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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.

Objective To determine whether method of maxillary advancement in adolescents with cleft palate with or without cleft lip (CP ± L) influences post-operative velopharyngeal function. Design Retrospective cohort. Setting Pediatric Tertiary Care Hospital. Participants One hundred and ninety-nine patients with CP ± L after LeFort I osteotomy for maxillary advancement at our institution between January 2007 and June 2019. Interventions LeFort I osteotomy via distraction osteogenesis (DO) or conventional osteotomy (CO). Main Outcome Measures Patients who underwent DO or CO were compared for the presence of new velopharyngeal insufficiency (VPI), as measured by perceptual rating by a craniofacial speech-language pathologist. Of the 199 patients who underwent maxillary advancement, 126 were available for analysis. The DO group was younger, male, and had more severe maxillary hypoplasia. Following surgery, 17/41 (41.5%) of the DO group had new VPI, compared to just 23/85 (27.1%) of the CO group. After adjusting for cleft type and predicted maxillary advancement, however, there was not sufficient evidence to reject the null hypothesis of no difference in risk of post-operative VPI between the two surgical groups (prevalence ratio [PR] 1.40, 95% CI 0.68-2.90). Increased prevalence of VPI after DO versus CO was primarily observed among patients with a pre-operative velopharyngeal need ratio < 0.8 (PR = 2.01, 95% CI 0.79-5.10) and patients with normal velopharyngeal function pre-operatively (PR = 2.86, 95% CI 0.96-8.50). Our results suggest an increased rather than decreased risk of VPI following DO relative to CO. This association is primarily seen among those with a smaller velopharyngeal ratio or perceptually normal velopharyngeal function pre-operatively.

ObjectiveThe Food Standards Code regulates health claims on Australian food labels. General-level health claims highlight food–health relationships, e.g. ‘contains calcium for strong bones’. Food companies making claims must notify Food Standards Australia New Zealand (FSANZ) and certify that a systematic literature review (SLR) substantiating the food–health relationship has been conducted. There is no pre- or post-notification assessment of the SLR, potentially enabling the food industry to make claims based on poor-quality research. The present study assessed the rigour of self-substantiation.DesignFood–health relationships notified to FSANZ were monitored monthly between 2013 and 2017. These relationships were assessed by scoping published literature. Where evidence was equivocal/insufficient, the relevant government food regulatory agency was asked to investigate. If not investigated, or the response was unsatisfactory, the project team conducted an independent SLR which was provided to the government agency.SettingAustralia.ParticipantsSelf-substantiated food–health relationships.ResultsThere were sixty-seven relationships notified by thirty-eight food companies. Of these, thirty-three relationships (52 %) from twenty companies were deemed to have sufficient published evidence. Four were excluded as they originated in New Zealand. Three relationships were removed before investigations were initiated. The project initiated twenty-seven food–health relationship investigations. Another six relationships were withdrawn, and three relationships were awaiting government assessment.ConclusionsTo ensure that SLR underpinning food–health relationships are rigorous and reduce regulatory enforcement burden, pre-market approval of food–health relationships should be introduced. This will increase consumer and public health confidence in the regulatory process and prevent potentially misleading general-level health claims on food labels.

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.

Food choices determine consumers’ dietary and energy intakes, and in turn their risk of obesity and diet-related diseases. Factors affecting food choices are complex, varied, and inter-connected. The aims of this study were to assess the relative importance of four factors influencing food choices (taste, price, healthiness, and convenience) and identify segments of consumers according to their ratings. Australian consumers (n = 1,558) aged 18 + years completed an online survey assessing a range of factors influencing their food choices, including the perceived importance of taste, price, healthiness, and convenience. Latent profile analysis was undertaken to identify segments, with bivariate analyses then conducted to describe the differences between the derived segments. Overall, taste was reported to be the dominant factor determining food choices (Mean (M) = 4.42; SD = 0.72; z-score = 0.43), followed by price (M = 4.19; SD = 0.78; z-score = 0.15), healthiness (M = 4.07; SD = 0.82, z-score = 0.00), and finally convenience (M = 3.79; SD = 0.82, z-score = -0.35). However, there were variations in absolute and relative ratings across the four identified segments. Two segments (‘High involvement’ and ‘Taste focused’, together accounting for 53% of the sample) rated taste highest, and the other two segments (‘Moderate involvement’ and ‘Indifferent’, 47% of the sample) rated price highest. Age, gender, residential location, and responsibility for grocery shopping were associated with segment membership. Understanding the dominant drivers of food choices across different consumer segments is useful for the development of tailored nutrition promotion messages and interventions to address obesity and other diet-related diseases.

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).

Objectives: Evaluation of hypernasality requires extensive perceptual training by clinicians and extending this training on a large scale internationally is untenable; this compounds the health disparities that already exist among children with cleft. In this work, we present the objective hypernasality measure (OHM), a speech analytics algorithm that automatically measures hypernasality in speech, and validate it relative to a group of trained clinicians. Methods: We trained a deep neural network (DNN) on approximately 100 hours of a publicly-available healthy speech corpus to detect the presence of nasal acoustic cues generated through the production of nasal consonants and nasalized phonemes in speech. Importantly, this model does not require any clinical data for training. The posterior probabilities of the deep learning model were aggregated at the sentence and speaker-levels to compute the OHM. Results: The results showed that the OHM was significantly correlated with the perceptual hypernasality ratings in the Americleft database ( r=0.797, ~p$

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.

Background In response to rising childhood obesity rates, the Australian food industry implemented two initiatives in 2009 to reduce the marketing of unhealthy food to children. This study evaluated the efficacy of these initiatives on the rate of unhealthy food advertising to children on Australian television. Methods The rates of food advertisements on three free-to-air commercial television channels and a youth-oriented digital channel in Sydney, Australia were analysed over 2 weekdays (16 h) and two weekend days (22 h). Advertisements were categorized according to the healthiness of foods advertised (non-core, core, miscellaneous) and signatory status to the food industry advertising initiatives. Results Total food advertising rates for the three channels increased from 5.5/h in 2011 to 7.3/h in 2015, due to an increase of 0.8/h for both core and miscellaneous foods. The rate of non-core food advertisements in 2015 (3.1/h) was similar to 2011 (3.0/h). The youth-oriented channel had fewer total food advertisements (3.7/h versus 7.3/h) but similar fast-food advertisement rates (1.3/h versus 1.3/h). Conclusions There was no change in the rate of unhealthy food advertising since 2011, suggesting minimal impact of the current food industry initiatives on reducing children's exposure to unhealthy food advertising.

Care of the patient with cleft lip and/or palate remains complex. Prior attempts at aggregating data to study the effectiveness of specific interventions or overall treatment protocols have been hindered by a lack of data standards. There exists a critical need to better define the outcomes- particularly those that matter most to patients and their families-and to standardize the methods by which these outcomes will be measured. This report summarizes the recommendations of an international, multidisciplinary working group with regard to which outcomes a typical cleft team could track, how those outcomes could be measured and recorded, and what strategies may be employed to sustainably implement a system for prospective data collection. It is only by agreeing on a common, standard set of outcome measures for the comprehensive appraisal of cleft care that intercenter comparisons can become possible. This is important for quality-improvement endeavors, comparative effectiveness research, and value-based health-care reform.

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.

Issue addressed: The aim of this study was to investigate predictors of adults' perceived acceptability of introducing alcohol to children less than 18 years of age.Methods: An online survey. Logistic regression analyses were used to examine the association between demographic characteristics, alcohol consumption, and social norms and adults' own age of initiation.Results: Alcohol consumption, age of initiation and perception of the acceptability of drunkenness were all correlated with the acceptability of introducing children to alcohol. The strongest predictor was adults' own age of initiation.Conclusions: Adults who began drinking before the age of 18, and those who drink more heavily, are more likely to perceive the provision of alcohol to children as acceptable.So what?: Policy and research should continue to focus on and monitor efforts to delay adolescent alcohol initiation and reduce consumption levels among adults. A shift in awareness and perceptions about alcohol use among adults has the potential to influence initiation and heavy drinking among adolescents.

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.

Aim 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. Methods 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. Results 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. Conclusions 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.

Rationale and objective Unhealthy, energy-dense nutrient-poor foods and beverages are heavily promoted through sport sponsorship. This naturalistic trial assessed whether exposing young adult spectators to various types of counter-advertising (CA) before watching an unhealthy food sponsored elite sporting event could diminish sponsorship effects and increase support for restrictions on sponsorship. Method Young adults (ages 18-29 years) who planned to watch the Australian Football League (AFL) Grand Final were recruited through an online panel and randomly assigned to one of four conditions: (A) control (neutral advertisement); (B) anti-industry CA (critiquing unhealthy food industry sponsorship of sport); (C) anti-product CA (critiquing the association of sports stars with unhealthy food); or (D) negative health effects CA (highlighting negative health consequences of unhealthy food consumption). Participants (N = 1316) completed a pre-test questionnaire and viewed their assigned CA online 1–3 days before watching the 2017 AFL Grand Final, which featured unhealthy food sponsorship. Results Participants who reported watching the AFL Grand Final (n = 802) answered post-test measures within five days of the event. Results indicated that participants found the anti-industry CA more believable, attention-grabbing, reassuring and encouraging than the anti-product CA. The anti-industry CA promoted less favourable attitudes to sponsor brands, the anti-product CA promoted reduced intentions to purchase the fast-food sponsor brand, and the negative health effects CA reduced preferences for fast food in general compared to the control condition. Conclusions Anti-industry CA may detract from favourable attitudes to unhealthy food sponsor brands and negative health effects CA may detract from intentions to consume fast food in the face of unhealthy food sponsorship exposure. Such interventions may require higher dosage levels than applied in the present study to bolster spectators’ resistance to the surfeit of unhealthy food sport sponsorship.

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).

Summary Background Child obesity interventions need to be based on a sound understanding of the factors that influence children's diets. Objective To investigate the relationship between a range of predictor variables and the frequency with which Australian children consume energy-dense, nutrient-poor (EDNP) foods. Methods A web panel provider was used to access 1302 parents of Australian children aged 8–14 years who responded to an online survey about their children's diets. Structural equation modelling was conducted to test a model of the factors contributing to the frequency of children's unhealthy food consumption. Results Of the tested variables, consumption of EDNP foods was primarily influenced by parents’ attitudes to these foods, children's pestering behaviours and perceived social norms relating to children's consumption of these products. Both pestering and social norms had significant direct effects on consumption frequency as well as indirect effects via their impact on parents’ attitudes to EDNP foods. Conclusion Environmental factors that contribute to both pestering and social norms are likely to be critical considerations in the development of child obesity interventions.

Aim Worldwide, there are concerns about the link between fast food and overall poor dietary quality and weight gain. Beverages and snack foods purchased from coffee chains may contribute excess energy and nutrients to the diet if they are consumed in addition to usual meals. The present study investigated the energy, saturated fat and sugar content of beverages and sweet snacks from major coffee chains and compared the nutrient content to daily intake (DI) reference values for adults. Methods Nutrition information per serve was sourced from the Australian websites of five coffee chains with the largest number of outlets in New South Wales and compared to DI reference values for adults for energy, saturated fat and sugars. Energy per serve was compared to 600 kJ, the Australian Dietary Guidelines recommendation for one serve of a discretionary food. Results Eighty-four per cent (n = 238) of sweet snacks and 65% (n = 79) of cold beverages provided more than two equivalent serves (1200 kJ) of a discretionary food. Sixteen (13%) cold beverages and 47 (16%) sweet snacks provided over 50% DI of saturated fat. Sixty-six (54%) cold beverages and 47 (16%) sweet snacks had more than half the DI of sugars. Conclusions Food and beverage items from coffee chains may contribute to excess intake of energy and other nutrients of public health concern if consumed in addition to meals. To assist consumers to make informed and healthier fast food choices, accessible detailed nutrition information should be available along with reductions in portion sizes and reformulation to more nutritious menu items.

Effective health interventions rely on a detailed understanding of the target audience’s attitudes relevant to the desired behavioural change. In the context of obesity interventions targeting parents, understanding parents’ attitudes to unhealthy foods and beverages is necessary to overcome barriers to adopting recommended behaviours. The aim of the present study was to assess the factors influencing parents’ attitudes to unhealthy foods and beverages to identify potential elements to incorporate into future obesity prevention programs. A sample of 1302 parents responded to an online survey that assessed their perceptions of the two product categories of soft drinks and energy dense, nutrient poor (EDNP) foods. Overall, attitudes to these products were favourable, with perceived convenience and enjoyment receiving higher scores than value for money and health considerations. The results suggest that interventions designed to improve children’s diets should aim to enhance perceptions of the convenience and taste of healthier alternatives, while also addressing factors such as food advertising and child pestering that can influence parents’ attitudes to unhealthy products.

ObjectiveThe present study examined the energy (kilojoule) content of Australian fast-food menu items over seven years, before and after introduction of menu board labelling, to determine the impact of the introduction of the legislation.DesignAnalysis of the median energy contents per serving and per 100g of fast-food menu items. Change in energy content of menu items across the years surveyed and differences in energy content of standard and limited-time only menu items were analysed.SettingFive of Australia’s largest fast food chains: Hungry Jack’s, KFC, McDonald’s, Oporto and Red Rooster.SubjectsAll standard and limited-time only menu items available at each fast-food chain, collected annually for seven years, 2009–2015.ResultsAlthough some fast-food chains/menu item categories had significant increases in the energy contents of their menus at some time points during the 7-year period, overall there were no significant or systematic decreases in energy following the introduction of menu labelling (P=0·19 by +17 kJ/100 g, P=0·83 by +8 kJ/serving). Limited-time only items were significantly higher in median energy content per 100 g than standard menu items (+74 kJ/100 g, P=0·002).ConclusionsWhile reformulation across the entire Australian fast-food supply has the potential to positively influence population nutrient intake, the introduction of menu labelling legislation in New South Wales, Australia did not lead to reduced energy contents across the five fast-food chains. To encourage widespread reformulation by the fast-food industry and enhance the impact of labelling legislation, the government should work with industry to set targets for reformulation of nutrient content.

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.

There is now considerable evidence for physical activity and,increasingly, for weight control interventions in survivors of themore prevalent cancers, especially breast cancer. However, inAustralia, as in most developed countries, such interventions are notincorporated into routine cancer care. The Healthy Living afterCancer (HLaC) project seeks to bridge this evidence-to-practicedivide. HLaC is an Australian National Health & Medical ResearchCouncil-funded Partnership Project involving collaboration betweenuniversity cancer researchers and four state-based Cancer Councils(cancer control advocacy and support organizations similar to theAmerican Cancer Society). The HLaC project, conducted from 2015to 2019, is evaluating the implementation of an evidence-based,6-month, telephone-delivered program targeting physical activity,healthy eating, and weight control among cancer survivors (of anycancer type following treatment with curative intent). The programis offered by the Cancer Councils free of charge via their telephone-based cancer support and information service. Cancer survivors canself-refer or be referred by a treating health professional. Screening,pre- and post-program assessment, and program delivery are all implemented by Cancer Council staff and nurses.In this phase IV dissemination and implementation study (single-group, pre-post design with assessments at baseline and 6 months)(1), primary outcomes relate to program implementation: adoption(referral sources), reach (number of participants) and retention, fidelity of implementation, participant and staff satisfaction, and fixed and recurrent costs of program delivery. Secondary outcomes are patient-reported and validated measures of physical activity and dietary intake/behavior, weight, quality of life, cancer-related side-effects, and fear of recurrence.To date, over 500 cancer survivors have been referred, with 89%screened as eligible and 91% consenting. Among the first 440 to complete the pre-program assessment, 88% were female (most with breast cancer); mean age was 55 years (SD 5 11); with meanBMI 5 29 kg/m2(SD 5 6). Among the first nearly 200 program completers (57% completion rate), significant (P < 0.05) and clinically meaningful improvements have been seen in all secondary patient-reported outcomes.This University-Cancer Council collaboration provides an opportunity for national dissemination of an evidence-based intervention to support healthy living among cancer survivors. Preliminary analysis of service-level outcomes suggests the program is feasible to deliver,with analysis of patient-reported outcomes showing it produces improvements in outcomes important to patients, clinicians, and public health. The end-of-program evaluation, including economic analysis, will provide the practice-based evidence needed to inform decisions regarding program sustainability.

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.

Background: Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes. Objectives: The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults’ total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults. Methods: A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns. Results: Recruitment is underway, and results will be available in 2018. Conclusions: The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people’s diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified. [JMIR Res Protoc 2018;7(1):e24]

BACKGROUND Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes. OBJECTIVES The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults’ total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults. METHODS A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns. RESULTS Recruitment is underway, and results will be available in 2018. CONCLUSIONS The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people’s diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified.

ObjectivesTo assess retailer compliance with a licensing scheme requiring tobacco retailers to list their business details with the government, to examine whether listed retailers are more likely to comply with a point-of-sale (POS) display ban and other in-store retailing laws and to explore variations in compliance between different retailer types and locations.MethodAn audit of 1739 retailers in New South Wales, Australia, was used to assess compliance with tobacco retailing legislation. Auditors actively searched for and audited unlisted retailers and all listed retailers in 122 metropolitan and regional postcodes. Multivariate generalised linear regression models were used to examine associations between compliance and retailer type, remoteness and demographic characteristics (socioeconomic level, proportion of population under 18 years and proportion born in Australia).ResultsOne unlisted tobacco retailer was identified for every 12.6 listed tobacco retailers. Unlisted retailers were significantly more likely than listed retailers to breach in-store retailing laws (pConclusionsSome tobacco retailers did not list their business details with the government as required, even though there was no financial cost to do so. Unlisted retailers were more likely to violate in-store regulations. The results suggest licensing schemes can be useful for providing a list of retailers, thus facilitating enforcement, but require a system to search for, and respond to, unlisted/unlicensed retailers.