Margaret Miller

BACKGROUND: Obesity‐driven nutrition education in schools does not appear to result in healthier adolescent food choices. This study explored food systems as an alternative pedagogical approach to engage students in nutrition education.METHODS: After playing a food systems computer game, 250 13‐ to 16‐year‐old students in 5 Western Australian secondary schools, participated in group discussions to distinguish learning and interests in food systems. Discussion records were thematically coded using constant comparative analysis.RESULTS: Students reported crop growth, food production and food waste, healthier food choices, and food systems as knowledge outcomes of game play. They requested additional content on food production, costing, handling, processing, and accessing local produce. Experiential activities were preferred pedagogical approaches.CONCLUSIONS: Cross‐curricular pedagogy which embraces human and planetary health through a food systems lens, can engage adolescents in nutrition education. Transformational computer games are effective to engage, educate and stimulate inquiry in food systems education.

This commentary engages with Suzuki and colleagues’ analysis about the ambiguity of multi-stakeholder discourses in the United Nations (UN) Political Declaration of the 3rd High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (HLM-NCDs), suggesting that blurring between public and private sector in this declaration reflects broader debates about multi-stakeholder partnerships (MSPs) and public-private partnerships (PPPs) in health governance. We argue that the ambiguity between the roles and responsibilities of public and private actors involved may downplay the role (and regulation) of conflicts of interest (COI) between unhealthy commodity industries and public health. We argue that this ambiguity is not simply an artefact of the Political Declaration process, but a feature of multi-stakeholderism, which assumes that commercial actors´ interests can be aligned with the public interest. To safeguard global health governance, we recommend further empirical and conceptual research on COI and how it can be managed.

BACKGROUND In this study, we examined nutrition‐related topics among adolescent students attending schools with different Indices of Community Socio‐Educational Advantage (ICSEA). METHOD Participating students (N = 206) from 5 schools in Western Australia completed a paper‐based questionnaire on nutrition‐related topics. Frequencies and independent chi‐square tests were used to identify differences between sexes and school ICSEA. RESULTS Of the participating students, 75% were interested in learning about 8 of 16 topics. We found statistically significant differences by sex (p < .01) for “Eating the right foods for preventing illness and disease,” “Eating the right food for being active” among girls, and “Reducing food waste” among boys. We also noted differences by school ICSEA. CONCLUSION Acknowledging sex and socioeducational differences in teaching and learning may help teachers to engage adolescent students in nutrition education.

Building on the success of the SNAC (Supporting Nutrition Australian Childcare) community, a comprehensive online programme SNACPlus provided professional development (PD) and resources to embed nutrition curriculum and supportive food environments in Early Childhood Education and Care (ECEC) services. Process and impact evaluation were conducted to determine the effectiveness of this intervention programme. Participants were recruited from nine long-day-care (LDC) centres and the current SNAC membership list. Resource access was monitored using web analytics. Changes in nutrition knowledge, attitudes, behaviours and food environment were measured using baseline (comparator group, n=100) and post-intervention surveys (intervention group, n=80), contextualised through open-ended questions. The majority of comparator participants perceived nutritious food provision as important yet lacked confidence about estimating serve sizes. Adjusting for years of experience, the intervention significantly influenced educators’ confidence about servings of grains (p=0.034), dairy (p=0.015), low fat meat (p=0.014) and food group servings estimation knowledge (pPlus positively influenced changes to food service and role-modelling; and knowledge, attitudes and behaviours improved at organisational and individual levels. SNACPlus provides online nutrition curriculum resources that positively impacted knowledge, attitudes and behaviours of ECEC staff and influenced systematic changes in food environments. Practice and policy implementation that includes all systems within the early years setting will help initiate and maintain healthy food environments.

Acute lymphoblastic leukemia (ALL) and childhood brain tumors (CBT) are 2 of the most common forms of childhood cancer, but little is known of their etiology. In 2 nationwide case-control studies we investigated whether breastfeeding, age of food introduction, or early diet are associated with the risk of these cancers. Cases aged 0–14 years were identified from Australian pediatric oncology units between 2003 and 2007 (ALL) and 2005 and 2010 (CBT) and population-based controls through nationwide random-digit dialing. Mothers completed questionnaires giving details of infant feeding up to the age of 2 yr. Data from 322 ALL cases, 679 ALL controls, 299 CBT cases, and 733 CBT controls were analysed using unconditional logistic regression. Breastfeeding was associated with a reduced risk of ALL [odds ratio (OR) = 0.52, 95% confidence interval (CI): 0.32, 0.84), regardless of duration. Introduction of artificial formula within 14 days of birth was positively associated with ALL (OR = 1.57, 95% CI: 1.03, 2.37), as was exclusive formula feeding to 6 mo (OR = 1.81, 95% CI: 1.07, 3.05). No associations were seen between breastfeeding or formula use and risk of CBT. Our results suggest that breastfeeding and delayed introduction of artificial formula may reduce the risk of ALL but not CBT.

Childhood brain tumors (CBT) are the second most common childhood cancers, yet their etiology is largely unknown. We investigated whether maternal gestational intake of folate and vitamins B6 and B12 was associated with CBT risk in a nationwide case-control study conducted 2005–2010. Case children 0–14 years were recruited from all 10 Australian pediatric oncology centers. Control children were recruited by national random digit dialing, frequency matched to cases on age, sex, and state of residence. Dietary intake was ascertained using food frequency questionnaires and adjusted for total energy intake. Data from 293 case and 726 control mothers were analyzed using unconditional logistic regression. The odds ratio (OR) for the highest versus lowest tertile of folate intake was 0.70 [95% confidence interval (CI): 0.48, 1.02]. The ORs appeared lower in mothers who drank alcohol during pregnancy (OR = 0.45, 95% CI: 0.22, 0.93), mothers who took folic acid (OR = 0.67, 95% CI: 0.42, 1.06) or B6/B12 supplements (OR = 0.51, 95% CI: 0.25, 1.06) and in children younger than 5 years (OR = 0.50, 95% CI: 0.27, 0.93). These findings are consistent with folate's crucial role in maintenance of genomic integrity and DNA methylation. Dietary intake of B6 and B12 was not associated with risk of CBT.

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30–50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women’s weight and related lifestyle behaviours in child-bearing years is an outstanding ‘missed opportunity’ for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Severe untreated dental decay affects a child’s growth, body weight, quality of life as well as cognitive development, and the effects extend beyond the child to the family, the community and the health care system. Early health behavioural factors, including dietary practices and eating patterns, can play a major role in the initiation and development of oral diseases, particularly dental caries. The parent/caregiver, usually the mother, has a critical role in the adoption of protective health care behaviours and parental feeding practices strongly influence children’s eating behaviours. This study will test if an early oral health promotion intervention through the use of brief motivational interviewing (MI) and anticipatory guidance (AG) approaches can reduce the incidence of early childhood dental decay and obesity.