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Issue Addressed: This paper aims to explore Victoria parents' perceptions of their current practices and barriers in providing school lunches for their primary school children. Methods: Respondents were asked via an online survey about their lunch provision practices, perceptions of the healthiness of school lunches, and barriers to providing healthy school lunches. Data were analysed using different statistical techniques: Chi‐square test, Spearman correlation analysis, Mann–Whitney U test, and Kruskal–Wallis test. Results: In total, 359 respondents completed the survey. Most respondents (84%) reported their child takes a home‐packed lunch to school every day. Most respondents provided fruits (94%), vegetables (57%), and sandwiches (54%) every day for school lunches, whilst other core food items such as milk, meats, and legumes were provided less frequently. A substantial proportion of respondents provided some discretionary food items frequently (e.g., the proportion of respondents providing selected discretionary food items daily or 3–4 times/week: salty crackers—50%, sweet cookies/biscuits—40%, chips—20%). Respondents strongly agreed or agreed with several barriers; examples include not packing certain foods due to food spoilage concerns (50%) (school‐related), the allocated time at their child's school is not enough to eat and enjoy school lunch (48%) (school‐related), need more meal ideas (61%) (parent‐related), healthy foods take more time to prepare (51%) (parent‐related), and children request easy‐to‐eat food for school lunches (50%) (child‐related). Core food score (an indicator of frequency of preparing/packing core food) was negatively correlated with parent‐related and child‐related barrier scores, whilst discretionary food score (an indicator of frequency of preparing/packing discretionary food) was positively correlated with these barrier scores. Conclusions: Overall, home‐packed lunches remain the main option in primary schools in Victoria, and parents face several challenges in providing healthy lunches for their primary school children. So What?: The findings suggest the need for strategies from school leaders, education authorities, and policymakers to improve the quality of lunch content and address the barriers faced by parents. [ABSTRACT FROM AUTHOR]

Background: Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alleviate this disparity. Methods: Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18–64 years from the 2010–2020 Behavioral Risk Factor Surveillance System, we implemented difference‐in‐differences regression to estimate the association between the Medicaid expansions and guideline‐adherent cervical cancer screening and health care coverage. Results: The Medicaid expansions were not associated with guideline‐adherent cervical cancer screening (AIAN: −1 percentage point [ppt] [95% confidence interval, CI: −4, 2 ppts]; White: 3 ppts [95% CI: −0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: −8 ppts [95% CI: −13, −2]; White: −6 ppts [95% CI: −9, −4]). Conclusions: While we observed improvements in health care coverage, we did not observe changes to guideline‐adherent cervical cancer screening following the ACA's Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths. [ABSTRACT FROM AUTHOR]

Objective: To explore population‐level American Indian & Alaska Native‐White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual‐level risk factors. Data Sources and Study Setting: We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017. Study Design: We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native‐White inequality. Data Collection/Extraction Methods: Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate. Principal Findings: After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0–34.8), 3.2 percentage points (95% CI: 1.8–4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie). Conclusions: The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low‐risk Robson group 1 and those with non‐cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality. [ABSTRACT FROM AUTHOR]

Objectives: We aim to contribute to the literature reporting tests of selection in utero. The theory of reproductive suppression predicts that natural selection would conserve mechanisms, referred to collectively as selection in utero, that spontaneously abort fetuses unlikely to thrive as infants in the prevailing environment. Tests of this prediction include reports that women give birth to fewer than expected male twins, historically among the frailest of infants, during stressful times. The onset of the COVID-19 pandemic in the United States in Spring 2020 demonstrably stressed the population. We test the hypothesis that conception cohorts in gestation at the onset of the pandemic in the United States yielded fewer than expected live male twin births. Methods: We retrieved deidentified data on the universe of live births in the United States from the National Center for Health Statistics birth certificate records. We applied Box-Jenkins time-series methods to the twin secondary sex ratio computed for 77 monthly conception cohorts spanning August 2013 to December 2019 to detect outlying cohorts in gestation at the onset of the pandemic. Results: The twin secondary sex ratio fell below expected values in three conception cohorts (i.e., July, September, and October 2019, all p < .05) exposed in utero to the onset of the pandemic. Conclusions: Our results add to prior findings consistent with selection in utero. The role of selection in utero in shaping the characteristics of live births cohorts, especially during the COVID-19 pandemic, warrants further scrutiny. [ABSTRACT FROM AUTHOR]

Background: The United States (US) data suggest fewer‐than‐expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID‐19 pandemic at different points in gestation on preterm birth. Objective: Our objective was to determine—among cohorts exposed to the early COVID‐19 pandemic—whether observed counts of overall, early and moderately preterm birth fell outside the expected range. Methods: We used de‐identified, cross‐sectional, national birth certificate data from 2014 to 2020. We used month and year of birth and gestational age to estimate month of conception for birth. We calculated the count of overall (<37 weeks gestation), early (<33 weeks gestation) and moderately (33 to <37 weeks gestation) preterm birth by month of conception. We employed time series methods to estimate expected counts of preterm birth for exposed conception cohorts and identified cohorts for whom the observed counts of preterm birth fell outside the 95% detection interval of the expected value. Results: Among the 23,731,146 births in our study, the mean prevalence of preterm birth among monthly conception cohorts was 9.7 per 100 live births. Gestations conceived in July, August or December of 2019—that is exposed to the early COVID‐19 pandemic in the first or third trimester—yielded approximately 3245 fewer moderately preterm and 3627 fewer overall preterm births than the expected values for moderate and overall preterm. Gestations conceived in August and October of 2019—that is exposed to the early COVID‐19 pandemic in the late second to third trimester—produced approximately 498 fewer early preterm births than the expected count for early preterm. Conclusions: Exposure to the early COVID‐19 pandemic may have promoted longer gestation among close‐to‐term pregnancies, reduced risk of later preterm delivery among gestations exposed in the first trimester or induced selective loss of gestations. [ABSTRACT FROM AUTHOR]

We examined Australian parents' opinions of primary school food and nutrition education (FNE) via a cross‐sectional survey that collected quantitative and qualitative data. Most parents agreed that primary schools should teach FNE, starting at either the first or the second year of primary school and delivered weekly or fortnightly for approximately 1–2 h. The majority of parents believed that FNE could be incorporated into several school subjects. Many believed that FNE should be taught to ensure equity and to promote healthy eating among children. Consideration of parents' opinions about school FNE programmes could help design and deliver more effective FNE programmes. [ABSTRACT FROM AUTHOR]

Background: Preliminary studies suggest that the SARS‐CoV‐2 pandemic and associated social, economic and clinical disruptions have affected pregnancy decision‐making and outcomes. Whilst a few US‐based studies have examined regional changes in birth outcomes during the pandemic's first months, much remains unknown of how the pandemic impacted perinatal health indicators at the national‐level throughout 2020, including during the 'second wave' of infections that occurred later in the year. Objectives: To describe changes in monthly rates of perinatal health indicators during the 2020 pandemic for the entire US. Methods: For the years 2015 to 2020, we obtained national monthly rates (per 100 births) for four perinatal indicators: preterm (<37 weeks' gestation), early preterm (<34 weeks' gestation), late preterm (34–36 weeks' gestation) and caesarean delivery. We used an interrupted time‐series approach to compare the outcomes observed after the pandemic began (March 2020) to those expected had the pandemic not occurred for March through December of 2020. Results: Observed rates of preterm birth fell below expectation across several months of the 2020 pandemic. These declines were largest in magnitude in early and late 2020, with a 5%–6% relative difference between observed and expected occurring in March and November. For example, in March 2020, the observed preterm birth rate of 9.8 per 100 live births fell below the 95% prediction interval (PI) of the rate predicted from history, which was 10.5 preterm births per 100 live births (95% PI 10.2, 10.7). We detected no changes from expectation in the rate of caesarean deliveries. Conclusions: Our findings provide nationwide evidence of unexpected reductions in preterm delivery during the 2020 SARS‐CoV‐2 pandemic in the US. Observed declines below expectation were differed by both timing of delivery and birth month, suggesting that several mechanisms, which require further study, may explain these patterns. [ABSTRACT FROM AUTHOR]

Background: Non‐Hispanic Black (NHB) women face a 50% increased risk of delivering preterm compared to non‐Hispanic White (NHW) women in the United States. Sociodemographic and pregnancy risk factors do not fully explain this inequity. This inequity exists even among women with a college education, although recent empirical analysis on racial inequities in preterm delivery (PTD) among college‐educated women is lacking. Furthermore, the contribution of preconception risk factors to the racial inequity in PTD has not been examined. Objectives: To determine whether: (i) there is a NHB‐NHW inequity in PTD among college‐educated women; (ii) the prevalence of known, measured sociodemographic, pregnancy, and preconception PTD risk factors differs between NHB and NHW college‐educated women; (iii) equalising the distribution of risk factors between college‐educated NHB and NHW women reduces or eliminates the racial inequity in PTD. Methods: We analysed US natality data from 2015 to 2016 among women with a college degree or higher (n = 2 326 512). We calculated frequencies of sociodemographic, pregnancy, and preconception risk factors among all women and separately by race/ethnicity. We used modified Poisson regression models to estimate the association between race/ethnicity and PTD controlling for known, measured sociodemographic, pregnancy, and preconception factors. Results: The largest percentage point differences in risk factors between NHW and NHB women were observed for marital status, trimester of care initiation, body mass index, and birth interval. Among college‐educated women, the unadjusted risk of PTD for NHB women was 1.77 (95% CI 1.74, 1.79) times the risk for NHW women. After controlling for sociodemographic, pregnancy, and preconception factors, this attenuated to RR 1.47 (95% CI 1.45, 1.49). Conclusions: A racial inequity in PTD persists among college‐educated women. Racism contributes to the NHB‐NHW inequity in PTD, in part, through its influence on known sociodemographic, pregnancy, and preconception risk factors for PTD and, in part, through unmeasured pathways. [ABSTRACT FROM AUTHOR]

Background: Making causal inference regarding impacts of macrolevel economic conditions during pregnancy on pregnancy outcomes is hampered by the presence of unmeasured variables that may influence women's probability of giving birth under certain economic conditions (ie, exposure) as well as her pregnancy outcomes. Maternal fixed-effects (FE) analyses, in which the association between exposure and outcomes is estimated within mothers who had discordant outcomes, can control for such unmeasured variables when they are invariant across pregnancies.Methods: We utilised a maternally linked data set of all singleton births in Michigan from 1990 to 2012 (n = 2 657 272 for full sample; n = 269 943 for FE analytic sample) to examine the relationship between state-level unemployment rates during pregnancy and preterm birth (PTB, <37 weeks' gestation). Measured maternal characteristics that change across pregnancies, for example, age, marital status, education, parity, and infant sex, were included as covariates in the model.Results: Using an FE approach, we found that each one percentage point increase in state unemployment in the first trimester of pregnancy was associated with a modest 3% increase in odds of PTB. Our results were consistent with previously published results in a national sample and held across random- versus fixed-effect models, analytic samples, and outcome measures.Conclusions: Our findings provide further evidence that economic downturn during early pregnancy may be associated with modest increases in PTB. [ABSTRACT FROM AUTHOR]

Objective: Suicide mortality rates in rural areas of the United States are twice that of rates in urban areas, and identifying which factors—eg, higher rates of suicidal distress, lower rates of help‐seeking behaviors, or greater access to firearms—contribute to this rural/urban disparity could help target interventions. Method: Using 2015‐2016 data on adult respondents to the California Health Interview Survey (n = 40,041), we examined associations between residence in a rural (vs nonrural) census tract and nonfatal suicidal ideation and attempt. Results: We found that living in a rural area was not associated with nonfatal suicidal behavior (OR for past‐year suicidal ideation = 0.87, 95% CI: 0.63‐1.20; OR for past‐year suicide attempt = 0.55, CI: 0.20‐1.48). Women living in rural areas had higher odds of lifetime suicidal ideation compared to women living in nonrural areas, but this difference was not significant (OR = 1.17, CI: 0.94‐1.44). We also found that, among individuals reporting suicidal behavior, there were few rural/nonrural differences in perceived need for treatment, such as seeing a physician or taking a prescription for mental health problems. Conclusions: Our results do not suggest higher suicidal distress or lower treatment‐seeking behaviors as explanations for the rural/urban disparity in suicide mortality rates. Further attention is needed to the unique risk factors driving suicidality in rural areas, as well as exploring heterogeneity in these factors across different rural contexts. [ABSTRACT FROM AUTHOR]

Aim: A health workforce with the ability to practice with Aboriginal communities is crucial to bridge the health gap between Aboriginal and non‐Aboriginal Australians. This study aimed to explore the impact of university Aboriginal health placements on preparing dietetic graduates for practice with Aboriginal communities. Methods: A mixed methods sequential explanatory design was used. A sample of 594 dietetic graduates was invited to complete a survey that identified Aboriginal health experiences and measured attitudes and self‐confidence towards working in Aboriginal health using a five‐point Likert scale. Participants were divided into placement versus no‐placement groups and compared using chi‐squared tests. Sixteen of 33 participants who had completed an Aboriginal health placement were invited to participate in a semi‐structured interview to explore how placement influenced practice with Aboriginal communities. Interviews were analysed using content analysis. Results: A final sample of 120 participants showed that placement participants reported significantly higher self‐confidence towards working in Aboriginal health compared with no‐placement participants (No‐placement = 35% agree, 36% neutral, 29% disagree; Placement = 74% agree, 11% neutral, 16% disagree; χ2 (2, 88) = 9.4; P = 0.01). Fifteen participants were interviewed. Interview data indicated that situated learning experiences, breaking down stereotypes, empathy through learning from Aboriginal people, and Aboriginal health role‐models were key components of Aboriginal health placements in preparing dietetic graduates for practice with Aboriginal communities. Conclusions: The results suggest that Aboriginal health placements may be an effective strategy for preparing dietetic graduates for practice with Aboriginal communities. The feasibility of placement or alternative curriculum content needs to be explored. [ABSTRACT FROM AUTHOR]

Objective: Salt reduction is a public health priority because it is a leading contributor to the global burden of disease. As in Australia there is uncertainty about the current level of salt intake, we sought to estimate current levels.Study Design: Random effects meta-analysis of data from 31 published studies and one unpublished dataset that reported salt or sodium consumption by Australian adults on the basis of 24-hour urine collections or dietary questionnaires.Data Sources: MEDLINE (via Ovid) and EMBASE (to August 2016).Data Synthesis: Thirty-one published studies and one unpublished dataset (1989-2015; 16 836 individuals) were identified. The mean weighted salt consumption estimated from 24-hour urine collections was 8.70 g/day (95% CI, 8.39-9.02 g/day); after adjusting for non-urinary salt excretion, the best estimate of salt intake in Australia is 9.6 g/day. The mean weighted intake was 10.1 g/day (95% CI, 9.68-10.5 g/day) for men and 7.34 g/day (95% CI, 6.98-7.70 g/day) for women. Mean weighted consumption was 6.49 g/day (95% CI, 5.94-7.03 g/day) when measured with diet diaries, 6.76 g/day (95% CI, 5.48-8.05 g/day) when assessed with food frequency questionnaires, and 6.73 g/day (95% CI, 6.34-7.11) when assessed by dietary recall. Salt intake had not decreased between 1989 and 2015 (R2 = -0.02; P = 0.36).Conclusion: Salt intake in Australian adults exceeds the WHO-recommended maximum of 5 g/day and does not appear to be declining. Measuring salt intake with methods based on self-reporting can substantially underestimate consumption. The data highlight the need for ongoing action to reduce salt consumption in Australia and robust monitoring of population salt intake. [ABSTRACT FROM AUTHOR]

Aim: The need for dietetic students to develop interprofessional collaborative practice capabilities is well recognised. The aim of this study was to examine the ability of an online interprofessional education (IPE) unit (using asynchronous and synchronous media) to improve dietetic students' confidence in understanding professional roles and attitudes associated with interprofessional practice along with exploring their experience in the unit. Methods: Final year master of dietetic students undertaking a compulsory online unit in IPE were invited to complete a questionnaire examining their confidence in understanding professional roles and their interprofessional attitudes both pre ‐ and post ‐ delivery of the unit, and to participate in semi ‐ structured telephone interviews to explore their experience in the unit. Results: Thirty ‐ five dietetic students completed the questionnaire pre ‐ and post ‐ unit, along with seven students undertaking a telephone interview. Their confidence in understanding the roles of other health professions (P = 0.000 to 0.014), self ‐ assessment of interprofessional communication and teamwork skills (P = 0.002) and attitudes towards interprofessional interaction (P = 0.001) and interprofessional relationships (P = 0.002) increased significantly from pre ‐ to post ‐ unit. The students articulated positives about the experience (flexibility of the delivery, opportunity to reflect on personal factors related to teamwork, increasing their knowledge of other professions) and some challenges (lack of body language, some technological difficulties, the need for regular contribution to the teams' asynchronous discussion boards). Conclusions: This study suggests that although there can be some challenges in online IPE, it can be a positive experience and can improve dietetic students' collaborative practice attitudes and confidence in understanding other professional roles. [ABSTRACT FROM AUTHOR]

Aim Reducing dietary sodium and increasing dietary potassium are recommended to reduce blood pressure. This study aimed to determine the main foods sources of sodium and potassium. Methods Participants were recruited via advertisements or blood pressure screening sessions. Food sources of sodium and potassium were assessed via 24-hour dietary records in 299 free-living Australian adults (141 male, 158 female; age 54.6(9.5)years; BMI 29.4(3.9)kg/m2). Results The mean sodium intake was 118(51)mmol/d (2725(1176)mg/d) and the mean potassium intake was 91(28)mmol/d (3550(1098)mg/d). Breads and cereals provided the majority (38%) of sodium with bread contributing 20%. Vegetable products/dishes contributed most potassium (23%) with potatoes providing 9%. Main meals provided 89% of sodium and 85% of potassium. Lunch and dinner provided similar sodium proportions (34% and 38%, respectively) but more energy was consumed at dinner (26% vs 40%, respectively). Lunch had the highest sodium density of all meals (420 mg/MJ). Conclusion A reduction in the salt content of processed foods, particularly bread, is recommended to decrease sodium intake. This reduction in salt content combined with meal specific education focusing on choosing lower sodium foods at lunch in particular, as well as incorporating more fruits and vegetables, could effectively reduce dietary sodium and increase potassium. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of specific advice for increasing fruit, vegetable and dairy intake in free-living men participating in a weight loss study. Methods: Subjects were randomised to one of two 12-week weight loss diets, either the WELL with daily targets of four serves of fruit, four serves of vegetables and three serves of dairy or a low fat diet (LF) with general advice to increase fruit and vegetable intake. Three-day food group diaries and a food frequency questionnaire assessed intake. Results: Fifty-four overweight/obese male adults completed the study (WELL, n = 27; LF, n = 27; body mass index (mean ± standard deviation), 30.4 ± 2.5 kg/m2; age, 47.7 ± 9.5 years). There was no difference in mean weight change between groups (WELL, −4.8 ± 3.3 kg; LF, −4.6 ± 3.1 kg). Subjects on the WELL diet had greater (mean difference ± standard error) fruit (0.7 ± 0.2 serves/day), vegetable (1.2 ± 0.2 serves/day) and dairy (1.1 ± 0.1 serves/day) intakes than the LF group (measured by the food group diaries) (all P < 0.01). The WELL group reached the daily target for fruit from week 1 (4.7 ± 1.4 serves/day), vegetables by week 6 (4.1 ± 1.5 serves/day) and for dairy by week 8 (3.0 ± 0.8 serves/day). Conclusions: Providing specific dietary targets to men for weight loss appears to promote greater consumption of fruit, vegetable and dairy foods than providing general dietary advice. Meeting dietary targets appears to require different adjustment periods depending on the food type. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on mental illness in dietetic students in Australia.