Australian policy levers for obesity prevention in early childhood

The five studies in this thesis focused on the actions undertaken and policy infrastructure provided by the Australian Federal, State and Territory Governments to prevent obesity in early childhood. The first study used the WHO Ending Childhood Obesity implementation plan to facilitate policy mapping and compare Australia’s national action to five similar countries (published paper). The second study explored the role of intergovernmentalism in achieving national food system action and policy coherence across states working on the same policy areas (published paper). The third study used policy mapping to compare states and territories and explored their eclectic approaches to obesity policy (published paper). Both studies interviewed senior officials in health departments in Australian jurisdictions to understand the barriers and enablers of prevention policy implementation. The fourth study used the New South Wales (NSW) Healthy Eating and Active Living (HEAL) Strategy 2013-2018 as a case study of cross-sectoral collaboration in Australia (paper under review). An in-depth policy mapping tool was developed to undertake iterative policy mapping. Semi-structured interviews with 25 senior public officials across 18 agencies in the NSW Government explored the factors effecting implementation of obesity prevention policies. The fifth study explored the perspectives of mothers of young children living in NSW (published paper). Survey questions were embedded into a follow-up cross-sectional survey in a large, randomised control trial – Communicating Healthy Beginnings Advice by Telephone. Mothers were asked how much they supported six different types of policy interventions by the NSW Government. These included food and physical activity environments, settings, support programs and routine measurement of children at health appointments. Potential confounders were included in the analysis to explore associations with their level of policy support

Creating a policy mapping tool for early childhood obesity prevention in Australian states and territories

Childhood obesity is an internationally recognised public health problem. The prevention of obesity is complex, it requires a systematic approach across all sectors of government. Policy represents the intention of a government to act in a particular area. Currently, there is no comprehensive tool to assess childhood obesity prevention policies in an Australian context

Enrolment of families with overweight children into a program aimed at reducing childhood obesity with and without a weight criterion: a natural experiment

© The Author(s). 2019 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Difficulties engaging families with overweight children to enrol into programs aimed at reducing childhood obesity have been well documented. During the implementation of the Parenting, Eating and Activity for Child Health Program (PEACH™) over a large geographical area (Queensland (QLD), Australia), a natural experiment developed. This experiment provided an opportunity to observe if there was a difference in enrolment for families with overweight children with a weight criterion (referred to as the period with a Targeted Eligibility Criterion (TEC)) compared to when a weight criterion was removed (the period referred to as Universal Eligibility Criterion (UEC)). We also examined the eligibility criterion’s relationship with attendance, parental concern about their child’s weight, estimation of overweight and obesity from parent-reported data. METHODS: A secondary analysis of baseline data from 926 overweight/obese children from 817 families enrolled in PEACH™ QLD was performed. Analyses were adjusted to control for the presence of clustered data. Bivariate statistics were performed using Pearson chi-square test with the second-order Rao-Scott correction, and Mann–Whitney U-test for non-parametric continuous variables. Generalized Estimating Equations (GEE) explored the association between weight status-based eligibility criteria and enrolment of overweight children. GEE were adjusted for sex, age and socioeconomic index and stratified for weight category. RESULTS: Compared to obese children, overweight children were almost twice as likely to be enrolled when the program did not have weight status-based eligibility criteria (during UEC period) (OR = 1.90 (CI 95% 1.35–2.68, p <  0.001)). Parents of overweight children enrolled during the UEC period were more likely to regard their child’s weight as less of a concern than during the TEC period (UEC 67% vs. TEC 45%, p = 0.036). Children whose parent-reported data underestimated their weight category were more likely to be enrolled while the program did not have weight-related eligibility criteria OR = 2.27 (CI 1.38–3.70, p <  0.01). Program session attendance did not appear to be impacted by the changes in eligibility criteria. CONCLUSIONS: The omission of weight criteria for healthy lifestyle programs is a consideration for health professionals and decision-makers alike when encouraging the enrolment of children who are overweight into healthy lifestyle programs

Sustainable Polysulfides for Oil Spill Remediation: Repurposing Industrial Waste for Environmental Benefit

© 2018 The Authors. Published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Crude oil and hydrocarbon fuel spills are a perennial threat to aquatic environments. Inexpensive and sustainable sorbents are needed to mitigate the ecological harm of this pollution. To address this need, this study features a low‐density polysulfide polymer that is prepared by the direct reaction of sulfur and used cooking oils. Because both sulfur and cooking oils are hydrophobic, the polymer has an affinity for hydrocarbons such as crude oil and diesel fuel and can rapidly remove them from seawater. Through simple mechanical compression, the oil can be recovered and the polymer can be reused in oil spill remediation. The polysulfide is unique because it is prepared entirely from repurposed waste: sulfur is a by‐product of the petroleum industry and used cooking oil can be used as a comonomer. In this way, sulfur waste from the oil industry is used to make an effective sorbent for combatting pollution from that same sector

What Works to Improve Nutrition and Food Sustainability across the First 2000 Days of Life: A Rapid Review

Informed by the Innocenti framework, this rapid review of systematic reviews (n = 60) and sentinel grey literature (n = 27) synthesises the evidence of what works to improve nutrition and food sustainability across the first 2000 days. Most systematic reviews focused on interventions targeting the behaviour of parents and caregivers (n = 49), with fewer reviews focusing on the personal (n = 7) and external (n = 4) food environments. No reviews focused on food supply-chain activities. Most reviews were rated as critically low (n = 28, 47%) or low (n = 21, 35%) quality using AMSTAR 2. Evidence supports the effectiveness of multi-component breastfeeding interventions, interventions delivered in home and child-care settings, particularly when involving parents, interactive skill building and repeated exposure to vegetables. Food vouchers and access to local farmers markets and community gardens have potential for improving access and availability to healthier foods, while evidence supports interventions improving the external food environment, including fiscal strategies such as the SSB tax, restrictions on marketing and advertising of discretionary products and improved food labelling. Overall, this review highlights the importance of action across a range of settings and sectors at the international, national and local levels to improve young children&rsquo;s diets

Sustained low consumption of fruit and vegetables in Australian children: findings from the Australian National Health Surveys

Issue addressed: Intakes of fruit and vegetables in children are inadequate. Our purpose was to examine national data on the proportion of Australian children meeting the fruit and vegetable recommendations in 2011-2012 and 2014-2015, assessing changes over time and differences by age, sex and socioeconomic status (SES). Methods: Secondary analysis of 2011-2012 and 2014-2015 Australian National Health Surveys of Australian children aged 2-18\ua0years. Percentages of children meeting fruit and vegetable recommendations by survey year, age group, sex and SES tertile were calculated using population weights supplied by the Australian Bureau of Statistics (ABS). Chi-squared tests and logistic regression were used to test for the relative influence of each factor. Results: In 2011-2012, 64.6%, 5.1% and 4.6% of children met the recommended intake for fruit, vegetable and fruit–vegetable combined, respectively. In 2014-2015, 68.2%, 5.3% and 5.1% of all children met the recommended intake for fruit, vegetable and fruit–vegetable combined, respectively. There was a large reduction in proportions of children meeting both the fruit and vegetable recommendations between 3 and 4\ua0years of age, which coincides with when most Australian children start pre-school. There were consistent differences by sex for both fruit and vegetables, but we found little evidence that SES is a significant factor predicting the difference in meeting the vegetable recommendations. Conclusions: The proportion of Australian children meeting fruit and vegetable recommendations are sub-optimal across all SES groups which suggests that a national approach across demographic strata is warranted. So what?: Future health promotion interventions should have a refocus on vegetables instead of “fruit and vegetables,” particularly in the key transition period when children start pre-school

A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland

Abstract Background PEACH™QLD translated the PEACH™ Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage. Methods The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges. Results Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH™ Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median = 5 vs 7) and completion rates (43% vs 56%). Conclusions Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over time. Trial registration ACTRN12617000315314. This trial was registered retrospectively on 28 February, 2017

Parent engagement and attendance in PEACH™ QLD – an up-scaled parent-led childhood obesity program

Abstract Background Parenting, Eating and Activity for Child Health (PEACH™) is a multicomponent treatment program delivered over ten group sessions to parents of overweight/obese primary school-aged children. It has been shown to be efficacious in an RCT and was recently translated to a large-scale community intervention funded by the Queensland (Australia) Government. Engagement (enrolment and attendance) was critical to achieving program outcomes and was challenging. The purpose of the present study was to examine sample characteristics and mediating factors that potentially influenced program attendance. Methods Data collected from parents who attended at least one PEACH™ Queensland session delivered between October 2013 and October 2015 (47 programs implemented in 29 discrete sites), was used in preliminary descriptive analyses of sample characteristics and multilevel single linear regression analyses. Mediation analysis examined associations between socio-demographic and parent characteristics and attendance at group sessions and potential mediation by child and parent factors. Results 365/467 (78%) enrolled families (92% mothers) including 411/519 (79%) children (55% girls, mean age 9 ± 2 years) attended at least one session (mean 5.6 ± 3.2). A majority of families (69%) self-referred to the program. Program attendance was greater in: advantaged (5.9 ± 3.1 sessions) vs disadvantaged families (5.4 ± 3.4 sessions) (p < 0.05); partnered (6.1 ± 3.1 sessions) vs un-partnered parents (5.0 ± 3.1 sessions) (p < 0.01); higher educated (6.1 ± 3.0 sessions) vs lower educated parents (5.1 ± 3.3 sessions) (p = 0.02); and self-referral (6.1 ± 3.1) vs professional referral (4.7 ± 3.3) (p < 0.001). Child (age, gender, pre-program healthy eating) and parent (perceptions of child weight, self-efficacy) factors did not mediate these relationships. Conclusions To promote reach and effectiveness of up-scaled programs, it is important to identify ways to engage less advantaged families who carry higher child obesity risk. Understanding differences in referral source and parent readiness for change may assist in tailoring program content. The influence of program-level factors (e.g. facilitator and setting characteristics) should be investigated as possible alternative mediators to program engagement