Purpose: Better food literacy is associated with healthier eating behaviours and greater vegetables and fruit consumption. However, the reliance of parents on take-out and prepackaged foods, and the removal of home economics education in schools has reduced the opportunities for adolescents to develop their food literacy skills. Therefore, elective high school culinary courses may play a role in improving food literacy and adolescents’ health through better nutrition. This study assessed the effectiveness of an 18-week elective high school culinary course on student’s food literacy, eating behaviours and vegetables and fruit consumption as compared to students enrolled in a personal and social development (PSD) course.

Method: Students enrolled in a culinarycourse (n = 159) or in a PSD course (n = 315) in five high schools in New Brunswick, Canada, were recruited for this quasi-experimental study. Students completed a self-administered questionnaire during the first week (September) and last week (January) of the 2019 fall semester. The questionnaire assessed students’ food literacy, including cooking and food skills, vegetablesand fruit consumption and eating behaviours. Group differences were assessed with mixed-effect models. Separate gender analyses were conducted.   

Results/findings: Girls enrolled in the culinary course reported greater improvements in overallfood literacy (22.31 vs 3.39, p=0.005), food skills (9.27 vs 0.95, p=0.022) and cooking skills (13.04 vs 2.45, p=0.009) than those in the PSD course. Boys in the cooking course reported greater improvements in overall food literacy (15.61 vs -3.32, p=0.014) and cooking skills (11.36 vs -1.31, p=0.002) than those in the PSD course, but not food skills (4.26 vs -2.00, p=0.158). For both genders, no effect was found for the consumption of vegetables and fruits (p=0.61), nor for eating behaviours (p =0.42). 

Conclusions: High school culinary courses are effective at improving overall food literacy and cooking skills in both genders, as well as food skills among girls. These findings support the importance of offering such courses in high schools. Reintegration of these types of courses within the curriculum is highly encouraged. 

Purpose: Many jurisdictions have policies that stipulate the number of daily or weekly minutes of physical activity (PA) that schools are required to schedule. Unfortunately, the implementation of such policies is less than optimal. The potential public health benefits that may result from these policies requires population-wide implementation. This study aimed to determine the effectiveness of a multi-strategy implementation intervention on increasing teachers’ implementation and maintenance of a mandatory PA policy.

Methods: A cluster RCT was undertaken with 61 primary schools within the Hunter New England region of Australia. Designed using the Behaviour Change Wheel and Theoretical Domains Framework a 12-month multi-strategy implementation intervention was delivered to schools which included; centralised technical assistance, ongoing consultation, principal’s mandated change, training school champions, development of implementation plans, educational outreach visits, provision of educational materials. Control schools received usual support. The primary outcome was weekly minutes of structured PA implemented by classroom teachers. Structured PA included time in physical education (PE), sport or in class PA such as integrated lessons or energizers. Data were collected at baseline (October-December 2017), 12-month (October-December 2018) and 18-month (April-June 2019) follow-up. Data were analysed using linear mixed effects regression models.

Results: Overall 400 teachers provided valid primary outcome data at each time point.  From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by an average of 45.30 minutes (95% CI: 33.75, 56.86; p<0.001) which remained at 18-months, however the effect size was smaller (27.61 minutes; 95% CI: 15.99, 39.22; p=<0.001). The difference between groups in the change from baseline in proportion of teachers implementing the required 150 minutes of weekly PA favored the intervention group at both 12 (OR: 7.59; 95% CI: 3.89, 14.80, p<0.001) and 18 months (OR: 3.54; 95% CI: 1.89, 6.65, p=<0.001).

Conclusions: A multi-strategy implementation intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research into the impact of scale-up strategies on the sustainability of physical activity policy implementation over longer time periods is warranted. 

Purpose: Despite departmental policies that mandate schools deliver a certain amount of physical activity per week, many schools find it difficult to meet such policies. The effectiveness of a multicomponent implementation intervention, the Physically Active Children in Education (PACE) intervention, in increasing teacher’s delivery of physical activity, has previously been established in primary schools from one local health district in New South Wales Australia. This study aimed to evaluate the scale-up of PACE to primary schools across multiple health districts.

Methods: We conducted an uncontrolled before and after study, with 100 schools across three Local Health Districts in New South Wales, Australia. Guided by the RE-AIM evaluation framework, data was collected via project officer records, and principal and teacher surveys to assess: the reach (percentage who received the intervention), adoption (proportion taking up the intervention), implementation (extent to which the intervention is delivered as intended) and cost of PACE. Descriptive data were used to describe the reach and adoption of the program. Linear mixed models were used to assess implementation, by evaluating the difference in the number of minutes teachers delivered physical activity from baseline to follow-up. A prospective, trial-based economic evaluation of the intervention versus usual practice was used to assess cost.

Results/findings: Reach of PACE was high, with 90% (n=100) of schools receiving all components of the program. Adoption was high-to-moderate with most (>50%) schools adhering to the majority of program components (11 of the 13 components). Implementation was successful with teachers increasing their delivery of total physical activity across the school week by 26.77 minutes (95% CI: 21.16, 32.39, p<0.001) after receiving PACE. The incremental cost per additional minute of physical activity scheduled was $39.11 per school (UI $31.48, $50.72) for the modelled adjusted result.

Conclusions: PACE has demonstrated to be a highly feasible, acceptable and implementable program that successfully supports teachers in increasing their delivery of physical activity. Given the ongoing and scalable benefits of PACE, it is important that we continue to extend and improve this program, while considering ways to reduce the associated cost and resources. 

Purpose: In partnership with a public transport (PT) provider and state and local government, we designed a theory-informed single-blinded randomised controlled trial, trips4health, to increase transport-related physical activity (PA) through increased PT use. The intervention involved four months of incentives (PT smartcard credits) for achieving increasing weekly PT use targets and weekly supportive text messages. The PT provider issued smartcard credits, and a messaging service delivered text messages. This paper reports the process evaluation undertaken before outcomes analysis.

Methods: Process evaluation was guided by the Medical Research Council UK’s framework for complex public health interventions. Data were collected through post-intervention surveys (analysed descriptively) and semi-structured interviews with participants, and partner interviews (before and during the study). Interviews were recorded, transcribed, and analysed thematically.

Results: The trial was placed on hold (March 2020) then abandoned (May 2020) due to COVID-19. At that time, 116 participants completed baseline measures, 110 were randomised, and 64 completed post-intervention measures. Of the intervention participants (n=29), smartcard incentives were well-received: 90% agreed they were helpful, 97% agreed they were liked, and 90% agreed they were received in a timely manner. Fifty-nine percent agreed the incentives motivated them to use PT more, but 56% felt they had no impact on PA. All text messages were delivered and well-received: 76% agreed the frequency was ‘just right’, 90% agreed they were easy to understand, 48% agreed messages were helpful, but only 19% agreed they were interesting; 45% disagreed that text messages made no difference to bus use or PA. In participant interviews (n=6), meeting targets was considered important but was not driven by financial gain; perceptions of who the intervention would impact on most differed by income. A suggested improvement was greater personalisation of text messages. In partner interviews (n=4), the intervention administration workload was not considered significant and the intervention was considered easy to upscale.

Conclusions: This process evaluation indicates that a program for incentivising PT use is acceptable for participants and feasible with support from key partners. This process evaluation provides important insights for the tailoring of strategies to increase PA through the incentivisation of PT use.

Purpose: Public health partnerships can achieve better outcomes than any individual or organisation can alone by sharing knowledge and skills, more-efficiently utilising available resources and executing joint activities. This study aimed to understand stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership in delivering a complex, multi-faceted salt reduction intervention between 2014 and 2020 in the Australian state of Victoria.

Methods: Semi-structured interviews were conducted with 14 Partnership and seven food industry stakeholders in 2019. The Consolidated Framework for Implementation Research, designed to understand the effectiveness of intervention implementation, was adapted for the Partnership intervention and used to guide the qualitative analysis.

Results/findings: The Partnership was viewed as essential for intervention planning and decision-making and an enabler for intervention delivery. Partnership goals of capacity building and collaborative action were perceived to have been achieved. The implementation team executed intended intervention activities and outputs, with some adaptations to strategy. Barriers and enablers to implementation were identified by interviewees, such as conflicting individual, organisational and Partnership values and building positive relationships between the Partnership and food industry, respectively. Regarding the consumer arm of the multi-faceted intervention, stakeholders discussed an unsuccessful attempt to shift consumers along the Transtheoretical Model stages of change through three campaign waves. Perceived challenges in intervention delivery and engaging the target population were identified including limited campaign mediums as a result of tight budgets, the short intervention timeframes and ineffective campaign messaging for the target audience. The political and social climate was viewed as not conducive to achieving Partnership aims.

Conclusions: Establishing a Partnership with diverse skills and experience facilitated collaborative action, capacity building and execution of the salt reduction intervention. Monitoring and evaluating implementation of the intervention informed strategic adaptations, which allowed for optimisation of Partnership approach. Future public health partnerships should consider the importance of creating strong networks within the partnership and the balance between intervention adaptation and maintaining fidelity.

Purpose: Sport and recreation facilities promote health through physical activity, yet their food outlets predominantly sell unhealthy food and drink. Limited studies explore the long-term impacts of implementing healthy retail initiatives. The aim of the study was to evaluate the impact of a government-led healthy drink initiative in food outlets at sporting facilities on health behaviour and financial impact on the sale of pre-packed drinks sold.

Methods: Electronic weekly sales data from November 2015 to February 2020 was provided by 8 seasonal, typically outdoor pools; and 10 non-seasonal outlets in Victoria, Australia. The initiative started in March 2018 and involved either limiting ‘red’ (unhealthiest) drinks to <20% of display, or removing ‘red’ drinks from display completely, whilst increasing display of ‘green’ (healthiest) drinks to >50%. Health behaviour was measured by weekly percentage of ‘red’ and ‘green’ drinks sold; and financial impact by total weekly sales for all drinks.

Seasonal and non-seasonal outlets were analysed separately due to differences in seasonal sales patterns throughout the study period. Seasonal sales outcomes pre- and post-initiative were compared using multilevel linear models and non-seasonal outlets were analysed individually using an interrupted time series analysis.

Results: In seasonal outlets, the mean volume of ‘red’ drinks sold reduced from 47.9% to 25.4% and ‘green’ drinks increased from 40.8% to 50.5%. There was no statistical evidence of a change in total weekly drink revenue. 

The observed percentage volume of ‘red’ drinks sold in February 2020 was lower than what would have been predicted (had there been no intervention) in six of ten non-seasonal outlets, higher than predicted in two, and equivalent to predictions in two. The observed percentage volume of ‘green’ drinks sold was lower than what would have been predicted in one of ten non-seasonal outlets, higher than predicted in four, and equivalent to predictions in five. In nine of ten outlets, weekly drinks revenue in February 2020 was equivalent to predictions based on there being no intervention.

Conclusion: Reducing the availability of unhealthy drinks can be an effective public health policy to improve the healthiness of customer purchases without impacting revenue.