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Purpose This study examined the association of social contexts and food preparation location with the quality of meals and snacks (predominately from the five food groups (FFG) versus discretionary foods) in a sample of young Australian adults (18–30 years old) using wearable camera technology. Methods A sub-sample from the cross-sectional MYMeals study wore a wearable camera that captured images every 30 s for three consecutive days. Eating episodes from 133 participants (55% female) were classified across 4 domains: food quality (observed proportion of FFG and discretionary items), preparation location, social interaction, and screen use. Socio-economic status (SES) was assigned using residential postcode and gender self-reported. Associations of contexts and demographic factors with food quality stratified by meal type were determined using mixed binary logistic regression models. Results Of the 1840 eating episodes identified, 1775 were included in analysis (n = 8 preparation location and n = 57 food components that could not be identified were excluded). Food prepared at home was more likely to be from the FFG at lunch (OR = 4.8 95% CI 2.7–8.6), dinner (OR = 14.8 95% CI 7.6–28.6), and snacks (OR = 3.2 95% CI 2.2–4.8). Participants from higher SES areas were more likely to consume breakfasts (OR = 3.2 95% CI 1.4–7.4) and lunches (OR = 1.9 95% CI 1.0–3.7) predominately from the FFG. Females were more likely to consume lunches (OR = 2.0 95% CI 1.1–3.8) that was largely from the FFG. Social interaction and screen use were not associated with meal or snack quality. Conclusion Wearable cameras have verified the importance of addressing meals and snacks prepared outside of home as an important contributor of discretionary food.

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.

Young adults are the highest consumers of food prepared outside home (FOH) and gain most weight among Australian adults. One strategy to address the obesogenic food environment is menu labelling legislation whereby outlets with &gt, 20 stores in one state and &gt, 50 Australia-wide must display energy content in kJ. The aim of this study was to assess the contribution of FOH to the energy and macronutrients, saturated fat, total sugars and sodium intakes of young Australians. One thousand and one 18 to 30-year-olds (57% female) residing in Australia’s most populous state recorded all foods and beverages consumed and the location of preparation for three consecutive days using a purpose-designed smartphone application. Group means for the daily consumption of energy, percentage energy (%E) for protein, carbohydrate, total sugars, total and saturated fats, and sodium density (mg/1000 kJ) and proportions of nutrients from FOH from menu labelling and independent outlets were compared. Overall, participants consumed 42.4% of their energy intake from FOH with other nutrients ranging from 39.8% (sugars) to 47.3% (sodium). Independent outlets not required to label menus, contributed a greater percentage of energy (23.6%) than menu labelling outlets (18.7%, p &lt, 0.001). Public health policy responses such as public education campaigns, extended menu labelling, more detailed nutrition information and reformulation targets are suggested to facilitate healthier choices.

Background Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. Methods In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. Results Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p Conclusions This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors’ health and quality-of-life at a relatively low cost. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Digital technology, including the internet, smartphones, and wearables, provides the possibility to bridge the mental health treatment gap by offering flexible and tailored approaches to mental health care that are more accessible and potentially less stigmatising than those currently available. However, the evidence base for digital mental health interventions, including demonstration of clinical effectiveness and cost-effectiveness in real-world settings, remains inadequate. The James Lind Alliance Priority Setting Partnership for digital technology in mental health care was established to identify research priorities that reflect the perspectives and unmet needs of people with lived experience of mental health problems and use of mental health services, their carers, and health-care practitioners. 644 participants contributed 1369 separate questions, which were reduced by qualitative thematic analysis into six overarching themes. Following removal of out-of-scope questions and a comprehensive search of existing evidence, 134 questions were verified as uncertainties suitable for research. These questions were then ranked online and in workshops by 628 participants to produce a shortlist of 26. The top ten research priorities, which were identified by consensus at a stakeholder workshop, should inform research policy and funding in this field. Identified priorities primarily relate to the safety and efficacy of digital technology interventions in comparison with face-to-face interventions, evidence of population reach, mechanisms of therapeutic change, and the ways in which the effectiveness of digital interventions in combination with human support might be optimised.

Objective: To monitor patterns of use of e‐cigarettes to understand their potential impact on the New South Wales (NSW) population in Australia. Methods: A cross‐sectional online survey was carried out with a sample of adults in NSW in February 2016. Ever and past 30‐day use of e‐cigarettes, reasons for use, place of purchase and use within outdoor and enclosed public places were assessed along with sociodemographic characteristics. Results: Ever and past 30‐day use was reported by 13% and 4% of the sample, respectively. More than one‐third of participants did not purchase their own e‐cigarette (36.3%). The most frequently reported reason for using an e‐cigarette for smokers and ex‐smokers was to help quit smoking (45.3% and 44.7%, respectively) while for non‐smokers it was novelty (40%). E‐cigarettes were most commonly used at home (59.4%), in outdoor dining areas (36.8%) and in the workplace (27.8%). Conclusions: E‐cigarettes are being used by a small percentage of the NSW population. Reasons for e‐cigarette use varied with smoking status. Different sociodemographic characteristics were associated with ever and past 30‐day use of e‐cigarettes. E‐cigarettes are being used in areas that are covered by smoke‐free legislation. Implications for public health: Given e‐cigarettes are being used in smoke‐free areas, policy‐makers could take a precautionary approach by including e‐cigarette use under smoke‐free legislation.

Background Community misconception of what causes cancer is an important consideration when devising communication strategies around cancer prevention, while those initiating social marketing campaigns must decide whether to target the general population or to tailor messages for different audiences. This paper investigates the relationships between demographic characteristics, identification of selected cancer risk factors, and associated protective behaviours, to inform audience segmentation for cancer prevention social marketing. Methods Data for this cross-sectional study (n = 3301) are derived from Cancer Council New South Wales’ 2013 Cancer Prevention Survey. Descriptive statistics and logistic regression models were used to investigate the relationship between respondent demographic characteristics and identification of each of seven cancer risk factors; demographic characteristics and practice of the seven ‘protective’ behaviours associated with the seven cancer risk factors; and identification of cancer risk factors and practising the associated protective behaviours, controlling for demographic characteristics. Results More than 90% of respondents across demographic groups identified sun exposure and smoking cigarettes as moderate or large cancer risk factors. Around 80% identified passive smoking as a moderate/large risk factor, and 40–60% identified being overweight or obese, drinking alcohol, not eating enough vegetables and not eating enough fruit. Women and older respondents were more likely to identify most cancer risk factors as moderate/large, and to practise associated protective behaviours. Education was correlated with identification of smoking as a moderate/large cancer risk factor, and with four of the seven protective behaviours. Location (metropolitan/regional) and country of birth (Australia/other) were weak predictors of identification and of protective behaviours. Identification of a cancer risk factor as moderate/large was a significant predictor for five out of seven associated cancer-protective behaviours, controlling for demographic characteristics. Conclusions These findings suggest a role for both audience segmentation and whole-of-population approaches in cancer-prevention social marketing campaigns. Targeted campaigns can address beliefs of younger people and men about cancer risk factors. Traditional population campaigns can enhance awareness of being overweight, alcohol consumption, and poor vegetable and fruit intake as cancer risk factors. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3540-x) contains supplementary material, which is available to authorized users.

BACKGROUND: Fruit and vegetable (F&V) consumption is below recommendations, and cost may be a barrier to meeting recommendations. Limited evidence exists on individual perceptions about the cost, actual spending and consumption of F&V. This study investigated perceptions and beliefs about cost of F&V and whether this is a barrier to higher consumption. METHODS: An online survey of Australian adults (n = 2474) measured F&V consumption; expenditure on F&V and food; and perceived barriers to consumption. Multivariable logistic regression examined associations between participants' responses about cost of F&V and demographic factors, and with actual consumption and expenditure on F&V. RESULTS: Cost was identified as a barrier for 29% of people not meeting recommended fruit servings and for 14% of people not meeting recommendations for vegetables. Cost was a more common barrier for those on lower incomes (fruit aOR 1.89; 95% CI 1.20-2.98 and vegetables aOR 2.94; 95% CI 1.97-4.39) and less common for older participants (fruit aOR 0.33; 95% CI 0.17-0.62 and vegetables aOR 0.31; 95% CI 0.18-0.52). There was no association between the perceived barriers and actual F&V spending. Twenty percent of participants said F&V were not affordable; 39% said cost made it difficult to buy F&V, and for 23% the cost of F&V meant they bought less than desired. CONCLUSIONS: A minority reported F&V were not affordable where they shopped and that cost was a barrier to higher consumption. However, it is apparent that young adults and those on low incomes eat less than they would like because of cost. Strategies that remove financial impediments to consumption are indicated for these population sub-groups.

Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11–17 years with CFM ( n = 107) and demographically similar controls ( n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = −1.15 to −0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = −0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = −0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.

Children&rsquo, s favourite food and beverage brands use various tactics to foster positive associations and loyalty. This brand-consumer dynamic is frequently influenced by the use of implicit techniques and emotional appeals. Few studies have used physiological methods to examine the connections that brands build with children and the influence this has on their automatic responses. These techniques are potentially less prone to bias than behavioural or cognitive methods. This is the first study to explore the implicit response that children have to images of their favourite food and beverage brands using skin conductance responses as a marker of arousal. Australian children aged 8&ndash, 11 years (n = 48) were recruited. Images of the participants&rsquo, favourite branded food and beverage products, alongside images of the same products unpackaged, their family and friends, and neutral objects were presented in a randomised order with a standard timed interval between images. Children were significantly more aroused by branded images of their favourite food and beverage products than by their unpackaged counterparts (p &lt, 0.042, d = 0.4). The physiological response to the branded products was similar to the response to the children&rsquo, s family and friends (p = 0.900, d = &minus, 0.02). These findings suggest that children may have an implicit connection to their favourite branded products.

Children&rsquo, s exposure to unhealthy food marketing is one factor contributing to childhood obesity. The impact of marketing on children&rsquo, s weight likely occurs via a cascade pathway, through influences on children&rsquo, s food brand awareness, emotional responses, purchasing and consumption. Thus, building emotional attachments to brands is a major marketing imperative. This study explored Australian children&rsquo, s emotional attachments to food and drink brands and compared the strength of these attachments to their food marketing exposure, using television viewing as a proxy indicator. A cross-sectional face-to-face survey was conducted with 282 Australian children (8&ndash, 12 years). Children were asked to indicate their agreement/disagreement with statements about their favourite food and drink brands, as an indicator of the strength and prominence of their brand attachments. Questions captured information about minutes/day of television viewing and the extent that they were exposed to advertising (watched live or did not skip through ads on recorded television). For those children who were exposed to advertisements, their age and commercial television viewing time had significant effects on food and drink brand attachments (p = 0.001). The development of brand attachments is an intermediary pathway through which marketing operates on behavioural and health outcomes. Reducing children&rsquo, s exposure to unhealthy food marketing should be a policy priority for governments towards obesity and non-communicable disease prevention.

Nutrition labelling can influence consumers&rsquo, assessments of food healthiness and their food choices. However, there is a lack of consensus about the optimal type and amount of nutrition information to provide on food packages. This study analysed consumers&rsquo, preferences for front-of-pack information relating to energy and various nutrients (sugar, saturated fat, sodium, fibre, carbohydrate, and protein). The aim was to identify discrete preference segments within the Australian market where the current Health Star Rating front-of-pack labelling system can be displayed with different levels of nutrition information. Adults (n = 1558) completed a survey assessing socio-demographics, self-reported nutrition knowledge, diet healthiness, special dietary requirements, and perceived importance of the provision of energy and nutrient information on the front of food packs. Latent profile analysis identified five consumer segments within the sample that ranged from groups exhibiting high levels of interest in various forms of nutrition information to one with very low interest and one with divergent scores according to whether nutrients were perceived as positive or negative for health. The results indicate that different forms of front-of-pack labelling featuring varying degrees of information about energy and specific nutrients are likely to be of interest and use to different market segments.

Verbal trait disorders encompass a wide range of conditions and are marked by deficits in five domains that impair a person’s ability to communicate: speech, language, reading, spelling, and writing. Nonword repetition is a robust endophenotype for verbal trait disorders that is sensitive to cognitive processes critical to verbal development, including auditory processing, phonological working memory, and motor planning and programming. In the present study, we present a six-generation extended pedigree with a history of verbal trait disorders. Using genome-wide multipoint variance component linkage analysis of nonword repetition, we identified a region spanning chromosome 13q14–q21 with LOD = 4.45 between 52 and 55 cM, spanning approximately 5.5 Mb on chromosome 13. This region overlaps with SLI3, a locus implicated in reading disability in families with a history of specific language impairment. Our study of a large multigenerational family with verbal trait disorders further implicates the SLI3 region in verbal trait disorders. Future studies will further refine the specific causal genetic factors in this locus on chromosome 13q that contribute to language traits. Electronic supplementary material The online version of this article (doi:10.1007/s00439-016-1717-z) contains supplementary material, which is available to authorized users.

ObjectiveThe formation of food brand associations and attachment is fundamental to brand preferences, which influence purchases and consumption. Food promotions operate through a cascade of links, from brand recognition, to affect, and on to consumption. Frequent exposures to product promotions may establish social norms for products, reinforcing brand affect. These pathways signify potential mechanisms for how children’s exposure to unhealthy food promotions can contribute to poor diets. The present study explored children’s brand associations and attachments for major food brands.DesignA cross-sectional online survey was conducted. Fourteen study brands were used, with each child viewing a set of seven logos. The questionnaire assessed perceptions of food brands and perceptions of users of brands, using semantic differential scales, and perceived brand ‘personalities’, using Likert scales.SettingNew South Wales, Australia, October–November 2014.SubjectsChildren aged 10–16 years (n417).ResultsChildren demonstrated strong positive affect to certain brands, perceiving some unhealthy food brands to have positive attributes, desirable user traits and alignment to their own personality. Brand personality traits of ‘smart’ and ‘sporty’ were viewed as indicators of healthiness. Brands with these traits were ranked lower for popularity.ConclusionsChildren’s brand associations and attachments indicate the potential normative social influences of promotions. While children are aware of brand healthiness as an attribute, this competes with other brand associations, highlighting the challenge of health/nutrition messaging to counter unhealthy food marketing. Restricting children’s exposure to unhealthy food marketing and the persuasive nature of marketing is an important part of efforts to improve children’s diet-related health.

Background Unhealthy foods are promoted heavily, through food company sponsorship of elite sport, resulting in extensive exposure among young adults who are avid sport spectators. This study explores the effects of sponsorship of an elite sporting event by: (A) non-food brands (control), (B) unhealthy food brands, (C) healthier food brands, or (D) an obesity prevention public health campaign on young adults’ brand awareness, attitudes, image perceptions, event-sponsor fit perceptions, and preference for food sponsors’ products. Methods A between-subjects web-based experiment was conducted, consisting of four sponsorship conditions (A through D) featuring three product categories within each condition. Australian adults (N = 1132) aged 18–24 years were recruited via a national online panel. Participants viewed promotional videos and news stories about an upcoming international, multi-sport event (with sponsor content edited to reflect each condition), completed a distractor task, and then answered questions assessing the response variables. Regression analyses were conducted to test for differences by sponsorship condition on the respective outcome measures. Results Compared to the control condition, unhealthy food sponsorship promoted higher awareness of, and more favourable attitudes towards, unhealthy food sponsor brands. Unhealthy food sponsorship also led to greater perceived event-sponsor fit and transfer of perceptions of the sporting event to the unhealthy food sponsor brands, relative to the control group. Exposure to sponsorship for healthier foods produced similar sponsorship effects for healthier food sponsor brands, as well as prompting a significant increase in the proportion of young adults showing a preference for these products. Obesity prevention campaign sponsorship promoted higher campaign awareness and perceived event-sponsor fit, but did not impact food attitudes or preference for unhealthy versus healthier foods. Conclusion Findings suggest that restricting elite sport sponsorship to healthier food brands that meet set nutritional criteria could help promote healthier eating among young adults. Sporting organisations should be encouraged to seek sponsorship from companies who produce healthier food brands and government-funded social marketing campaigns. Clinical trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) registration number ACTRN12618000368235. Retrospectively registered 12 March 2018.

Exposure to unhealthy food marketing stimulates children's food consumption. A child's responsiveness is influenced by individual factors, resulting in an increased vulnerability to advertising effects among some children. Whether these differential responses may be altered by different parental feeding behaviours is unclear. The purpose of this study was to determine the relationship between parental feeding practices and children's food intake responses to food advertising exposure. A randomised, crossover, counterbalanced, within subject trial was conducted across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017 with 160 children (7–12 years, n = 40/camp). Children were randomised to either a multiple media (TV and Internet) or single media (TV) condition and exposed to food (3 days) and non-food (3 days) advertising in an online game and/or a cartoon. Children's food consumption (kilojoules (kJ)) was measured at a snack immediately after advertising exposure and then at lunch later in the day. Parents completed the Child Feeding Questionnaire, and ‘restriction’ and ‘pressure to eat’ subscale scores were calculated. While food advertising affected all children in the multiple media condition, there was an increased effect on snack intake among children whose parents reported pressuring them to eat, with children consuming an additional 356 kJ after food advertising compared with non-food advertising. This was 209 kJ more than children whose parents did not pressure them to eat. In the single media condition, only children whose parents reported restrictive feeding practices ate more at lunch on food advertising days than non-food advertising days (240 kJ). These data highlight an increased susceptibility to food advertising among children whose parents report controlling feeding practices.

Background Policies restricting children’s exposure to unhealthy food marketing have been impeded by the lack of evidence showing a direct link between food advertising exposure and children’s energy intake and body weight. Food advertising exposure increases children’s immediate food consumption, but whether this increased intake is compensated for at later eating occasions is not known; consequently the sustained effect on diets remains unclear. Methods We conducted a within-subject, randomised, crossover, counterbalanced study across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017. Children (7–12 years, n = 160) were recruited via local schools, email networks and social media. Two gender- and age-balanced groups were formed for each camp (n = 20), randomised to either a multiple- or single- media condition and exposed to food and non-food advertising in an online game and/or a television cartoon. Children’s food consumption (kilojoules) was measured at a snack immediately after exposure and then at lunch later in the day. Linear mixed models were conducted to examine relationships between food advertising exposure and dietary intake, taking into account gender, age and weight status. Results All children in the multiple-media condition ate more at a snack after exposure to food advertising compared with non-food advertising; this was not compensated for at lunch, leading to additional daily food intake of 194 kJ (95% CI 80–308, p = 0.001, d = 0.2). Exposure to multiple-media food advertising compared with a single-media source increased the effect on snack intake by a difference of 182 kJ (95% CI 46–317, p = 0.009, d = 0.4). Food advertising had an increased effect among children with heavier weight status in both media groups. Conclusion Online (‘advergame’) advertising combined with TV advertising exerted a stronger influence on children’s food consumption than TV advertising alone. The lack of compensation at lunch for children’s increased snack intake after food advertising exposure suggests that unhealthy food advertising exposure contributes to a positive energy-gap, which could cumulatively lead to the development of overweight. Trial registration Australian New Zealand Clinical Trials Registry, number ACTRN12617001230347 (Retrospectively registered).

Objectives: To investigate community support for government-led policy initiatives to positively influence the food environment, and to identify whether there is a relationship between support for food policy initiatives and awareness of the link between obesity-related lifestyle risk factors and cancer. Methods: An online survey of knowledge of cancer risk factors and attitudes to policy initiatives that influence the food environment was completed by 2474 adults from New South Wales, Australia. The proportion of participants in support of seven food policy initiatives was quantified in relation to awareness of the link between obesity, poor diet, insufficient fruit and vegetable consumption, and physical inactivity with cancer and other health conditions. Results: Overall, policies that involved taxing unhealthy foods received the least support (41.5%). Support was highest for introducing a colour-coded food labelling system (85.9%), restricting claims being made about the health benefits of foods which are, overall, unhealthy (82.6%), displaying health warning labels on unhealthy foods (78.7%) and banning unhealthy food advertising that targets children (72.6%). Participants who were aware that obesity-related lifestyle factors are related to cancer were significantly more likely to support food policy initiatives than those who were unaware. Only 17.5% of participants were aware that obesity, poor diet, insufficient fruit and vegetable consumption, and physical inactivity are linked to cancer. Conclusions: There is strong support for all policies related to food labelling and a policy banning unhealthy food advertising to children. Support for food policy initiatives that positively influence the food environment was higher among those who were aware of the link between cancer and obesity-related lifestyle factors than among those who were unaware of this link. Increasing awareness of the link between obesity-related lifestyle factors and cancer could increase community support for food policy initiatives, which, in turn, support the population to maintain a healthy weight.

Objectives In this paper, we report maintenance of behavior change in a nutrition and physical activity intervention for cancer survivors at 12-months follow-up. Methods The ENRICH (Exercise and Nutrition Routine Improving Cancer Health) program was an 8-week face-to-face program for cancer survivors and caregivers, focused on healthy eating, healthy weight, resistance training, and a walking program. Randomized controlled trial participants completed a survey and 7-days of pedometry at baseline, 8-weeks, and 20-weeks. Intervention participants completed 12-month measures. Maintenance was assessed by examining change between 20-weeks and 12-months for cancer survivors. Results Sixty cancer survivors in the intervention group completed baseline data collection, and 29 (48%) completed 12-month assessments. Initial improvements in step counts, weight, and body mass index were maintained from 20-weeks to 12-months. Vegetable consumption declined significantly (difference -30g/day; p = .04). Moderate-to-vigorous physical activity increased significantly (difference 55 minutes/week; p = .05). Conclusions Physical activity and weight improvements were maintained over 12-months indicating the potential for a multiple health behavior intervention to help cancer survivors sustain improvements to lifestyle behaviors. Additional support is warranted to assist cancer survivors to make and maintain dietary changes.

Objective: This study investigated the differences between the amount of shade covering typical activity areas in playgrounds of higher and lower socioeconomic status (SES) areas within metropolitan Sydney, Australia. Methods: Using an established audit tool, surveyors visited 139 urban playgrounds and made 1,033 shade observations recording the estimated percentage of an activity area that was covered by shade and the type of shade available. Results: Shade coverage was significantly associated with SES of an area and with type of activity area (p

There is evidence that easily accessible, comprehensible and consistent nutrient information on the front of packaged foods could assist shoppers to make healthier food choices. This study used an online questionnaire of 4357 grocery shoppers to examine Australian shoppers' ability to use a range of front-of-pack labels to identify healthier food products. Seven different front-of-pack labelling schemes comprising variants of the Traffic Light labelling scheme and the Percentage Daily Intake scheme, and a star rating scheme, were applied to nine pairs of commonly purchased food products. Participants could also access a nutrition information panel for each product. Participants were able to identify the healthier product in each comparison over 80% of the time using any of the five schemes that provided information on multiple nutrients. No individual scheme performed significantly better in terms of shoppers' ability to determine the healthier product, shopper reliance on the 'back-of-pack' nutrition information panel, and speed of use. The scheme that provided information about energy only and a scheme with limited numerical information of nutrient type or content performed poorly, as did the nutrition information panel alone (control). Further consumer testing is necessary to determine the optimal format and content of an interpretive front-of-pack nutrition labelling scheme.

ObjectiveTo determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme.DesignThe Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and ‘below the line’ social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011).SettingThe intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia.SubjectsParents of primary school-aged children (Kindergarten to Year 6).ResultsThe programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0·5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P= 0·004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies.ConclusionsThe Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns. This suggests that funding for localised, community-based programmes should be increased.

Little is known about the complex combination of factors influencing the extent to which children request unhealthy foods from their parents. The aim of this study was to develop a comprehensive model of influencing factors to provide insight into potential methods of reducing these requests. A web panel provider was used to administer a national online survey to a sample of 1302 Australian parent-child dyads (total sample n=2604). Initial univariate analyses identified potential predictors of children's requests for and consumption of unhealthy foods. The identified variables were subsequently incorporated into a path analysis model that included both parents' and children's reports of children's requests for unhealthy foods. The resulting model accounted for a substantial 31% of the variance in parent-reported food request frequency and 27% of the variance in child-reported request frequency. The variable demonstrating the strongest direct association with both parents' and children's reports of request frequency was the frequency of children's current intake of unhealthy foods. Parents' and children's exposure to food advertising and television viewing time were also positively associated with children's unhealthy food requests. The results highlight the need to break the habitual provision of unhealthy foods to avoid a vicious cycle of requests resulting in consumption.

Australian and most international Dietary Guidelines recommend people consume more fruits and vegetables (FV) to maintain a healthy weight and reduce chronic disease risk. Previous Australian and international surveys have shown sub-optimal consumption of FV.This study aimed to assess adults' FV consumption, knowledge of recommended servings, readiness to change, barriers/enabling factors, so that this knowledge might be used for campaigns that support improved consumption.An online survey of a representative sample of adults living in New South Wales, Australia (n = 2474) measuring self-reported FV consumption; attitudes towards FV consumption; stage of change for increasing FV; barriers to consumption; and knowledge of cancer-health benefits.FV consumption was below recommendations, with vegetable consumption notably low. Only 10% of participants ate at least five servings of vegetables/day (median intake was two daily servings), and 57% consumed two servings fruit/day. There was poor recognition that intake of vegetables was inadequate and this was a barrier to improving vegetable consumption; with preferences for other foods, habit and cost also important barriers. Key barriers to increasing fruit intake were habit, preferences for other foods, perishability, and cost. For vegetable consumption, 49% of participants were in the pre-contemplation stage of change, whereas for fruits 56% were in the action/maintenance stage. Sixty-four percent of respondents believed that eating FV would protect against cancer, with 56% reporting they thought not eating enough FV would cause cancer.Understanding what motivates and prevents people from consuming FV is important for developing effective health promotion programs. Similar to previous surveys, there has been little shift in FV consumption. Social marketing campaigns have been shown to improve health-related behaviours, and this study may assist in identifying audience segmentation for better targeted campaigns.

Childhood apraxia of speech (CAS) is a severe and socially debilitating form of speech sound disorder with suspected genetic involvement, but the genetic etiology is not yet well understood. Very few known or putative causal genes have been identified to date, e.g., FOXP2 and BCL11A. Building a knowledge base of the genetic etiology of CAS will make it possible to identify infants at genetic risk and motivate the development of effective very early intervention programs. We investigated the genetic etiology of CAS in two large multigenerational families with familial CAS. Complementary genomic methods included Markov chain Monte Carlo linkage analysis, copy-number analysis, identity-by-descent sharing, and exome sequencing with variant filtering. No overlaps in regions with positive evidence of linkage between the two families were found. In one family, linkage analysis detected two chromosomal regions of interest, 5p15.1-p14.1, and 17p13.1-q11.1, inherited separately from the two founders. Single-point linkage analysis of selected variants identified CDH18 as a primary gene of interest and additionally, MYO10, NIPBL, GLP2R, NCOR1, FLCN, SMCR8, NEK8, and ANKRD12, possibly with additive effects. Linkage analysis in the second family detected five regions with LOD scores approaching the highest values possible in the family. A gene of interest was C4orf21 (ZGRF1) on 4q25-q28.2. Evidence for previously described causal copy-number variations and validated or suspected genes was not found. Results are consistent with a heterogeneous CAS etiology, as is expected in many neurogenic disorders. Future studies will investigate genome variants in these and other families with CAS.

The purpose of this study was to determine the prevalence of children's food requests, and parents' experiences of food marketing directed towards children, in the supermarket environment. A mixed-method design was used. Firstly, intercept interviews were conducted with parents accompanied by a child/children on exiting supermarkets (sampled from a large regional centre in Australia). Parents were asked about the prevalence and types of food requests by child/children during their supermarket visit and whether they purchased these foods. Secondly, focus groups (n = 13) and telephone interviews (n = 3) were conducted exploring parents' experiences of supermarket shopping with children and the impact of child-directed marketing. Of the 158 intercept survey participants (30% response rate), 73% reported a food request during the supermarket visit. Most requested food items (88%) were unhealthy foods, with chocolate/confectionery being the most common food category requested (40%). Most parents (70%) purchased at least one food item requested during the shopping trip. Qualitative interviews identified four themes associated with food requests and prompts in the supermarket: parents' experience of pester power in the supermarket; prompts for food requests in the supermarket; parental responses to pestering in the supermarket environment, and; strategies to manage pestering and minimize requests for food items. Food requests from children are common during supermarket shopping. Despite the majority of the requests being unhealthy, parents often purchase these foods. Parents reported difficulties dealing with constant requests and expressed desire for environmental changes including confectionery-free checkouts, minimization of child friendly product placement and reducing children's exposure to food marketing.

ObjectiveTo determine parents’ and children's attitudes towards food, beverage and alcohol sponsorship of elite and children's sports and the acceptability of policies and alternative funding models to limit this sponsorship.DesignTelephone surveys were conducted with parents in February–May 2011. One child from each household was invited to complete an online survey. Surveys assessed parents’ perceptions about the influence of sponsorship on children and support for limiting sponsorship, and children's awareness of and attitudes towards sponsors.SettingRandomly sampled households in New South Wales, Australia.SubjectsParents (n 825) and children aged 10–16 years (n 243).ResultsThree-quarters of parents supported the introduction of policies to restrict unhealthy food, beverage and alcohol sponsorship of children's and elite sports. More parents (81 %) supported the introduction of alternative funding models to allow these companies to sponsor sport provided there was no visible branding. Two-thirds of children recalled sponsors of their favourite elite sports team/athlete, with 428 sponsors recalled. Of these, 11 % were food/beverage companies and 3 % were alcohol-related. For 39 % of sponsors, children reported feeling better about the company after it had sponsored a team/athlete.ConclusionsAustralian parents support restrictions on unhealthy food, beverage and alcohol sport sponsorship. Children's positive associations regarding sponsors are likely to be linked to brand preferences and usage.

Objectives Sponsorship is recognised as a significant marketing tool and restricting unhealthy food sponsorship of children's sport has been recommended by leading health agencies as a contribution towards preventing childhood obesity. This study aimed to determine the junior sporting community's support for policy interventions to restrict unhealthy food sponsorship. Methods Sports clubs known to have food sponsors and representing the most popular sports for Australian children across a range of demographic areas were recruited. Interview-based questionnaires were conducted at clubs with parents (n = 200) and officials (n = 20), and with governing sporting associations (n = 20). Questionnaires measured respondents’ attitudes towards sponsorship and support for sponsorship regulations. Results Many officials and parents perceived children to be ‘very’ influenced by elite sport sponsorship (65% of association officials, 53% of parents and 45% of club officials). Children were thought to be less influenced by sponsorship of their own sporting clubs (10%, 11% and 10%, respectively). However, 50% of officials and 70% of parents supported restrictions to children's sport sponsorship. Respondents were most supportive of restricting the use of unhealthy food logos on children's uniforms. Conclusions Restricting unhealthy food sponsorship is supported by the sporting community and policy change is needed to reduce the perceived impact of this marketing. Alternative funding mechanisms have the potential to maintain sport funding whist reducing promotional opportunities for unhealthy food.

The present study examined associations between food marketing exposure and adolescents’ food choices and reported consumption of energy-dense and nutrient-poor (EDNP) foods. A cross-sectional survey of 12,188 Australian secondary students aged 12–17 years was conducted, using a web-based self-report questionnaire. Measures included students’ level of exposure to commercial television and non-broadcast types of food marketing, whether they had tried a new product or requested a product they had seen advertised, and their reported consumption of fast food, sugary drinks and sweet and salty snacks. Results indicated greater exposure to commercial television, print/transport/school food marketing and digital food marketing were all independently associated with students’ food choices. High commercial television viewers (>2 h/day) were more likely to report higher consumption of EDNP foods (ORs ranged from 1.31 for fast food to 1.91 for sweet snacks). Some associations between digital food marketing exposure and students’ eating behaviors were found; however, print/transport/school food marketing was only related to sweet snack consumption. These study results suggest that cumulative exposure to television food advertising and other food marketing sources are positively linked to adolescents’ food choices and eating behaviors. Policy changes to restrict food marketing to young people should include both television and non-broadcast media.

The impact of children's fast food meals on their daily nutritional requirements has not been assessed in Australia. Analysis of the nutritional composition of children's meals from six fast food chains was conducted. The energy, saturated fat, sugar and sodium content of all children's meals from the chains were assessed against the fast food industry-defined nutrient criteria for healthy meals and children's recommended daily nutritional requirements, as defined by the Nutrient Reference Values and the Dietary Guidelines for Children and Adolescents in Australia. Overall children's fast food meals are high in saturated fat, sugar and sodium. Only 16% and 22% of meals met the industry's nutrient criteria for children aged 4-8 and 9-13 years, respectively. Seventy-two percent of fast food meals exceeded 30% of the daily energy recommendations for 4 year old children, and 90% of meals exceeded 30% of the upper limit for sodium for children aged 4-8. Some meals also exceeded the upper limit for sodium and daily saturated fat recommendations for children aged 4-8 years. Reformulation of children's meals to improve their nutritional composition and revision of the industry's nutrient criteria to align with children's dietary requirements are urgently needed.

Issue addressed: High smoking rates among the disadvantaged lead to inequalities in health, quality-of-life and financial well-being. Non-government social and community service organisations (SCSO) are a promising setting for tobacco control interventions targeting disadvantaged smokers. Methods: Financial grants were provided to twenty SCSO in New South Wales to support multi-level changes in service culture, smokingrelated policies and cessation support between 2007 and 2009. Evaluation was conducted using a mixed-methods approach that included key informant interviews, document analysis and staff survey data. Results: SCSO working with disadvantaged clients can feasibly implement tobacco control activities, including smoking-related policy changes and cessation support. Tobacco control activities were generally acceptable to staff and clients, and staff pessimism regarding their clients' ability to quit reduced, as did the acceptability of staff smoking with their clients. Improvements in levels of organisational support for cessation training and resources, smoking policies and provision of free nicotine replacement therapy (NRT) were reported. within mental health SCSO there was a positive response from staff to cessation support, financial benefits of quitting and the role of NRT. Conclusions: The evaluation pointed to the acceptability and feasibility of engaging disadvantaged smokers by SCSO, and that tobacco policy and attitude changes can be achieved by small investments, such as grant programs.

ObjectiveTo assess parents’ responses to common, potentially misleading strategies for marketing energy-dense and nutrient-poor (EDNP) child-oriented foods.DesignBetween-subjects online experiment to test whether nutrient claims and sports celebrity endorsements on the front of packs of EDNP products lead parents to prefer and rate these foods more favourably.SettingAustralia.SubjectsA total of 1551 parents of children aged 5–12 years, who were the main household grocery buyers.ResultsInclusion of nutrient claims or sports celebrity endorsements on EDNP products led parents to perceive these products to be more nutritious than if they did not include such promotions. When asked to choose between a pair of different products (EDNP v. healthier), 56 % of parents did not read a nutrition information panel (NIP) before making their choice and this did not differ by promotion condition. These parents were more likely to choose an EDNP product if it included a nutrient claim (OR = 1·83, 95 % CI 1·31, 2·56; P < 0·001) or sports celebrity endorsement (OR = 2·37, 95 % CI 1·70, 3·32; P < 0·001). Sports celebrity endorsements also enhanced parent's perceptions of typical consumers of the product, perceptions of product healthiness and quality, as well as purchase intentions.ConclusionsNutrient claims and sports celebrity endorsements tip consumer preferences towards EDNP products bearing such promotions, especially among the majority who do not read the NIP. As parents largely determine what foods are available to children at home, it is critical that initiatives aimed at reducing the persuasive impact of food marketing include this target group.

Objective: Australian data indicate that 63% of children participated in sport in 2009, a 4% increase since 2000. Children's high participation in sport, and the association between sport and health, means that these settings provide an opportunity to promote other aspects of health, such as healthy eating, to children. This study aimed to determine healthy eating practices and policies at children's sports clubs. Methods: Sports clubs (n=108) for the nine most popular sports for children aged 5 to 14 were randomly sampled from three large geographical areas across one state and one territory in Australia. A purpose-designed telephone questionnaire for sports club officials was developed to determine the food and beverages sold, provided and promoted at sports clubs and the availability of healthy-eating policies. Results: The most frequently sold item at canteens was water, followed by sports drinks, chocolate/confectionery and soft drink. Only 20% of canteens promoted healthy food. Thirty-nine per cent of clubs made recommendations on the food and beverages to be consumed during sport, mostly relating to water consumption. The majority (76%) engaged in fundraising; many in collaboration with chocolate/confectionery companies. Only three clubs had a written policy on healthy eating. Conclusion: Addressing the low uptake of healthy eating policies would be a useful strategy to improve the healthiness of sports clubs. Implications: Policies could seek to reduce the availability and promotion of unhealthy food and beverages through canteens, vending machines and fundraising.

ObjectiveThe aim of the present study was to describe the nature and extent of food marketing on popular children’s websites and food product websites in Australia.MethodsFood product websites (n119) and popular children’s websites (n196) were selected based on website traffic data and previous research on frequently marketed food brands. Coding instruments were developed to capture food marketing techniques. All references to food on popular children’s websites were also classified as either branded or non-branded and according to food categories.ResultsWebsites contained a range of marketing features. On food product websites these marketing features included branded education (79·0 % of websites), competitions (33·6 %), promotional characters (35·3 %), downloadable items (35·3 %), branded games (28·6 %) and designated children’s sections (21·8 %). Food references on popular children’s websites were strongly skewed towards unhealthy foods (60·8 %v. 39·2 % healthy food references;P< 0·001), with three times more branded food references for unhealthy foods. Branded food references displayed similar marketing features to those identified on food product websites.ConclusionsInternet food marketing uses a range of techniques to ensure that children are immersed in brand-related information and activities for extended periods, thereby increasing brand familiarity and exposure. The relatively unregulated marketing environment and increasing use of the Internet by children point to the potential increase in food marketing via this medium. Further research is required to investigate the impact of Internet food marketing on children’s food preferences and consumption, and regulatory options to protect children.

SUMMARY The aim of this study was to assess the content and extent of food references and marketing within popular children’s magazines in Australia. Sixteen popular Australian children’s magazines were selected, as determined by readership and circulation data. Back copies of each magazine were purchased for publications released between January and December 2006 (n ¼ 76). Each magazine was assessed for food references on the basis of 23 food categories and 7 food-referencing types and as either branded or non-branded food references. There were a high number of overall food references within the children’s magazines, with the majority of these being for unhealthy food products (63.7% unhealthy versus 36.3% healthy foods, p , 0.001). The food groups with the highest proportion of branded food references, and therefore paid marketing, were ice cream and iced confection (85.6% branded references), fast food restaurant meals (83.4%), high-sugar drinks (78.9%) and snack foods (73.4%). Of all magazines, those targeting males and children aged 7– 12 years had the highest proportion of unhealthy food references (78.1 and 69.8% unhealthy food references, respectively). Food references within children’s magazines are common and skewed towards unhealthy foods. Children’s high magazine readership rates and a lack of advertising and product placement regulations for magazines in Australia make this media an attractive target for food marketers. The timely establishment of food marketing regulations within magazines are recommended to prevent further expansion of food marketing in this area.

Background:Physical activity and consuming a healthy diet have clear benefits to the physical and psychosocial health of cancer survivors, with guidelines recognising the importance of these behaviors for cancer survivors. Interventions to promote physical activity and improve dietary behaviors among cancer survivors and carers are needed. The aim of this study was to determine the effects of a group-based, face-to-face multiple health behavior change intervention on behavioral outcomes among cancer survivors of mixed diagnoses and carers. Methods:The Exercise and Nutrition Routine Improving Cancer Health (ENRICH) intervention was evaluated using a two-group pragmatic randomized controlled trial. Cancer survivors and carers (n = 174) were randomly allocated to the face-to-face, group-based intervention (six, theory-based two-hour sessions delivered over 8 weeks targeting healthy eating and physical activity [PA]) or wait-list control (after completion of 20-week data collection). Assessment of the primary outcome (pedometer-assessed mean daily step counts) and secondary outcomes (diet and alcohol intake [Food Frequency Questionnaire], self-reported PA, weight, body mass index, and waist circumference) were assessed at baseline, 8-and 20-weeks. Results:There was a significant difference between the change over time in the intervention group and the control group. At 20 weeks, the intervention group had increased by 478 steps, and the control group had decreased by 1282 steps; this represented an adjusted mean difference of 1761 steps (184 to 3337; P = 0.0028). Significant intervention effects for secondary outcomes, included a half serving increase in vegetable intake (difference 39 g/day; 95 % CI: 12 to 67; P = 0.02), weight loss (kg) (difference -1.5 kg; 95 % CI, -2.6 to -0.3; P = 0.014) and change in body mass index (kg/m2) (difference -0.55 kg/m2; 95 % CI, -0.97 to -0.13; P = 0.012). No significant intervention effects were found for self-reported PA, total sitting time, waist circumference, fruit, energy, fibre, alcohol, meat, or fat consumption. Conclusions:The ENRICH intervention was effective for improving PA, weight, body mass index, and vegetable consumption even with the inclusion of multiple cancer types and carers. As an example of successful research translation, the Cancer Council NSW has subsequently adopted ENRICH as a state-wide program.

Previous research has identified convenience, enjoyment, value for money and perceived goodness as primary dimensions of parents' attitudes to foods and beverages. The aim of the present study was to examine the factors associated with parents' scores on each of these attitudinal dimensions to identify key issues for future interventions designed to improve parents' food provision behaviours and children's diets.A sample of 1302 Australian parents of children aged 8 to 14 years completed an online survey relating to their food-related beliefs. Linear regression analyses were undertaken to examine factors associated with parents' attitudes to soft drinks and energy-dense nutrient-poor foods.Consistent factors were identified for both energy-dense, nutrient-poor foods and soft drinks, indicating that similar approaches could be adopted in interventions for both product categories. The primary factors were social norms, child pestering, television viewing and exposure to food advertising.Food advertising represents a common link between the primary factors, indicating that it constitutes a critical component of future interventions designed to modify parents' attitudes to unhealthy food products and to reduce the frequency with which these foods are consumed by children.

Among other focus areas, interventions designed to improve children's diets need to address key factors contributing to children's consumption of sugar-sweetened beverages. The present study employed structural equation modelling to investigate the relationship between a broad range of predictor variables and the frequency with which Australian children consume soft drinks. In total, 1302 parents of children aged 8 to 14 years responded to an online survey about their children's food consumption behaviours. Soft drink consumption frequency was primarily influenced by parents' attitudes to soft drinks, children's pestering behaviours, and perceived social norms relating to children's consumption of these products. Importantly, pestering and social norms had significant direct effects on consumption frequency in addition to indirect effects via their impact on parents' attitudes to soft drink.

Environmental and societal factors are significant determinants of children's initiation to and use of alcohol. Schools are important settings for promoting well-being and substantial resources have been devoted to curriculum-based alcohol programs, but the effects of these in reducing the misuse of alcohol have been modest. Adults can and do consume alcohol at school events when students are present, but there is a dearth of evidence about parents' level of support for the practice. The aim of this study was to examine parents' level of support for the purchase and consumption of alcohol at primary school fundraising events when children are present.Four hundred seventy-nine Australian parents of children aged 0-12 years participated in an online survey. Logistic regression was used to assess the impact of parent characteristics on the level of agreement with parental purchase and consumption of alcohol at school fundraising events when children are present.The majority of parents (60%) disagreed/strongly disagreed with the practice of adults being able to purchase and consume alcohol at school fundraising events when children were present. The 21% of parents who supported the practice were more likely to be daily smokers and/or have higher (6) Alcohol Use Disorders Identification Test-alcohol consumption scores.Despite the fact that the majority of parents disagree with this practice, published reports suggest that adults' use of alcohol at primary school events is an emerging issue. It is important that school decision-makers are mindful of the financial and educational value of fundraising activities.

Background Several options are advocated by policy experts to mitigate alcohol-related harms, although the most effective strategies often have the least public support. While knowledge of tobacco-related health risks predicts support for relevant public health measures, it is not known whether knowledge of alcohol health risks is similarly associated with the acceptability of policies intended to reduce alcohol consumption and related harms. This study aims to gauge public support for a range of alcohol policies and to determine whether or not support is associated with knowledge of a long-term health risk of alcohol consumption, specifically cancer. Methods 2482 adults in New South Wales (NSW), Australia, participated in an online survey. Logistic regression analysis was used to examine the association between demographic data, alcohol consumption, smoking status, knowledge of alcohol as a risk factor for cancer and support for alcohol-related policies. Results Most participants were supportive of health warnings, restricting access to internet alcohol advertising to young people, and requiring information on national drinking guidelines on alcohol containers. Almost half of participants supported a ban on sport sponsorship, while less than 41% supported price increases, volumetric taxation, or reducing the number of retail outlets. Only 47% of participants identified drinking too much alcohol as a risk factor for cancer. Knowledge of alcohol as a risk factor for cancer was a significant predictor of support for all policies, while level of alcohol consumption had a significant inverse relationship with policy support. Conclusion The finding that support for alcohol management policies is associated with awareness that drinking too much alcohol may contribute to cancer could assist in the planning of future public health interventions. Improving awareness of the long term health risks of alcohol consumption may be one avenue to increasing public support for effective alcohol harm-reduction policies.

Objectives: Labelling of food from fast food restaurants at point-of-purchase has been suggested as one strategy to reduce population energy consumption and contribute to reductions in obesity prevalence. The aim of this study was to examine the effects of energy and single traffic light labelling systems on the energy content of child and adult intended food purchases. Participants and methods: The study employed a randomised controlled trial design. English speaking parents of children aged between three and 12 years were recruited from an existing research cohort. Participants were mailed one of three hypothetical fast food menus. Menus differed in their labelling technique – either energy labels, single traffic light labels, or a no-label control. Participants then completed a telephone survey which assessed intended food purchases for both adult and child. The primary trial outcome was total energy of intended food purchase. Results: A total of 329 participants completed the follow-up telephone interview. Eighty-two percent of the energy labelling group and 96% of the single traffic light labelling group reported noticing labelling information on their menu. There were no significant differences in total energy of intended purchases of parents, or intended purchases made by parents for children, between the menu labelling groups, or between menu labelling groups by socio-demographic subgroups. Conclusions: This study provided no evidence to suggest that energy labelling or single traffic light labelling alone were effective in reducing the energy of fast food items selected from hypothetical fast food menus for purchase. Additional complementary public health initiatives promoting the consumption of healthier foods identified by labelling, and which target other key drivers of menu item selection in this setting may be required.

Objective Assess the effect of counter-advertisements on parents' appraisals of unhealthy foods featuring front-of-package promotions (FOPPs). Design A 2 × 2 × 5 between-subjects Web-based experiment. Parents were randomly shown an advertisement (counter-advertisement challenging FOPP/control advertisement) and then a pair of food products from the same category: an unhealthy product featuring an FOPP (nutrient content claim/sports celebrity endorsement) and a healthier control product with no FOPP. Setting Australia. Participants A total of 1,269 Australian-based parents of children aged 5–12 years recruited from an online panel. Main Outcome Measures Parents nominated which product they would prefer to buy and which they thought was healthier, then rated the unhealthy product and FOPP on various characteristics. Analysis Differences between advertisement conditions were assessed using logistic regression (product choice tasks) and analysis of variance tests (ratings of unhealthy product and FOPP). Results Compared with parents who saw a control advertisement, parents who saw a counter-advertisement perceived unhealthy products featuring FOPPs as less healthy, expressed weaker intentions for buying such products, and were more likely to read the nutrition facts panel before nominating choices (all P Conclusions and Implications Counter-advertising may help reduce the misleading influence of unhealthy food marketing and improve the accuracy of parents' evaluations of how nutritious promoted food products are.

ObjectiveThe current study examined the impact of television and Internet food advertising on Australian parents and children.DesignParents and their children aged 8 to 14 years were exposed to a television advertisement, an Internet advertisement or a control picture for four commonly advertised energy-dense, nutrient-poor foods.SettingOnline web panel survey, Australia.SubjectsParents (n1302) and their children aged 8 to 14 years (n1302).ResultsAfter a single exposure to each advertisement, parent respondents in the two exposure conditions evaluated the products more favourably, had a greater desire to consume the products and thought the product could be consumed more frequently than those in the control condition. Similar trends were observed among children, although the differences were statistically significant only for the frequency of food consumption in the Internet advertisement condition and the evaluation of one product.ConclusionsThe results have implications for assumptions of adults’ immunity to advertising. This is of particular importance in efforts to address child obesity and the reliance on parents to mediate the effects of food advertising.

The purpose of this study was to evaluate a global deficit in sequential processing as candidate endophenotypein a family with familial childhood apraxia of speech (CAS). Of 10 adults and 13 children in a three-generational family with speech sound disorder (SSD) consistent with CAS, 3 adults and 6 children had past or present SSD diagnoses. Two preschoolers with unremediated CAS showed a high number of sequencing errors during single-word production. Performance on tasks with high sequential processing loads differentiated between the affected and unaffected family members, whereas there were no group differences in tasks with low processing loads. Adults with a history of SSD produced more sequencing errors during nonword and multisyllabic real word imitation, compared to those without such a history. Results are consistent with a global deficit in sequential processing that influences speech development as well as cognitive and linguistic processing.

ObjectiveTo investigate nutrition literacy among adult grocery buyers regarding energy-related labelling terms on food packaging.DesignQualitative interviews and quantitative surveys to determine shoppers’ understanding of energy terms (‘energy’, ‘calories’ and ‘kilojoules’) and how energy terms affect perceptions of healthiness and intentions to purchase breakfast cereals, muesli bars and frozen meals.SettingIndividual in-depth interviews and surveys in two metropolitan supermarkets, Sydney, Australia.SubjectsAustralian adults (interview n 40, survey n 405) aged 18–79 years.ResultsThe relationship between energy and perceived healthiness of food varied by product type: higher energy breakfast cereals were perceived to be healthier, while lower energy frozen meals were seen as healthier choices. Likewise, intentions to purchase the higher energy product varied according to product type. The primary reason stated for purchasing higher energy products was for sustained energy. Participants from households of lower socio-economic status were significantly more likely to perceive higher energy products as healthier. From the qualitative interviews, participants expressed uncertainty about their understanding of kilojoules, while only 40 % of participants in intercept surveys correctly answered that kilojoules and calories measured the same thing.ConclusionsAustralian consumers have a poor understanding of energy and kilojoules and tend to perceive higher energy products as healthier and providing sustained energy. This has implications regarding the usefulness of industry front-of-pack labelling initiatives and quick service restaurant menu labelling that provides information on energy content only. Comprehensive and widely communicated education campaigns will be essential to guide consumers towards healthier choices.

ObjectiveThe objective of the present research was to test the efficacy of Fruit & Veg $ense sessions in increasing fruit and vegetable consumption.DesignA wait-list randomised controlled trial was conducted (n 292). Intervention participants attended a Fruit & Veg $ense session and received newsletters at weeks 2 and 5 after attending the session. All participants completed an FFQ and a questionnaire measuring knowledge, attitudes, barriers and stage of change for fruit and vegetable consumption at baseline and 6 weeks.SettingHunter region of New South Wales, Australia.SubjectsTwo hundred and ninety-two parents with children of primary school age.ResultsThe intervention group significantly increased its mean consumption of fruit and vegetables by 0·62 servings compared with 0·11 in the control group (difference of 0·51, P = 0·001). Compared with the control group, there were significant increases in intervention participants’ knowledge of daily recommended servings (for fruit and vegetables) and serving size (for vegetables), improvement in stage of change for vegetable consumption and a decrease in the number of perceived barriers to fruit and vegetable consumption.ConclusionsFruit & Veg $ense is efficacious in increasing fruit and vegetable consumption among parents of primary-school children. The study adds significantly to the limited evidence regarding fruit and vegetable interventions and the feasibility of engaging peer educators to deliver community education sessions. A broader implementation trial to test the effectiveness of Fruit & Veg $ense is recommended.

The ability of food advertising to trigger food consumption and influence social norms relating to food consumption has resulted in increasing attention being given to the prevalence and nature of food advertising. The present study investigated the use of negative themes in food advertisements aired on Australian television to determine the prevalence of depictions of violence/aggression, mocking, nagging, boredom, loneliness, food craving, mood enhancement, and the emotional use of food across 61 days of programming time. The results suggest that advertisers are using negative themes to capture attention and invoke an emotional response in the target audience. Sixteen percent (14,611) of the 93,284 food advertisements contained negative themes, with mood enhancement and food craving being the most commonly depicted negative themes. Advertisements with negative themes were more likely to be for non-core foods and to be aired during children's popular viewing times than at other times. The potential for negative themes in food advertising to promote unhealthy food consumption behaviors among children is likely to be of concern to policy makers. Building on this exploratory study, further research is needed to investigate how nutrition-related decision making is affected by exposure to food advertisements employing negative emotional themes.

Objective To investigate consumers' understanding of terms commonly used to provide guidance about frequency and quantity of food consumption. Methods A survey of 405 shoppers explored how frequently consumers thought food labeled with the terms “eat often,” “eat moderately,” “eat occasionally,” “a sometimes food,” and “an extra food” should be eaten. In a separate phase, 30 grocery buyers responded to open-ended questions about their interpretation of these terms. Results Responses indicated significant differences in meaning between the terms. However, the specific interpretation of each term varied considerably across respondents. The qualitative research found the terms to be highly subjective, and there was a high degree of uncertainty about the meaning of the term “an extra food” in particular. Conclusions and Implications Food frequency and descriptive terms currently used do not provide meaningful or consistent nutritional guidance. There is a need for simple, unambiguous terminology.

Objective: The issue of marketing unhealthy food to children and its contribution to childhood obesity has become a highly politicised debate in Australia. The aim of this study was to compare recent television food advertising patterns in 2008 to previously published Australian research on television advertising from 2006 and 2007, to examine any changes following policy debates. Methods: Television broadcasting was recorded for two weekdays and two weekend days between 6:00 and 22:00 in February 2008 for all three commercial television channels. Food advertisements were classified as core/healthy, non-core/unhealthy or miscellaneous. Television audience data were obtained to determine broadcast periods corresponding to children's peak viewing times. Results: The overall rate of food advertising decreased over time: from seven food advertisements/hour/channel in 2006/07 to five in 2008. However, the relative contribution of non-core food advertising to overall food advertising remained stable. In 2008, the proportion of food advertisements for non-core foods was significantly higher during children's peak viewing times (p