In 2013, it was estimated that approximately 4% of alcohol was delivered to the individual's own home and much of this was organised by mail order [1]. The use of home delivery services to purchase alcohol in Australia has since burgeoned, with industry estimates suggesting 14% annual growth prior to COVID-19 [2]. However, it is thought that home delivery services have tripled during the COVID-19 pandemic [3] when rules around home delivery were relaxed in most Australian jurisdictions [4]. For many consumers, the pandemic was the first time they used a delivery service for alcohol [5]. The long-term influence of the pandemic on how people buy and consume alcohol, now that many people have taken the step of trying these services, is currently unknown. Industry bodies predict that in a post-COVID world drinking at home will increase, as will the use of home delivery [6]. Further, consumers tend to spend more money online than they do in-store in order to make delivery fees worthwhile [7]. However, without systematic data reporting requirements for alcohol home delivery services, nor sophisticated survey and other measures, policymakers are dependent on information that industry bodies wish to make publicly available to evaluate its impacts on alcohol use and harms. Liquor licensing has traditionally provided governments with regulatory tools to reduce (or increase) the availability of off-premise alcohol. This in turn was thought to reduce the harms associated with alcohol, given that greater availability has been clearly linked to more high-risk drinking [8, 9]. Alcohol home delivery circumvents this regulatory lever by removing the so-called ‘convenience costs’ to consumers associated with travelling to purchase alcohol. Furthermore, the recent rapid proliferation of home delivery services is occurring in a relatively loosely regulated space, with limited direct evidence available to date to inform the development of regulations. New South Wales and Western Australia introduced some regulation of home delivery of alcohol in 2022, such as not delivering alcohol to an intoxicated person or a minor [10, 11]. Other states, such as Victoria, are making some of the relaxed regulations introduced during the COVID-19 pandemic permanent [12] (while also introducing regulations that apply to the first time a person has alcohol delivered by a given company and regarding delivery to an intoxicated person [13]). Although alcohol delivery services have been available for decades, these have mainly been wine subscription services delivered by postal or package services [1]. In the past decade, alcohol delivery has expanded dramatically in scope, with a diverse market including wine clubs, established retailers and start-ups [14]. These services can be grouped into three categories. One of these, planned delivery, is like ordering groceries—alcohol can be quite cheap, but it is usually delivered at least 48 h after ordering. While cheap alcohol is linked with harmful drinking [15], this form of delivery increases the convenience of purchasing alcohol at low cost, but does not facilitate impulsive drinking decisions. Conversely, delivery apps, such as ‘Uber Eats’ and ‘Door Dash’ or alcohol-specific services like ‘Tipple’, can deliver alcohol within 60 min of ordering (some services guarantee 30 min), usually at increased cost. These delivery apps could facilitate impulsive purchases. Impulsivity is a key driver of risky drinking and harm, predicting heavy episodic drinking and alcohol-related problems [16, 17]. In turn, alcohol consumption increases impulsivity [18], meaning that there is potential for a feedback loop. With delivery apps, the concerns about ready availability are somewhat offset by the higher price of alcohol, potentially discouraging larger purchases. However, recently, rapid delivery has been adopted by established packaged liquor outlets—these services can deliver cheap alcohol within 2 h of ordering (at least for now, these services could become more efficient over time). Unlike delivery apps, these services not only facilitate impulsive purchases, but do so at low cost. This represents a major shift in alcohol accessibility, as people can order cheap alcohol and have it delivered quickly to increase the amount of alcohol available during a drinking session. The recent introduction and expansion of rapid delivery services, and the absence of relevant data on their impacts, means that their impact on individual- and population-level alcohol consumption and harm is unknown. Please note that this information would be de-identified, with the data point most specific to an individual being postcode. Some of these data have been collected in New South Wales from mid-2021 [19], however a broader dataset needs to be collected across all Australian jurisdictions. Without such comprehensive data or the ability to access it, policymakers will not have the evidence needed to inform policy that is best placed to reduce harms from delivered alcohol. While there has been research done in the past on the varying risks of harm associated with drinking at on- or off-licensed premises [20], the recent proliferation of delivery services means that we are yet to build a similar evidence base on the impacts of home delivery. Data on the use of these services are vital for informing evidence-based policy in this rapidly expanding space. Sarah Callinan: Conceptualisation (equal), Writing - original draft presentation (lead), Writing - review and editing (equal). All other authors Conceptualisation (equal), Writing - review and editing (equal). This work was funded by an Australian Research Council Discovery Project 200100496. KC currently receives funding from Australian Research Council and Cancer Council Western Australia. The author have no conflict of interest. An ethics statement is not applicable to this paper.

BACKGROUND:Nutrition and health claims influence consumer purchasing. Claims include content claims, which refer to the amount of a nutrient contained in a product, and health claims, which refer to health benefits of foods or nutrients in a product. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC). The present study aimed to explore consumer perceptions of content claims used on food and beverage labelling and advertisements. METHODS:Semi-structured focus groups were conducted with Australian consumers. Analysis involved an inductive, reflexive approach to thematic analysis. RESULTS:Six focus groups involving 26 participants were conducted. Four main interconnected themes were generated: (1) complex factors influence food choice; (2) content claim scepticism; (3) the difference between content and health claims is unclear; and (4) the regulation of content claims is not common knowledge. Content claims were used, although generally viewed through a lens of scepticism and mistrust, and seen as a promotional tool for the food industry. Product complexity appeared to increase content claim use as a result of consumer uncertainty of the content of complex products, such as ultraprocessed foods. Most participants were aware that content and health claims were in some way regulated. Overall, they did not know further detail, including the relevant regulatory body. CONCLUSIONS:For content claims to support the consumer they need to be accurate and their use limited to healthier foods. This can be achieved by requiring products with content claims to meet NPSC thresholds, as required for products making health claims.

Objective: The use of food packaging as a vehicle for marketing to children is under investigated. Our objective was to determine the prevalence and types of child-directed promotional techniques used on food packaging in Australia. Design: Based on existing literature and regulations, we developed a framework to classify on-pack child-directed promotional techniques involving the use of characters and other elements that appeal to children. We analysed the packaging of all products in eight food categories available for sale from supermarkets in 2019 and recorded the use of child-directed promotions on pack. We assessed the number and proportion of products displaying child-directed promotional techniques overall and assessed the healthiness of products using child-directed promotions against four indicators of healthiness to provide summary data overall and for the manufacturers who most frequently employed child-targeted strategies. Setting: Data were collected from the FoodSwitch database in Sydney, Australia. Results: 901/8006 (11·3 %) products displayed one or more child-directed on-pack element. Most frequent was on foods for infants and young children ( n 315), confectionery ( n 283), snack foods ( n 172) and dairy ( n 168). Personified characters were the most commonly used element ( n 512). Products using child-directed promotional techniques scored poorly on all four indicators of healthiness: mean health star rating 2·34 (out of 5); 81 % ultra-processed and 6·1 % and 4·5 % products eligible to market to children under Western Pacific and Mexican nutrient profiling schemes, respectively. Conclusions: Australian children are targeted by promotional techniques on the packaging of unhealthy food products. Stronger regulation of these techniques is warranted to protect children’s health.

IssuesThere is a decline in youth drinking, but also a causal link between alcohol marketing and drinking among young people. Therefore, novel alcohol marketing strategies should be scrutinised, particularly where children are exposed. This includes marketing for zero-alcohol products (ZAP) (containing 0.00% to 1.15% alcohol by volume), which has expanded considerably in recent times. This review examines how the current industry-managed regulatory approach to alcohol marketing applies to ZAPs in Western Australia.ApproachThe marketing mix (four Ps of marketing: product, promotion, place, price) was used as a framework to examine federal and state government policies and industry managed codes. Policies were included if they applied to marketing of alcohol products, for example, product labelling, promotion and advertising across various media, the place of purchase and pricing measures (taxation).Key FindingsZAPs were inconsistently defined, meaning that products between 0.05% and 1.15% alcohol by volume were covered under some but not all alcohol policy measures, and application to products under 0.5% alcohol by volume was limited.ImplicationsGovernment policy should more clearly define alcohol marketing and whether ZAPs and other alcohol brand extensions should be treated in the same way as alcoholic products.ConclusionIn Western Australia, the ways in which alcohol policy measures apply to ZAPs are limited and close attention must be paid to how ZAPs may provide additional marketing opportunities for the alcohol industry.

Background Few studies have explored behavioural and financial impacts of retail initiatives after 2 years to address the unhealthy food environments common in local government sporting settings. Aims To evaluate the impact of a 2-year local government capacity building intervention in sporting facility food outlets on (1) the healthiness of refrigerated drink choices available and visible to customers, (2) healthiness of refrigerated drinks sold and (3) refrigerated drink revenue. Methods 52 sporting facilities within 8 local governments from Victoria, Australia, participated in an intervention between March 2018 and February 2020 by limiting ‘red’ (least healthy) drinks to ≤20% of refrigerator display and increasing ‘green’ (healthiest) drinks to ≥50% of display. Mixed models assessed changes in mean percentage of ‘red’, ‘amber’ and ‘green’ drinks displayed over time, compared with baseline. Facilities provided electronic weekly itemised sales data (December 2015 to February 2020). Weekly volume of ‘red’ or ‘green’ drinks sold as a proportion of total drinks sold, and total refrigerated drinks revenue were compared preimplementation and postimplementation using mixed models (seasonal facilities), and mixed-effect interrupted time series models (non-seasonal facilities). Results Display of ‘red’ drinks decreased by mean −17.1 percentage points (pp) (95% CI −23.9 to −10.3) and ‘green’ drinks increased 16.1 pp (95% CI 9.30, 22.9) between baseline and 18-month audits. At nine seasonal facilities, compared with the summer preimplementation, the mean volume of ‘red’ drinks sold decreased by −19.0 pp (95% CI −28.6, to –9.51) and refrigerated drink revenue decreased by−AU$81.8 (95% CI −AU$123 to –AU$40.8) per week. At 15 non-seasonal facilities, by February 2020, the volume of ‘red’ drinks sold decreased on average by −11.0 pp (95% CI −21.6 to –0.41) with no change in drink revenue. Conclusion Reducing the display of unhealthy drinks can be an effective public health policy to improve the healthiness of customer purchases, provided there is consideration of potential impacts on revenue.

OBJECTIVE:Local governments (LGs) often own or manage sport and recreation facilities and can promote health in these settings by implementing healthy food policies. The primary aim of this study was to assess the policies, attitudes and practices of Australian LGs relating to obesity prevention and the provision of healthy food in this setting.METHODS:In July 2020, all 539 Australian LGs were invited to complete a survey. We assessed LG priorities to obesity prevention, promoting healthy eating and public health as well as the presence of healthy food policies in sporting facilities.RESULTS:203 (38%) LGs completed the survey. Improving public health was a high priority, while obesity prevention and promoting healthy eating were a medium priority. 22% of LGs reported that the priority given to promoting healthy food had increased over the previous year and stayed the same at 65%. Ten per cent of LGs had a healthy food and drink policy in sporting facilities, with 32% reporting having made changes without a policy. LGs located in major cities, with larger populations and with more facilities reported having made more healthy changes at their facilities.CONCLUSION:Promoting health is a priority for LGs across Australia, but very few have policies relating to the food environments in their sporting facilities.IMPLICATIONS FOR PUBLIC HEALTH:Ongoing monitoring is important to assess changes over time and identify LGs where greater support is required.

AbstractObjective:To systematically audit the extent of unhealthy sponsorship within junior community sporting clubs and ascertain whether differences exist across geographical areas and sport types.Design:Club sponsorship data were assessed to determine the extent of unhealthy food/beverage, alcohol and gambling sponsorship using a cross-sectional design. Differences across geographical areas were assessed using logistic regressions.Setting:A stratified random sampling procedure was used to select thirty communities across the state of Victoria, Australia. Within each community, local clubs across the top eight participating junior sports were selected for audit.Participants:Sponsorship data were collected from 191 club websites and Facebook pages in September–November 2019.Results:Unhealthy sponsorships represented 8·9 % of all identified sponsorship arrangements. A quarter of all clubs accepted alcohol (25·6 %) and unhealthy food sponsors (25·9 %), and one-fifth of all clubs accepted high-risk food (unhealthy brands with large market share) (18·1 %) and gambling sponsors (20·4 %). Acceptance of unhealthy sponsorship differed across sport types with football, netball, cricket and soccer clubs having the greatest numbers. Compared with metro areas, a significantly greater proportion of sporting clubs in regional areas were affiliated with unhealthy food (32·7 % v. 19·6 %) and high-risk food sponsors (26·9 % v. 9·8 %). A higher proportion of clubs in low socio-economic status (SES), compared with the high SES areas, were affiliated with alcohol (33·9 % v. 16·5 %) and gambling sponsors (27·4 % v. 12·6 %).Conclusion:Victorian children participating in community junior sports are being exposed to marketing of unhealthy brands and products. Public health intervention is necessary to protect children from this exposure.

Unhealthy food marketing influences attitudes, preferences, and consumption of unhealthy foods, leading to excess weight gain. Outdoor advertising is highly visible (often displayed on publicly owned assets), but the evidence supporting regulation is unclear. This systematic scoping review of academic and grey literature aimed to (1) describe potential health and economic impacts of implementing government-led policies that restrict unhealthy food advertising in outdoor spaces or on public assets (including studies examining prevalence of advertising, associations with health outcomes and interventional studies); (2) identify and describe existing policies; and (3) identify factors perceived to have influenced policy implementation. Thirty-six academic studies were eligible for inclusion. Most reported on prevalence of unhealthy food advertising, demonstrating high prevalence around schools and in areas of lower socioeconomic position. None examined health and economic impacts of implemented policies. Four jurisdictions were identified with existing regulations; five had broader marketing or consumer protection policies that captured outdoor food marketing. Facilitators of policy implementation included collaboration, effective partnerships, and strong political leadership. Barriers included lobbying by food, media, and advertising industries. Implementation of food marketing policies in outdoor spaces and on public assets is feasible and warranted. Strong coalitions and leadership will be important to drive the policy agenda forward.

Purpose of Review This paper aimed to summarise existing literature on strategies to improve the healthiness of retail food environments in the East Asia and Pacific (EAP) region, and propose a prioritised research agenda on this topic. Recent Findings Little research on retail food environments has been conducted in the EAP region. Several approaches for measuring retail food environments were identified, although none have been tailored to the EAP context. A small number of policies and initiatives to promote healthy retail food environments have been implemented in EAP. Lessons learnt from successful implementation of initiatives in other regions could be applied in EAP. Summary Retail food environments have a strong influence on food choices and health outcomes. Research can contribute to efforts to improve the healthiness of retail food environments in EAP by (1) describing the current state of retail food environments to highlight areas of good practice and concern and (2) identifying policies and initiatives that are likely to be effective, and mechanisms for their successful implementation.

Abstract Objective: To quantify sales trends for key energy-dense, nutrient-poor (EDNP) foods and beverages over 5 years in Australia. Design: The Euromonitor Global Market Information Database and linear regression models were used to estimate average annual change in sales per capita of thirteen EDNP food categories and two EDNP beverage categories (defined using Australian Dietary Guidelines) over 5 years (2012–2017 for foods and 2011–2016 for beverages). The average annual change in sales was divided by the observed sales in 2012 (foods) or 2011 (beverages) to estimate the average percentage-change in sales per capita per annum. Setting: All major retail outlets in Australia. Participants: Euromonitor Global Market Information Database sales data. Results: Between 2012 and 2017, sales per capita per annum of frozen pizza (6 %), pastries (5 %), potato chips (crisps) (5 %), tortilla chips (3 %), chocolate confectionery (2 %), frozen processed potatoes (2 %), ice cream (2 %) and sugar confectionery (0·2 %) increased. There were no changes in sales of sweet biscuits, chocolate spreads and cakes, and sales of savoury biscuits and processed meat decreased (–2 and –1 %, respectively). Between 2011 and 2016, sales per capita per annum of sports and energy drinks increased (4 %), sales of regular (sugar-sweetened) cola (–6 %) and all non-cola soft drinks (–1 %) decreased and sales of diet cola did not change. Conclusions: Sales of EDNP foods and beverages generally increased or remained stable relative to population growth. Our results demonstrate the need for public health policies to reduce sales of EDNP foods and beverages.

Introduction There is emerging evidence that food industry involvement in nutrition research may bias research findings and/or research agendas. However, the extent of food industry involvement in nutrition research has not been systematically explored. This study aimed to identify the extent of food industry involvement in peer-reviewed articles from a sample of leading nutrition-related journals, and to examine the extent to which findings from research involving the food industry support industry interests. Methods All original research articles published in 2018 in the top 10 most-cited nutrition- and dietetics-related journals were analysed. We evaluated the proportion of articles that disclosed involvement from the food industry, including through author affiliations, funding sources, declarations of interest or other acknowledgments. Principal research findings from articles with food industry involvement, and a random sample of articles without food industry involvement, were categorised according to the extent to which they supported relevant food industry interests. Results 196/1,461 (13.4%) articles reported food industry involvement. The extent of food industry involvement varied by journal, with The Journal of Nutrition (28.3%) having the highest and Paediatric Obesity (3.8%) having the lowest proportion of industry involvement. Processed food manufacturers were involved in the most articles (77/196, 39.3%). Of articles with food industry involvement, 55.6% reported findings favourable to relevant food industry interests, compared to 9.7% of articles without food industry involvement. Conclusion Food industry involvement in peer-reviewed research in leading nutrition-related journals is commonplace. In line with previous literature, this study has shown that a greater proportion of peer-reviewed studies involving the food industry have results that favour relevant food industry interests than peer-reviewed studies without food industry involvement. Given the potential competing interests of the food industry, it is important to explore mechanisms that can safeguard the integrity and public relevance of nutrition research.

Objective: Sporting facilities owned or managed by local governments (LGs) can promote health by selling healthy food and drinks. This study assessed the policies, attitudes and practices of LGs in Victoria, Australia, relating to obesity prevention and the provision of healthy food in their sporting facilities. Methods: An online survey was e-mailed to all Victorian LGs (n=79) in July 2018. Questions assessed LGs' healthy food policies relating to sport and recreation facilities and the priority LGs give to obesity prevention. Results: Forty-nine LGs (62%) completed the survey from July to November 2018. Obesity prevention and promotion of healthy food and drink were a moderate to high priority for councils. The priority LGs give to healthy food promotion was reported to have increased over the previous year in 55% of LGs. Those LGs in areas of higher socioeconomic position and located in major cities had made more healthy changes at their facilities. Conclusion: Obesity prevention is a priority for LGs, and they are making changes to improve the food environments in their sporting facilities. Greater support may be required for smaller LGs and those in socioeconomically disadvantaged areas to create healthier food environments. Implications for public health: Monitoring changes to healthy eating policies within council facilities is essential to understand how local government actions are contributing to obesity prevention.

Price is a key determinant of food choice, particularly for low-income households who may be more sensitive to price-lowering strategies such as price promotions and generic/retailer-owned brands. Price-lowering strategies may therefore represent important policy targets to improve population nutrition and reduce inequities. This study aimed to describe household purchasing patterns of price promoted and generic branded foods and beverages in New Zealand (2016-2017). One year of grocery purchase data from a national consumer research panel in New Zealand (n = 1778 households) were analysed. Purchases were classified by processing level and food type. Linear mixed models were fitted to estimate the mean proportion of annual household purchases (unique items and volumes (kg/L)) that were price promoted or generic branded (overall and by food category), and to assess whether purchasing patterns were modified by income level. On average, price promoted products constituted 50% (95%CIs; 49,51) of all unique annual household grocery items purchased. Fifty-nine percent (95%CIs; 58,60) of processed, 55% (95%CIs; 54,56) of ultra-processed, 45% (95%CIs; 44,46) of unprocessed and 45% (95%CIs; 44,46) of ingredient purchases were price promoted. By volume, the proportion of purchases that were price promoted was highest for meat (65%[95%CIs; 64,66]), sugar-sweetened beverages (64%[95%CIs; 62,65]), dairy foods (64%[95%CIs; 63,66]), confectionary (64%[95%CIs; 63,66]), snack foods (63%[95%CIs; 61,64]), oils (61%[95%CIs; 60,62]) and non-sugar-sweetened beverages (60%[95%CIs; 58,62]), and lowest for dairy beverages (30%[95%CIs; 28,31]), sugar/honey (33%[95%CIs; 32,35]) and sauces/spreads (39%[95%CIs; 37,40]). On average, generic brands constituted 10% (95%CIs; 9,10) of all household purchases. Overall, a significantly greater proportion of purchases made by low and middle-income households were price promoted and generic branded compared to high-income households (p < 0.001 for both), a pattern generally observed across food categories. This study supports recent calls to address unhealthy food and beverage price promotions in comprehensive policy strategies aiming to improve population diets and weight.

Objectives. To examine the prevalence and magnitude of price promotions in a major Australian supermarket and how they differ between core (healthy) and discretionary (less healthy) food categories. Methods. Weekly online price data (regular retail price, discount price, and promotion type) on 1579 foods were collected for 1 year (April 2017 to April 2018) from the largest Australian supermarket chain. Products audited were classified according to Australian Dietary Guidelines definitions of core and discretionary foods and according to their Health Star Rating (a government-endorsed nutrient profiling scheme). Results. On average, 15.1% (95% confidence interval [CI] = 14.7%, 15.3%) of core foods and 28.8% (95% CI = 28.6%, 29.0%) of discretionary foods were price promoted during a given week. Average discounts were -15.4% (95% CI = -16.4, -14.4) for core products and -25.9% (95% CI = -26.8, -25.1) for discretionary products. The percentage of products on price promotion and the size of the discount were larger for products with a lower Health Star Rating (P < .05). Conclusions. Price promotions were more prevalent and greater in magnitude for discretionary foods than for core foods. Policies to reduce the prevalence and magnitude of price promotions on discretionary foods could improve the healthiness of food purchased from supermarkets.