The role of Australian local governments in creating a healthy food environment: an analysis of policy documents from six Sydney local governments

Objective : This paper examines policies from six local governments (LGs) relevant to promoting a healthy food supply and consumer food environment. Methods : We analysed the six LGs’ food and nutrition policies against a framework based on Australian literature and international policy frameworks. Policy content was collected by searching LG websites and analysed with reference to recommended policy actions in the framework. Results : All LGs took action on reducing food waste, providing food/meal services for disadvantaged groups, and providing information/education on food and nutrition. A sub‐set also supported urban/local food production and markets selling fresh, healthy food. Our search did not identify any indication of a comprehensive policy framework to guide action on food and nutrition, nor did we find policies restricting opening of unhealthy food outlets, encouraging the opening of healthy food outlets, or reducing unhealthy food marketing. Conclusions : Local governments in Australia are implementing policies to support improved nutrition. However, there are further opportunities for action, including discouraging unhealthy food outlets and restricting unhealthy food marketing. Implications for public health : The legal remit of LGs includes responsibilities relevant to food and nutrition. Further research is needed regarding how their powers could be better leveraged to improve diet‐related health.     

Food references and marketing to children in Australian magazines: a content analysis

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

Persuasive food marketing to children: use of cartoons and competitions in Australian commercial television advertisements

While there is a recognized link between high levels of exposure to advertising of unhealthy foods and overweight and obesity among children, there is little research on the extent to which these exposures include persuasive marketing techniques. This study aimed to measure children's exposure to the use of persuasive marketing within television food advertisements. Advertisements broadcast on all three commercial Australian television channels were recorded for an equivalent 1 week period in May 2006 and 2007 (714 h). Food advertisements were analysed for their use of persuasive marketing, including premium offers, such as competitions, and the use of promotional characters, including celebrities and cartoon characters. Advertised foods were categorized as core, non-core or miscellaneous foods. Commercial data were purchased to determine children's peak viewing times and popular programs. A total of 20 201 advertisements were recorded, 25.5% of which were for food. Significantly more food advertisements broadcast during children's peak viewing times, compared to non-peak times, contained promotional characters (P < 0.05) and premium offers (P < 0.001). During programs most popular with children, there were 3.3 non-core food advertisements per hour containing premium offers, compared to 0.2 per hour during programs most popular with adults. The majority of advertisements containing persuasive marketing during all viewing periods were for non-core foods. Persuasive marketing techniques are frequently used to advertise non-core foods to children, to promote children's brand recognition and preference for advertised products. Future debate relating to television advertising regulations must consider the need to restrict the use of persuasive marketing techniques to children.     

Trends in food advertising to children on free-to-air television in Australia

Objective: The issue of marketing unhealthy food to children and its contribution to childhood obesity has become a highly politicised debate in Australia. The aim of this study was to compare recent television food advertising patterns in 2008 to previously published Australian research on television advertising from 2006 and 2007, to examine any changes following policy debates. Methods: Television broadcasting was recorded for two weekdays and two weekend days between 6:00 and 22:00 in February 2008 for all three commercial television channels. Food advertisements were classified as core/healthy, non‐core/unhealthy or miscellaneous. Television audience data were obtained to determine broadcast periods corresponding to children's peak viewing times. Results: The overall rate of food advertising decreased over time: from seven food advertisements/hour/channel in 2006/07 to five in 2008. However, the relative contribution of non‐core food advertising to overall food advertising remained stable. In 2008, the proportion of food advertisements for non‐core foods was significantly higher during children's peak viewing times (p<0.01). Conclusions and implications: Australian children remain exposed to a disproportionate volume of television advertisements for unhealthy foods on commercial television, which are shown during time periods when the highest numbers of children are watching. Regulations to limit unhealthy food advertising during the time periods when a significant number of children are watching are required.     

Parental awareness and attitudes about food advertising to children on Australian television

OBJECTIVE: To assess parents' concern regarding television food advertising to children and the marketing methods used, their awareness of existing regulations and support for strengthening restrictions, and to determine whether these factors differ across sociodemographic groups. METHODS: A randomly selected sample of 400 parents of children under 14 years in all Australian States and Territories completed the cross-sectional telephone survey in March 2007. Data were weighted by metropolitan and regional population proportions. RESULTS: Parents were concerned about unhealthy food advertising to children (67.3%), use of popular personalities (67.7%), toys (76.4%), and advertising volume (79.7%). Older parents, of high socioeconomic status (SES), with fewer household televisions were more likely to be concerned. Only 47.4% of parents were aware of current regulations and those with a tertiary education were more likely to be aware: odds ratio (OR) 2.96 (95% CI: 1.55-5.65). Parents supported a change from self-regulation (92.8%), a ban on unhealthy food advertising to children (86.8%) and, to a lesser extent, a ban on all food advertising (37.3%). CONCLUSIONS AND IMPLICATIONS: There was widespread parental concern about food advertising and strong support for tighter restrictions. Given that the existing regulations rely on complaints and awareness is low, particularly among parents with lower education levels, a system of external monitoring and enforcement is essential. Clearly more effective regulations are needed to protect children and parental support for this is high.     

The commercial food landscape: outdoor food advertising around primary schools in Australia

Objective: Food marketing is linked to childhood obesity through its influence on children's food preferences, purchase requests and food consumption. We aimed to describe the volume and nature of outdoor food advertisements and factors associated with outdoor food advertising in the area surrounding Australian primary schools. Methods: Forty primary schools in Sydney and Wollongong were selected using random sampling within population density and socio‐economic strata. The area within a 500m radius of each school was scanned and advertisements coded according to pre‐defined criteria, including: food or non‐food product advertisement, distance from the school, size and location. Food advertisements were further categorised as core foods, non‐core foods and miscellaneous drinks (tea and coffee). Results: The number of advertisements identified was 9,151, of which 2,286 (25%) were for food. The number of non‐core food advertisements was 1,834, this accounted for 80% of food advertisements. Soft drinks and alcoholic beverages were the food products most commonly advertised around primary schools (24% and 22% of food advertisements, respectively). Non‐core food products were twice as likely to be advertised close to a primary school (95 non‐core food advertisements per km 2 within 250 m vs. 46 advertisements per km 2 within 250–500 m). Conclusions: The density of non‐core food advertisements within 500 m of primary schools, and the potential for repeated exposure of children to soft drink and alcoholic beverage advertisements in particular, highlights the need for outdoor food marketing policy intervention. Implications: Outdoor advertising is an important food marketing tool that should be considered in future debates on regulation of food marketing to children.     

Cricket: notching up runs for food and alcohol companies?

Objective: To analyse sports sponsorship by food and alcohol companies by quantifying the proportion of time that the main sponsor's logo was seen during each of three cricket telecasts, the extent of paid advertising during the telecast and the contribution by the main sponsor to this, and to describe the associated ground advertising.
Methods: DVD recordings of the three telecasts were analysed for visibility of the main sponsor's logo during actual playing time and for each sponsor's proportion of the advertising time during breaks in telecast.
Results: The main sponsor's logo was visible on a range of equipment and clothing that resulted in it being clearly identifiable from 44% to 74% of the game time. The proportion of paid advertising time in these three telecasts varied from 3% to 20%, reflecting the difference in advertising content of paid television versus free-to-air.
Implications: While television food advertising to children is under review, sporting telecasts also reach children and, until recently, have avoided scrutiny. This content analysis of three recent cricket telecasts reveals an unacceptable level of exposure to food and alcohol marketing, particularly in the form of the main sponsor's logo. Sponsorship is not covered by the voluntary codes of practice that address some forms of advertising. A new system of regulation is required to reduce this unacceptable level of exposure.     

Density of outdoor food and beverage advertising around schools in Ulaanbaatar (Mongolia) and Manila (The Philippines) and implications for policy

Children’s exposure to unhealthy food marketing is recognised by leading international health organisations as a probable causal factor for obesity. Outdoor advertising near schools embeds commercial food messages into children’s everyday lives and acts as a cue for food purchases. This project aimed to describe food advertising in the area around schools in two demographically and culturally disparate cities in the Asia Pacific Region. Data on outdoor food advertising were collected from the area within 500?m of 30 primary schools in each of two cities: Ulaanbaatar, Mongolia and Manila, The Philippines. For each food advertisement, information was collected on: distance from the school (within 250 or 500?m); size, setting, type and position of the advertisement; and the food/drink product type promoted (core/healthy, non-core/unhealthy and miscellaneous). Density of advertisements was calculated per 100?m². The density of food advertising was twice as high in the area closest to schools compared to the area further from schools (.9 vs. .5 in Ulaanbaatar and 6.5 vs. 3.3 advertisements per 100?m² in Manila). Almost all food advertisements were for non-core/unhealthy foods/drinks (92% in Ulaanbaatar and 85% in Manila), and soft drinks were most frequently promoted. Children in Ulaanbaatar and Manila are exposed to large numbers of advertisements for unhealthy foods/drinks on their way to and from school, and these are particularly clustered within the immediate vicinity of schools. Clear directions for policy development are outlined to reduce children’s exposure to this marketing, including restricting the placement and content of outdoor advertising.     

The effects of different regulation systems on television food advertising to children

OBJECTIVE: The aim of this study was to model children's potential exposure to television food advertisements under different regulatory scenarios to demonstrate the policy implications of regulatory change in Australia. METHODS: Television advertising data was collected from Sydney commercial television channels from 14-20 May 2006. Extrapolating from these data, the patterns of food advertising under four regulatory scenarios were examined, including arrangements restricting the content, volume and timing of advertisements. RESULTS: Each scenario resulted in a reduction of total and non-core food advertisements. The scenario to restrict non-core food advertisements during the major viewing period (7:00-20:30) led to the largest reduction in total and non-core food advertisements (79.2% reduction), with no change in the frequency of core food advertisements. CONCLUSIONS: The results illustrate the potential for reducing children's exposure to food advertising through simple regulatory restrictions. IMPLICATIONS: This research contributes to future debates on the regulation of television food advertising. It is particularly relevant as Australian regulations will be under review in 2007.     

Regulating the types of foods and beverages marketed to Australian children: How useful are food industry commitments?

Aim: Any regulation of food marketing to children requires clear definitions of the types of foods considered inappropriate and subject to restrictions. The aim of this research was to examine the commitments made by signatory companies of the Australian Food and Grocery Council's Responsible Marketing to Children Initiative regarding the types of foods considered appropriate for marketing to children. Methods: Nutrient criteria developed by signatory food companies were examined by comparing (i) thresholds set for negative nutrients (saturated fats, added sugars and sodium) and total energy to two existing nutrient criteria: Healthy Kids Association and the National Heart Foundation Tick, and (ii) the types of foods considered appropriate for marketing to children, if applying companies' commitments or the product's nutrient profile using the Food Standards Australia and New Zealand nutrient profiling tool. Results: All five company-developed nutrient criteria examined specified higher thresholds for negative nutrients compared with existing criteria, and were more likely to report negative nutrients per serve rather than per 100 g. When applying company commitments, 57% more energy-dense, nutrient-poor foods and beverages were considered appropriate for marketing to children, compared with nutrient profiling. Conclusion: Food industry commitments regarding the types of foods considered appropriate for marketing to children do not adequately restrict the marketing for energy-dense, nutrient-poor foods. It is recommended food manufacturers who commit to restricting their marketing of unhealthy foods to children use a standardised, independent nutrient profiling tool based on per 100 g/100 mL to determine the appropriateness of foods and beverages for marketing to children.     

The distribution of harmful product marketing in public outdoor spaces and the effectiveness of marketing bans

Children's exposure to the marketing of harmful products in public outdoor spaces may influence their consumption of those products and affect health into adulthood. This study aimed to: i) examine the spatial distribution of children's exposure to three types of marketing-related ‘harms’ (alcohol, unhealthy food, and gambling) in outdoor spaces in the Wellington region, New Zealand/Aotearoa; ii) compare differences in the distribution of harms by socioeconomic deprivation; and iii) estimate the effectiveness of different policies that ban such marketing. Data were from 122 children aged 11–13y who wore wearable cameras and GPS devices for four consecutive days from July 2014 to June 2015. Images were analysed to identify harmful product marketing exposures in public outdoor spaces. Eight policy scenarios were examined to identify the effectiveness of marketing bans, for all children and by socioeconomic deprivation. Children's ratio of harmful marketing was higher for children from high deprivation households and was also found to cluster, with hots spots observed around city centers. The effectiveness of marketing bans depended on the target setting and ban area, with banning 400 m around bus stops leading to the largest reduction. Effectiveness varied also by type of harm and socioeconomic deprivation. For example, banning alcohol marketing in residential areas was estimated to have a larger effect on exposure reduction for children from high deprivation households. Our findings suggest that alcohol, unhealthy food and gambling marketing often cluster outdoors and that targeted bans of such marketing would likely improve child health and, for some banning scenarios, promote equity.     

How three countries in the Americas are fortifying dietary salt reduction: A north and south perspective

A chronic disease/risk factor prevention framework with three policy environments - communications, physical and economic - was used to organize population level interventions that address the “over consumption of dietary salt”, a key risk factor for cardiovascular diseases. The framework was then used to map the population based strategies to reduce dietary salt consumption being applied in three countries in the Americas - Argentina, Canada and Chile - each with a history of multi-sector approaches to deal with the risk factors for chronic disease, offering a north versus south perspective.Results show that in all three countries policy instruments are concentrated in the communications environment, e.g. media and education campaigns and/or regulations for standardized information on the salt or sodium content of packaged food products. Notable gaps are the requirement for nutrient information on meals and food items prepared by food establishments and restrictions on advertising and marketing of foods to children. In the physical environment, referring to the sodium levels in commercially prepared foods and meals available on the market, voluntary reformulation of food products is underway at this time in the three countries. Argentina and Chile began with bread and have gradually added other food categories; Canada at the outset is addressing all food categories where products have added salt. Argentina alone is at this point actively approaching regulations to limit the salt content of food, preferring this over ongoing monitoring of voluntary targets. No government in the three counties has yet considered action in the economic environment, a complex area where the research on and initiatives to limit or disadvantage energy-dense food products to address obesity may also capture foods that are highly salted. In the meantime, with recent research estimating substantially higher gains in population health from government legislation to limit salt in foods compared to voluntary approaches, decision makers in countries, whether in the north or south, committed to reducing dietary salt can take Argentina's example to strengthen their interventions in the physical environment with regulatory instruments. This will sustain reformulations made to date, “level the playing field” industry-wide and broadly and equitably distribute the health benefits of low salt foods.     

Risk assessment to underpin food regulatory decisions: an example of public health nutritional epidemiology

The approach used by food regulation agencies to examine the literature and forecast the impact of possible food regulations has many similar features to the approach used in nutritional epidemiological research. We outline the Risk Analysis Framework described by FAO/WHO, in which there is formal progression from identification of the nutrient or food chemical of interest, through to describing its effect on health and then assessing whether there is a risk to the population based on dietary exposure estimates. We then discuss some important considerations for the dietary modeling component of the Framework, including several methodological issues that also exist in research nutritional epidemiology. Finally, we give several case studies that illustrate how the different methodological components are used together to inform decisions about how to manage the regulatory problem.     

Attitudes to food and nutrition policy from five different sectors in Australia

This study attempted to examine the views of representativesof five sectors of the Australian food and nutrition systemabout ways in which consumers' nutrition status can be strengthened.The study was conducted in two stages: stage one was in theform of a postal Delphi survey in which 56 representatives drawnfrom the farming, food processing, regulatory, food safety andnutrition sectors were asked to suggest ways to improve theAustralian food sytem. These results were summarised in theform of a short 64 item opinion statement inventory. In stagetwo this was completed (via postal administration) by 253 representativesfrom the same five sectors. The findings show that there waswidespread support for policy proposals to do with educationand enforcement of current regulations. However, there werealso major differences between the groups. Multidimensionalscaling and discriminant analytic approaches showed that foodprocessors and regulators tended to hold views supportive ofthe present status quo, whereas nutritionists and, to a lesserextent, farmers and food safety personnel supported changesto the system. The possible causes of these differences arediscussed along with the implications of the findings for theimplementation of the Australian food and nutrition policy.     

Research for leveraging food policy in universal eating disorder prevention

Policy and legislation have emerged as important levers for universal prevention efforts in the context of eating disorders. However, to date, little attention has been paid to generating research that will inform opportunities to regulate the food environment, specifically the way that food is produced and marketed. The present paper aims to lay out a framework for research that will examine (1) the ways in which food industry may influence risk for eating disorders and (2) the impact of legislative efforts on eating disorder cognitions and behaviors. For these two pathways, specific examples of research that would serve to inform policy efforts aiming to decrease the risk for eating disorders by targeting the food environment are proposed. Overall, the present paper aims to issue a call for the eating disorder field to become involved in food policy and regulation.     

Experts’ views regarding Australian school‐leavers’ knowledge of nutrition and food systems

Objective: To explore Australian experts’ views regarding strengths and gaps in school‐leavers’ knowledge of nutrition and food systems ( N&FS) and factors that influence that knowledge. Method: Semi‐structured interviews were conducted with 21 highly experienced food‐related experts in Australia. Qualitative data were analysed thematically using Attride‐Stirling's thematic network framework. Results: Two global themes and several organising themes were identified. The first global theme, ‘structural curriculum‐based problems’, emerged from three organising themes of: inconsistencies in provided food education programs at schools in Australia; insufficient coverage of food‐related skills and food systems topics in school curricula; and the lack of trained school teachers. The second global theme, ‘insufficient levels of school‐leavers knowledge of N&FS ’, was generated from four organising themes, which together described Australian school‐leavers’ poor knowledge of N&FS more broadly and knowledge translation problem for everyday practices. Conclusion: Study findings identified key problems relating to current school‐based N&FS education programs in Australia and reported knowledge gaps in relation to N&FS among Australian school‐leavers. Implications: These findings provide important guidance for N&FS curriculum development, to clearly articulate broadly‐based N&FS knowledge acquisition in curriculum policy and education documents for Australian schools.     

Which Australian food composition database should I use?

Aim:  This paper describes the differences between the NUTTAB and AUSNUT food composition databases now available in Australia.
Method:  The NUTTAB and AUSNUT food composition databases are described in detail by officers of Food Standards Australia New Zealand directly involved in the database management and development. The positions of Food Standards Australia New Zealand in terms of revisions and policy directions are given from an authoritative perspective.
Results:  Food Standards Australia New Zealand develops two different sets of food composition databases, NUTTAB and AUSNUT. NUTTAB is a reference database that contains primarily analysed data for Australian foods. AUSNUT is a survey database that contains only data that are directly relevant to the particular national nutrition survey for which it was developed. These databases are available free of change from the Food Standards Australia New Zealand website.
Conclusions:  Food Standards Australia New Zealand develops two distinct series of food composition databases. Users will need to be aware of the similarities and differences of each database type to be able to determine which is the most suitable for their needs.     

Setting priorities for a research agenda to combat drug-resistant tuberculosis in children

Setting: Numerous knowledge gaps hamper the prevention and treatment of childhood drug-resistant tuberculosis (TB). Identifying research priorities is vital to inform and develop strategies to address this neglected problem.Objective: To systematically identify and rank research priorities in childhood drug-resistant TB.Design: Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, we compiled 53 research questions in four research areas, then classified the questions into three research types. We invited experts in childhood drug-resistant TB to score these questions through an online survey.Results: A total of 81 respondents participated in the survey. The top-ranked research question was to identify the best combination of existing diagnostic tools for early diagnosis. Highly ranked treatment-related questions centred on the reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration. The prevalence of drug-resistant TB was the highest-ranked question in the epidemiology area. The development type questions that ranked highest focused on interventions for optimal diagnosis, treatment and modalities for treatment delivery.Conclusion: This is the first effort to identify and rank research priorities for childhood drug-resistant TB. The result is a resource to guide research to improve prevention and treatment of drug-resistant TB in children.     

A six country study of young children’s media exposure,logo recognition,and dietary preferences

Childhood obesity is a global public health concern. Previous research, mainly conducted in developed countries, suggests that marketing and media exposure is associated with unhealthy eating behaviors. This cross-sectional study was done with 2422 children, mean age 5.5 years, SD = .5, from six low- and middle-income counties (LMICs) (Brazil, China, India, Nigeria, Pakistan, and Russia). The analyses investigated media exposure, logo recognition, and preferences for international foods and beverages, such as globally distributed items like McDonald’s hamburgers and Coca-Cola soft drinks. Overall and in each country, path analysis models showed that media exposure and logo recognition directly and indirectly predicted the selection of international foods and beverages, controlling for child’s sex, age, home location, and parental education. Public health and communication experts must continue to investigate and understand these relationships, so as to inform regulations around food and beverage marketing.