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Background The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents’ responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. Methods Parents of toddlers aged 12 to < 36 months ( N  = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains \"good\" ingredient'; 'free from \"bad\" ingredient'; and unregulated 'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. Results For the overall sample, brief exposure to ‘free from \"bad\" ingredient’ claims increased participant’s intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that ‘contains \"good\" ingredient’ claims and ‘child-related’ claims significantly impacted parent’s preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed ‘contains \"good\" ingredient’ or ‘free from \"bad\" ingredient’ claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. Conclusions Findings indicate that ‘free from \"bad\" ingredient’ claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. ‘Contains \"good\" ingredient’ claims and ‘child-related’ claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children’s diets and health.

Commercial toddler foods (CTFs) are widely used. Many are nutritionally poor despite displaying health, nutrition or marketing claims implying healthiness. This study aimed to: (i) explore how claims on CTFs influence parents' product perceptions and preferences, and gauge support for regulatory reform to ensure CTFs are marketed responsibly; (ii) identify other factors influencing parent's and toddlers' perceptions and preferences towards CTFs and toddler feeding in general. Six moderator‐led online focus groups (N = 47) were conducted with parents of toddlers (aged 12 to < 36 months) in Victoria, Australia, using a discussion guide and mock CTFs to elicit discourse. Discussions were audio‐recorded, transcribed, and analysed using exploratory content and thematic analysis. Parents found CTFs displaying claims more appealing, despite awareness and scepticism of claims. Parents expressed frustration over industry's use of claims and supported stronger regulation of claims. Some doubted the effectiveness of regulations, concerned that industry would find ways to circumvent rules. Parents perceive visual features (especially cartoon characters) on CTFs as highly influential for toddlers. Parents support honest labelling of CTFs, reflecting a product's actual ingredients and nutritional profile, especially signposting of sugar content. Parents evaluate CTFs based on perceived healthiness and convenience, often relying on social media and brand reputation for guidance on what to feed their toddlers. While parents are aware of, and sceptical about claims on CTFs, these claims still influence their perceptions. Findings highlight the need for stronger regulations to ensure that claims on CTFs do not create inaccurate perceptions of their healthiness. Commercial toddler foods (CTFs) are widely used. Many are nutritionally poor despite displaying health, nutrition or marketing claims implying healthiness. This study used focus groups with parents of toddlers in Victoria, Australia, to explore how claims on CTFs influence parents' product perceptions and preferences, and gauge support for regulatory reform to ensure CTFs are marketed responsibly; and identify other factors influencing parent's and toddler's perceptions and preferences towards CTFs and toddler feeding in general. While parents are aware of, and sceptical about claims on CTFs, these claims still influence their perceptions, and the findings highlight the need for stronger regulations to ensure that claims on CTFs do not create inaccurate perceptions of their healthiness. Summary Parents find claims on CTFs appealing and influential, notwithstanding awareness and scepticism of such claims. ‘Free from “bad” ingredient’ claims (e.g., preservative‐free), which appeal to risk avoidance motivation, hold slightly greater appeal and influence on parents' product perceptions compared to other types of claims commonly featured on CTFs. Parents stressed the need for transparent and honest labelling of CTFs with regard to claims, as well as product names, ingredients lists and nutritional information. Many parents expressed strong concern about the sugar content in CTFs, supporting stricter limits and clearer signposting of sugar in CTFs to highlight potential harm. Many parents expressed strong support for stricter regulation of claims on CTFs to ensure that these products are marketed suitably and do not create inaccurate perceptions of product healthiness.

ObjectiveTo evaluate the LiveLighter ‘Sugary Drinks’ campaign impact on awareness, knowledge and sugar-sweetened beverage (SSB) consumption.DesignCohort study with population surveys undertaken in intervention and comparison states at baseline (n=900 each), with 78% retention at follow-up (intervention: n=673; comparison: n=730). Analyses tested interactions by state (intervention, comparison) and time (baseline, follow-up).Setting and participantsAdults aged 25–49 years residing in the Australian states of Victoria and South Australia.InterventionThe 6-week mass media campaign ran in Victoria in October/November 2015. It focused on the contribution of SSBs to the development of visceral ‘toxic fat’, graphically depicted around vital organs, and ultimately serious disease. Paid television advertising was complemented by radio, cinema, online and social media advertising, and stakeholder and community engagement.Primary outcome measureSelf-reported consumption of SSBs, artificially sweetened drinks and water.Secondary outcome measuresCampaign recall and recognition; knowledge of the health effects of overweight and SSB consumption; perceived impact of SSB consumption on body weight and of reduced consumption on health.ResultsA significant reduction in frequent SSB consumption was observed in the intervention state (intervention: 31% compared with 22%, comparison: 30% compared with 29%; interaction p<0.01). This was accompanied by evidence of increased water consumption (intervention: 66% compared with 73%; comparison: 68% compared with 67%; interaction p=0.09) among overweight/obese SSB consumers. This group also showed increased knowledge of the health effects of SSB consumption (intervention: 60% compared with 71%, comparison: 63% compared with 59%; interaction p<0.05) and some evidence of increased prevalence of self-referent thoughts about SSB’s relationship to weight gain (intervention: 39% compared with 45%, comparison: 43% compared with 38%; interaction p=0.06).ConclusionsThe findings provide evidence of reduced SSB consumption among adults in the target age range following the LiveLighter campaign. This is notable in a context where public health campaigns occur against a backdrop of heavy commercial product advertising promoting increased SSB consumption.

The aim of this study was to describe advertising expenditure for sugary drinks compared with alternative cold non‐alcoholic beverages (artificially sweetened beverages, plain water, plain milk) between 2016 and 2018 across Australian media channels. Monthly estimates of advertising expenditure for non‐alcoholic beverages were obtained from Nielsen Media and aggregated by product type and media. Total sugary drink advertising expenditure between 2016 and 2018 ($129.5M) significantly exceeded expenditure on artificially sweetened drinks ($23.26M), plain water ($14.27M), and plain milk ($31.30M). Television and out‐of‐home advertising accounted for the largest share of sugary drink advertising (45%, 35%). Expenditure on out‐of‐home advertising was more heavily dominated by sugary drinks (75%) than advertising in all media combined (65%). Sugary drink advertising peaked in warmer months and was lowest in August. Soft drinks (26%), flavoured milks (24%) and energy drinks (21%) accounted for the majority of sugary drink advertising. Cold non‐alcoholic beverage advertising in Australian media is dominated by the advertising of sugary drinks. Restricting unhealthy beverage advertising on television and out‐of‐home media may be most effective initially. However, comprehensive restrictions capturing a broader range of media and settings would be optimal to prevent displacement and limit advertising reach and exposure.

Issue addressed: The reach and impact of the LiveLighter and Aboriginal sugarsweetened beverage (SSB) advertisements among Aboriginal and Torres Strait Islander adults. Methods: The Aboriginal SSB advertisement launched online in January 2015 and aired on NITV in October/November 2015 as part of the Government-funded Live- Lighter campaign. The advertisement was developed in Victoria and featured members of the Victorian Aboriginal community. Another LiveLighter advertisement targeting the general population was broadcast over the same period. Online surveys were completed by 150 Aboriginal and/or Torres Strait Islander adults in November/December 2015. Results: Around half of respondents reported seeing either the Aboriginal (47%) or the LiveLighter (56%) SSB advertisement, and the proportion was significantly greater in Victoria (Aboriginal: 60%, LiveLighter: 66%) than other states/territories (Aboriginal: 29%, LiveLighter: 43%). Compared to the LiveLighter advertisement, the Aboriginal campaign was seen to be more believable, to be more relevant and to have an important message for the Aboriginal community (P < 0.001). Participants from Victoria were significantly more likely to identify the sugar content of regular soft drink, compared with those from other states/territories (68% vs 40%, P < 0.001). Sixty per cent of participants who had seen the Aboriginal SSB advertisement reported they drank less SSBs compared with 48% of those not exposed, though the difference was not statistically significant (P > 0.05). Conclusions: Results suggest the Aboriginal advertisement resonated with Aboriginal and Torres Strait Islander people and impacted knowledge about the sugar content of SSBs, particularly in Victoria where the campaign originated. So what?: This study highlights the importance of Aboriginal and Torres Strait Islander- led health promotion campaigns and tailoring health messages to the local Aboriginal and/or Torres Strait Islander community.

Online meal ordering services are increasing in popularity in Australia and globally. Meals ordered online for home delivery are typically less healthy than home-made meals, potentially contributing to weight gain. The aim of the present study was to identify the types of consumers who are most likely to engage in online meal ordering. A cross-sectional survey including items relating to demographic and lifestyle factors was disseminated via a web panel provider. Australia. A total of 2010 Australian adults aged 18+ years. More than a quarter of respondents (28 %) engaged in online meal ordering at least once in the previous month. Younger respondents, those with a higher BMI, and those with higher education and income levels were more likely to have done so. Consuming higher levels of sugary drinks and fast-food restaurant patronage were significantly associated with ordering meals online for home delivery. The outcomes of this study suggest that the use of online meal ordering services is becoming a common practice in Australia, and it is therefore important to implement evidence-based strategies and policies to encourage individuals to make healthy food choices when using these services.

Abstract With the global industry for commercial infant and toddler foods growing, there are concerns that nutrient-poor foods, particularly snacks, are being marketed as suitable for children under 36 months. The current study aimed to document the prevalence of commercial snack foods (CSFs) for infants (<12 months) and toddlers (12 to <36 months) compared to other product categories in Australia, and assess their nutritional composition, taste profile, texture and level of processing. Data were from a 2022 cross-sectional audit of infant and toddler foods conducted across three major Australian supermarkets. Using food categories outlined in WHO Europe’s Nutrient and Promotion Profile Model (NPPM), CSFs were defined as ‘snacks and finger foods’ and ‘confectionery’ products. Around a quarter (23%) of infant foods and two-thirds (67%) of toddler foods were CSFs, and most (77%) were assessed as being sweet rather than savoury. Only 19% of CSFs met all applicable NPPM compositional requirements, with toddler CSFs performing comparatively worse than infant CSFs, particularly in terms of their energy density (18% of products compliant vs. 72%) and total sugar content (42% vs. 88%). Overall, 71% of CSFs were categorized as dissolvable (either with or without an initial crispy/crunchy texture), while 63% were ultra-processed based on the NOVA classification system. These study findings indicate that a significant portion of the Australian market for infants and toddlers consists of CSFs that are largely sweet, dissolvable and ultra-processed and non-compliant with international recommendations for key nutrients. Comprehensive reforms are needed to improve the nutritional quality of these products.

The current study aimed to assess the nutritional quality of Australian secondary school canteen menus. Stratified national samples of schools provided canteen menus in 2012-2013 and 2018, which were systematically assessed against a 'traffic light' classification system according to the National Healthy School Canteen Guidelines. Items were classified as green (healthiest and recommended to dominate canteen menus), amber (select carefully) or red (low nutritional quality, should not appear on canteen menus), and pricing and promotional strategies were recorded. Australia. Canteen menus from 244 secondary schools (2012-2013 148, 2018 96). A total of 21 501 menu items were classified. Forty-nine percent of canteen menus contained at least 50 % green items; however, nearly all (98·5 %) offered at least one red item and therefore did not comply with national recommendations. Snacks and drinks had the least healthy profile of all product sectors, and a large proportion of schools supplied products typically of poor nutritional quality (meat pies and savoury pastries 91·8 %, sugary drinks 89·5 %, sweet baked goods 71·5 %, ice creams 64·1 % and potato chips 44·0 %). Red items were significantly cheaper than green items on average, and many schools promoted the purchase of red items on canteen menus (52·8 %). There were few differences between survey waves. There is considerable room for improvement in the nutritional quality of canteen menus in Australian secondary schools, including in the availability, pricing and promotion of healthier options. Additional resources and services to support implementation of national guidelines would be beneficial.

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016–18. Eligible public health advertising expenditure for the entire period (total AUD $27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$ 129M) and diet/weight loss products and services (AUD $122M). Artificially sweetened drinks accounted for an additional AUD$ 23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

BackgroundPrevalence figures for health-related behaviors disguise the existence of behavioral clusters. A growing body of work indicates the potential effectiveness of using simultaneous (versus sequential) approaches to targeting health-related behaviors to make deeper inroads into addressing non-communicable diseases. To inform future interventions designed to simultaneously address multiple risk factors, the aim of the present study was to identify behavioral clusters including nine behaviors relating to smoking, alcohol consumption, nutrition, physical activity, and sleep.MethodA latent class analysis was applied to a nationally representative sample of 1849 adult Australians.ResultsOf the four identified segments, one was characterized by a relatively healthy behavioral profile and another demonstrated poor results across multiple lifestyle domains. The other two groups comprised individuals who demonstrated healthy behaviors in some domains (e.g., substance use) but not in others (primarily physical inactivity and junk food consumption, respectively).ConclusionsResults suggest the opportunity to encourage individuals in the latter two groups to build on existing positive behaviors to achieve greater overall compliance with health recommendations. Particularly intensive interventions are likely needed for those in the unhealthiest group to address the potentially reinforcing effects of their multiple unhealthy behaviors.