Fruit and vegetable consumption and the risk of proximal colon, distal colon and rectal cancers in a case-control study in Western Australia

Background Fruits and vegetables (F/V) have been examined extensively in nutrition research in relation to colorectal cancer (CRC). However, their protective effect is subject to debate, possibly because of different effects on different subsites of the large bowel.

Objective To determine whether any association between F/V consumption and risk of CRC differed by subsite of the bowel (proximal colon, distal colon, and rectum).

Design The Western Australian Bowel Health Study is a population-based, case-control study conducted between June 2005 and August 2007. Complete food frequency questionnaire data were analysed from 834 CRC cases and 939 controls. Logistic regression analysis was used to estimate the effects of quartiles of F/V intake on risk of CRC at different subsites. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for CRC overall and for the three separate subsites.

Results Risk of proximal colon cancer and rectal cancer was not associated with intakes of total F/V, total vegetable, or total fruit. Brassica vegetable intake was inversely related with proximal colon cancer (Q4 vs Q1 OR 0.62; 95% CI 0.41 to 0.93). For distal colon cancer, significant negative trends were seen for total F/V, and total vegetable intake. Distal colon cancer risk was significantly decreased for intake of dark yellow vegetables (Q4 vs Q1 OR 0.61; 95% CI 0.41 to 0.92) and apples (Q4 vs Q1 OR 0.51; 95% CI 0.34 to 0.77). An increased risk for CRC was found to be associated with intake of fruit juice (Q4 vs Q1 OR 1.74; 95% CI 1.24 to 2.45).

Conclusions Our results suggest that different F/V may confer different risks for cancer of the proximal colon, distal colon, or rectum. Future studies might consider taking into account the location of the tumor when examining the relation between F/V consumption and risk of CRC.

Prescribed fluid consumption and its effects on the physiology and work behaviour of Australian wildland firefighters

The present study examined firefighters' ability to consume a prescribed fluid volume (1200 ml · h-1) during a wildland fire suppression shift and compare the effect of this additional fluid prescription with self-paced drinking on firefighters' hydration status and plasma sodium concentration post shift and their heart rate, core temperature and physical activity during their shift. Thirty-four firefighters were evenly divided into two drinking groups: self paced and prescribed. Prescribed drinkers did not meet the required 1200 ml·h-1 intake, yet they consumed twice the fluid drank by the self-paced group. No differences were noted between groups in plasma sodium levels or hydration status before or after their shift. Prescribed fluid consumption resulted in significantly lower core temperature between two and six hours into the shift. This did not coincide with lower cardiovascular strain, greater physical activity when compared to the self-paced drinking group. Additional fluid consumption (above self-paced intake) did not improve firefighter activity or physiological function (though it may buffer rising core temperature). It seems that wildland firefighters, at least in mild to warm weather conditions, can self-regulate their fluid consumption and work behaviour to leave the fireground hydrated at the conclusion of their shift.

A pilot study of a telephone-based parental intervention to increase fruit and vegetable consumption in 3-5 year old children

Objective : To examine the potential efficacy of a brief telephone-based parental intervention in increasing fruit and vegetable consumption in children aged 3–5 years and to examine the feasibility of intervention delivery and acceptability to parents.

Design : A pre–post study design with no comparison group. Telephone surveys were conducted approximately 1 week before and following intervention delivery.
Setting Participants were recruited through pre-schools in the Hunter region, New South Wales, Australia.

Subjects : Thirty-four parents of 3–5-year-olds received four 30-min interventional telephone calls over 4 weeks administered by trained telephone interviewers. The scripted support calls focused on fruit and vegetable availability and accessibility within the home, parental role modelling of fruit and vegetable consumption and on implementing supportive family eating routines.

Results : Following the intervention, the frequency and variety of fruit and vegetable consumption increased (P = 0·027), as measured by a subscale of the children's dietary questionnaire. The intervention was feasible to be delivered to parents, as all participants who started the intervention completed all four calls, and all aspects of the interventional calls, including the number, length, content, format and relevance, were considered acceptable by more than 90 % of parents.

Conclusions : A brief telephone-based parental intervention to encourage fruit and vegetable consumption in pre-school-aged children may be effective, feasible and acceptable. Further investigation is warranted in a randomised controlled trial.

Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status : the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07)

The objective was to study the multidimensional nature of the relationship between adult obesity (OB) and socio-economic status (SES),
using comprehensive indices of SES taken separately or synthesised in an overall index. A nationally representative sample of adults aged
18–79 years was taken from the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07).
Weight and height were measured and OB defined as BMI $ 30 kg/m². SES variables were reported in questionnaires and included
occupation, education and characteristics of household wealth. Composite indices of SES (household wealth and overall SES indices)
were computed by correspondence analysis, and relationships with OB were investigated with logistic regression analysis. In total, 11·8
(95% CI 10·1, 13·4) % of French adults were obese, without significant difference by sex. While no significant relationship was observed
in men, all SES indicators were inversely correlated to OB in women. Both education and the household wealth index were retained in the
stepwise multivariate model, confirming that different socio-economic variables are not necessarily proxies of each other regarding the OB
issue. On the other hand, ‘controlling for SES’ while including several measures of SES in multivariate models may lead to collinearity, and
thus over-adjustment. A more integrative approach may be to derive a synthetic index by including the SES factors available in a given
study. Beyond this methodological perspective, understanding how OB is related to the different dimensions of SES should help to
target the more vulnerable groups and increase the effectiveness of prevention.

Supermarket Healthy Eating for Life (SHELf): protocol of a randomised controlled trial promoting healthy food and beverage consumption through price reduction and skill-building strategies

Background: In the context of rising food prices, there is a need for evidence on the most effective approaches for promoting healthy eating. Individually-targeted behavioural interventions for increasing food-related skills show promise, but are unlikely to be effective in the absence of structural supports. Fiscal policies have been advocated as a means of promoting healthy eating and reducing obesity and nutrition-related disease, but there is little empirical evidence of their effectiveness. This paper describes the Supermarket Healthy Eating for LiFe (SHELf) study, a randomised controlled trial to investigate effectiveness and cost-effectiveness of a tailored skill-building intervention and a price reduction intervention, separately and in combination, against a control condition for promoting purchase and consumption of healthy foods and beverages in women from high and low socioeconomic groups.
Methods/design: SHELf comprises a randomised controlled trial design, with participants randomised to receive either (1) a skill-building intervention; (2) price reductions on fruits, vegetables and low-joule soft drink beverages and water; (3) a combination of skill-building and price reductions; or (4) a control condition. Five hundred women from high and low socioeconomic areas will be recruited through a store loyalty card program and local media. Randomisation will occur on receipt of informed consent and baseline questionnaire. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups.
Discussion: This study will build on a pivotal partnership with a major national supermarket chain and the Heart Foundation to investigate the effectiveness of intervention strategies aimed at increasing women’s purchasing and consumption of fruits and vegetables and decreased purchasing and consumption of sugar-sweetened beverages. It will be among the first internationally to examine the effects of two promising approaches - skill-building and price reductions - on diet amongst women.

Access to alcohol outlets and harmful alcohol consumption : a multi-level study in Melbourne, Australia

Aims To assess the association between access to off-premises alcohol outlets and harmful alcohol consumption.
Design, setting and participants Multi-level study of 2334 adults aged 18–75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne.
Measurements Alcohol outlet density was defined as the number of outlets within a 1-km road network of respondents’ homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi-level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short-term harm at least weekly and monthly; drinking at levels associated with long-term harm and frequency of consumption.
Findings Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short-term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short-term harm was when there were eight or more outlets (short-term harm weekly: OR 2.36, 95% CI 1.22–4.54 and short-term harm monthly: OR 1.80, 95% CI 1.07–3.04). We found no evidence to support an association between proximity and harmful alcohol consumption.
Conclusions The number of off-premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off-premises alcohol outlets could reduce levels of harmful alcohol consumption.

Association of risky alcohol consumption and accreditation in the 'Good Sports' alcohol management programme

Background Involvement in community sports clubs is often associated with high levels of risky alcohol consumption; however, developing prevention-focused interventions in these settings can be complex. We examined the association of reduced risky alcohol consumption with the implementation of the Good Sports Programme (GSP)—a programme that accredits clubs in three stages, on the basis of their implementation of alcohol-related harm reduction strategies.

Methods Using a cross section of football and cricket clubs, consumption was compared between clubs accredited at level 1, 2 or 3 of the GSP and clubs not accredited (92 clubs; 1924 individuals). Drinking above Australian guidelines for short-term risk (more than four standard drinks) on the last playing day prior to the survey and drinking at the club over the last 12 months at average levels exceeding short- and long-term risk (more than two standard drinks) guidelines were also examined.

Results Multilevel modelling indicated that higher accreditation stage (0, 1, 2, 3) was associated with a 0.79 reduction in the odds of risky consumption on the playing day; a 0.85 reduction in the odds for short-term risky drinking, and a 0.86 reduction in long-term risky drinking.

Conclusions The findings suggest that higher accreditation in the GSP is associated with reduced rates of risky alcohol use at a population level.

Ethical consumption : a critical introduction

A not-so-quiet revolution seems to be occurring in wealthy capitalist societies - supermarkets selling ‘guilt free’ Fairtrade products; lifestyle TV gurus exhorting us to eat less, buy local and go green; neighbourhood action groups bent on ‘swopping not shopping’. And this is happening not at the margins of society but at its heart, in the shopping centres and homes of ordinary people. Today we are seeing a mainstreaming of ethical concerns around consumption that reflects an increasing anxiety with - and accompanying sense of responsibility for - the risks and excesses of contemporary lifestyles in the ‘global north’.

This collection of essays provides a range of critical tools for understanding the turn towards responsible or conscience consumption and, in the process, interrogates the notion that we can shop our way to a more ethical, sustainable future. Written by leading international scholars from a variety of disciplinary backgrounds - and drawing upon examples from across the globe - Ethical Consumption makes a major contribution to the still fledgling field of ethical consumption studies. This collection is a must-read for anyone interested in the relationship between consumer culture and contemporary social life.