John Coveney

Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample

OBJECTIVES Explore the level of general nutrition knowledge and demographic influences of knowledge levels in a community sample. DESIGN AND SETTING A sample of volunteers, recruited from community centres in two suburbs of differing socio-economic status, in Adelaide, South Australia. SUBJECTS Two hundred and one people, aged 18 years and older, completed a modified and validated version of the General Nutrition Knowledge Questionnaire (113 items). The questionnaire was self-administered and completed under supervision. RESULTS Basic messages about eating more fruit, vegetables and fibre, and less fatty and salty foods were best understood. Confusion was evident with more detailed nutrition information. For example, 90 % of the people were aware of the recommendations to eat more fruit and vegetables, but 56 % and 62 % knew the recommended number of servings of fruit and vegetables, respectively. Descriptive statistics showed significant demographic variation in nutrition knowledge levels; multiple regression analysis confirmed the significant independent effects of gender, age, highest level of education and employment status on nutrition knowledge level (P < 0.01 level). The model accounted for 40 % of the variance in nutrition knowledge scores. CONCLUSIONS There is demographic variation in nutrition knowledge levels and a broad lack of awareness of some public health nutrition recommendations. Having a detailed understanding of the deficiencies in community knowledge should allow for future nutrition education programmes to target subgroups of the population or particular areas of nutrition education, to more efficiently improve knowledge and influence dietary behaviour.

In pursuit of the study of pleasure: implications for health research and practice

Many public health interventions attempt to promote health and well-being while simultaneously engaging with or negating pleasure-seeking activities. Yet the examination of pleasure is under-researched, especially within health and health-related areas. We examine pleasure as both an innate drive and a socially constructed phenomenon. Using the development of religious ideas in western cultures, we identify four forms of pleasure: carnal pleasure, disciplined pleasure, ascetic pleasure and ecstatic pleasure. These pleasures dramatically affect the construction of social and cultural identities. Moreover, they influence approaches to our understandings of health in general and interventions to public health in particular. The pursuit of the study of pleasure opens up a number of worthwhile areas for cross-disciplinary discussion and study.

A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition.

BACKGROUND The role played by lay knowledge in understanding health inequalities has received increased interest recently. Very little is known, however, about how lay knowledge of food and health varies across social class. The present exploratory study compared and contrasted ways in which people from different social backgrounds draw on and use different forms of lay knowledge about food and health. METHOD Parents from 40 families were recruited from two socio-economically different suburbs (20 families from each suburb). In-depth interviews were conducted with the mother and father in each family to examine lay knowledge about food and health. All interviews were transcribed and coded for specific themes. Responses from each suburb were compared and contrasted. RESULTS Different forms of lay knowledge about food and health were noted, especially concerning childrens eating habits. Parents in the high-income suburb were more likely to discuss food and health in technical terms informed by contemporary nutritional or medical priorities. Parents in the low-income suburb did not share this discourse, but instead were more likely to discuss food in terms related to childrens outward appearance or functional capacity. CONCLUSIONS AND IMPLICATIONS The research highlights differences in lay knowledge about food and health across social class. It emphasises the need for public health nutrition policy-makers and practitioners to pay attention to lay knowledge on its own terms, rather than attempting to educate from predetermined assumptions, principles and standards.

An ecological analysis of factors associated with food insecurity in South Australia, 2002-7

OBJECTIVE To estimate the extent of food insecurity in South Australia and its relationship with a variety of socio-economic variables. DESIGN Data collected routinely from 2002 to 2007 by SA Health were analysed to explore food security in the States population. An ecological analysis of data collected by the South Australian Monitoring and Surveillance System (SAMSS) that collects data on key health indicators. Questions on food security are asked periodically from July 2002 to December 2007. SETTING South Australia. SUBJECTS Over 37,000 interviewees took part in SAMSS surveys. Questions about food security were asked of 19,037 subjects. The sample was weighted by area, age and gender so that the results were representative of the South Australian population. RESULTS Seven per cent (1342/19,037) of subjects reported running out of food during the previous year and not having enough money to buy food (food insecurity). Logistic regression analysis found food insecurity to be highest in households with low levels of education, limited capacity to save money, Aboriginal households, and households with three or more children. CONCLUSIONS The study confirms that food insecurity is strongly linked to economic disadvantage. Increasing cost of food is likely to exacerbate food insecurity. This is of concern given that food insecurity is associated with poor health, especially obesity and chronic disease. Comprehensive action at all levels is required to address root causes of food insecurity. Regular surveillance is required to continue to monitor levels of food security, but more in-depth understandings, via qualitative research, would be useful.

Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann

Abstract Social theory provides a lens through which we can analyse the role of trust in health systems. However, the majority of theoretically informed trust literature addresses ‘institutional’ or ‘interpersonal’ trust individually, failing to investigate trust as determined by a ‘web’ of mutually interacting relationships between individuals and social systems. Current theoretical assumptions are also problematic as they fail to recognise the role that social factors (such as socio-economic status, class and age) play in an individual’s willingness to trust. Through the analysis and critique of existing social theories of trust, this paper demonstrates a need for further empirical research into the multidimensionality of trusting relationships, while suggesting new directions for research in public health.

How do South Australian consumers negotiate and respond to information in the media about food and nutrition? The importance of risk, trust and uncertainty

The amount of information in the media about food and nutrition is increasing. As part of the risk society, consumers have a moral imperative to synthesize this information in order to manage their diet. This article explores how media information about food affects how consumers place trust in the food system and strategies adopted to manage conflicting nutritional information. Qualitative interviews were undertaken with 47 shoppers drawn from higher and lower socio-economic metropolitan and rural locations. There was an overriding trust in the Australian food system; however, participants talked about the impact of the large amounts of complex, confusing and often contradictory information. For some, this led to an active search for ‘truth’. For others it created uncertainty and anxiety, and for others a sense of paralysis or stasis. The findings are explored in relation to the production and consumption of risks in late modernity and the interrelationship between trust and risk.

The government of girth

Abstract The current preoccupation with body weight in western cultures is arguably unprecedented. The obesity crisis has engaged not only health communities, but numerous other public and private organisations, and, in so doing, has created moral alarm as well as a medical crisis. This paper examines the development of obesity and will discuss the ways in which fatness has been rationalised within health discourses. It will explore the way that the corpulent body, once historically considered as a physiological state, is now regarded as a state of moral pathology representing an ‘epidemic’. The prospect of this disease sweeping through populations, reaching into virtually every social group, is presented as all the more frightening when no known effective prevention or cure is at hand. The paper will look at the ways in which new forms of government have developed with the panoptic capacity to gaze across populations and objectify the everyday activities of individuals. This ‘government of girth’ reaches an apogee in the problematisation of children and body weight. Three subject positions in childhood provide a number of opportunities to problematise children: the sick child, the anti-social child, and the innocent child. Each of these amplifies concern about the state of health of children, the permissive nature of parenting and potential moral social decay.

Food stress in Adelaide: the relationship between low income and the affordability of healthy food.

Healthy food is becoming increasingly expensive, and families on low incomes face a difficult financial struggle to afford healthy food. When food costs are considered, families on low incomes often face circumstances of poverty. Housing, utilities, health care, and transport are somewhat fixed in cost; however food is more flexible in cost and therefore is often compromised with less healthy, cheaper food, presenting an opportunity for families on low incomes to cut costs. Using a “Healthy Food Basket” methodology, this study costed a weeks supply of healthy food for a range of family types. It found that low-income families would have to spend approximately 30% of household income on eating healthily, whereas high-income households needed to spend about 10%. The differential is explained by the cost of the food basket relative to household income (i.e., affordability). It is argued that families that spend more than 30% of household income on food could be experiencing “food stress.” Moreover the high cost of healthy foods leaves low-income households vulnerable to diet-related health problems because they often have to rely on cheaper foods which are high in fat, sugar, and salt.

Why food policy is critical to public health

It has been said that anyone who is fond of sausages and legislation should not watch either being made (Beers, 1996). Not surprisingly perhaps, the combination of these spectacles— the making of food legislation—has been for many recent commentators nothing short of stomach-churning. Over the past two decades the development and implementation of food policy action (or inaction, in the eyes of some) has received criticism rising by degrees to moral outrage. As food scares have been followed by food scandals the extent to which the food supply comes under scrutiny has been increasing. Most vocal have been nongovernment organizations, consumer lobby groups, environmentalists and academics with an interest in the food supply (Lang, 1997a). In this editorial I want to examine the critical importance of the study of food policy for public health. Food policy, as a process of regulating the supply of food for a population, has a long history. Intervention in the food supply to protect the public’s health, however, is a relatively new development. Britain in the nineteenth century saw some of the first effective efforts, when legislation to protect public health from food adulteration was introduced in 1872 (Drummond &Wilbraham, 1994). Australia was also a pioneer in this area: the Pure Foods Act developed in 1905 in Victoria was indeed hailed as a major achievement for public health (Hutchinson, 1958). Protection of the public’s health informed food policy in Britain during the world wars where the need to secure enough food to feed the nation, especially under blockade conditions, was a major consideration. In the postwar period, however, food policy in many countries became less focused on protecting the health of the population (which, it was believed, would benefit anyway by rising prosperity through a postwar employment boom) and more focused on what Lang et al. (2001) call a ‘productionist’ model. This model was predicated on increased (mass) production methods through the application of science and technology, ready access to local and world markets, and an integration of agrochemical and food manufacturing interests. Intensified food production methods, especially in the UK, appear to have brought with them a number of health problems for humans (e.g. Creutzfeld-Jakob Disease, Campylobacter, and E. coli Salmonella) and animals (e.g. BSE and Foot and Mouth Disease). These problems have highlighted the importance of an examination of food policy, regulation and legislation from a

Trust in the Australian food supply: Innocent until proven guilty

International research demonstrates diminishing trust in the food supply associated with food scares which undermine trust in expert advice. Even though Australia has not experienced major food scares, there is evidence of diminishing trust in the food supply. Interviews were conducted with 47 South Australian food shoppers from high (n = 17) and low (n = 16) socio-economic regions of Adelaide and from rural South Australia (n = 14) about food governance and trust in the Australian food supply. Participants display a high level of trust in the food supply associated with a perception that Australian food is safe; a lack of exposure to food risks; and trust in personal food safety practices. The media was the only factor which created distrust in the food system. Other participants express confidence in the food supply where confidence is understood as a lack of reflection. Contrary to concepts of reflexive modernisation which presume an increasing awareness of risk and placement of trust as a means of reducing uncertainly, participants adopt an ‘innocent until proven guilty’ approach displaying little knowledge or interest in knowing about food regulation relying instead on routine food safety practices as a means of managing uncertainty.