaling up community-based obesity prevention in Australia : background and evaluation design of the health promoting communities : being active eating well initiative

Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion : This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.

Mediators of longitudinal associations between television viewing and eating behaviours in adolescents

Background: Television viewing has been associated with poor eating behaviours in adolescents. Changing unhealthy eating behaviours is most likely to be achieved by identifying and targeting factors shown to mediate the association between these behaviours. However, little is known about the mediators of the associations between television viewing and eating behaviours. The aim of this study was to examine mediators of the longitudinal associations between television viewing (TV) and eating behaviours among Australian adolescents.
Method: Eating behaviours were assessed using a web-based survey completed by a community-based sample of 1729 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline (2004-2005) and two years later. TV viewing and the potential mediators (snacking while watching TV and perceived value of TV viewing) were assessed via the web-based survey at baseline.
Results: Adolescents who watched more than two hours of TV/day had higher intakes of energy-dense snacks and beverages, and lower intakes of fruit two years later. Furthermore, the associations between TV viewing and consumption of energy-dense snacks, energy-dense drinks and fruit were mediated by snacking while watching TV. Perceived value of TV viewing mediated the association between TV viewing and consumption of energy-dense snacks, beverages and fruit.
Conclusion: Snacking while watching TV and perceived value of TV viewing mediated the longitudinal association between TV viewing and eating behaviours among adolescents. The efficacy of methods to reduce TV viewing, change snacking habits while watching TV, and address the values that adolescents place on TV viewing should be examined in an effort to promote healthy eating among adolescents.

Understanding determinants of nutrition, physical activity and quality of life among older adults : the Wellbeing, Eating and Exercise for a Long Life (WELL) study

Background : Nutrition and physical activity are major determinants of health and quality of life; however, there exists little research focusing on determinants of these behaviours in older adults. This is important, since just as these behaviours vary according to subpopulation, it is likely that the determinants also vary. An understanding of the modifiable determinants of nutrition and physical activity behaviours among older adults to take into account the specific life-stage context is required in order to develop effective interventions to promote health and well-being and prevent chronic disease and improve quality of life.

Methods : The aim of this work is to identify how intrapersonal, social and environmental factors influence nutrition and physical activity behaviours among older adults living in urban and rural areas. This study is a cohort study of adults aged 55-65 years across urban and rural Victoria, Australia. Participants completed questionnaires at baseline in 2010 and will complete follow-up questionnaires in 2012 and 2014. Self-report questionnaires will be used to assess outcomes such as food intake, physical activity and sedentary behaviours, anthropometry and quality of life. Explanatory variables include socioeconomic position, and measures of the three levels of influence on older adults' nutrition and physical activity behaviours (intrapersonal, social and perceived environmental influences).

Discussion : Obesity and its determinant behaviours, physical inactivity and poor diet are major public health concerns and are significant determinants of the quality of life among the ageing population. There is a critical need for a better understanding of the determinants of nutrition and physical activity in this important target group. This research will provide evidence for the development of effective policies and programs to promote and support increased physical activity and healthy eating behaviours among older adults.

Daily eating frequency and cardiometabolic risk factors in young Australian adults : cross-sectional analyses

Eating frequency may be important in the development of overweight and obesity and other cardiometabolic risk factors; however, the evidence is inconsistent. The aim of the present study was to examine the associations between the number of eating occasions and cardiometabolic risk factors in a national population-based sample of young adults. A cohort of 1273 men and 1502 women, aged 26–36 years, completed a meal pattern chart to record when they had eaten during the previous day (in hourly intervals). The total number of eating occasions was calculated. Diet quality was assessed, waist circumference was measured and a fasting blood sample was taken. Dietary intake was compared with the Australian Guide to Healthy Eating. The associations between the number of eating occasions and cardiometabolic risk factors were calculated using linear regression. Analyses were adjusted for age, education and physical activity. Most men ate three to five times per d and most women ate four to six times. The proportion of participants meeting dietary recommendations increased with the number of eating occasions. For men, an additional eating occasion was associated with reductions in mean values for waist circumference ( − 0·75 cm), fasting glucose ( − 0·02 mmol/l), fasting insulin ( − 0·34 mU/l; 2·04 pmol/l), TAG ( − 0·03 mmol/l), total cholesterol ( − 0·08 mmol/l) and LDL-cholesterol ( − 0·06 mmol/l). Adjustment for waist circumference attenuated the results. Significant trends were not observed for women. In conclusion, a higher number of eating occasions were associated with reduced cardiometabolic risk factors in men. Many associations were mediated by waist circumference.