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Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011–2015 and 2019–2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases. [ABSTRACT FROM AUTHOR]

Transnational corporations (TNCs) shape population health both positively and negatively through their national and international social, political and economic power and influence; and are a vital commercial determinant of health. Individual and group advocacy and activism in response to corporate products, practices or policy influences can mediate negative health impacts. This paper discusses the unequal power relations existing between TNCs that promote their own financial interests, and activists and advocates who support population and environmental health by challenging corporate power. It draws on interview data from 19 respondents who informed 2 health impact assessments conducted on TNCs; 1 from the fast food industry, and 1 from the extractive industries sector. It reveals the types of strategies that civil society organizations (CSOs) have used to encourage TNCs to act in more health promoting ways. It discusses the extent to which these strategies have been effective, and how TNCs have used their power to respond to civil society action. The paper highlights the rewards, and the very real challenges faced by CSOs trying to change TNC practices related to health, within a neoliberal policy environment. It aims to provide evidence for socially oriented actors to inform their advocacy for changes in public policy or corporate practices that can contribute to improving population health and equity and tackling commercial determinants of health. [ABSTRACT FROM AUTHOR]

Summary: This article reports on findings that indicate how First Nations musical activities function as cultural determinants of health. Drawing on early findings from a 3-year Australian Research Council funded project titled The Remedy Project: First Nations Music as a Determinant of Health, we detail Australian and Ni Vanuatu First Nations musicians' reported outcomes of musical activity using a First Nations cultural determinants of health framework. The broader findings indicate that our respondents see musical activity as actively shaping all known domains of cultural health determinants, and some surrounding political and social determinants. However, this paper focusses specifically on the political and economic determinants that emerged in analysis as the most dominant subthemes. We argue that this study provides strong impetus for continued investigation and reconceptualization of the place of music in cultural health determinant models. Lay Summary: This article looks at how making and performing music, recording music and listening to music helps the health of First Nations peoples in Australia and Ni Vanuatu. Music is an important part of the lives of First Nations peoples from these places and so research was done to try to understand why it is meaningful. Music can be used as an outlet for personal feelings, and can also be a way that groups of people can express common concerns. First Nations musicians talked about how music makes them feel, and how music is used to strengthen relationships between people, and between people and their culture. Musicians also talked about how music helps them express their political and economic goals. The findings backed up existing First Nations' models of health that say that health for First Nations People's needs to be thought about in a holistic way. The findings also showed that the relationship between music and health needs to be studied more so that we can better understand how it helps maintain links with the past, gives a guide for the present and opens options for the future. Graphical Abstract [ABSTRACT FROM AUTHOR]

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care. [ABSTRACT FROM AUTHOR]

Effective interventions are needed to stop homophobic behaviours in sport settings as these behaviours are associated with negative health and social outcomes for individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer or other diverse genders and sexualities. This paper reports the results of a quasi-experimental study commissioned by a public health agency to explore the benefits of a novel intervention that has been widely adopted by Australian community sport clubs. The 'Pride Cup' intervention includes education for club leaders, sport participants and the hosting of a rainbow-themed 'pride game'. Survey responses of male participants from six randomly selected sport clubs which had received the intervention (n = 148) were compared to responses (n = 137) from six randomly selected comparison clubs (Australian Football, cricket, field hockey, roller derby). Employing a post-test-only design, the study explored differences in homophobic attitudes, behaviours and individual efficacy to react negatively to homophobic behaviours. The study found significant differences (p < 0.001) in self-reported use of homophobic slurs (e.g. fag) in the last 2 weeks by participants in the treatment (11%) versus comparison (31.8%) clubs, and significant differences in the perceived use of these slurs by teammates (25.9% vs. 56.6%) or coaches (7.8% vs. 23.3%). There were also significant differences in efficacy scores, but no differences in homophobic attitudes. These results, combined with evidence of community-driven adoption, support the allocation of public health resources to conduct larger scale trials using pre/post designs to confirm these findings. [ABSTRACT FROM AUTHOR]

Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women's lives. This paper draws on 50 qualitative interviews with midlife women (45–64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or 'breaking up with') alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing drinking patterns. If classed differences are not attended to in health promotion efforts, this might mitigate the effectiveness of alcohol risk messaging to women. [ABSTRACT FROM AUTHOR]

Popular commercial meal kit subscription services (MKSSs) may support families to overcome barriers to cooking and eating at home, and facilitate improved vegetable consumption. The global meal kit market has expanded rapidly creating a gap in our understanding of the health-promoting potential of MKSSs. This paper describes the contemporary MKSS market in Australia and provides a vegetable-specific content analysis of a sample of recipes. A 1-week subscription was purchased for all Australian-based MKSSs (n  = 9) and websites were systematically reviewed to document key characteristics and recipe features. Vegetable content of all available recipes within a 1-week period were analysed. Our findings highlight the rapid expansion and evolution of MKSS market offerings over the past decade and their potential to support family vegetable consumption. Across all analysed recipes (n  = 179), MKSSs provided a median of 2.5 vegetable serves per person (range 0.7–7.5 serves) and a median of 3 different types of vegetables from 2 vegetable subgroups (i.e. dark green, red and orange, starchy, legumes and all other vegetables). This suggests that MKSSs may support family vegetable consumption if families select recipes with a greater number and variety of vegetables. However, an opportunity remains for MKSSs to improve both vegetable quantity and variety to positively influence population health. Further research is required to describe how families use meal kits promoting a greater understanding of their potential to improve family nutrition. [ABSTRACT FROM AUTHOR]

Although rising rates of obesity are recognized as a major concern for Australian public health, debate on what (if any) responsive action should be undertaken is conceptually and normatively complex. It is shaped by diverse values and interests; different representations of the problem; and many options for action by government, the private sector or individuals. This paper presents research documenting arguments for and against implementing a sugar tax in Australia. It is based on semi-structured interviews with representatives from industry (n  = 4), public health (n  = 4), policy think tanks (n  = 2); and document and media analyses. The research design was informed by framing and agenda setting theory with results reported under four main themes: framing economic impacts, framing equity, framing obesity and framing the 'nanny state' versus individual liberty argument. We found that proposals for a sugar tax as part of policy responses to the issue of overweight and obesity in Australia are framed very differently by actors who either support or oppose it. A conclusion is that policy makers and public health advocates involved in policy debates on a sugar tax need to understand the role of problem and 'solution' framing, and develop positions based on protecting the public interest as a basic ethical responsibility of governments and public agencies. [ABSTRACT FROM AUTHOR]

Summary Meal kits are popular for consumers seeking greater convenience in preparing meals at home. The market share for meal kit subscription services (MKSSs) is growing in developed nations including Australia, however, literature about their health promoting qualities, e.g. nutritional composition, is scarce. This study aimed to assess the characteristics and nutritional composition of meals offered from an MKSS over 12 months. Nutritional data were extracted from recipes available to order from HelloFresh in Australia from 1 July 2017 to 30 June 2018. In total, 346 (251 unique) recipes were retrieved. Per serve (median size 580 g), meals contained a median of 2840 kJ (678 kcal) of energy, 58 g carbohydrate (14 g sugar), 44 g protein, 28 g total fat (8 g saturated fat) and 839 mg sodium. Median energy from macronutrients was total fat (38%), carbohydrates (34%), protein (25%) and saturated fat (11%). This paper is the first to describe characteristics of recipes available from an MKSS over a 12-month period of time. With their growing popularity, meal kit delivery services have the capacity to influence consumer food behaviours, diets and subsequently population health. MKSSs may function to promote health though education, training, and enabling home cooking behaviours, and may be a powerful commitment device for home cooking behaviour change. However, it is important for health professionals, including dietitians and nutritionists, to understand the nutritional risks, benefits and suitability of this contemporary mealtime option before recommending them to clients and members of the public as part of health promotion. Lay summary Meal kit delivery services are growing in popularity in developed countries, complementing busy lifestyles with pre-measured ingredients and recipe instructions delivered to the home. These meal kits have the ability to influence consumer diets and population health, and may support health promoting diet behaviours, e.g. eating vegetables, and enable home cooking. In this study, we reviewed a years' worth of recipes from a popular meal kit service. We report that a typical recipe contained approximately nine different ingredients, comprising three vegetables and required three ingredients from the home pantry. Meals took ∼35 min to prepare and were found to be relatively high in energy from fat and protein, and relatively low in energy from carbohydrates. The level of sodium varied widely and some meals exceeded the Australian Suggested Dietary Target for sodium (<2000 mg). Meal kit recipes were found to have health promoting qualities, frequently including vegetable ingredients, however, improvements to recipes would make these meal kits more health promoting. Current diet intakes and the nutritional composition of meal kits recipes should be reviewed before being recommended by health professionals. [ABSTRACT FROM AUTHOR]

Recently, many programs have been funded to tackle Indigenous Australian smoking. This study assessed what challenges and unexpected responses could occur when developing anti-tobacco messages for Indigenous communities. A cross-sectional telephone survey of organizations involved in making anti-tobacco messages for the target population was conducted in 2012-2013. Open-ended questions explored cultural challenges to message development and unexpected outcomes. Responses were noted and these qualitative data were independently coded by two researchers using an inductive analysis. Non-parametric tests explored associations between organization orientation, whether target group feedback about messages was sought (pre-tests) and the presence of the above factors. The 47 organizations represented included: 22 Aboriginal Medical Services (AMS), 13 government organizations (GO), eight non-government organizations (NGO) and four universities. The response rate was 83%. Cultural challenges were reported equally by organizations oriented towards Aboriginal communities and those oriented towards the general population. Organizations conducting target group pre-tests of the messages were more likely to report cultural challenges (p=0.002). Four main themes were revealed: the diversity of Aboriginal and Torres Strait Islander cultures; the selection of rolemodels; conflicts and delays; and unexpected outcomes. Nearly 60% of organizations reported better-than-expected outcomes e.g. community appreciation and pride. A further 40% reported negative responses, e.g. messages being misunderstood or confronting. Cultural challenges and unexpected outcomes are reported by Australian organizations when developing anti-tobacco messages for Indigenous Australians warranting attention to improve the salience of anti-tobaccomessages for Indigenous peoples. NB. In this paper, Indigenous Australians is a term used to refer to Aboriginal and Torres Strait Islander peoples, the first inhabitants of Australia. No offence is intended. The authors acknowledge and respect that Aboriginal and Torres Strait Islander people are diverse populations with different language and cultural groups. [ABSTRACT FROM AUTHOR]

Reducing the burden of postnatal maternal mental health problems is an international public health priority. We developed What Were We Thinking (WWWT), a psychoeducation programme for primary postnatal health care that addresses known but neglected risks. We then demonstrated evidence of its effects in a before-and-after controlled study in preventing maternal postnatal mental health problems among women without a psychiatric history participating in the intervention compared to usual care (AOR 0.43; 95% CI 0.21, 0.89) when conducted by specialist nurses. Testing its effectiveness when implemented in routine primary care requires changes at practitioner, organizational and health system levels. This paper describes a programme of translational formative evaluation to inform the protocol for a cluster RCT. Following the UK Medical Research Council (MRC) Guidance for evaluating complex interventions, we conducted a translational formative evaluation using mixed methods. Collection and analysis of postnatal health service documents, semi-structured interviews, group discussions and an online survey were used to investigate service provision, consumers' needs and expectations, clinicians' attitudes and clinical practice, and the implications for health service delivery. Participants were expectant parents, health care providers, health service managers and government policy makers. Results documented current clinical practice, staff training needs, necessary service modifications to standardize advice to parents and include fathers, key priorities and drivers of government health policy, and informed a model of costs and expected health and social outcomes. Implementation of WWWT into routine postnatal care requires adjustments to clinical practice. Staff training, modifications to service opening hours and economic implications for the health system also need to be considered. The MRC Guidance for developing and evaluating complex interventions is a useful framework for conceptualizing and reporting translational formative evaluation, which is an essential step in the evidence trajectory. The results of the evaluation will inform the protocol for a cluster RCT of WWWT and associated health economic evaluation. [ABSTRACT FROM AUTHOR]

Health in All Policies (HiAP) is a policy development approach that facilitates intersectoral responses to addressing the social determinants of health and health equity whilst, at the same time, contributing to policy priorities across the various sectors of government. Given that different models of HiAP have been implemented in at least 16 countries, there is increasing interest in how its effectiveness can be optimized. Much of the existing literature on HiAP remains descriptive, however, and lacks critical, empirically informed analyses of the elements that support implementation. Furthermore, literature on HiAP, and intersectoral action more generally, provides little detail on the practical workings of policy collaborations. This paper contributes empirical findings from a multi-method study of HiAP implementation in South Australia (SA) between 2007 and 2013. It considers the views of public servants and presents analysis of elements that have supported, and impeded, implementation of HiAP in SA. We found that HiAP has been implemented in SA using a combination of interrelated elements. The operation of these elements has provided a strong foundation, which suggests the potential for HiAPto extend beyond being an isolated strategy, to form a more integrated and systemic mechanism of policy-making. We conclude with learnings from the SA experience of HiAP implementation to inform the ongoing development and implementation of HiAP in SA and internationally. [ABSTRACT FROM AUTHOR]

Process evaluation is valuable in guiding development of effective intervention programmes but rare in adolescent weight management. This paper presents a process evaluation of the Loozit® randomized controlled trial, a community-based behavioural lifestyle intervention for obese 13-16 year olds. Adolescents were randomized to receive the two-phase Loozit® group programme, with (n = 73) or without (n = 78), additional therapeutic contact (telephone coaching, short message service and/or emails) in Phase 2. Quantitative and qualitative process data were collected. Facilitators used a standardized evaluation form to document participant attendance, and comment on lesson adherence and process delivery. Adolescents and parents completed satisfaction questionnaires at 2-, 12- and 24-month follow-ups. Following the intervention, 14 adolescents who provided informed written consent were interviewed about their experience with additional therapeutic contact. Data were analysed using descriptive statistics, parametric and non-parametric tests to compare group means, and thematic analyses. Group attendance rates averaged 85 and 47% during Phases 1 (0-2 months) and 2 (3-24 months), respectively. Facilitators frequently noted that participants reported making healthy lifestyle changes. Elements enjoyed in the sessions included practical activities, fun active games, resistance training and forming new friendships. Adolescents struggled with setting specific, measurable, achievable, realistic and timely (SMART) goals. Overall, participants were satisfied with the help received including the telephone and electronic contact. More than 80% of participants found the programme changed adolescents' eating and physical activity habits, and 89% of parents reported changing parenting strategies. Future adolescent group-based programmes may enhance participant engagement and programme effectiveness by including more interactive and frequent telephone and electronic contact. [ABSTRACT FROM AUTHOR]

Suicide is a major public health issue globally. The World Health Organization has called for nations to create comprehensive national suicide prevention strategies including multisectoral collaboration, awareness raising, advocacy and capacity building. The workplace provides opportunity and structure for suicide prevention programs. However, many of these programs are poorly documented and evaluated. The MATES in Construction (MATES) program is a multimodal workplace-based suicide prevention program designed for and by the construction industry. This systematic review examined the available evidence for the effectiveness of the MATES program and is reported according to PRISMA guidelines. A literature search resulted in the inclusion of 12 peer-reviewed articles published between January 2010 and February 2023 containing primary data of evaluations of MATES. There was evidence of the effectiveness of the MATES program in improving mental health and suicide prevention literacy, helping intentions and reducing stigma. The results highlighted the importance of worker-to-worker peer approaches with workers consistently stating that supervisors were the least trusted resources for mental health and suicide concerns. Favourable results were found in relation to reduced suicide risk in the construction industry. The evidence base for MATES is limited in terms of causal inference with very few controlled evaluations and no experimental studies having been conducted to date. Improved understanding of how the program motivates volunteers, their experiences and research on the longer-term impacts of the program on the industry is required. [ABSTRACT FROM AUTHOR]

There is increasing public health focus on how corporate practices impact population health and well-being. While the commercial determinants of the climate crisis pose serious threats to human and planetary health, governments largely seek to balance climate action with economic imperatives. Global stakeholders recognize that young people have important voices in influencing climate responses. However, few studies have investigated young people's perceptions of the commercial determinants of the climate crisis. A qualitatively led online survey of n = 500 young Australians (15–24 years) investigated their understanding of corporate responses to the climate crisis, factors that influenced these responses and strategies to respond. A reflexive approach to thematic analysis was used. Three themes were constructed from the data. First, young people perceived that corporate responses to the climate crisis focussed on soft options and lacked meaningful action. Second, they stated that these responses were largely influenced by economic imperatives rather than planetary health, with policy levers needed to implement environmentally responsible corporate practices. Third, young people perceived that systems needed change to create demand for a cleaner environment, leading to improved practices. Young people have a clear understanding of the commercial determinants of the climate crisis and associated threats to population health. They recognize that corporate practices (and consumer demand) will not change without significant policy and structural change. Public health and health promotion stakeholders should work alongside young people to influence decision-makers to address harmful corporate behaviours. [ABSTRACT FROM AUTHOR]

To inform public health policy implementation in Australia, our study investigated the level of public support for six policy initiatives addressing unhealthy diet. The policy initiatives included taxing soft drinks and energy drinks, taxing less healthy food and beverage purchases, zoning to restrict the supply of junk foods near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugar-sweetened beverages from vending machines in schools, and public places. Data from a cross-sectional population-based study for 4040 Australians aged 15+ years, were analysed. A high overall support across all policy initiatives was observed. Nearly three-quarter of public support was observed for policy initiatives targeting children (zoning to restrict the supply of junk food near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugars-sweetened beverages from vending machines in schools), and half of Australians supported policy initiatives of taxing soft drinks and energy drinks and taxing less healthy food and beverage purchases. Australian women and those with tertiary level of education were more likely to support public health initiatives targeting children and all policy initiatives respectively. Interestingly, young adults expressed low level of support for all policy initiatives. The study demonstrated considerable public support for policy initiatives focussed on protecting children from unhealthy diet in Australia. Framing, designing and implementing policies targeting children is potentially a good starting point for policymakers to create a health promoting food environment. [ABSTRACT FROM AUTHOR]

Indigenous Standpoint Theory forms the epistemological foundation for this study and methodological choices were made within this theoretical framework to ensure culturally responsive research processes that engaged the Indigenous agenda of self-determination and rights. The objectives of this research were to determine: (i) Indigenous perceptions of the facilitators and barriers to exercise; (ii) The potential feasibility and sustainability of an exercise intervention. In this context, Participatory Action Research methods were used to design the data-gathering instrument for the study—a questionnaire, co-designed with the Noongar Aboriginal community of Perth, Western Australia. This self-administered questionnaire, distributed to participants by email, post and manual delivery, sought to elicit the factors that impact uptake and retention of regular exercise activities. Questionnaire data included individual demographic detail and specific question responses on labelled 5 point Likert Scales. Specific question responses were tabulated by Likert Scale label category and the response distribution for each question was enumerated. Simple descriptive statistics (measures of central tendency and variance) were used to characterize the data set and the Chi squared test was used to evaluate frequency differences between males and females. A total of 133 participants (71 females) completed the questionnaire. The results indicated that people valued exercise. The most common barriers indicated by participants were exercising with an injury (63%), changing diet (58%), finding time to exercise every day (55%) and exercising the next day with pain from exercising the day before (54%). A larger proportion of males (34%) than females (24%) reported greater ease in finding time to exercise every day (p  < 0.05). Facilitators mainly related to the potential social and community benefits of exercising with other people, preferably in small groups, and the importance of a culturally secure venue. These findings shed light on what a culturally secure exercise programme might involve for the Noongar community. As this may have implications for other Aboriginal and Torres Strait Islander and international First Nations' Peoples, more focused research is needed on the place of traditional physical activities and the nature of culturally secure exercise programmes and spaces to enable wider application. [ABSTRACT FROM AUTHOR]

Summary: Few tools and mechanisms exist to assist the reorientation of health services, especially in the Indigenous Australian health context; where improving health status and life expectancy is a priority. We developed a health promotion systems assessment tool (HPSAT) to provide health services with the information and support they need to drive health system change. Tool development occurred using a participatory, iterative approach that included a literature review, expert input by Indigenous and non-Indigenous stakeholders and annual group workshops in four Indigenous Australian primary health care (PHC) services. Four health system components: (i) organizational environment; (ii) service delivery systems; (iii) information systems and decision support; and (iv) adaptability and integration, form the framework of the tool. A scoring system monitors system change over time. The HPSAT provides a constructive framework to support health services to collectively assess and support reorientation in Indigenous Australian PHC services. Participation of key stakeholders with an intimate knowledge about the local context was pivotal in developing a user-friendly and fit-for-purpose tool. Maximum benefits of the tool are likely to be gained when used as part of a continuous quality improvement intervention. Lay Summary: Primary health care services are important providers of health promotion approaches. In Australia, the health status and life expectancy of Indigenous peoples is much lower than that of the general population. Meeting Indigenous peoples' acute and chronic care needs can influence PHC service delivery models. Few tools and mechanism are available to support the reorientation of Indigenous Australian PHC services from an acute and chronic care model to a more comprehensive model, with greater emphasis on health promotion and prevention. This article describes the development and trialling of a tool providing Indigenous Australian PHC services with the information and support they need to reorient their health systems towards health promotion. The health promotion systems assessment tool provides a useful framework to facilitate collective appraisal of service delivery models and to identify opportunities for health system reorientation in Indigenous Australian PHC context. The tool has the potential to benefit many other health services seeking to reorient their systems towards health promotion. [ABSTRACT FROM AUTHOR]

Summary: We aimed to understand the process of setting or varying food standards related to non-nutritive sweeteners (NNS) in Australia and New Zealand. Overconsumption of added sugars is a risk factor for non-communicable diseases. Limiting added sugar consumption is recommended by the World Health Organization. NNS are sweet substances with little to no energy that can be used to maintain the sweetness of packaged food when added sugar is reduced. The health and dietary pattern impacts of NNS are contested. Understanding how and why applications for NNS are submitted, assessed and approved within food regulatory systems is important to contextualize the increasing availability of NNS in the food supply. We completed an interpretive content analysis of applications to change the Food Standards Australia and New Zealand (FSANZ) Code, risk assessments and stakeholder submissions. Literature used in risk assessments were drawn from a mixture of documents supplied by industry and peer-reviewed studies. Risk assessments were primarily focussed on toxicological outcomes, while broader public health outcomes were not explicitly considered. Consumption data available to FSANZ were collected several years prior to dietary exposure assessments, and thus may not accurately represent current intakes. The study findings raise questions about whether the scope of what constitutes a 'risk' to public health in the setting of food standards needs to extend beyond immediate toxicological and food safety concerns, to include longer-term dietary balance considerations. [ABSTRACT FROM AUTHOR]

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016–18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising. [ABSTRACT FROM AUTHOR]

There are a range of stereotypes and assumptions associated with women's gambling behaviours. While researchers have demonstrated that the practices associated with women's gambling are changing and becoming increasingly normalized, there is a limited understanding of how younger women ascribe meanings to these practices. This study explored the gambling practices of younger women. Forty-one women (20–40 years) participated in qualitative telephone interviews. Participants were asked open-ended questions about personal engagement in gambling, including experiences of gambling, gambling engagement, and experiences with different gambling products and environments. Data interpretation was guided by reflexive thematic analysis. Three themes were constructed from the data: (i) gambling infrastructures, including both products and the embedding of gambling in community environments, contributed to the convenient and regular consumption of gambling, with gambling easy to access and engage with; (ii) social networks and intergenerational gambling practices impacted the perceived social value and competencies related to gambling; and (iii) technology facilitated new gambling practices, routinizing gambling behaviours through automation and building perceived competencies with a range of gambling products. Gambling regulation and public health responses to gambling often focus on either individual behaviours or product characteristics. This study suggests that this focus is too narrow and excludes important influences on younger women's gambling practices, which include the infrastructure that supports the provision and consumption of gambling products. Public health research, policy and practice must consider the full range of determinants that may contribute to the initiation and continuation of gambling in younger women. [ABSTRACT FROM AUTHOR]

Age-Friendly Cities (AFC) is a framework for promoting healthy ageing through local actions. We use systems thinking to assess potential outcomes of actions to support older people's mobility, undertaken within an AFC commitment in Greater Sydney. Interviews with 20 informants involved in providing space, infrastructure, or services that affect how older people get around were analysed using causal loop diagrams (CLDs). Four approaches to support older people's mobility were identified and situated to the Multiple Governance Framework: land use, open and public space, supplementary transport, and community transport. Analysis revealed potential for unwanted consequences associated with each, which can be generalised into three generic potential outcomes for other jurisdictions to consider. A recommendation from this research is for policy actors to examine feedback interactions between actions so that they can foresee a wider range of outcomes and take defensive action against those unwanted. By situating CLDs within the Multiple Governance Framework, this research not only identifies what to look for, in terms of potential outcomes, but also where to look, in terms of the level of decision-making. This research offers a new way to assess the functioning of AFC governance networks by their collective outcomes and challenges the standards for the evaluation of AFC. [ABSTRACT FROM AUTHOR]

Citizen science connects academic researchers with the public through combined efforts in scientific inquiry. The importance of involving impacted populations in health research is well established. However, how to achieve meaningful participation and the methodological impact of citizen science needs further examination. We examined the feasibility of using citizen science to understand the impact of alcohol advertising on Australian women through a breast cancer prevention project. Two hundred and eighty-two ('participants') citizen scientists completed demographic and behavioural questions via an online survey. The research participants moved into the role of citizen scientists by completing the data collection tasks of capturing and classifying images of alcohol advertising they saw online. Interrater reliability tests found high levels of agreement between citizen scientists and academic researchers with the classification of alcohol advertising brand (Kappa = 0.964, p  < 0.001) and image type (Kappa = 0.936, p  < 0.000). The citizen scientists were women aged 18 and over, with 62% between 35 and 55 years old. The majority were from major cities (78%), had attained a bachelor's degree or higher-level education (62%) and were recruited via email or Facebook (86%). The use of citizen science provided methodological gains through the creation of a unique dataset with higher levels of validity than the existing literature, which employed traditional investigator-driven research methodologies. Citizen science enriched the dataset and provided a powerful methodological vehicle to understand an environmental determinant of health. The study illuminates how public participation benefitted the research process, the challenges and the potential for citizen science to improve public health. [ABSTRACT FROM AUTHOR]

Food security is an increasing problem for older adults who are living longer and having to stretch their resources further. Initiatives such as subsidized community market days are increasingly important in bolstering food security amongst these groups but there have been few attempts to understand these initiatives from the perspective of community members. This exploratory study examined the utility of a novel citizen science approach to engage older adults in evaluating and improving a local food security initiative. Using the Our Voice methodology, citizen scientists recorded their perceptions of their local Market Day via photographs and audio narratives. Thirteen citizen scientists captured 127 photographs and 125 commentaries. Citizen scientists participated in workshops to discuss, code and synthesize their data, and used their findings to advocate for change. A number of improvements to the Market Day were made by key stakeholders on the basis of citizen scientist recommendations, including improving the processes for sourcing and storing food and changing the layout to improve access. This study demonstrates that citizen science is a useful and feasible approach to engaging community members in capturing data and advocating for change to ensure that local initiatives meet the needs of communities. [ABSTRACT FROM AUTHOR]

Implementing programs at scale has become a vital part of the government response to the continuing childhood obesity epidemic. We are studying the largest ever scale-up of school and child care obesity prevention programs in Australia. Health promotion teams support primary schools and early childhood services in their area to achieve a number of specified, evidence-based practices aimed at organizational changes to improve healthy eating and physical activity. Key performance indicators (KPIs) were devised to track program uptake across different areas—measuring both the proportion of schools and early childhood services reached and the proportion of practices achieved in each setting (i.e. the proportion of sites implementing programs as planned). Using a 'tight–loose–tight' model, all local health districts receive funding and are held accountable to reaching KPI implementation targets. However, local teams have independent discretion over how to best use funds to reach targets. Based on 12 months of ethnographic fieldwork and interviews across all districts, this study examines variations in the decision making and strategizing processes of the health promotion teams. We identified three distinct styles of practice: KPI-driven practice (strategic, focussed on targets); relationship-driven practice (focussed on long-term goals); and equity-driven practice (directing resources to sites most in need). In adapting to KPIs, teams make trade-offs and choices. Some teams struggled to balance a moral imperative to attend to equity issues, with a practical need to meet implementation targets. We discuss how models of program scale-up and tracking could possibly evolve to recognize this complexity. [ABSTRACT FROM AUTHOR]

This study aimed to explore the experience of being a Community Foodies (CF) peer educator with respect to personal benefits, specifically, personal development, wellbeing and empowerment. Qualitative semi-structured telephone interviews conducted with metropolitan and country peer educators of the CF programme. The CF programme in South Australia (SA) delivers nutrition education to disadvantaged communities. Ten adult peer educators from the CF programme: seven from country SA and three from Adelaide. Phenomenon of interest is that peer educators' perceptions of personal growth and development from involvement in the CF programme. The interviews were audiotaped and analysed thematically. The experience of being a nutrition peer educator improved personal skills and knowledge, dietary habits, self-esteem, confidence, sense of belonging and civic engagement. Peer educators felt that the CF programme was run in a straightforward, easy to understand way, with a welcoming environment and abundant support from the coordinators. Apart from benefits to themselves, peer educators appeared to be most proud of their capacity to contribute to the nutritional health of the broader community. Peer education programmes in disadvantaged communities provide policy makers with valuable and cost-effective approaches to improve health, build self-efficacy, strengthen community engagement, and, foster active participation and trust. [ABSTRACT FROM AUTHOR]

To investigate factors that enable or challenge the initiation and actioning of health and wellbeing policy in Australian local governments using political science frameworks. An online survey was distributed to staff and elected members of Australian local governments. The survey sought responses to a range of variables as informed by political science frameworks. Data were analysed using descriptive statistics and results were compared between local governments of different geographical sizes and locations using Kruskal–Wallis non-parametric testing. There were 1825 survey responses, including 243 CEOs, representing 45% of Australian local governments. Enablers for local government policy initiation and action included the high priority given to health and wellbeing (44%), local leadership (56%) and an organizational (70%) and personal obligation (68%) to the community to act. Less true is a favourable legislative environment (33%), leadership from higher levels of government (29%) and sufficient financial capacity (22%). Cities are better positioned to initiate and action health policy, regardless of the broader legislative environment. Health and wellbeing is a high priority for Australian local governments, despite lack of funding and limited lobbying and support from other sectors and higher levels of government. The insights from political science frameworks assist to understand the policy process, including the interrelatedness of enablers and challenges to initiating and actioning health and wellbeing policy. Further understanding the policy drivers would support practitioners and researchers advocating to influence local health and wellbeing policy. [ABSTRACT FROM AUTHOR]

Young people in out of home care (OoHC) typically have worse mental health outcomes than peers who grow up within a family of origin. Innovations to improve the mental health of this group have tended to focus on pathology rather than mental health promotion and prevention of mental illnesses, and are often costly and challenging to implement. This qualitative study explored perspectives from young people with experience of OoHC in Melbourne, Australia regarding the promotion of mental health in OoHC. The study informed the subsequent development of a system-level intervention to support workers and carers in OoHC and evaluation of its implementation, the Ripple study. We conducted thematic analysis of data from interviews and focus groups with 14 young people aged 18–24 years with diverse identities and experiences of foster, kinship and residential care. We identified four key themes. These were providing a home-like environment; having someone to talk to; connecting to the wider community and having opportunities to become an active citizen. There is a need for both mental health promotion and treatment approaches in interventions to support workers and carers and young people in OoHC. Mental health promotion strategies should include a focus on enhancing existing capacities of carers and workers. Mental health promotion for young people in OoHC depends on strong intersectoral collaboration and youth participation. [ABSTRACT FROM AUTHOR]

Australian women shoulder the bulk of household duties including family food provisioning, despite increasing participation in the workforce. This research aimed to understand employed mothers' daily-lived experience of family food provisioning, in particular, the intersection between family food provisioning, gender inequality and nutritional guidelines as they impact women's time and health. Semi-structured interviews were conducted with 22 employed mothers in South Australia. Participants had at least one child aged less than 13 years. Qualitative data was analysed using a thematic content approach. Time-scarcity was common and associated with stress in relation to family food provisioning; this relationship was particularly apparent among employed mothers who were also studying. Most mothers valued nutrition and strove to provide nutritious meals, although they tended to work from their own nutritional understandings, not the national nutrition guidelines; they saw the nutrition guidelines as unhelpful because of the time demands that were implied. The study invites policy makers, practitioners and researchers to consider time for family food provisioning as a social determinant of family as well as women's health, and structural strategies to address this health inequity for women. [ABSTRACT FROM AUTHOR]

Rapid urbanization requires health promotion practitioners to understand and engage with strategic city planning. This policy analysis research investigated how and why health was taken up into strategic land use planning in Sydney, Australia, between 2013 and 2018. This qualitative study develops two case studies of consecutive instances of strategic planning in Sydney. Data collection was done via in-depth stakeholder interviews (n   =   11) and documentary analysis. Data collection and analysis revolved around core categories underpinning policy institutions (actors, structures, ideas, governance and power) to develop an explanatory narrative of the progress of 'health' in policy discourse over the study period. The two strategic planning efforts shifted in policy discourse. In the earlier plan, 'healthy built environments' was positioned as a strategic direction, but without a mandate for action the emphasis was lost in an economic growth agenda. The second effort shifted that agenda to ecological sustainability, a core aspect of which was 'Liveability', having greater potential for health promotion. However, 'health' remained underdeveloped as a core driver for city planning remaining without an institutional mandate. Instead, infrastructure coordination was the defining strategic city problem and this paradigm defaulted to emphasizing 'health precincts' rather than positioning health as core for the city. This research demonstrates the utility in institutional analysis to understanding positioning health promotion in city planning. Despite potential shifts in policy discourse and a more sophisticated approach to planning holistically, the challenge remains of embedding health within the institutional mandates driving city planning. [ABSTRACT FROM AUTHOR]

Males employed in the construction industry are at greater risk of suicide than other employed males. It is plausible that a high level of stigma against mental health problems explains the elevated rates of suicide among this group. This study sought to test the effectiveness of an electronic mental health stigma intervention on suicide ideation, communication about suicide and attempts. Participants were randomly assigned to receive either a series of brief contact interventions over a 6-week period or a wait list control. Suicidal ideation, communication about suicide and suicide attempts were assessed using the Suicidal Behaviors Questionnaire-Revised at post-intervention. We used linear regression to assess effectiveness at post-intervention, adjusting for relevant covariates using both conventional methods and a propensity score approach. Results indicate that the intervention had no significant impact on suicidal thoughts, communication or suicide attempts. There was some indication that individuals in the intervention group reported a slight increase in attempts and communication about suicide. These observations underscore an urgent need for more research to understand the complex and nuanced relationship between stigma and suicide in non-clinical populations. [ABSTRACT FROM AUTHOR]

Notwithstanding the historical benefits of coal in aiding human and economic development, the negative health and environmental impacts of coal extraction and processing are of increasing concern. Environmental impact assessments (EIAs) are a regulated policy mechanism that can be used to predict and consider the health impacts of mining projects to determine if consent is given. The ways in which health is considered within EIA is unclear. This research investigated 'How and to what extent are health, well-being and equity issues considered in Environmental Impact Assessments (EIAs) of major coal mining projects in New South Wales, Australia'. To this end we developed and applied a comprehensive coding framework designed to interrogate the publicly available environmental impact statements (EISs) of three mines in New South Wales (NSW), Australia, for their inclusion of health, well-being and equity issues. Analysis of the three EISs demonstrates that: the possible impacts of each mine on health and well-being were narrowly and inadequately considered; when health and well-being were considered there was a failure to assess the possible impacts specific to the particular mine and the communities potentially affected; the cumulative impacts on human health of multiple mines in the same geographical area were almost completely ignored; the discussions of intragenerational and intergenerational equity did not demonstrate a sound understanding of equity and, it is essential that governments' requirements for the EIA include detailed analysis of the health, well-being, equity and cumulative impacts specific to the proposed mine and relevant communities. [ABSTRACT FROM AUTHOR]

Gambling is recognized as a significant public health problem. However, there is little research exploring community attitudes towards gambling and the development of advocacy initiatives. Engaging adults and young people in advocacy efforts is recognized as being beneficial to the successful implementation of harm prevention and reduction strategies. This study explored the attitudes of young people and their parents towards the alignment of gambling with sport, and the strategies they perceive could be used to prevent and reduce gambling related harm. Using a Constructivist Grounded Theory approach, 30 family groups from Melbourne, Australia participated in semi-structured interviews. Parents and young people were asked about gambling and its promotion, alignment with sporting codes, the potential impact on young people and strategies that may prevent or reduce gambling harm. Thematic analysis was undertaken to interpret the data. The sample comprised 29 parents, one grandparent and 48 young people. Themes emerging from the data related to the use of imagery and appeal strategies in advertisements, the normalization of betting in advertisements and the alignment of betting with sport. Parents and young people also identified a number of potential gambling harm prevention and reduction initiatives. Parents and young people were able to describe a range of strategies used by gambling companies to promote their products, understand the potential impact of these strategies, and recommend strategies to reduce harm. Given this level of understanding there is clearly an opportunity to engage young people and stakeholders in advocacy initiatives aimed at reducing and preventing gambling harm. [ABSTRACT FROM AUTHOR]

The concept of cultural safety (CS) has been developed as a critical perspective on healthcare provided to Indigenous service users in neo-colonial countries such as New Zealand, Australia and Canada. Unlike other frameworks for culturally competent healthcare, a CS approach recognizes impacts of colonization and power inequalities on Indigenous peoples and asks how these may manifest in healthcare settings. It has been argued that CS thinking is suited to critical analysis of public policy, but there has been limited work in this direction. Drawing on literature on CS in Australian healthcare, we defined a CS framework consisting of five concepts: reflexivity, dialogue, reducing power differences, decolonization and regardful care. Our research examined whether and in what terms this framework could be adapted as a tool for critical analysis of Australian public policy as it affects Aboriginal and Torres Strait Islander peoples. We used a collaborative inquiry process combining perspectives of an Aboriginal researcher and a non-Indigenous researcher. We developed a thematic analysis framework to examine how the five concepts might be reflected in contemporary writings on policy by leading Aboriginal or Torres Strait Islander thinkers. We found the framework is applicable as a tool for policy analysis; bringing together key concerns raised by Aboriginal and Torres Strait Islander leaders and critical concepts such as sovereignty and interface thinking. We concluded the framework is likely to be a useful tool for critical, systemic thinking about public policy as it affects Indigenous peoples and for specifying areas where performance can be improved to achieve culturally safe policy. [ABSTRACT FROM AUTHOR]

Despite the enormous potential of social media for health promotion, there is an inadequate evidence base for how they can be used effectively to influence behaviour. In Australia, research suggests social media use is higher among Aboriginal and Torres Strait Islander people than the general Australian population; however, health promoters need a better understanding of who uses technologies, how and why. This qualitative study investigates what types of health content are being shared among Aboriginal and Torres Strait people through social media networks, as well as how people engage with, and are influenced by, health-related information in their offline life. We present six social media user typologies together with an overview of health content that generated significant interaction. Content ranged from typical health-related issues such as mental health, diet, alcohol, smoking and exercise, through to a range of broader social determinants of health. Social media-based health promotion approaches that build on the social capital generated by supportive online environments may be more likely to generate greater traction than confronting and emotion-inducing approaches used in mass media campaigns for some health topics. [ABSTRACT FROM AUTHOR]

Adults with low literacy are less empowered to take care of their health, have poorer health outcomes and higher healthcare costs. We facilitated partnerships between adult literacy teachers and community health providers to deliver a health literacy training program in adult basic education classrooms. Following course completion we interviewed 19 adult education teachers (15 delivering the health literacy program; 4 delivering standard literacy classes) and four community health providers (CHPs) about their experiences, and analysed transcripts using Framework analysis. Written feedback from eight teachers on specific course content was added to the Framework. Health literacy teachers reported a noticeable improvement in their student's health behaviours, confidence, vocabulary to communicate about health, understanding of the health system and language, literacy and numeracy skills. CHP participation was perceived by teachers and CHPs as very successful, with teachers and CHPs reporting they complemented each other's skills. The logistics of coordinating CHPs within the constraints of the adult education setting was a significant obstacle to CHP participation. This study adds to existing evidence that health is an engaging topic for adult learners, and health literacy can be successfully implemented in an adult basic learning curriculum to empower learners to better manage their health. Health workers can deliver targeted health messages in this environment, and introduce local health services. Investment in adult literacy programs teaching health content has potential both to meet the goals of adult language and literacy programs and deliver health benefit in vulnerable populations. [ABSTRACT FROM AUTHOR]

Workplaces are considered promising settings for protecting and promoting the health and wellbeing of employees. To date, few workplaces, particularly small and medium sized enterprises (SME), or their workers, have adopted Workplace Health Promotion (WHP), raising questions as to why. We conducted interviews in 10 SME in the Australian Capital Territory (ACT) asking managers and workers to reflect on the reasons for their participation (or not) in WHP activities. We qualitatively explored factors that managers consider important when deciding whether to offer WHP and compared these to worker considerations regarding participation. Both workers and managers identified time constraints as a major barrier for participation in WHP activities. If WHP was implemented, time constraints arose mainly from: difficulties scheduling and synchronising activities to include most staff, even then casual staff were mostly excluded; and the duration of time required by employees to participate in the offered activities, and whether this was in paid (work) or unpaid (worker) time. Workers struggled to participate in WHP in their scheduled breaks and were reluctant to use time outside of work hours. We have developed a model illustrating the emerging tension between managers' and workers' needs for WHP participation. WHP participation will likely remain low until this tension, and associated financial implications, are widely acknowledged and addressed. Our research indicates that time should be considered more explicitly and thoughtfully in the workplace engagement and WHP design, to actively respond to constraints from activity duration, scheduling and synchronisation. [ABSTRACT FROM AUTHOR]

Like many nations, population ageing is challenging Australia's economic future; increasing the workforce participation of mothers and mature-aged adults are two policy strategies to address it. Drawing on a Health in All Policies (HiAPs) framework, our study aims to supply longitudinal evidence on connections between this policy strategy and health. Considering physical inactivity, poor mental health, overweight and obesity we estimate associations with the level of participation (not employed compared with part- or full-time employed). Using eight waves of data from the Household, Income and Labour Dynamics in Australia survey, a series of random intercept logistic models estimate the odds for mothers (n = 2105) and Australians aged 55-64 years (n = 3201) on each health outcome. We find that there are health benefits as well as risks linked to level of participation. Mothers who worked >20 h/wk had higher odds of physical inactivity, as did mature-aged Australians working either part - or full-time. Working part- or full-time was unrelated to overweight or obesity over the span of our study. Level of participation was unrelated to mental health among mature-age Australians, although part-time (but not full-time) work benefited mothers'. In terms of health, working more may offer mixed blessings to these two target populations; part-time work appears to be optimal. By using health as a metric, our study adds to the case for a HiAPs approach. [ABSTRACT FROM AUTHOR]

Intersectoral action between public agencies across policy sectors, and between levels of government, is seen as essential for effective action by governments to address social determinants of health (SDH) and to reduce health inequities. The health sector has been identified as having a crucial stewardship role, to engage other policy sectors in action to address the impacts of their policies on health. This article reports on research to investigate intersectoral action on SDH and health inequities in Australian health policy. We gathered and individually analysed 266 policy documents, being all of the published, strategic health policies of the national Australian government and eight State/Territory governments, current at the time of sampling in late 2012-early 2013. Our analysis showed that strategies for intersectoral action were common in Australian health policy, but predominantly concerned with extending access to individualized medical or behavioural interventions to client groups in other policy sectors. Where intersectoral strategies did propose action on SDH (other than access to health-care), they were mostly limited to addressing proximal factors, rather than policy settings affecting the distribution of socioeconomic resources. There was little evidence of engagement between the health sector and those policy sectors most able to influence systemic socioeconomic inequalities in Australia. [ABSTRACT FROM AUTHOR]

Research funding is increasingly supporting collaborations between knowledge users and researchers. Partnering Healthy@Work (pH@W), an inaugural recipient of funding through Australia's Partnership for Better Health Grants scheme, was a 5-year partnership between the Menzies Institute for Medical Research, University of Tasmania and the Tasmanian State Service (TSS). The partnerships purpose was to evaluate a comprehensive workplace health promotion programme (Healthy@Work) targeting 30 000 public sector employees; generating new knowledge and influencing workplace health promotion policy and decision-making. This mixed methods study evaluates the partnership between policy-makers and academics and identifies strategies that enabled pH@W to deliver key project outcomes. A pH@W document review was conducted, two partnership assessment tools completed and semi-structured interviews conducted with key policy-makers and academics. Analysis of the partnership assessment tools and interviews found that pH@W had reached a strong level of collaboration. Policy-relevant knowledge was generated about the health of TSS employees and their engagement with workplace health promotion. Knowledge exchange of a conceptual and instrumental nature occurred and was facilitated by the shared grant application, clear governance structures, joint planning, regular information exchange between researchers and policy-makers and research student placements in the TSS. Flexibility and acknowledgement of different priorities and perspectives of partner organizations were identified as critical factors for enabling effective partnership working and research relevance. Academic-policy-maker partnerships can be a powerful mechanism for improving policy relevance of research, but need to incorporate strategies that facilitate regular input from researchers and policy-makers in order to achieve this. [ABSTRACT FROM AUTHOR]

The article presents a best practice model that can be utilized by food system actors to assist with (re) building trust in the food system, before, during and after a food incident defined as 'any situation within the food supply chain where there is a risk or potential risk of illness or confirmed illness or injury associated with the consumption of a food or foods' (Commonwealth of Australia. National Food Incident Response Protocol. Commonwealth of Australia, Canberra, 2012). Interviews were undertaken with 105 actors working within the media, food industry and food regulatory settings across Australia, New Zealand (NZ) and the United Kingdom(UK). Interview data produced strategy statements, which indicated participant views on how to (re)build consumer trust in the food system. These included: (i) be transparent, (ii) have protocols and procedures in place, (iii) be credible, (iv) be proactive, (v) put consumers first, (vi) collaborate with stakeholders, (vii) be consistent, (viii) educate stakeholders and consumers, (ix) build your reputation and (x) keep your promises. A survey was designed to enable participants to indicate their agreement/disagreement with the ideas, rate their importance and provide further comment. The five strategies considered key to (re)building consumer trust were used to develop a model demonstrating best practice strategies for (re)building consumer trust in the food system before, during and after a food incident. In a world where the food system is increasingly complex, strategies for (re)building and fostering consumer trust are important. This study offers a model to do so which is derived from the views and experiences of actors working across the food industry, food regulation and the media. [ABSTRACT FROM AUTHOR]

Unhealthy diets are the major contributor to poor health in Australia and many countries globally. The majority of food spending in Australia occurs in supermarkets, which stock and sell both healthy and unhealthy foods. This study aimed to compare the foods advertised in the marketing catalogues (circulars) from four Australian supermarket chains with the Australian Guide to Healthy Eating. The content of national online weekly supermarket catalogues from four major Australian supermarket retailers was audited from June-September 2013 (12 weeks). Advertised products were categorized as (i) foods in the five core food groups (plus water); (ii) discretionary foods plus fats and oils; (iii) alcohol and (iv) other (food not fitting into any other category). Across all chains combined, 34.2% of foods advertised were from the five core food groups, 43.3% were discretionary foods, 8.5% were alcohol and the remaining 14.0% were 'other' foods. The percentage of advertised foods in the five core food groups varied between 29.3 and 38.3% across the four chains, whereas the percentage of discretionary foods varied between 34.8 and 49.0%. Australian supermarket catalogues heavily promote discretionary foods and contribute towards an environment that supports unhealthy eating behaviour. Strategies to increase the ratio of healthy-to-unhealthy foods need to be explored as part of efforts to improve population diets. [ABSTRACT FROM AUTHOR]

Community-based initiatives (CBIs) that build capacity and promote healthy environments hold promise for preventing obesity and non-communicable disease, however their characteristics remain poorly understood and lessons are learned in isolation. This limits understanding of likely effectiveness of CBIs; the potential for actively supporting practice; and the translation of community-based knowledge into policy. Building on an initial survey (2010), an online survey was launched (2013) with the aim to describe the reach and characteristics of Australian CBIs and identify and evaluate elements known to contribute to best practice, effectiveness and sustainability. Responses from 104 CBIs were received in 2013. Geographic location generally reflected population density in Australia. Duration of CBIs was short-term (median 3 years; range 0.2-21.0 years), delivered mostly by health departments and local governments. Median annual funding had more than doubled since the 2010 survey, but average staffing had not increased. CBIs used at least two strategy types, with a preference for individual behaviour change strategies. Targeting children was less common (31%) compared with the 2010 survey (57%). Logic models and theory were used in planning, but there was low use of research evidence and existing prevention frameworks. Nearly, all CBIs had an evaluation component (12% of budget), but dissemination was limited. This survey provides information on the scope and varied quality of the current obesity prevention investment in Australia. To boost the quality and effectiveness of CBIs, further support systems may be required to ensure that organizations adopt upstream, evidence-informed approaches; and integrate CBIs into systems, policies and environments. [ABSTRACT FROM AUTHOR]

In this article, we discuss qualitative findings basing on the experiences of refugee women living in Melbourne, Australia, who participated in a peer support training programme and received a free mobile phone. We pay attention to social support as a health enhancing strategy and empowerment that occurred among the participants. Participation in peer support groups and access to a mobile phone were beneficial for the women. Peer support functioned as social support among group members. The programme allowed the women to be connected to their families and the wider communities and assisted them to access health care and other settlement aspects with greater ease. It also increased personal empowerment among the women. Our programme shows that by tapping on community resources to ameliorate personal or resettlement issues, the burden on service providers can be reduced. Our findings also offer a model for future research and programmes regarding refugee people elsewhere. [ABSTRACT FROM AUTHOR]

Translating evidence-based interventions into community practice is vital to health promotion. This study used the RE-AIM framework to evaluate the larger dissemination of the ManUp intervention, an intervention which utilized interactive web-based technologies to improve the physical activity and nutrition behaviors of residents in Central Queensland, Australia. Data were collected for each RE-AIM measure (Reach, Effectiveness, Adoption, Implementation, Maintenance) using (i) computer-assisted telephone interview survey (N=312) with adults (18years and over) from Central Queensland, (ii) interviews with key stakeholders from local organizations (n= 12) and (iii) examination of project-related statistics and findings. In terms of Reach, 47% of participants were aware of the intervention; Effectiveness, there were no significant differences between physical activity and healthy nutrition levels in those aware and unaware; Adoption, 73 participants registered for the intervention and 25% of organizations adopted some part of the intervention; Implementation, 26% of participants initially logged onto the website, 29 and 17% started the web-based physical activity and nutrition challenges, 33% of organizations implemented the intervention, 42% considered implementation and 25% reported difficulties; Maintenance, an average of 0.57 logins and 1.35 entries per week during the 12 week dissemination and 0.27 logins and 0.63 entries per week during the 9-month follow-up were achieved, 22 and 0% of participants completed the web-based physical activity and nutrition challenges and 33.3% of organizations intended to continue utilizing components of the intervention. While this intervention demonstrated good reach, effectiveness, adoption and implementation warrant further investigation. [ABSTRACT FROM AUTHOR]

The obesity epidemic is a consequence of the interaction of cultural, environmental, genetic and behavioural factors; framing the issue is central to determining appropriate solutions. This study used content and thematic framing analysis to explore portrayal of responsibility for obesity in policy documents in Australia, France and Switzerland. For Australia and France, obesity causality was a combination of individual and environmental factors, but for Switzerland, it was predominantly individual. The primary solutions for all countries were health promotion strategies and children's education. Industry groups proposed more school education while health advocates advised government intervention. Where France emphasized cultural attitudes towards taste, Australia focused on sport. The French were most keen on legislating against unhealthy foods compared with Switzerland where there was opposition towards regulation of individual's choices. To curb the increasing prevalence of obesity, allocation of responsibility needs to be considered and initiatives enacted accordingly. [ABSTRACT FROM AUTHOR]

Public policy strategies impact on population health by acting on the effectiveness, availability and distribution of the social determinants of health. Reducing obesity and promoting healthy weight is a key focus of governments, health promoters and researchers, and can benefit from a systems approach with 'upstream' policy action beyond the health sector. Although the literature identifies many areas for hypothetical non-health policy action, and in particular relating to food and activity environments, few have identified practical, politically viable and relatively cost-free processes by which non-health sectors would want to commit to such action. This article details how the Government of South Australia used the Health in All Policies (HiAP) approach in the SA HiAP Healthy Weight Project. It mapped the core business and policy directions of 44 state departments against research on 'what works' to address obesity. Negotiations then developed high-level policy commitments to address factors promoting healthy weight which predominantly changed ways of working rather than requiring new expenditure and also assisted departments in meeting their own goals; departmental chief executives endorsed the commitments. By starting from departmental documents, and not restricting the project to departments with more 'obvious' obesity prevention potential, we gained commitment to a broader range of policy actions than identified elsewhere; for example, for prisons, environment and botanic gardens, housing and vocational education. The SA HiAP Healthy Weight Project provides one example of a workable, evidence-based systems approach to increase commitment to practical and politically viable opportunities across government to address the non-health environments supporting healthy weight. [ABSTRACT FROM AUTHOR]

Area-based strategies have been widely employed in efforts to improve population health and take action on social determinants of health (SDH) and health inequities, including in urban areas where many of the social, economic and environmental factors converge to influence health. Increasingly, these factors are recognized as being part of a complex system, where population health outcomes are shaped by multiple, interacting factors operating at different levels of social organization. This article reports on research to assess the extent to which an alliance of health and human service networks is able to promote action on SDH within an Australian urban region, using a complex systems frame. We found that such an alliance was able to promote some effective action which takes into account complex interactions between social factors affecting health, but also identified significant potential barriers to other forms of desired action identified by alliance members. We found that a complex systems lens was useful in assessing a collaborative intervention to address SDH within an urban region. [ABSTRACT FROM AUTHOR]

Networks in health care typically involve services delivered by a defined set of organizations. However, networked associations between the healthcare system and consumers or consumer organizations tend to be open, fragmented and are fraught with difficulties. Understanding the role and activities of consumers and consumer groups in a formally initiated inter-organizational health network, and the impacts of the network, is a timely endeavour. This study addresses this aim in three ways. First, the Unbounded Network Inter-organizational Collaborative Impact Model, a purpose-designed framework developed from existing literature, is used to investigate the process and products of inter-organizational network development. Second, the impact of a network artefact is explored. Third, the lessons learned in inter-organizational network development are considered. Data collection methods were: 16 h of ethnographic observation; 10 h of document analysis; six interviews with key informants and a survey (n = 60). Findings suggested that in developing the network, members used common aims, inter-professional collaboration, the power and trust engendered by their participation, and their leadership and management structures in a positive manner. These elements and activities underpinned the inter-organizational network to collaboratively produce the Health Expo network artefact. This event brought together healthcare providers, community groups and consumers to share information. The Health Expo demonstrated and reinforced inter-organizational working and community outreach, providing consumers with community-based information and linkages. Support and resources need to be offered for developing community inter-organizational networks, thereby building consumer capacity for self-management in the community. [ABSTRACT FROM AUTHOR]

There is increasing emphasis on wellbeing as a target for mental health promotion, especially during the formative period of childhood. Despite growing research on the importance of mental wellbeing, there is little information on how to effectively promote it or how to promote it equitably. This article presents a scoping review of interventions which seek to promote mental wellbeing and reduce inequities in children and young people living in high income countries. We used Fair Foundations: The VicHealth framework for health equity (VicHealth (2013) Melbourne, Australia: The Victorian Health Promotion Foundation) to identify points of entry at three layers of influence: (i) socio-economic, cultural and political contexts, (ii) daily living conditions, and (iii) individual and family health-related factors. We identified more than 1000 interventions which aimed to prevent or treat childhood mental illness, but there were far fewer that aimed to promote children's or young people's mental wellbeing. The interventions we studied were either universal or specifically targeted children from disadvantaged families: none explicitly used an equity framework to guide their design or evaluation or addressed social gradients in wellbeing. Most interventions remained focused on proximate factors, although we also identified a handful of interventions that sought to address children's access to services and their educational and neighbourhood environments. However, we found encouraging evidence that interventions in family and educational settings were successful in building children's strengths and supporting positive parenting, universally and within disadvantaged groups. Such positive programme evaluations signal the potential for using a proportionate universalism approach that emphasizes equity in the promotion of mental wellbeing. [ABSTRACT FROM AUTHOR]