Heather Yeatman

Measuring local food environments: an overview of available methods and measures.

Reliable and valid measures of local food environments are needed to more fully understand the relationship between these environments and health and identify potential intervention points to improve access to, and the availability of, healthy foods. These measures also inform policy making, including the zoning of food outlets and food labelling/information requirements. A literature review was undertaken using health, behavioural and social sciences, nutrition and public health databases and grey literature, to determine available information on the measurement of local food environments. Included articles were those measuring aspects of food environments published from 2000 to 2010. A range of tools and methods are available to measure different components of food environments. Those focusing on community nutrition environments record the number, type and location of food outlets. The tools that focus on the consumer nutrition environment incorporate other factors, such as available food and beverage products, their price and quality, and any promotions or information to prompt consumers to make purchasing decisions. A summary and critique of these measures are provided.

Suboptimal iodine status of Australian pregnant women reflects poor knowledge and practices related to iodine nutrition

OBJECTIVE To assess the iodine status and knowledge and practices related to iodine nutrition of Australian women during pregnancy. METHODS A cross-sectional study was conducted at a public antenatal clinic in the Illawarra region of New South Wales. One hundred thirty-nine pregnant women across all trimesters provided a spot urine sample (n = 110) and completed a short questionnaire (n = 139) in English. Iodine status was based on World Health Organization/International Committee for the Control of Iodine Deficiency Disorders urine iodine concentration (UIC) categories. RESULTS Median UIC was 87.5 μg/L (interquartile range 62); only 14.5% of participants had an adequate UIC value ≥150 μg/L. Fifteen percent of women had very low UIC values (<50 μg/L), whereas 45.5% had values in the 50- to 99-μg/L range. Knowledge of the adverse health effects of an inadequate iodine intake was poor. Approximately half the participants were able to indicate good dietary sources of iodine, such as fish (58%) and iodized salt (51%). However, a high level of confusion regarding other foods was evident. Only a small number of participants (11%) reported that they had intentionally changed their diet to increase iodine intake during pregnancy, but 59% indicated supplement use, of which 35% contained iodine. Those who were taking supplements that contained iodine had significantly higher UIC levels (139.1 μg/L) than those who were not (90.8 μg/L, P < 0.05). CONCLUSION Public health strategies, including nutritional education and supplementation, are urgently required to improve the iodine status of pregnant women. Currently, no readily accessible information on iodine is available to women attending antenatal clinics in Australia.

Nutrition Advice During Pregnancy: Do Women Receive it and Can Health Professionals Provide it?

A healthy diet during pregnancy is essential for normal growth and development of the foetus. Pregnant women may obtain nutrition information from a number of sources but evidence regarding the adequacy and extent of this information is sparse. A systematic literature review was conducted to identify sources of nutrition information accessed by pregnant women, their perceived needs for nutrition education, the perceptions of healthcare providers about nutrition education in pregnancy, and to assess the effectiveness of public health programs that aim to improve nutritional practices. The Scopus data base was searched during January, 2013 and in February 2014 to access both qualitative and quantitative studies published between 2002 and 2014 which focused on healthy pregnant women and their healthcare providers in developed countries. Articles were excluded if they focused on the needs of women with medical conditions, including obesity, gestational diabetes or malnutrition. Of 506 articles identified by the search terms, 25 articles were deemed to be eligible for inclusion. Generally, women were not receiving adequate nutrition education during pregnancy. Although healthcare practitioners perceived nutrition education to be important, barriers to providing education to clients included lack of time, lack of resources and lack of relevant training. Further well designed studies are needed to identify the most effective nutrition education strategies to improve nutrition knowledge and dietary behaviours for women during antenatal care.

Urinary sodium excretion, dietary sources of sodium intake and knowledge and practices around salt use in a group of healthy Australian women

Objective: Strategies that aim to facilitate reduction of the salt content of foods in Australia are hampered by sparse and outdated data on habitual salt intakes. This study assessed habitual sodium intake through urinary excretion analyses, and identified food sources of dietary sodium, as well as knowledge and practices related to salt use in healthy women.

Listeria education in pregnancy: lost opportunity for health professionals.

Objective: To explore the level of Listeria awareness among pregnant women attending antenatal services and to gain a better understanding of womens knowledge of Listeria risk and factors that affect their practice in this regard.

Midwives and nutrition education during pregnancy: A literature review

OBJECTIVES This review explored the extent to which the role of midwives in nutrition education during pregnancy has been reported in the literature and areas requiring further research were identified. REVIEW METHOD A review of the literature was undertaken. Articles included in the review were published in English, in scholarly journals, and provided information about the knowledge, education, and attitudes of midwives towards nutrition during pregnancy. RESULTS AND DISCUSSION Few studies were identified. The included studies were exploratory and descriptive. Studies had reported that midwives lacked a basic knowledge of nutrition requirements during pregnancy. This might be attributed to inadequate nutrition education provided in both undergraduate and postgraduate midwifery programmes. The nutrition education components of midwifery courses were not identified within the studies reviewed. CONCLUSION Limited international or Australian research is available that reports on the role of midwives in nutrition education during pregnancy and the nutrition content of midwifery curricula. This represents an important omission in midwives capacity to support the health of pregnant women and their babies. More research is required to explore the educational needs of midwives to enhance nutritional care for pregnant women.

Poor knowledge and practices related to iodine nutrition during pregnancy and lactation in Australian women: pre-and post-iodine fortification

A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139) and non-pregnant (n = 75) women in 2007–2008 are compared with surveys of pregnant (n = 147) and lactating women (n = 60) one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification) and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%–62%). A low intake of fish and seafood resulted in this food group contributing only 3%–8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.

Improvement in iodine status of pregnant Australian women 3 years after introduction of a mandatory iodine fortification programme

INTRODUCTION In order to address population-level mild iodine deficiency in Australia, a mandatory iodine fortification programme of salt used in bread was introduced in late 2009. METHODS A before-after study was conducted to assess changes in median urinary iodine concentration (MUIC) measurements, according to supplement use, in convenience samples of pregnant women attending a public antenatal clinic in a regional area of New South Wales, Australia in 2008 (n=139), 2011 (n=147) and 2012 (n=114). Knowledge and practices related to iodine nutrition were investigated in 2012, using self-administered questionnaires. RESULTS The mild iodine deficiency confirmed pre-fortification (MUIC (IQR)=87.5 (62-123.5; n=110)) has steadily improved to 145.5 μg/L (91-252) in 2011 (n=106) and 166 (97-237) in 2012 (n=95) (sufficiency ≥ 150 μg/L). However, only women taking supplements containing iodine had MUIC indicative of sufficiency in both years surveyed post fortification (2011: 178 μg/L vs. 109 μg/L, P<0.001; 2012: 202 μg/L vs. 124 μg/L, P<0.05). Despite bread being the vehicle for iodine fortification, dairy foods remained major contributors to total iodine intake (58%). Overall knowledge regarding health implications of iodine deficiency was poor. CONCLUSIONS Iodine status of women has improved since the introduction of mandatory iodine fortification; however supplementation is indicated during pregnancy.

Using interviews and peer pairs to better understand how school environments affect young children’s playground physical activity levels: a qualitative study

School break times provide a daily opportunity for children to be active; however, research indicates this time is underutilized. Reasons for low childrens playground activity levels have primarily focused on physical barriers. This research aimed to contribute to physical environmental findings affecting childrens playground physical activity levels by identifying additional variables through the interview process. Thirteen public schools were included in the sample (total 2946 children). Physical activity and environmental data were collected over 3 days. Environmental variables were manually assessed at each of the 13 schools. Observational data were used to determine which three schools were the most and least active. The principal, three teachers and 20 students in Grades 4-6 from these six schools (four lower and two average socioeconomic status) were invited to participate in the interview process. Student interviews involved the paired interview technique. The main themes generated from the school interviews included the effect of non-fixed equipment (including balls), playground markings, playground aesthetics, activity preference, clothing, the amount of break time available for play, teacher playground involvement, gender, bullying, school policies, student confidence in break-time activity and fundamental movement skills. The effect of bullying on playground physical activity levels was concerning.

Women's awareness of the importance of long-chain omega-3 polyunsaturated fatty acid consumption during pregnancy: knowledge of risks, benefits and information accessibility

OBJECTIVE To evaluate pregnant womens knowledge regarding the importance of long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) consumption during pregnancy and assess their views on current information availability. DESIGN A 27-item demographic and food safety/behaviour questionnaire was administered to pregnant women during their antenatal clinic visits. chi2 tests were performed using SPSS. SETTING Antenatal clinics at two regional hospitals in New South Wales, Australia. SUBJECTS One hundred and ninety (n 190) pregnant women. RESULTS Three quarters of the women had not received information regarding LC n-3 PUFA. Approximately half of the women were aware of issues relating to LC n-3 PUFA; however, their knowledge was limited, with most obtaining their knowledge from books and magazines. Women generally had low (30 %, 29 %) to moderate (28 %, 24 %) levels of concern about LC n-3 PUFA and mercury, respectively. CONCLUSIONS Pregnant women lack knowledge of LC n-3 PUFA and health-care services do not provide pregnant women with adequate information on the importance of eating foods high in LC n-3 PUFA during pregnancy.