Search

Abstract Background Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries. Methods Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes. Results Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies. Conclusions Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Abstract Background Although communities have long been exhorted to make efforts to enhance their own health, such approaches have often floundered and resulted in little or no health benefits when the capacity of the community has not been adequately strengthened. Thus being able to assess the capacity building process is paramount in facilitating action in communities for social and health improvement. The current review aims to i) identify all domains used in systematically documented frameworks developed by other authors to assess community capacity building; and ii) to identify the dimensions and attributes of each of the domains as ascribed by these authors and reassemble them into a comprehensive compilation. Methods Relevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies assessing capacity building or community development or community participation were selected and assessed for methodological quality, and quality in relation to the development and application of domains which were identified as constituents of community capacity building. Data extraction and analysis were undertaken using a realist synthesis approach. Results Eighteen articles met the criteria for this review. The various domains to assess community capacity building were identified and reassembled into nine comprehensive domains: "learning opportunities and skills development", "resource mobilization", "partnership/linkages/networking", "leadership", "participatory decision-making", "assets-based approach", "sense of community", "communication", and "development pathway". Six sub-domains were also identified: "shared vision and clear goals", "community needs assessment", "process and outcome monitoring", "sustainability", "commitment to action" and "dissemination". Conclusions The set of domains compiled in this review serve as a foundation for community-based work by those in the field seeking to support and nurture the development of competent communities. Further research is required to examine the robustness of capacity domains over time and to examine capacity development in association with health or other social outcomes.

Abstract Background Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. Methods Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94). Results 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP→ IND) and indirect intervention strategies (i.e., HP→ INT→ IND, HP→ POL → IND) were used most often; networking strategies, which link at least two targets (i.e., HP→[ORG-ORG]→IND), were used the least. The program did not become more ecological over time. Conclusions The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability.

Retail food environments play a pivotal role in influencing dietary behaviors, and therefore have huge potential as settings for promoting good nutrition and preventing obesity. Conducting research in retail settings can be challenging due to the varied motivations of the parties involved and the complex nature of retail environments. To improve the quality and consistency of research in this field, we have identified 16 thematic topics aimed at guiding researchers and public health practitioners on how to conduct healthy food retail research. A summary for each topic, encompassing existing methodologies, best practice examples, and knowledge gaps, was developed based on available literature and the collective experience and expertise of 32 multidisciplinary researchers from a high-income perspective engaged in healthy food retail research in a diverse range of retail settings. A summary checklist describing key considerations at each stage of conducting healthy food retail research was also developed., (© 2025 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background: Contracts can be an effective lever to implement and manage health-enabling food retail environments. However, guidance for the effective use of contracts in food retail settings is limited. The use of contracts to create healthy food vending environments is one area where policy attention has been focussed in high income countries. We applied a public health regulatory framework to publicly available guidance documents on healthy vending to develop best practice recommendations for using contracts to create healthy food vending environments., Methods: Document analysis involved i) snowball sampling to identify eligible publicly available healthy vending guidance documents from an identified seed paper; ii) application of a public health regulatory framework to extract data across three domains of form, substance and governance of healthy vending initiatives; and iii) synthesis of data to form best practice recommendations. Eligible documents were those aimed at implementing healthier vending; published from 2000 onwards; accessible online; and included recommendations beyond nutrition standards alone, including a reference to at least one regulatory governance process (administration, implementation, monitoring, enforcement or review)., Results: Twelve of 92 documents identified were eligible and all were from the United States (US). All noted that products need to comply with nutrition standards. Other aspects of regulatory substance (i.e., pricing, promotion, placement, labelling and contract length) were less well considered as were elements of regulatory governance (regulatory rules, administration, implementation, monitoring, enforcement and review). Our adapted framework covers three regulatory domains with nine components, and a further 20 recommendations for best practice application in healthy vending., Conclusions: To be effective, contracts used to manage healthy food vending should include more than the nutrition standards for healthy food and drinks. Clearly stating the contract objectives, operative terms and conditions, and defining responsibilities for monitoring, review and enforcement within the contract, in addition to the nutrition standards, will assist practitioners in creating effective and sustained contract-based initiatives aimed at improving the healthiness of vending, or potentially other food retail environments., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

A form of food retail regulation called the Stores Licensing Scheme was introduced by the Australian Government in 2007-2022 to ensure food security in remote Indigenous communities of the Northern Territory. We examined evaluations of this Scheme implemented under the Northern Territory National Emergency Response and Stronger Futures Northern Territory Acts. Grey literature search identified nine primary source evaluations. Reported outcomes were extracted and thematic analysis utilised to determine barriers and enablers. Outcomes included improved availability and quality of groceries, financial structures, and retail practices, albeit not consistently reported. Governance and food cost were perceived barriers. Future policy aimed to improve food security through community stores should consider food cost subsidy, measures to incentivise all stores to improve standards, and improved governance arrangements enabling self-determination for Aboriginal and Torres Strait Islander Store Directors., (© 2024. The Author(s).)

Background: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia., Methods: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023., Discussion: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly., Trial Registration: ACTRN12622000596707, Protocol version 1., (© 2024. The Author(s).)

Reporting key dietary indicators from sales data can help us guide store decision makers in developing effective store policy to support healthier customer purchases. We aimed to develop a web-based reporting tool of key dietary indicators from sales data to support health-promoting policy and practice in stores in geographically remote Aboriginal and Torres Strait Islander communities. Tool development included identifying key dietary indicators (informed by sales data from 31 stores), community consultation (19 Aboriginal and Torres Strait Islander store directors and two store managers) and a web-build. Tool evaluation involved feedback interviews with stakeholders (25 store managers and two nutritionists). Key dietary indicators aligned with Australian Dietary Guideline food groupings and recommendations. An online portal for accessing and customising reports was built. Stakeholder feedback indicated that the strengths of the reports were the visuals, ease of interpretation, providing information that was not currently available and potential to increase capacity to support healthy food retailing. Difficulties were defining healthiness classification with alignment to other nutrition guidelines used and ensuring reports reached relevant store decision makers. This tool may be valuable to support store decision makers in identifying and prioritising nutrition issues and optimising the health-enabling attributes of stores.

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities., (© 2024. The Author(s).)

Objective: Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these., Design: Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework., Setting: Food retail., Participants: Food retail settings using private regulatory measures to create healthier food retail environments., Results: In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary ( n 16), mandatory ( n 6) measures, both ( n 2) or did not disclose ( n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35)., Conclusions: We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.

Background: Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail., Methods: We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input., Results: One-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store's health-enabling practice (n = 20) and frequency of occurrence (n = 6)., Conclusions: The application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores., (© 2024. The Author(s).)

Background: Food retailers can be reluctant to initiate healthy food retail activities in the face of a complex set of interrelated drivers that impact the retail environment. The Systems Thinking Approach for Retail Transformation (START) is a determinants framework created using qualitative systems modelling to guide healthy food retail interventions in community-based, health-promoting settings. We aimed to test the applicability of the START map to a suite of distinct healthy food marketing and promotion activities that formed an intervention in a grocery setting in regional Victoria, Australia., Methods: A secondary analysis was undertaken of 16 previously completed semi-structured interviews with independent grocery retailers and stakeholders. Interviews were deductively coded against the existing START framework, whilst allowing for new grocery-setting specific factors to be identified. New factors and relationships were used to build causal loop diagrams and extend the original START systems map using Vensim., Results: A version of the START map including aspects relevant to the grocery setting was developed ("START-G"). In both health-promoting and grocery settings, it was important for retailers to 'Get Started' with healthy food retail interventions that were supported by a proof-of-concept and 'Focus on the customer' response (with grocery-settings focused on monitoring sales data). New factors and relationships described perceived difficulties associated with disrupting a grocery-setting 'Supply-side status quo' that promotes less healthy food and beverage options. Yet, most grocery retailers discussed relationships that highlighted the potential for 'Healthy food as innovation' and 'Supporting cultural change through corporate social responsibility and leadership'., Conclusions: Several differences were found when implementing healthy food retail in grocery compared to health promotion settings. The START-G map offers preliminary guidance for identifying and addressing commercial interests in grocery settings that currently promote less healthy foods and beverages, including by starting to address business outcomes and supplier relationships., (© 2023. The Author(s).)

The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess: (1) the Thumbs system's alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying 'unhealthy' (contributing to discretionary energy and added sugars) and 'healthy' products against HSR and NTSCG; (3) areas for optimisation. Food and beverage products sold between 05/2018 and 05/2019 in fifty-one remote stores were classified in each system. System alignment was assessed by cross-tabulating percentages of products, discretionary energy and added sugars sold assigned to the same healthiness levels across the systems. The system/s capturing the highest percentage of discretionary energy and added sugars sold in 'unhealthy' products and the lowest levels in 'healthy' products were considered the best performing. Cohen's κ was used to assess agreement between the Thumbs system and the NTSCG for classifying products as healthy. The Thumbs system classified product healthiness in line with the HSR and NTSCG, with Cohen's κ showing moderate agreement between the Thumbs system and the NTSCG ( κ = 0·60). The Thumbs system captured the most discretionary energy sold (92·2 %) and added sugar sold (90·6 %) in unhealthy products and the least discretionary energy sold (0 %) in healthy products. Modifications to optimise the Thumbs system include aligning several food categories to the NTSCG criteria and addressing core/discretionary classification discrepancies of fruit juice/drinks. The Thumbs system offers a classification algorithm that could strengthen the HSR system.

This study explored the local food environment of Hong Kong and Singapore using a qualitative case study approach to inform future upstream public health nutrition policies. Food outlets that provide food to be eaten in the home were mapped in selected areas of high and low socioeconomic status (SES) of Hong Kong and Singapore. Food outlet density relative to land area was determined. In both countries, lower SES areas surveyed were shown to have higher food outlet density while higher SES areas had fewer but larger food outlets. In Hong Kong, both SES areas reported similar proportions of healthy and unhealthy food outlets.This study highlights the accessibility of food outlet types through their geographical location and density. Future research assessing the differences in eating culture between these two countries should be considered alongside this study's findings, to investigate strategies influencing the food environment in order to promote healthier eating habits., (© 2023. The Author(s).)

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.

Objective: This article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet., Methods: Convergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisations that provide a nutrition professional service to food retail stores in remote Australia. The study participants include 11 nutrition professionals and eight organisation representatives, including managers, organisation directors and policy officers. Systems-mapping and thematic analysis of the in-depth interviews were conducted using a capacity development framework. Descriptive analysis was applied to pre-interview survey and mapping data., Results: A gap between the aspirational work and current capacity of nutrition professionals to engage effectively with stores was identified. Engagement with stores to improve population health was valued by organisations. Dominance of the medical health model limited organisation strategic support for store work and created barriers. Key barriers included the limited access to training, decision-support tools, information, financial resources and organisational structures that directed store work., Conclusions: Provision of adequate store-specific training, resources and organisational support may empower the nutrition professional workforce to be powerful leaders in co-design for healthy food retail., Implications for Public Health: Building capacity for this critical workforce to engage in food retail practice change must consider the influence of the broader health system and employer organisations and need for access to evidence-based decision-support tools., Competing Interests: Conflicts of interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Julie Brimblecombe reports financial support was provided by the National Health and Medical Research Council. Co-author Khia De Silva was employed as Nutrition Manager by The Arnhem Land Progress Aboriginal Corporation (ALPA). This co-author had no input in to data collection or analysis and had input in to all other aspects of the study., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: This article aims to examine the framing of the issue of food security in very remote Aboriginal and Torres Strait Islander communities in print media and press releases during the beginning of the COVID-19 pandemic in 2020., Methods: Newspaper articles were identified following a systematic search of the Factiva database, and press releases were identified from manual search of key stakeholder websites from January to June 2020 and analysed using a combined adapted framework of the Bacchi's What's the Problem Represented to be? Framework and the Narrative Policy Framework., Results: A food delivery "problem" dominated representations in press releases, and food supply at store level had prominence in print media. Both presented the cause of food insecurity as a singular, identifiable point in time, framed the issue as one of helplessness and lack of control, and proposed policy action., Conclusions: The issue of food security was represented in the media as a simple issue requiring an immediate fix, as opposed to a complex issue requiring a systems-level and sustained policy response., Implications for Public Health: This study will help to guide future media dialogue to impact on both immediate and longer-term solutions to food insecurity in very remote Aboriginal and Torres Strait Islander communities in Australia., Competing Interests: Conflicts of interest The authors report no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)