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AIM: Shocks to the food system (such as extreme weather events, wars, and pandemics) are felt by institutional food systems. For hospitals, these shocks affect the quantity, quality, and variety of foods that can be offered to patients. One strategy to buffer the hospital food supply from external threats is to prioritise ingredients produced locally. Thus, the aim of the current research is to describe the country of origin of all foods purchased by a large, metropolitan healthcare organisation and to identify opportunities for improving the locality of the food supply. METHODS: This study was of a cross-sectional, observational design. The country of origin for all foods procured over a 1-year period by a large, urban healthcare organisation was determined by proportion of food budget spend. State of origin was identified for fresh fruit, vegetables, and meat. The organisation was in Queensland, Australia and utilised a cook-fresh, room-service foodservice model. Descriptive analysis was used to to determine the number of items and the proportion of budget spend on all foods produced in Australia, and by food category. Similar descriptive statistics were generated to determine the proportion of the budget spend on fresh fruits, vegetables and meats produced in Queensland. RESULTS: Over the 1-year period, 659 individual food items were purchased by the hospital foodservice, and 502 food items were included in the anlaysis. In total, 53% of the food budget was spent on Australian foods (100% Australian ingredients) and almost all fruit (73%) and vegetables (91%) were Australian grown. Procuring fresh fruit (28%), vegetables (35%), and meat (46%) from within the state was less common, and this may reflect the primary states of production across Australia, and seasonal variability of the food supply. CONCLUSIONS: Findings offer priority areas for improving the locality of the food supply. Future research to determine if procuring more foods locally has benefits to consistency of the food supply is warranted.

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AIMS: This systematic review aims to describe the dietary quality, dietary intake and related behaviours of adults diagnosed with cystic fibrosis. METHODS: A comprehensive literature search was conducted in four databases (Medline, CINAHL, EMBASE, CENTRAL); studies were included if they addressed dietary intake, diet quality or eating behaviours among adults (≥15 years) living with cystic fibrosis and were published from January 2000 to November 2022. The Mixed Methods Appraisal Tool was used to assess the risk of bias and quality of included studies. Findings were synthesised narratively. RESULTS: Nineteen observational studies (n = 2236) were included and considered high to moderate quality. Most (13/19) studies reported that individuals with cystic fibrosis were consuming high-energy diets; where studies reported energy intake as a proportion of requirements met, energy intake was high, even when using individualised or cystic fibrosis-specific referents. In addition, fat intakes as a proportion of energy appeared high (29%-39% of total energy), particularly as current guidelines recommend macronutrient profile similar to the general population (<30% of total energy). There was considerable variation in the reporting of fatty acid profiles and other nutrients. Five studies reported on concerns regarding diet and eating in this population. CONCLUSION: Findings from the current review suggest dietary intakes of adults with cystic fibrosis appear to be less than optimal and concerns about diet, weight and food may be emerging in this population. Future research utilising consistent measures of dietary assessment and reporting, reporting of medical therapies, and exploring potential concerns about diet and eating is warranted.

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AIM: To explore the chef's experience with a newly implemented indoor hospital-based kitchen garden designed to supplement herbs ordered for patient meals and improve staff engagement. BACKGROUND: Hospital-based therapeutic and kitchen gardens have emerged as effective health-promoting tools in hospital healthcare environments. They promote emotional, mental, and physical well-being for patients, visitors, and staff. However, formal evaluations are limited, and studies focusing on indoor hospital kitchen gardens are noticeably absent in the literature. METHODS: Qualitative evaluation of a hospital-based kitchen garden. Open-ended interviews were conducted approximately 6 months after garden implementation and explored key informants (n = 6) overall experience, engagement with the garden, perceived benefits, and opportunities for improvement. Interview data was analyzed using a thematic approach. RESULTS: The implementation of the kitchen gardens was met with overall acceptance among staff. However, the project's feasibility faced challenges related to local food service leadership, communication, and certain aspects of the garden setup. Despite these obstacles, the gardens contributed positively to the quality of meals by including fresh herbs and fostering greater staff engagement. CONCLUSIONS: The chefs viewed the concept of the hospital-based kitchen garden favorably, noting that it closely aligned with their mission of providing nutritious meals to patients. However, consideration of the broader issues facing hospital food services may be required to seamlessly integrate this task into the kitchen staff's daily routine. Further research is warranted to investigate the effective implementation and feasibility of indoor kitchen gardens in hospitals and their impact on patient menus, food service staff, and the workforce.

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Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence. Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT). Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality. Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.

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OBJECTIVE: Evaluate the acceptability and feasibility and explore the potential health impacts of a hospital-based herb and vegetable garden. METHODS: Mixed-method program evaluation assessed dietetic and food service staff health, well-being, and garden engagement. Surveys were administered at baseline and follow-up (6 months). Key informant interviews (n = 6) were conducted at 6 months to evaluate program feasibility. RESULTS: There was good acceptance and engagement with the garden, with 18 participants volunteering to maintain the garden. Key informant interviews identified workforce, leadership, and garden design engagement factors. Participants also noted several psychosocial benefits. CONCLUSION AND IMPLICATIONS: A hospital-based garden for staff is feasible if programmatic improvements are addressed. More robust evaluations considering challenges with measuring key outcomes with survey methodology and extended periods are warranted.

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ISSUE ADDRESSED: Dietary intake of Australian adolescents is suboptimal. Schools are an ideal setting for health promotion initiatives to develop healthy lifestyle behaviours among adolescents. However, we do not know which nutrition-focused, school-based interventions are effective at improving health outcomes in adolescents in Australia. Therefore, the aim was to evaluate the effect of nutrition interventions on health outcomes in Australian secondary school students. METHODS: MEDLINE, EMBASE, CINAHL, ERIC and Informit were systematically searched on 4th November 2022. Studies in any language evaluating nutrition interventions implemented in Australian secondary schools were included. Studies evaluating interventions conducted in primary schools or outside the school setting were excluded, as were any grey literature, systematic reviews and meta-analyses. Screening and data extraction were performed in duplicate. Quality was assessed using the Mixed Methods Appraisal Tool. RESULTS: Thirteen studies (n = 27 224) reporting on nutrition interventions implemented in Australian secondary schools were included. Studies were conducted in five different states and a capital territory within Australia and were mostly randomised controlled trials. Most studies reported a significant improvement on nutrition-related health outcome measures (dietary behaviour n = 6, nutritional knowledge and attitudes n = 4 and anthropometric n = 1). CONCLUSIONS: This review found limited studies reporting on nutrition interventions in Australian secondary schools. However, most were shown to be effective in improving nutrition-related health outcomes. SO WHAT?: Since there were limited studies in peer-reviewed journals, more research in this area is needed to confirm the effectiveness of nutrition interventions in Australian secondary schools and to assess long-term effects on student's health outcomes.

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BACKGROUND: Nurses are the largest health professional body globally. Despite the significant role they play in healthcare, nurses exhibit poor dietary habits and have high rates of chronic diseases. Understanding the factors underlying healthy eating for nurses in the workplace is important to implement effective interventions. OBJECTIVE: To identify enablers and barriers related to healthy eating among nurses employed in a hospital setting. DESIGN: A systematic literature review of qualitative, quantitative, and mixed methods research (PROSPERO ID: CRD42021290913). DATA SOURCES: A comprehensive systematic search was conducted across PubMed, CINAHL, Embase, Web of Science and ProQuest databases for papers published after January 2015. METHODS: Two authors independently screened titles and abstracts of 4139 deduplicated studies, performed critical appraisals on eligible studies using the Mixed Methods Appraisal Tool and extracted data relevant to the research question. This review includes papers that examined nurses' eating behaviours specifically, were conducted in a hospital setting and distinguished healthy eating from other behaviours. Data synthesis was conducted through descriptive summarisation of studies and enablers and barriers were classified according to the socio-ecological model. RESULTS: A total of 29 studies were identified with 8024 participants. 8 studies were qualitative, 18 quantitative, and 3 were mixed method design. At an environmental level, barriers were high accessibility and availability of unhealthy foods, high cost and low availability of healthy foods and lack of storage and preparation facilities, while an enabler was close proximity to healthy options. Novel organisational enablers were considered roster planning which allowed for established routines around meals, and structured workplace programs that encouraged improvement in health behaviours, while barriers were shift work, inconsistent rosters and high work demands. An interpersonal enabler was supportive networks while barriers were work culture, social norms of celebrations and gifts of food from patients. Finally, intrapersonal barriers were stress and fatigue, personal values, beliefs, attitudes, and individual characteristics, with the latter two also acting as enablers. CONCLUSIONS: This review identifies the complexity and interconnectedness of enablers and barriers to healthy eating across four domains of the socio-ecological model. Multi-faceted strategies which address factors across several domains are recommended for healthcare organisations to facilitate healthy eating among nurses. Further research is needed to assess these strategies and understand the extent to which eating behaviours can be improved.

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INTRODUCTION: Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality. METHOD: PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively. RESULTS: Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed. DISCUSSION: Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality. IMPLICATIONS FOR RESEARCH AND PRACTICE: Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.

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AIM: The current study describes food-purchasing behaviours of healthcare staff, determines whether purchasing food at work is associated with overall indicators of healthy eating, and explores opportunities for improving the hospital food environment. METHODS: A secondary analysis of a health and wellbeing survey of healthcare workers (n = 501) in Queensland, Australia. Multiple regression models describe the associations between food purchases and indicators of healthy eating, while controlling for age, gender and work role. RESULTS: More than 60% of staff purchased food/drinks at work in the past week, and this was inversely associated with indicators of healthy eating. For example, among those purchasing food/drinks at work on most days, only 18% reported their overall diet as excellent or very good, compared to 50% of those who do not purchase food/drink at work (odds ratio [OR] = 0.24; 95% confidence interval [CI] = [0.12,0.48] in adjusted models). Staff feedback prioritised strategies to make healthy meals more accessible and affordable. CONCLUSION: Improvements to the retail food environment in hospitals could have a positive impact on the overall nutritional wellbeing of staff.

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Family meals provide a unique opportunity for families to eat well and engage positively with each other. In response to the challenges presented by the COVID-19 (coronavirus disease 2019) pandemic, a new initiative to support health care staff to share healthy meals with their families was developed. At a hospital in Queensland, Australia, dietetic staff collaborated with the on-site food service retailer to develop and offer a range of hot meals that staff could take home for their families at the end of their day. The meals were nutritious, reasonably priced, and designed to feed a family of four. The dietetic staff worked with the hospital marketing department and staff health and wellness program to promote the initiative. Over the 3 months that it has been running, nearly 300 meals have been purchased. Anecdotal comments from the food service retailer highlighted that the initiative was a good thing to do for staff to maintain a positive reputation of the business. The staff evening meal initiative is a healthy, affordable, educational, and socially engaging alternative to takeaway meals and food delivery by app, and it is mutually beneficial for health care staff and the on-site food retailer. The initiative also offers a unique opportunity for promoting nutrition and social engagement during stressful times.

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The current report explores how well vending machines are meeting the needs of health care organizations and their staff and visitors in Australia. Hospital vending machines often provide the only source of food through the night to staff and visitors and traditionally offer less-healthy options. Findings presented in this report suggest that vending machines are not meeting current statewide policies and guidelines for healthier food environments in health care. This is despite widespread support for healthier refreshments in hospitals by staff, visitors, and patients. Alternatives to traditional vending and opportunities for nutrition educators and researchers are discussed.

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Evidence of the benefits of culinary nutrition education is growing in the literature. Culinary nutrition education programs are naturally experiential, social, skills-based, and effective in improving nutrition-related beliefs, knowledge, and behaviors. In this article, we explore a set of motivational experiences in culinary nutrition education that have been identified as "drivers" of behavior change. These drivers emerged from 20 years of implementation and evaluation of hands-on cooking programs across the life span in more than 30 states within the United States. From these drivers, we developed a framework to guide both new and existing programs that can be best designed to motivate behavior change. These frameworks add value to the work of culinary nutrition educators and will inform and support future culinary nutrition education programs. In future research, health educators implementing skills-based health promotion programs in diverse settings can test the application of this framework to determine its relevance in broader areas.

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OBJECTIVE: To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared. DESIGN: Data were from a nationally representative health survey. SETTING: Secondary schools in New Zealand, 2012. PARTICIPANTS: A total of 7769 students, 9 % were SGM individuals. RESULTS: Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96). CONCLUSIONS: SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.

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OBJECTIVE: To assess the feasibility of a family meal intervention to address indicators of parent and adolescent nutrition and well-being and household food security. METHODS: Nine adolescents and a parent/caregiver were recruited from a youth health clinic. Families were provided with meal plans, recipes, and ingredients for 5 meals weekly for 4 weeks. Participants completed baseline and follow-up surveys and open-ended interviews. RESULTS: Overall, fidelity to the intervention was high among families; the frequency of family meals increased by approximately 2 meals/wk. Both parent/caregivers and adolescents reported improvements to nutrition (4 of 9 increased vegetable consumption for both) and most reported improvements to mental well-being. Household food insecurity also reduced during the intervention (means of 8.2 and 0.2 at baseline and follow-up, respectively). CONCLUSIONS AND IMPLICATIONS: Providing families with meal plans, recipes, and ingredients is an acceptable way to increase weekly frequency of family meals. Future research may consider the family meal as a way to engage with families about broader concerns.

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OBJECTIVE: Our aim is to examine the unbiased association between use of school-based health services (SBHS) and student health outcomes. DATA SOURCES: Data are from a nationally representative health and well-being survey of 8500 New Zealand high school students from 91 high schools. STUDY DESIGN: Student data were linked to the level of SBHS available to them: no SBHS, regular clinics from visiting health professionals, a health professional onsite, or a health team onsite. DATA COLLECTION/EXTRACTION METHODS: Causal analyses are used to compare utilization of SBHS and their association with student-reported health outcomes, including foregone health care, depressive symptoms, emotional and behavioral difficulties, suicide risk, substance use, and unsafe sexual behaviors. PRINCIPAL FINDINGS: Results from the multinomial propensity score-weighted regressions show that the use of SBHS was associated with poorer health outcomes, suggesting that selection bias was present due to unmeasured confounders. Instrumental variable analyses found that that students using team-based SBHS had a 4.7 percent (95% CI 0.5-8.9) probability of high levels of depressive symptoms compared to 14.2 percent (95% CI 11.5-16.8) among students not using team SBHS. For suicide attempt, students using team-based SBHS had a 2.0 percent (95% CI -0.3-4.2) probability of a suicide attempt in the previous 12 months compared to 5.6 percent (95% CI 2.6-8.5) among students not using team SBHS. CONCLUSIONS: These analyses suggest that team-based SBHS are associated with better mental health among students who attend them.

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AIM: To explore secular trends of adolescent weight control concerns and behaviours, between 2007 and 2012, and determine if these vary by body size. METHODS: Data were drawn from two nationally representative youth health surveys, Youth'07 and Youth'12. Multiple logistic regression models were used to determine differences in the prevalence of weight control behaviours and concerns between the two time points, controlling for socio-demographic variables. RESULTS: Between 2007 and 2012, both boys and girls were significantly more likely to report concerns about their weight, though the prevalence of trying to lose weight increased for boys, but not girls. Trends in weight control behaviours varied by body size for boys and girls. Perhaps the most striking findings were the increases in proportions of underweight girls and healthy weight boys who were trying to lose weight. CONCLUSIONS: The current study highlights the growing concerns that young people are experiencing in relation to weight control. Given the persistently high rates of adolescent obesity in New Zealand and globally, greater support for young people with regards to healthy eating and weight management is warranted.

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PURPOSE OF REVIEW: The purpose of this review was to examine the knowledge, attitudes and behaviours (KAB) related to dietary salt intake among adults in high-income countries. RECENT FINDINGS: Overall (n = 24 studies across 12 countries), KAB related to dietary salt intake are low. While consumers are aware of the health implications of a high salt intake, fundamental knowledge regarding recommended dietary intake, primary food sources, and the relationship between salt and sodium is lacking. Salt added during cooking was more common than adding salt to food at the table. Many participants were confused by nutrition information panels, but food purchasing behaviours were positively influenced by front of package labelling. Greater emphasis of individual KAB is required from future sodium reduction programmes with specific initiatives focusing on consumer education and awareness raising. By doing so, consumers will be adequately informed and empowered to make healthier food choices and reduce individual sodium intake.

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A growing body of research suggests that children and adolescents who share frequent meals with their families report better nutrition indicators, family relationships and mental health. Yet, little research has examined whether parents who share meals with their families report the same indicators of wellbeing. The current paper addresses this question using population-based survey data and a sample of parents in the United States (n = 889, mean age 31 years) that responded to the fourth wave of the Project EAT study in 2015-16. Multiple regression models were used to examine associations between frequency of family meals and indicators of nutritional, social and emotional wellbeing, controlling for demographic and household characteristics. Analyses also examined if associations were moderated by sex, as mothers tend to be more responsible for household and childcare tasks. Results suggested that parent report of frequent family meals was associated with higher levels of family functioning, greater self-esteem, and lower levels of depressive symptoms and stress (p-value for all <0.001). Frequency of family meals was also related to greater fruit and vegetable consumption (both p < 0.05), but was unrelated to other indicators of parent body size and nutritional wellbeing. Associations between frequency of family meals and parent wellbeing were similar for both mothers and fathers. Findings from the current study suggest that frequent family meals may contribute to the social and emotional wellbeing of parents. Future strategies to promote family meals should consider the potential impacts on the health and wellbeing of the whole family.

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OBJECTIVE: To determine whether perceived cooking skills in emerging adulthood predicts better nutrition a decade later. METHODS: Data were collected as part of the Project Eating and Activity in Teens and Young Adults longitudinal study. Participants reported on adequacy of cooking skills in 2002-2003 (age 18-23 years) and subsequently reported on nutrition-related outcomes in 2015-2016 (age 30-35 years) (n = 1,158). Separate regression models were used to examine associations between cooking skills at age 18-23 years and each subsequent outcome. RESULTS: One fourth of participants described their cooking skills as very adequate at 18-23 years, with no statistically significant differences by sociodemographic characteristics. Reports of very adequate cooking skills at age 18-23 years predicted better nutrition-related outcomes 10 years later, such as more frequent preparation of meals including vegetables (P < .001) and less frequent fast food consumption (P < .001). CONCLUSIONS AND IMPLICATIONS: Developing adequate cooking skills by emerging adulthood may have long-term benefits for nutrition over a decade later. Ongoing and new interventions to enhance cooking skills during adolescence and emerging adulthood are warranted but require strong evaluation designs that observe young people over a number of years.

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