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PurposeDuring the COVID-19 pandemic people worldwide in the same household spent more time together and school children engaged in remote learning throughout extended lockdowns and restrictions. The present study aimed to explore parents' perceptions of their involvement and enjoyment in food-related interactions with their children during coronavirus disease 2019 (COVID-19)-associated lockdowns/restrictions and changes in their children's food intake, especially children's lunches during the remote learning period.Design/methodology/approachData from parents (n = 136) were collected via an online survey in 2020. Parents' responses to closed-ended questions were analysed via descriptive statistics and open-ended responses were analysed thematically.FindingsMost parents (62%) reported that they interacted more with their school-aged (5–17 years) children about food during COVID-19 compared to pre-pandemic times. These interactions included cooking, menu planning, eating, conversations around food, and gardening. Most parents (74%) prepared meals with their children during the pandemic and most of them (89%) reported that they enjoyed it. Most parents (n = 91 out of 121) perceived that their children's lunches during remote learning were different to when attending school in person and these changes included eating hot and home-cooked food and more elaborate meals.Originality/valueThis study sheds important insights into a sample of Australian parents' food-related interactions with their school-aged children during the COVID-19 pandemic and associated lockdowns and parents' observations and perceptions of changes in the children's food intake during the remote learning period.

PurposeThis paper examines the views of Australian primary school parents regarding the food and nutrition education (FNE) curriculum. Associations with personal values (Universalism and Hedonism) and demographic measures were also explored.Design/methodology/approachAn online survey was conducted among 787 parents in March 2021. Parents rated the importance of 17 FNE topics. They were also asked about their support for six curriculum improvements and to state their own improvement suggestions.FindingsParents viewed the “Effect of food on health” and “Food hygiene” as the most important topics. Three FNE components were derived: (1) food safety and preparation, (2) health and nutrition information, (3) food origins and environmental sustainability. The “Food safety and preparation” component score was associated with both universalism-nature and hedonism values but negatively associated with parental education. The “Health and nutrition information” component score was associated with universalism-nature value and main language spoken at home. Lastly, the “Food origins and environmental sustainability” component score was associated with universalism-nature value. The two personal values, universalism-nature and hedonism, were more strongly associated with parents' views of curriculum topics than parental demographic characteristics. Parents had several criticisms of current FNE, including school food environments not resonating with FNE taught in the classroom and that FNE might increase the risk of eating disorders. They also suggested that the FNE curriculum should support both parents and teachers by providing relevant resources and training.Originality/valueAustralian parents' views of the importance of FNE topics and how to improve FNE in primary schools have been under-examined.

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

Objective:Refugees are vulnerable to food insecurity (FI). This is attributable to a combination of inequitable social determinants and cultural differences. In 2019, 92 % of refugee resettlement (host country provides residency/citizenship) occurred in high-income countries, but little is known about the factors impacting their food security status in this setting. The review’s objective was to therefore thematically identify factors affecting food security among refugees resettling in high-income countries.Design:This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Between May–July 2020 and February 2021, peer-reviewed studies focused on FI, and published in English from 2000–2020, were searched on Medline, CINAHL, Scopus, Informit, PsychArticles, Proquest and EmBase.Setting:Only studies set in high-income countries were included.Participants:Fifty percent or more of study participants had to be refugees who had resettled within 5 years.Results:Twenty studies from six high-income countries were included. Culturally based food practices and priorities, confidence in navigating local foodways and transport, level of community connections and capabilities in local language and food preparation were key themes associated with food security.Conclusions:Utilising the four themes of culture, confidence, community and capabilities, there is an opportunity to improve the cultural sensitivity of measurement tools, develop understanding of how community-based resources (such as social capital) can be leveraged as food security buffers and modify existing food security initiatives to better serve refugee needs.

PurposePrimary schools provide continuous, intensive contact with large numbers of children starting from a young age, thus providing an appropriate setting for the promotion of healthy eating through food and nutrition education (FNE). This qualitative study explores the views of Australian primary school parents about FNE in primary schools.Design/methodology/approachIn total, 19 parents of primary school children from Victoria participated in semi-structured interviews. Audio recordings were transcribed and underwent thematic analysis using Nvivo. A total of three themes emerged: FNE topics currently taught in primary schools, essential food skills and knowledge for primary school children and the importance of FNE.FindingsMost parents thought that FNE is as important as the core subjects of primary school. Parental support for FNE, which is delivered over a prolonged period, and expanded by hands-on content such as cooking and gardening classes was evident. Parents viewed these classes as likely to improve children's food-related knowledge and healthy eating behaviours. Parents expressed appreciation for schools' emphasis on food sustainability and its alignment with school policies and practices. Parents were keen to see more sustainability included in the curriculum.Practical implicationsThese results may have implications for curriculum developers and schools, as the findings can assist the design of food and nutrition curricula for primary schools which can empower children as well as their families to make better food-related decisions.Originality/valueAustralian parents' views of FNE in primary schools have been under examined.

Dietary recalls have been used previously to identify food sources of iodine in Australian schoolchildren. Dietary assessment can provide information on the relative contributions of individual food groups which can be related to a robust objective measure of daily intake (24-h urinary iodine excretion (UIE)). In Australia, the government has mandated the use of iodised salt in breadmaking to address iodine deficiency. The aim of this study was to determine the dietary intake and food sources of iodine to assess their contribution to iodine excretion (UIE) in a sample of Australian schoolchildren. In 2011–2013, UIE was assessed using a single 24-h urine sample and dietary intake was assessed using one 24-h dietary recall in a convenience sample of primary schoolchildren from schools in Victoria, Australia. Of the 454 children with a valid recall and urine sample, 55 % were male (average age 10·1 (1·3 (sd) years). Mean UIE and dietary iodine intake were 108 (sd 54) and 172 (sd 74) μg/d, respectively. Dietary assessment indicated that bread and milk were the main food sources of iodine, contributing 27 and 25 %, respectively, to dietary iodine. Milk but not bread intake was positively associated with UIE. Multiple regression (adjusted for school cluster, age and sex) indicated that for every 100 g increase in milk consumption, there was a 3 μg/d increase in UIE (β = 4·0 (se 0·9), P < 0·001). In conclusion, both bread and milk were important contributors to dietary iodine intake; however, consumption of bread was not associated with daily iodine excretion in this group of Australian schoolchildren.

PurposeTeachers play important roles in school food and nutrition education. This study aims to explore Australian teachers' self-efficacy beliefs (i.e. belief in their own capabilities to perform specific teaching tasks) in teaching secondary school food and nutrition-related subjects.Design/methodology/approachTeachers' overall self-efficacy beliefs in teaching these subjects (overall-SEB) and self-efficacy beliefs in teaching different food and nutrition-related topics (topics-SEB) were explored using a survey among 183 teachers in 2017. Principal components analysis derived three overall-SEB components: “Motivation and accommodation of individual differences”, “Classroom management” and “Communication and clarification” and three topics-SEB components: “Food system”, “Food and nutrition information” and “Food preparation”.FindingsOverall, higher percentages of teachers were confident or very confident in the majority of items that loaded on “Classroom management” and “Communication and clarification” compared to “Motivation and accommodation of individual differences”. Moreover, higher percentages of teachers were confident or very confident about items that loaded on “Food and nutrition information” and “Food preparation” compared” to “Food system”. The overall-SEB and topics-SEB were higher among more experienced teachers. There were moderate positive correlations between overall-SEB and topics-SEB components.Originality/valueThe exploration of broader aspects of self-efficacy beliefs related to teaching secondary school food and nutrition-related subjects makes this study unique. The findings highlight that these teachers had high self-efficacy beliefs in teaching food and nutrition education, but there are gaps in tailoring the teaching process to meet the diverse needs of students and teaching broader food-related topics.

Young Australian adults’ exhibit high consumption of Energy Dense and Nutrient Poor (EDNP) foods; however, there is limited research concerning the factors influencing their consumption. This study aimed to explore socio-psychological factors associated with young Australian adults’ (18–30 years) consumption of EDNP foods with consideration of the Food Related Lifestyle Model (FRLM) as a potential framework. Through qualitative descriptive research methodology, 38 young adults were interviewed. Data were thematically analyzed. Participants were classified into three groups based on their living arrangements namely, parental, shared and independent households. Five themes emerged, (1) psychological factors (2) intrinsic qualities of EDNP foods, (3) social factors, (4) accessibility and affordability and (5) health related beliefs. The FRLM takes into consideration some of the factors reported in this study as influencers of EDNP food intakes. However, the FRLM omits important psychological factors (motivation, restraint, cravings, coping strategies and habits) identified by participants as influencers over their EDNP food intakes. The FRLM may need to be extended in its application to EDNP food intakes of young Australian adults. Social marketing campaigns highlighting health risks, addressing social and environmental factors are suggested. The social desirability of healthier alternatives in social gatherings of young adults could be increased.

This study explored the views of participants who completed a 5-week, online, interactive, family-based, salt reduction education program (Digital Education to LImit Salt in the Home). A secondary aim was to explore the views of school staff on the delivery of food and nutrition education in schools. Children aged 7–10 years, their parents and principals/teachers from participating schools located in Victoria, Australia, completed a semi-structured evaluation interview. Audio-recordings of interviews were transcribed verbatim and analysed using NVivo. Twenty-eight interviews (13 children; 11 parents; 4 school staff) were included. Thematic analysis revealed that the program was well received by all groups. Children reported that the interactivity of the education sessions helped them to learn. Parents thought the program was interesting and important, and reported learning skills to reduce salt in the family diet. School staff supported the delivery of nutrition education in schools but indicated difficulties in sourcing well-packed nutrition resources aligned with the curriculum. It appears that there is support from parents and teachers in the delivery of innovative, engaging, nutrition education in schools, however such programs need to be of high quality, aligned with the school curriculum and readily available for incorporation within the school’s teaching program.

Background Investigating effects of whole diets on blood pressure (BP) can contribute to development of diet-based recommendations for health. Our aim was to assess the relationship between dietary patterns and BP in a sample of free-living Australian adults. Methods Usual dietary patterns of participants recruited to dietary intervention studies were assessed using factor analysis (two 24-h recalls). The mean of seven days of daily, seated BP measurements were used. Results Complete data from 251 participants (112 males; mean age 55.1(9.1) (SD) years; body mass index (BMI) 29.5(3.9) kg/m2) was included. Three dietary patterns were identified. Only Dietary Pattern 2 was positively associated with home systolic BP (β = 1.88, 95% CI 0.16, 3.60) after adjusting for age, sex, BMI, anti-hypertensive medication, smoking, education, physical activity and energy intake. This dietary pattern was characterised by high consumption of low-fibre bread, pasta, noodles and rice, meat dishes, poultry dishes and egg dishes, mixed cereal dishes, salted nuts and low consumption of milk and yoghurt (low-fat), vegetable juice, vegetables and high-fibre bread. Dietary Pattern 2 was also positively associated with intakes of energy (P = 0.002) and sodium (P = 0.005) and inversely associated with potassium intake (P = 0.002). After adjustment for energy, only the inverse association with potassium remained (P Conclusions In this sample of Australian adults, Dietary Pattern 2 was associated with higher BP and thus chronic disease risk, supporting the evidence that diets high in energy and sodium, and low in potassium from vegetables and dairy, are detrimental to cardiovascular health.

Purpose Urinary iodine concentration (UIC (μg/ml) from spot urine samples collected from school-aged children is used to determine the iodine status of populations. Some studies further extrapolate UIC to represent daily iodine intake, based on the assumption that children pass approximately 1 L urine over 24-h, but this has never been assessed in population studies. Therefore, the present review aimed to collate and produce an estimate of the average 24-h urine volume of children and adolescents (> 1 year and Methods EBSCOHOST and EMBASE databases were searched to identify studies which reported the mean 24-h urinary volume of healthy children (> 1 year and Results Of the 44 studies identified, a meta-analysis of 27 studies, with at least one criterion for assessing the completeness of urine collections, indicated that the mean urine volume of 2–19 year olds was 773 (654, 893) (95% CI) mL/24-h. When broken down by age group, mean (95% CI) 24-h urine volume was 531 mL/day (454, 607) for 2–5 year olds, 771 mL/day (734, 808) for 6–12 year olds, and 1067 mL/day (855, 1279) for 13–19 year olds. Conclusions These results demonstrate that the average urine volume of children aged 2–12 years is less than 1 L, therefore, misclassification of iodine intakes may occur when urine volumes fall below or above 1 L. Future studies utilizing spot urine samples to assess iodine status should consider this when extrapolating UIC to represent iodine intakes of a population.

Young Australian adults exhibit poor food behaviour however, there is limited research as to why young adults choose to eat healthy or unhealthy foods. This study aimed to explore how young adults' (18-30 years) in Australia classify foods as healthy and unhealthy. Through a social-constructivist approach, 38 young adults (76% females and 21% males; mean age = 24.1 years) were interviewed Australia-wide. Data were thematically analysed. Participants were classified into three groups based on their living arrangements namely, parental, shared and independent households. Four themes emerged, food preparation; food groups; nutrient composition and perceived impact. Food classification criteria based on nutrients were the most frequently used criterion to classify foods as unhealthy. A strong emphasis was placed on avoiding less healthy nutrients and there were limited discussions about beneficial nutrients. Participants belonging to the different household groups defined 'moderation' in several ways to justify their consumption of unhealthy foods. Reading food labels was a key criterion for evaluating healthiness amongst the participants of the parental and independent household groups, not among the shared household group. Findings reveal how living arrangements influenced young adults' perceptions of healthiness. Future public health policy could incorporate the language of young adults identified in this study in the transfer of nutritional knowledge to young adults.

Young Australian adults exhibit poor food behaviors. These include increased consumption of Energy-Dense, Nutrient-Poor (EDNP) foods, sugar-sweetened beverages, and low consumption of fruit and vegetables. However, little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected young Australian adults' pre-existing adverse food behaviors.The present study aimed to understand the impact of the COVID-19 pandemic on food practices by exploring views of young adults living in Australia.Through qualitative descriptive methods, data gathered through individual interviews were thematically analyzed. Participants included 38 young adults aged 18-30 y with a mean age of 24.1 y (76% female).Five themes emerged:Young Australian adults reported more negative and fewer positive changes in food practices. The observed negative changes in food practices are likely to have accentuated young Australian adults' previously known poor food behaviors. This study adds to the international literature by reporting ways that young adults implemented positive changes during the pandemic and future directions of their food practices.

Background/AimsSalt intake among Australian adults exceeds recommendations, increasing the risk of cardiovascular disease. Knowledge, attitudes and behaviours (KABs) are modifiable factors that may influence salt consumption. It is not known whether salt-related KABs among parents and caregivers of children under 18 years of age differ from other adults who do not care for children under 18 years of age. Therefore, we aimed to determine whether salt-related KABs differed between parents and caregivers and other adults. This information can be used to inform messages included in salt reduction consumer awareness campaigns.MethodsAdults, aged 18–65 years, were recruited from four shopping centres, Facebook and a consumer research panel in the state of Victoria, Australia. Participants indicated if they were a parent or a caregiver of a child/children ResultsA total of 840 parents/caregivers and 1558 other adults completed the survey. Just over half of the parents/caregivers and other adults were female, with a mean (SD) age of 41.1 (10.3) years and 44.3 (15.3) years, respectively. Mean construct scores for salt-related KABs were similar between the two groups. Parents/caregivers were less likely to be aware of the relationship between salt and sodium (OR=0.73, p=0.002) and more likely to report difficulty in interpreting sodium information displayed on food labels (OR=1.36, p=0.004). Parents/caregivers were more likely to be concerned about a range of food-related issues, including the amount of saturated fat, sugar and salt in food. Parents/caregivers were more likely to report that they were trying to reduce their salt intake (OR=1.27, p=0.012) and more likely to report adding salt at the table (OR=1.28, p=0.008).ConclusionsThere were some differences in salt-related KABs between parents/caregivers and other adults. These findings provide insight into particular messages that could be focused on in consumer awareness campaigns that seek to improve parents’/caregivers’ KABs related to salt intake. Specifically, messages targeted at parents/caregivers should include practical guidance to reduce table salt and resources to assist in interpreting sodium information on food labels and the relationship of sodium to salt.

Developing healthy eating behaviours is important to assist children in maintaining good health and decrease the risk of chronic health conditions. Recent nutrition promotion efforts in Australian primary schools have mainly focused on canteen guideline compliance and obesity prevention interventions. The aim of this study was to investigate the primary school food environment, specifically, allocated lunch eating duration and the governance of children's lunch breaks. Parents (n = 402) and teachers (n = 123) were asked via an online survey, about school allocated lunch eating duration and its adequacy. Respondents were asked about the supervision, monitoring and feedback of children's lunches, as well as how they felt about these practices. Parents (n = 308) and teachers (n = 102) also responded to the open-ended question “What could be done to improve the school food environment at your school?“. Ten minutes was the allocated lunch eating duration reported by most parents and teachers and 54% of those parents and 30% of those teachers rated this as inadequate. Increasing the allocated lunch eating duration was frequently cited as a way to improve the school food environment. A similar proportion of parents and teachers agreed with teachers monitoring food intake, not providing feedback on food brought to school, and that parents should decide what children eat. More parents (44%) than teachers (23%) believed that teachers should eat their own lunch with the children. These findings provide an insight into the primary school lunch environment and the views of two key stakeholder groups. School food policies should consider these findings in future revisions, particularly with regards to eating times.

Schools are regarded as a key setting for obesity prevention, providing an opportunity to reach a large number of children, frequently and over a prolonged period, through formal and informal opportunities to learn about health behaviours. However, the low value placed on health versus academic achievement is a barrier to effective implementation of food and nutrition (F&N) education. This study used a qualitative exploratory approach to explore the views of teachers and key health and education sector stakeholders regarding opportunities for F&N education within the Australian primary school setting. To the best of our knowledge, this is the first study to explore this topic from the perspectives of state-level coordination and development through to local-level implementation and support within the Australian primary school context. Only 2.6% of the Victorian Curriculum related to F&N education, taught through two (of seven) learning outcomes: Health and Physical Education, and Technologies. While stakeholders considered child health a priority, and schools an ideal setting for F&N education, barriers included a lack of strategic policy alignment, limited leadership and coordination, a ‘crowded curriculum’ and poor availability of shelf-ready resources with explicit curriculum links. A cross-curriculum approach was considered essential for F&N education to become embedded as a core component of the curriculum.

Purpose Secondary school food education provides students with opportunities to build lifelong healthy dietary practices. A number of stakeholder groups are important for the success of this form of education. Accordingly, the purpose of this paper is to examine young adults’ and parents’ opinions of secondary school food education. Design/methodology/approach An online survey was administered to 1,086 respondents drawn from a commercial research panel. Findings In total, 50-60 per cent of all respondents agreed that food education should be compulsory for years seven to ten and 31-32 per cent of respondents agreed that it should be compulsory for years 11 and 12. Almost 69 per cent suggested one to three hours per week for food education. More than 75 per cent of respondents agreed that there should be a non-compulsory food and nutrition subject for year 11 and 12 students and believed that this subject would help students to develop their food-related knowledge and skills. Practical implications There is a gap between parents’ and young adults’ views of school food education and what is actually practiced in Australian secondary schools. Obtaining their opinions in future food-related education and policy reforms could help design and deliver food education to better meet the expectations of its recipients: students and their families. Originality/value The examination of large number of young adults’ and parents’ opinions of school food education makes this study unique.

Objectives To determine whether historical neighborhood poverty measures are associated with mothers' reports of their children's sleep duration and to compare results from historical neighborhood poverty measures to contemporaneous measures of neighborhood poverty. Design The Geographic Research on Wellbeing (GROW) study is a follow-up survey of mothers who gave birth between 2003 and 2007. GROW mothers assessed their own and their children's health and health behaviors 5-10 years later (2012-2013). Setting Urban Californian counties. Participants GROW respondents. Measurements We categorized children's sleep as adequate or inadequate using clinical age-specific guidelines and based on mothers' reports of their child's sleep duration. We conducted a latent class analysis to identify historical poverty classes for all California census tracts using data from 1970 to 2005-2009, and we categorized current neighborhood poverty based on data from 2005 to 2009 only. We then assigned children to different neighborhood exposure classes based on their neighborhood of residence at birth and follow-up. Results Logistic models indicated that net of controls for demographics, child behavior and health characteristics, mother characteristics, and household socioeconomic status, children who grew up in historically low (OR: 0.64, 95% confidence interval = 0.45-0.92) or historically moderate poverty classes (OR: 0.68, 95% confidence interval = 0.48-0.98) had lower odds of inadequate sleep duration compared with children who grew up in historically high poverty. We show that the historical specification of neighborhood poverty remained significant despite controls, whereas contemporaneous measures of neighborhood poverty did not. Conclusions Our findings indicate strong associations between historical neighborhood poverty and child sleep duration.

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

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

PurposeImplementation of a new food literacy curriculum provides multiple health and social benefits to school students. The success of any new curriculum execution is partly determined by teachers’ perceptions about the new curriculum contents, and barriers and challenges for its delivery. The purpose of this paper is to explore teachers’ views of a new food literacy curriculum named Victorian Certificate of Education Food Studies for senior secondary school students in Victoria, Australia.Design/methodology/approachA qualitative study design was used in this study. In total, 14 teachers who were planning to teach the new curriculum were individually interviewed in October-December 2016. The interviews were transcribed and analysed using the template analysis technique.FindingsThe majority of teachers appreciated the inclusion of food literacy and nutrition concepts in the new curriculum. However, half of the teachers had doubts about their readiness to teach it. Most teachers mentioned that they needed more training and resources to increase their confidence in teaching the curriculum.Practical implicationsThese findings reveal that teachers need more awareness, resources, and guidance to increase their confidence in delivering the new curriculum. Provision of more resources and opportunities for training in food literacy concepts and instructional methods could facilitate its implementation.Originality/valueThese findings serve as an important first step to gain the perspectives of secondary school teachers’ opinions about the new curriculum. Moreover, these opinions and suggestions could inform the future design and implementation of similar food literacy curricula in Australia or elsewhere.

Purpose The purpose of this paper is to investigate the food system professionals’ opinions of a new senior secondary school food literacy curriculum named Victorian Certificate of Education Food Studies in Victoria, Australia. Design/methodology/approach A purposive sample of 34 food system professionals from different sub-sectors within the Australian food system was interviewed individually in late 2015 and early 2016. Interviews were analysed using the template analysis technique. Findings Most participants appreciated the extensive coverage of food literacy aspects in this new curriculum. However, many suggested amendments to the curriculum including pay less emphasis on food history-related topics and pay more focus on primary food production, nutrition awareness and promotion, and food security, food sovereignty, social justice, and food politics. Practical implications A well-structured, comprehensive secondary school food literacy curriculum could play a crucial role in providing food literacy education for adolescents. This will help them to establish healthy food patterns and become responsible food citizens. The findings of this study can be used to modify the new curriculum to make it a more comprehensive, logical, and feasible curriculum. Moreover, these findings could be used to inform the design of new secondary school food literacy curricula in Australia and other countries. Originality/value The exploration of perspectives of professionals from a broad range of food- and nutrition-related areas about school food literacy education makes this study unique. This study highlights the importance of food professionals’ opinions in secondary school food-related curricula development.

Background: The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence for the association between being breastfed and the development of metabolic syndrome in children and adolescents. Methods: Articles were obtained from searches using PubMed and Embase databases, as well as from secondary searches through reference lists. Study quality was assessed using a three-level quality rating system. Results: Of 11 studies reviewed, 7 found a protective association between breastfeeding and metabolic syndrome and 4 found no association. There was no clear dose–response relationship between duration of breastfeeding and metabolic syndrome risk and insufficient evidence to demonstrate an added effect of being exclusively breastfed. The overall quality of the articles was moderate. In general, lower quality articles found no significant association, whereas higher quality articles found a significant association. Conclusion: Our review demonstrated a limited amount of high-quality research on the relationship between being breastfed and development of metabolic syndrome in children and adolescents. The evidence presented in this review suggests that being breastfed may be protective against metabolic syndrome, but further research with improvements in study design, such as improved measurement of breastfeeding and the use of prospectively collected data, will improve our understanding of this relationship.

Food literacy education at senior secondary school could provide immediate health benefits to adolescents. In the long term, this will help strengthen the relationship between citizens and the food...

We know little about the relationship between the macroeconomy and birth outcomes, in part due to the methodological challenge of distinguishing effects of economic conditions on fetal health from effects of economic conditions on selection into live birth. We examined associations between state-level unemployment rates in the first 2 trimesters of pregnancy and adverse birth outcomes, using natality data on singleton live births in the United States during 1990-2013. We used fixed-effect logistic regression models and accounted for selection by adjusting for state-level unemployment before conception and maternal characteristics associated with both selection and birth outcomes. We also tested whether associations between macroeconomic conditions and birth outcomes differed during and after (compared with before) the Great Recession (2007-2009). Each 1-percentage-point increase in the first-trimester unemployment rate was associated with a 5% increase in odds of preterm birth, while second-trimester unemployment was associated with a 3% decrease in preterm birth odds. During the Great Recession, however, first-trimester unemployment was associated with a 16% increase in odds of preterm birth. These findings increase our understanding of the effects of the Great Recession on health and add to growing literature suggesting that macro-level social and economic factors contribute to perinatal health.

Recent efforts to explain the stark social and racial disparities in adverse birth outcomes that have persisted for decades in the U.S. have looked beyond prenatal factors, to explore preconception social conditions that may influence perinatal health via dysregulation of physiologic processes. The extant evidence supporting this link however remains limited, both due to a lack of data and theory. To address the latter, this manuscript generates a structured set of theoretical insights that further develop the link between two preconception social conditions — place and social relationships — and perinatal health. The insights propose the following. Place: necessarily encompasses all social contexts to which females are exposed from infancy through young adulthood; encompasses a variety of related exposures that, when possible, should be jointly considered; and may compound the effect of poverty—in childhood, adolescence, or young adulthood—on perinatal health. Social relationships: span relationships from early life through adulthood, and extend to intergenerational associations; often involve (or induce) major changes in the lives of individuals and should be examined with an emphasis on the developmental stage in which the change occurred; and necessarily encompass a lack of social integration, or, social isolation. We also identify potential biological and social-structural mechanisms linking these preconception social conditions to perinatal health, and conclude by identifying promising directions for future research.

BACKGROUND In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes. METHODS The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM-care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes. RESULTS Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22-0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23-4.41; P

Objectives Growing evidence suggests that pre-conception stressors are associated with increased risk of preterm delivery (PTD). Our study assesses stressors in multiple domains at multiple points in the life course (i.e., childhood, adulthood, within 6 months of pregnancy) and their relation to PTD. We also examine heterogeneity of associations by race/ethnicity, PTD timing, and PTD clinical circumstance. Methods We assessed stressors retrospectively via mid-pregnancy questionnaires in the Pregnancy Outcomes and Community Health Study (1998–2004), a Michigan pregnancy cohort (n = 2559). Stressor domains included abuse/witnessing violence (hereafter “abuse”), loss, economic stress, and substance use. We used logistic and multinomial regression for the following outcomes: PTD (