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OBJECTIVES: To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement. DESIGN: A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received. RESULTS: The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, 'teen language' and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content. CONCLUSION: Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents' exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements.

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OBJECTIVE: To investigate the factors that may account for the delay in diagnosis and treatment in Fijian female breast cancer patients. METHODS: This study adopted a qualitative approach to gain an in-depth understanding of individual barriers and participants' experiences within the Fijian context. Utilising semi-structured interviews, the study interviewed breast cancer survivors, community women, healthcare professionals, and traditional healers. RESULTS: Two primary themes emerged from participants' narratives relating to barriers to early breast cancer detection: (1) individual-related factors and (2) healthcare system-related factors. Within these, five sub-themes were identified. For individual-related factors, these included: cultural & religious beliefs, social support, and awareness & misconception. For healthcare system factors, the sub-themes were: House of death and limited community accessibility to screening and awareness initiatives. CONCLUSION: The results highlighted the need for targeted interventions that consider the importance of cultural beliefs, improve awareness, and foster trust in the healthcare system.

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Introduction: Fast food consumption is associated with excessive intake of energy-dense foods; a major determinant of childhood obesity. The lack of data on the marketing strategies used to promote fast food to adolescents in low and middle-income countries (LMICs) acts as a barrier to global efforts to reduce the marketing of unhealthy foods to young people around the world. Objectives: This systematic review aimed to identify the adolescent-directed marketing strategies of transnational fast food corporations in LMICs. Methods: A systematic search of eight scientific databases (PubMed, CINAHL, Medline, Embase, ProQuest, PsycInfo, Scopus and Google Scholar) was conducted. Following PRISMA guidelines, primary research articles written in English were included if they were published between 1 January 2010 and 30 December 2022, and reported any adolescent-directed marketing activity undertaken by a transnational fast food company operating in a LMIC. Articles were excluded if they were not peer reviewed. The quality of the included articles was assessed using a condensed version of the Consolidated Criteria for Reporting Qualitative Research tool. Results: Twelve articles met the eligibility criteria and were included in this review. A narrative synthesis of these articles revealed that the most documented strategies used to promote fast food to adolescents in LMICs were the use of incentives or premium offers, product appeals, promotional characters and brand familiarity. These strategies were mostly observed on social media, suggesting that there are serious concerns about adolescent exposure to fast food via social media in developing settings, especially as contextual differences in the nature of such marketing were identified. Discussion: The promotion of fast food to adolescents in LMICs is contextual in nature, with the nature of marketing strategies employed by transnational fast food corporations varying greatly across cultural and socio-economic contexts. These findings are crucial for the development of guidelines and regulations restricting the marketing of fast food to adolescents in lower income settings, contributing to global efforts to reduce adolescent exposure to unhealthy food promotion.

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CLINICAL RELEVANCE: Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. BACKGROUND: Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4- to 5-year-olds delivered in Queensland, Australia. METHODS: The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores . RESULTS: Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). CONCLUSION: It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.

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OBJECTIVES: Lack of physical activity presents substantial health risks to older adults living in residential aged care facilities. The objective of this review was to examine the suitability of physical activity outcome measurement instruments among cognitively sound residents. METHODS: Search terms were used to explore health, nursing and social science databases to identify applicable English-language research from January 2000 to July 2020. RESULTS: Sixteen papers met the inclusion criteria. The findings show that a diverse range of outcome measurement instruments have been used to evaluate physical activity intervention effectiveness. Most were found not to be validated for use specifically with residential aged care populations. CONCLUSIONS: A range of Outcome Measurement Instruments (OMI) appear to effectively measure physical activity intervention outcomes among residential aged care older adults. Results highlighted the need for greater rigour in study design and selection of valid and population-appropriate instruments for use with this population.

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OBJECTIVES: To inform strategies to increase physical activity amongst Older Residential Care Facility Residents (ORCFR), this research explored self-identified motivators for, benefits of and barriers to physical activity engagement. METHODS: The research was framed within a salutogenic model of health, viewing health as a continuum shaped by one's health resources and life stressors. This exploratory qualitative research examined the physical activity experiences of seven ORCFR in Brisbane, Australia. Semi-structured interviews with open-ended questions assessed basic demographics, Physical Activity (PA) levels, perceived benefits of and barriers to PA. The resulting data underwent thematic analysis. RESULTS: After seven interviews, data saturation was reached, revealing three major themes and seven subthemes. These were positive socialisation (inclusion) with subthemes of enjoying social contact and avoiding "zombieland" (loneliness). Negative socialisation (isolation) with subthemes of avoiding conflict and feeling awkward. Maintaining independence was the benefit, with subthemes of getting around to socialise, activities of daily living and preserving health to socialise. CONCLUSION: Conventional physical activity programs emphasising medical and clinical benefits are disconnected from ORCFR motivators, as residents perceive benefits in terms of mobility and socialisation. This disconnect partially explains poor acceptability and uptake of ORCFR physical activity interventions over the last 25 years.

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The COVID-19 pandemic has led to increased levels of stress and alcohol consumption. This study examined the effect of resilience on the relationship between stress and changes in alcohol consumption in the context of the COVID-19 pandemic in early 2020. A cross-sectional survey of 502 adults in Queensland, Australia (mean age = 45.68 (16.61)), found 23.9% of individuals had increased their alcohol consumption since the start of the pandemic. Regression modelling demonstrated a significant association between perceived stress and change in alcohol consumption. The study also revealed resilience was a moderating factor, where high levels of resilience buffered against increases in alcohol consumption associated with stress during the COVID-19 pandemic.

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BACKGROUND AND OBJECTIVE: In most Pacific Island Countries and Territories (PICTs), cancer patients commonly present at very late stages and by the time the disease is diagnosed, it is often too late for treatment. This review examines the evidence on factors associated with low cancer screening participation and late presentation of cancer among women of the PICTs. MATERIALS AND METHODS: Medline, PubMed, ProQuest and The Cumulative Index to Nursing and Allied Health Literature were searched to identify relevant studies for this review. Terms of medical subject headings was performed in combination with other key words such as "screening", "delay", "determinants", "awareness". RESULTS: Eleven studies met the inclusion criteria of this review. Six factors were identified from these studies: resources and facilities, trust in the health care system, culture and tradition, modesty, awareness and socioeconomic status. CONCLUSION: Due to several barriers and factors, women in the PICTs are hindered from accessing cancer screening practices and often present late with cancer symptoms leading to advanced stage diagnosis. The findings of this study provide a foundation for future studies that could focus more in-depth to explain how these factors contribute to the presentation of cancer in late stages.

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Nutrient supply regulates the activity of phytoplankton, but the global biogeography of nutrient limitation and co-limitation is poorly understood. Prochlorococcus adapt to local environments by gene gains and losses, and we used genomic changes as an indicator of adaptation to nutrient stress. We collected metagenomes from all major ocean regions as part of the Global Ocean Ship-based Hydrographic Investigations Program (Bio-GO-SHIP) and quantified shifts in genes involved in nitrogen, phosphorus, and iron assimilation. We found regional transitions in stress type and severity as well as widespread co-stress. Prochlorococcus stress genes, bottle experiments, and Earth system model predictions were correlated. We propose that the biogeography of multinutrient stress is stoichiometrically linked by controls on nitrogen fixation. Our omics-based description of phytoplankton resource use provides a nuanced and highly resolved description of nutrient stress in the global ocean.

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Leadership and communication capabilities of federal leaders during crises are imperative to support and guide citizens' behaviors and emotions. The following content analysis examines crisis communication delivered by the Australian Prime Minister (PM), Scott Morrison during the COVID-19 pandemic. Communication delivered over seven months starting from the first reported case of COVID-19 in Australia, was analyzed through a process of coding to identify central organizing crisis communication frames and themes and measured against eleven main themes based on principles of Crisis and Emergency Risk Communication (CERC) recommended by the WHO and US Centers for Disease Control and Prevention. Transcripts were sourced from the PM's official website and 91 communiques were analyzed. Key epidemiological indicators and public health measures were reviewed over timeframe to examine changes in communication over the pandemic. Findings indicated that PM Morrison included many features of CERC within his official messaging. Our analysis revealed that the original framework was limited in its scope to encompass certain messages and thus the allocation of new frames,'public health and medical advice' and 'assuring and commending the public and institutions', allowed for a more thorough analysis of communication during a novel global health pandemic. The temporal analysis demonstrated that the government's policy and communication temporally followed case numbers and relative threat of the virus. This study has provided an in-depth review of CERC during the first phase of the COVID-19 pandemic. New frames and themes for the current CERC framework are suggested which can be transferable to other crises in Australia and other countries.

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ISSUE ADDRESSED: Adolescence is a transition period between childhood and adulthood during which an individual is more likely to engage in drug use. Peer education is one strategy suggested to discourage adolescents from engaging in negative lifestyle behaviours including drug use. This qualitative research was conducted to understand the perspectives of student peer educators to provide counselling to their peers around drug use. METHODS: Data were gathered at 10 senior high schools in five regions of Surabaya through semi-structured interviews (student peer educators: n = 20; teachers: n = 13) and focus group discussions (three FGDs with student peer educators: n = 25). The data were analysed through thematic analysis following procedures of data reduction, data presentation and conclusion drawing. RESULTS: The peer educators showed readiness (actual or potential) to provide counselling based on the external factor (confidence of ongoing support) and internal factors (motivate healthy lifestyle choices, ready with an open ear, self-development and share knowledge and experience). CONCLUSIONS: The readiness to provide counselling emphasises the preparedness of the students to help their peers and appeared underpinned by their self development and personal experiences. A capacity building program to enable student peer educators to enhance their skills to motivate healthy lifestyle choices would be of benefit. SO WHAT?: The confidence in ongoing support factor recognises the essential role of stakeholders to visibly advocate for the reactivation of the peer educator program for high school students as a clear sign of support.

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The functional food market is one of the fastest growing segments of the global food industry. The aims of this study were to understand the association of demographic characteristics and food choice motives (FCMs) with (a) attitudes toward functional foods and (b) consumption of functional foods in Australian emerging adults. Data were collected through a paper-based and online questionnaire completed by 370 young adults aged between 17 and 29 years. A binomial logistic regression was used to determine the association between demographic characteristics and FCMs with attitudes towards functional foods. The logistic regression model was statistically significant at χ2(11) = 48.310 (p < 0.001) and explained 18.1% of the variance in attitude towards functional food. Of the several predictors, only the FCMs natural content and weight control were statistically significant. A binomial logistic regression was also used to determine the association between demographic characteristics and FCMs with the consumption of functional foods. The logistic regression model was statistically significant at χ2(9) = 37.499 (p < 0.001) and explained 14.1% of the variance in functional food consumption. Of the eight predictors, three were statistically significant: living situation, natural content and health. Findings highlight that when targeting emerging adults, functional food companies could benefit from promoting the natural and health properties of their products. Furthermore, consumption can be increased by targeting the parents of emerging adults and by designing functional foods that attract emerging adults interested in controlling weight.

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Oceanic emissions represent a highly uncertain term in the natural atmospheric methane (CH4) budget, due to the sparse sampling of dissolved CH4 in the marine environment. Here we overcome this limitation by training machine-learning models to map the surface distribution of methane disequilibrium (∆CH4). Our approach yields a global diffusive CH4 flux of 2-6TgCH4yr-1 from the ocean to the atmosphere, after propagating uncertainties in ∆CH4 and gas transfer velocity. Combined with constraints on bubble-driven ebullitive fluxes, we place total oceanic CH4 emissions between 6-12TgCH4yr-1, narrowing the range adopted by recent atmospheric budgets (5-25TgCH4yr-1) by a factor of three. The global flux is dominated by shallow near-shore environments, where CH4 released from the seafloor can escape to the atmosphere before oxidation. In the open ocean, our models reveal a significant relationship between ∆CH4 and primary production that is consistent with hypothesized pathways of in situ methane production during organic matter cycling.

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BACKGROUND: With prevalence estimates indicating that young Australian children are increasingly sedentary, it is important to identify the relevant attributes that are shaping this lack of activity. Literature has identified safety concerns of parents as a consistent barrier to physical activity participation of young children. Despite safety being a plausible determinant of young children's activity preferences, the impact of restrictive parenting practices has rarely been examined through quantitative research. The current study investigates the link between controlling and supportive physical activity parenting practices and preschool children's physical activity knowledge, preferences and parent-reported behaviour. METHODS: The current cross-sectional study included 138 parent-child dyads and involved two components of data collection including a child and a parent questionnaire. Results of the parent and child questionnaires were matched to determine correlations between physical activity parenting practices and preschool children's physical activity knowledge, preference and parent-reported behaviour. RESULTS: Children's preferences for physical activity correlated with a number of demographic characteristics and physical activity parenting practices, with the most influential variables being parental age, parental rules around active play outdoors and parental use of screen-time to reward/control child behaviour. Based on parental-reporting, children who preferred to be physically active were more likely to engage in physical activity and were less likely to engage in screen-time on the weekend. CONCLUSIONS: This study identified that parenting practices are not only associated with children's active and sedentary behaviours (parent-reported), but also with how children prefer to play (parent-reported). Future research should seek to clarify the relationship between children's activity preferences and parent's use of screen-time to reward and control their child's behaviour, given the developmental and behavioural health risks associated with excessive media/screen exposure in early childhood. Further research should investigate whether competing societal values of the importance of encouraging children's risky play and the need to prevent children from being injured, coupled with parent's busy schedules are contributing to parental ambivalence regarding how to promote active play for their children. Finally, research should be conducted to establish the relationship between physical activity parenting practices and children's objectively-measured activity level.

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BACKGROUND: Early childhood has been identified as a crucial period in which children develop physical activity preferences and behaviors. Both the knowledge of and preferences for physical activity are key proximal indicators of activity choices in children. Thus, accurate data collection tools are required to measure these variables. This review evaluates the data collection techniques that have been utilised to assess preschool children's knowledge of and preference for physical activity, and examines the validity and reliability of existing techniques. METHODS: A systematic search for relevant studies published from 1980 through to December 2017 was conducted via ProQuest, CINAHL, Embase, Scopus, ERIC, PubMed, MEDLINE, and ScienceDirect. RESULTS: Fourteen studies were eligible for inclusion in the review. The identified studies employed a limited but disparate range of techniques to assess children's physical activity knowledge and preferences. Findings reveal that four techniques were consistently used across the reviewed studies, including: interviews, structured play-based activities, questionnaires, and observations. Only four out of 14 included studies reported the assessment of the validity of the data collection tool used, and six reported testing the measures for at least one type of reliability. CONCLUSION: There is a need for validated and reliable measures to assess children's knowledge of and preference for physical activity. Greater consideration is required to align data collection techniques with the characteristics, needs and abilities of this study population.

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ISSUE ADDRESSED: A child's preference for active or sedentary play is a key proximal indicator of a child's physical activity behaviour. There is a need to understand children's physical activity preferences in order to make physical play more enjoyable to them, and this may encourage participation and a more positive relationship with physical activity. To date, little research has incorporated the perspectives of young children on this topic. This study specifically examines (a) what activities preschool children prefer; and (b) what children consider to be barriers and facilitators to participating in their preferred activity. METHODS: The authors employed visual methodologies to explore the activity preferences of 29 preschool children. Children were asked to draw their preferred activities and answer a series of open and closed questions about their drawing and what they think are the barriers and facilitators to participating in this activity. RESULTS: Participants expressed a desire to play unstructured activities with friends or family, to engage in imaginative, challenging play, as well as the opportunity to have control over the activity they engage in. Children reported that rules at home and at preschool, the availability of toys, friends and family and having access to a natural environment served as both barriers and facilitators to participating in their favourite activity. CONCLUSIONS: Listening to children's voices about their play preferences and the barriers and facilitators to engaging in these activities provides important insight into children's play behaviour and the promotion of active play in early childhood. Participants' desire for more natural features within their play environment and for challenging, unstructured and imaginative play may be considered as facilitators of their engagement in physical activity. SO WHAT?: The current findings suggest the incorporation of unstructured playtime within natural environments could support young children's participation in and increased enjoyment of physical activity.

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BACKGROUND: Homelessness is a persistent social issue with diverse impacts reaching far beyond individuals. Strategies and research concerning homelessness and health have largely focused on the risk factors and weaknesses of individuals. Such preoccupation has meant the potential strengths and resources within individuals, and so-called strength-based approaches have received less attention. Consequently, understanding how to effectively work with and engage this population in such interventions is limited. METHODS: The current study presents a process evaluation of an 8-week group fitness intervention in a supportive housing facility. The purpose of the intervention was to increase tenants' physical activity together with opportunities for social interaction and support to, in turn, improve physical and mental wellbeing, and ultimately help individuals re-engage in their community. The evaluation focused on seven key components: context, recruitment, reach/participation, dose delivered, dose received, satisfaction/feedback and fidelity. Data collection methods included observation, attendance records and participant and staff interviews. RESULTS: Findings indicate the intervention was appropriate, well delivered, and enjoyed by participants who highlighted the importance of the sessions for their mental wellbeing and social inclusion. The intervention being conducted on site, the trainers' ability to build good rapport with participants together with the supportive environment they created were central to successful implementation. CONCLUSION: Group fitness sessions represent a promising intervention to improve wellbeing of this population. However, the need for more personalised care when delivering fitness sessions, due to the complexity of health issues prevalent in this population, was identified. This has implications for already limited resources, including staffing. Strategies to address this are required to ensure the continuity of fitness programs. Impact evaluation to quantify changes/improvements in wellbeing would complement this work and add much to understanding the effects of participation.

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BACKGROUND: Preschool children's knowledge of, and preference for food and physical activity play an important role in the development of lifestyle behaviors throughout childhood. Valid and reliable instruments that are interactive and appealing to preschool children are needed, to obtain quality information in a way that actively engages children and encourages willing participation. The purpose of the current research is to assess the reliability and validity of an adapted computerized (iPad) version of the photo-pair food and exercise questionnaire (PPFEQ). METHODS: The adaptation of the PPFEQ involved generating the questionnaire as an iPad-based tool, updating the photo-pairs within the questionnaire and testing for validity and reliability. This involved four phases of investigation to assess test-retest reliability, internal consistency, sensitivity to change and percent agreement of the questionnaire. RESULTS: The adaption of the PPFEQ resulted in an 18-item questionnaire, titled the preschool food and play questionnaire (Pre-FPQ). The Pre-FPQ demonstrated acceptable reliability and sensitivity to change. Test-retest reliability and internal consistency improved with age, however, it was evident that the tool was not suitable for children younger than 4 years of age. CONCLUSIONS: Children encounter a dynamic world that shapes their knowledge, preferences, choices and behaviors. The Pre-FPQ is an innovative tool to measure preschool children's knowledge of and preference for food and physical activity. The questionnaire offers the advantage of being presented in a well-received modality for preschool children as well as being easy and inexpensive to administer. This new tool is likely to be useful for the assessment of the effectiveness of healthy lifestyle programs implemented in the childcare setting. Future work is needed to refine and improve measures of physical activity preference in preschool children.

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OBJECTIVE: To identify and review data collection techniques used to measure preschool children's knowledge of food and nutrition. DESIGN: A systematic review of published research guided by the Preferred Reported Items for Systematic Reviews and Meta-analyses statement. PARTICIPANTS: Published journal articles between 1980 and 2013 reporting research involving the measurement of preschool children's (aged 3-5 years) knowledge of food and nutrition. RESULTS: Twenty studies were eligible for inclusion. The studies reported the use of a range of innovative age-appropriate techniques to assess children's knowledge of food and nutrition. Data collection techniques were grouped under 3 broad approaches: (1) interviews, (2) use of stimulus material and prompts, and (3) structured play-based activities. Only 3 of the reviewed studies tested for both reliability (test-retest and internal consistency) and face and content validity. Only 9 of the reviewed studies reported pilot-testing their instruments before use. CONCLUSIONS AND IMPLICATIONS: Results from this review suggest that additional research is needed to develop more valid and reliable measures to assess preschool children's knowledge of food and nutrition. Assessment tools need to be pilot-tested, refined, and adapted to suit both the specific audience and the components of the nutrition knowledge being targeted by an intervention before implementing a nutrition education program.

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