Context and aim

Supermarket promotions play a significant role in purchasing behaviours, dietary intake and community health. When discretionary food and drink products are heavily promoted over everyday essential core food and drink products, this encourages purchases for cheaper, highly processed items which will influence unhealthy eating and poor health outcomes.

Cancer Council WA conducted a six-month analysis between November 2023 - April 2024 to investigate the type and extent of price promotions in the online catalogues of three major Australian supermarkets.

Methods and analysis/research findings


Cancer Council WA’s analysis of nine online catalogues found a significant disproportion of price promotion allocated for discretionary food and drink (56%) compared to core food and drink (30%) products. Sugary drinks, desserts and ice cream, unhealthy ready meals and confectionery/chocolate were the most frequently promoted product across all supermarkets. Additionally, discretionary products made up a significant proportion of ‘half buy’ (67%) and ‘multibuy’ (73%) promotions.

Translational outcomes


A Cancer Council WA supermarket advocacy report will be released in mid-2024 with findings to be disseminated through a national webinar and media release.
Government mandatory regulations and standards are urgently required to address supermarket price promotion practices and mitigate the current excessive promotion of unhealthy food and drink items. It is critical that policies are enforced through government regulations rather than voluntary industry-led regulations for meaningful and impactful change to supermarket environments.

Future actions

This analysis will add to the existing body of evidence which shows that unhealthy food and drink items are promoted significantly more than core food and drink items in Australian supermarkets. Results of this analysis can be presented at the conference.

Context and aim:
Increased spatial exposure to unhealthy food outlets such as fast-food outlets are thought to promote unhealthy eating behaviours. Locating fast-food outlets near schools is a potential public health risk to schoolchildren, given the easy access and repeated exposure to energy-dense nutrient-poor foods they provide. The aim of this study was to investigate the impact of fast-food outlets being built near schools on local residents’ experiences and perceptions of their neighbourhood.
Methods and research findings:
In-depth semi structured interviews were conducted among homeowners (n=11) located in Alkimos, Western Australia living within 500m of a new fast-food outlet. Interviews were thematically analysed using NVivo. Initial findings indicated residents were not consistently informed of the decision to build a fast-food outlet close to their properties and most were concerned about the quantity located within the area and questioned the planning approved by the local council/government. Some residents also expressed concern for the health and safety of the schoolchildren accessing the fast-food outlet and many perceived negative environmental impacts since the opening of the outlet, most notably increased traffic and litter.
Translational outcomes:
The project’s findings support advocacy efforts for change in local government planning and policy. The findings will be disseminated to researchers, relevant stakeholders including the WA Planning Department, the Planning Institute of Australia and all research participants (by email). A press release will also be issued to coincide with the publication of the main findings from this study. The data from this study could raise awareness within the community and policy makers that most residents are not supportive of fast-food outlets being built within residential areas.
Future actions:
Support advocacy to government through a ground up approach to highlight the need to promote and foster healthy eating environments in planning laws and the importance of listening to and engaging with residents to contribute to targeted policy in urban planning.

Tobacco smoking is a leading cause of preventable death and disease worldwide and disproportionately affects people living in lower socioeconomic areas. A pilot programme trialling the provision of free nicotine replacement therapy (NRT) to priority populations through community pharmacies was funded by the Tasmanian Department of Health. This study evaluates the feasibility of this approach.

A sequential explanatory mixed methods approach was used to evaluate engagement with the programme and provide insight into the experiences, barriers and/or facilitators towards free NRT and specialist support through community pharmacies. Two groups were involved in the programme: community pharmacists and people who smoke cigarettes. Eight pharmacists administered the programme to completion. A total of 55 eligible smokers were recruited to the 24-week programme. At the conclusion of the programme a subset of participants, 7 pharmacists and 10 smokers, completed semi-structured interviews. Engagement and process data collected by pharmacists were interpreted using descriptive statistics and basic analysis. Qualitative data collected through interviews were analysed using reflexive thematic analysis.

Of the 55 recruited smokers, 15 (27.3%) were still engaged with the programme at 24 weeks. Pharmacists reported finding the experience rewarding but felt constrained by external factors, such as having to fit the service in around other tasks. Adequate remuneration for service provision was seen as an important incentive to pharmacist service delivery. The pharmacists reflected that their existing relationships with their customers supported the programme success. Smokers reported few barriers to the programme itself, but reported that life circumstances, access to healthcare, as well as social norms created barriers to quitting smoking more generally.

Overall, pharmacists were supportive of the initiative and smokers appreciated the service. Smokers recognised that removing the barrier of finance and making smoking cessation services accessible through pharmacies was beneficial. Based on the data collected, it is recommended that where possible future cessation programmes aimed at priority populations: offer access to free—or highly-subsidised—treatments; provide choice and a range of treatment options; adequately remunerate health professionals involved; provide greater flexibility in the service delivery; utilise existing software and technology to assist workflow; and actively promote services available to smokers.

There is growing recognition of the need for food pricing policies, including taxes on unhealthy foods and subsidies for healthy foods, to shift consumer demand and combat the global epidemic of chronic diseases. Understanding the relationship between changes in food price and changes in food demand—specifically, the price elasticities of demand—is crucial for developing effective strategies in Australia.

We analysed how changes in food price affected food demand using a large grocery purchasing dataset (NielsenIQ Homescan, 2015 – 2019) and the Almost Ideal Demand System model. Preliminary results indicate that ‘non-alcoholic beverages’, ‘confectionery and snacks’, and ‘biscuits, cakes, and desserts’ were moderately responsive to changes in price, as a 10% increase in price was associated with a reduction in demand of 11.6%, 9.2%, and 8.4%, respectively. Similarly, ‘fruits’ and ‘vegetables’ were moderately responsive to changes in price, as a price reduction of 10% was associated with an increase in demand of 11.5% and 7.8%, respectively. Additionally, changes in the price of one category tended to have a minimal influence on the demand for other categories, and there was little variation in price responsiveness across different socio-economic levels.

These elasticity estimates can guide policymakers considering food pricing policies to promote healthier diets in Australia. It is likely that pricing policies targeting unhealthy food categories, fruits, and vegetables could substantially shift food purchasing patterns in Australia, all without causing meaningful shifts in demand for non-targeted categories.

Future work may use these price elasticity estimates to model the health impacts, equity implications, and cost-effectiveness of specific food pricing policies in Australia, such as a junk food tax and subsidies for fruits and vegetables.

What is the problem/issue that requires public health action?

Industrially-produced trans-fatty acids (iTFAs) added to foods have significant and inequitable health impacts in Australia. After years of inaction, Australian and New Zealand governments have recently consulted stakeholders on options to address iTFAs, though a lack of data was noted as a limitation. We aimed to assess the known and potential presence of iTFAs in Australian supermarkets, and will provide an overview of joint advocacy efforts to support effective, government-led action on iTFAs.

What do we know or have we learned to address this problem/issue, and how has this finding been derived?

Using the Australian FoodSwitch database, we assessed ingredients lists and nutrition information panels to identify potential and voluntarily declared iTFA presence and content in packaged supermarket products. Our initial analysis of 2022 data found that one in seven (14.4%) products definitely or potentially contained iTFAs, and products that quantified TFA content on-pack often reported excessive levels. A more complete investigation was hindered by deficiencies in labelling regulations that mean this harmful content need not necessarily be disclosed. What is not known to, or hidden from, consumers and regulators is cause for concern.

How has this been used in practice?

To highlight these findings and other relevant domestic and international research, we developed shared, evidence-based messages to raise awareness amongst the broader public health and consumer community and encourage responses to a government consultation paper. A number of health and consumer groups lodged submissions using our shared material, in alignment with our identified preferred policy options, following an effective engagement campaign.

What actions should we take in the future to address the problem/issue?

Feasible, cost-effective options to eliminate iTFAs in the Australian food supply are available. Coordinated and determined responses from a wide range of trusted groups working in the public interest provide a strong platform for government action. Ongoing monitoring and advocacy will be required to ensure regulatory options that provide optimal health benefits are implemented by governments despite food industry resistance.

Eating meals prepared out of the home is directly associated with lower diet quality and has implications for diet-related chronic disease. Although we expect that apartment living will become more prevalent as the Australian population grows, there is currently limited evidence of the meal purchasing behaviours of apartment residents. This study investigated the frequency of meal purchases by residents of houses and apartments, examining whether frequency differs by apartment block height.

This study utilised wave 21 of the Household, Income and Labour Dynamics in Australia (HILDA) Survey to compare the meal purchasing practices of residents of houses and apartments. The frequency of purchasing a meal (breakfast, lunch, dinner, and any meal) was compared for residents of apartments vs houses, and for apartment residents living in blocks of different heights (low: less than four storeys, medium: four to nine storeys, and high rise (ten or more storeys). Unadjusted preliminary analyses showed that apartment residents purchased meals significantly more often than house residents (mean 2.66 times weekly, SD = 1.08 vs mean 2.13, SD = 2.32, p<0.001). Residents of apartments in high-rise blocks made significantly more meal purchases weekly than those in medium-rise and low-rise blocks (3.67 times, SD = 3.17; vs 2.98, SD = 2.61; vs 2.45, SD = 2.51, p< 0.001). Similar results were evident for each meal purchase occasion (breakfast, lunch, dinner).

The finding that apartment residents, particularly those in taller apartment blocks, purchase more meals out than house residents, has potential health implications for our population as higher density living becomes more prevalent.

These findings will inform targeted interventions to increase residents’ cooking frequency, and advocacy for policy change to ensure healthy food is readily available in areas of high residential density.

Context and aim
Breast cancer is a pressing public health issue in Australia with a significant health burden. Since commencing in 1991, the BreastScreen Australia program has supported a decline in breast cancer mortality rates by 45% among women aged 50-74 years. However, breast cancer remains the most commonly diagnosed cancer in women, and the second most common cause of cancer death in Australian women. It was estimated that almost 3,300 women will have died from breast cancer in 2023. Challengingly, 22% of breast cancers in Australia are associated with a range of modifiable risk factors, including overweight and obesity, tobacco, and alcohol use.

Methods and analysis
Given the variability of risk factors, and the potential limitations of utilising age-based criteria alone, research has begun into how a risk-based approach to screening may be implemented to help reduce the burden of breast cancer in Australia. In 2023, Cancer Council Australia and The Daffodil Centre completed its four-year Roadmap to Optimising Screening in Australia – Breast (ROSA) project, with funding from the Department of Health and Aged Care. Considering that age-based criteria alone does not capture the full scope of risk factors that women may experience, ROSA aimed to explore options for the implementation of risk-based breast cancer screening in Australia, and options to limit potential screening harms including overdiagnosis.

Translational outcomes
ROSA delivered eight key recommendations which aim to address existing evidence gaps and provide support for implementation. These recommendations fed into the review of the BreastScreen Australia program and provide a roadmap for progress toward risk-based breast cancer screening. Building on the work of ROSA, Cancer Council Australia recently updated the National Cancer Prevention Policy (NCPP) on breast cancer, to reflect the changing landscape of breast cancer screening, and highlight key findings from the project.

Future actions
Risk based breast cancer screening has the potential to reduce the breast cancer burden and ensure that screening is as effective as possible for different groups of women; while maintaining the integrity of population screening. Cancer Council will continue to advocate for a best-practice breast cancer screening program that is robust and evidence-based, and which balances the potential benefits and harms of screening.

Context  and aim
Alcohol is a carcinogen, with an estimated 5,800 cases of cancer in Australia due to alcohol use in 2020.1 Drinking even small amounts of alcohol increases the risk of developing seven types of cancer - mouth, throat, larynx, oesophagus, breast, liver and bowel.2,3

Methods and analysis
Cancer Council Australia recently updated our National Alcohol and Cancer prevention policy to present comprehensive, evidence-based recommendations and policy initiatives to support healthy communities and reduce the risk of alcohol-caused cancer among the Australian population. This was informed by literature reviews, engagement with key experts in alcohol control policy, and consensus building around priority actions to mobilise national action to reduce alcohol-caused cancer.

Translational outcomes  
Alcohol industry representatives are known to utilise tactics adopted by the tobacco industry including casting doubt on legitimate science, lobbying, political donations, reputation management, and funding disinformation campaigns.4 Australians are concerned about these industry activities and are supportive of measures to limit policy influence of alcohol companies.5

Responsibility for alcohol policies is shared across all levels of government with current frameworks and strategies outlining evidence-informed policies, programs and other interventions to prevent and minimise harms from alcohol, including as a cause of cancer.   We identified four overarching priority areas: 1) Restriction of alcohol advertising and promotion; 2) Alcohol pricing policy reform; 3) Building community understanding of the risks of alcohol use through evidence informed health warning labels and public education campaigns; and 4) Restricting the physical availability of alcohol through strengthened liquor laws.  

Future actions
Alcohol policy changes have had an impact on cancer mortality in Australia6. Cancer Council is well placed to leverage current national strategic frameworks and mobilise the latest evidence-based recommendations to achieve national policy action to reduce the harms associated with alcohol use and improve long-term health outcomes among individuals, families and communities.

References  

1 Rumgay, H et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. The Lancet Oncology, Volume 22, Issue 8, 1071 - 1080  

2 Anderson BO, et al. Health and cancer risks associated with low levels of alcohol consumption. The Lancet Public Health. 2023 Jan;8(1). doi:10.1016/s2468-2667(22)00317-6

3 Ellis, L., et.al. (2023). Estimating cancers attributable to physical inactivity in Australia. Journal of science and medicine in sport, S1440-2440(23)00514-5. Advance online publication. https://doi.org/10.1016/j.jsams.2023.12.002

4 Lacy-Nichols J, Christie S, Cullerton K. (2023). Lobbying by omission: what is known and unknown about harmful industry lobbyists in Australia. Health Promotion International, 38(5). 

5 Alcohol Change Australia. 2023. Public Opinion on Alcohol in Australia: Knowledge, Attitudes and Support for Change. Available from: https://alcoholchangeaus.org.au/wp-content/uploads/2023/11/AlcoholChangeAustralia_Report_FINAL.pdf 

6 Jiang, H., R. et al. Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia's experience. BMC Med 17, 213 (2019). https://doi.org/10.1186/s12916-019-1453-z 

What is the problem?
Globally, the uptake of pasturised donor human milk use in hospitals for both healthy and vulnerable infants is hindered by shortages of safe and affordable donor human milk. Therefore, it is vital to understand what motivates women to donate their breast milk, and the aspects of their experience that are likely to aid or hinder donation.
What have we learned?
We conducted a meta-synthesis of the qualitative literature about women’s experiences of donating breastmilk, and identify gaps in current knowledge. This qualitative synthesis followed the meta-aggregation method for qualitative evidence synthesis outlined by the Joanna Briggs Institute and investigated three distinct questions: 1.) What are the experiences of lactating women donating milk after bereavement? 2.) What are the experiences of lactating women donating to a milk bank after a live birth? And 3.) What are the experiences of lactating women informally donating milk after a live birth?
How can this be used in practice?
The findings of this review will be useful for milk banking services seeking to recruit and retain donors, to assist health professionals to support the needs of their breast milk donors, and to understand experiences of informal donation.

The ORIGINS Project (ORIGINS)1 is the largest longitudinal cohort study in Australia, recruiting 10,000 pregnant women and their partners in the northern suburbs of Western Australia, and following up their children to primary school age. ORIGINS aims to understand the origins of health and disease and to promote a ‘healthy start to life’. Data and biological samples are collected from families at multiple time-points from pregnancy until early childhood. Collaboration and engagement are fundamental elements of ORIGINS. This is reflected in the unique aspect of ‘nesting’ observational and interventional research projects within ORIGINS, which promotes collaboration between researchers and stakeholders.

• There are over 50 nested projects within ORIGINS, with an additional 7 projects under review. The research projects cover an array of domains across child and family health and development.
• Investigators are from a range of institutions, participating in domain specific Research Interest Groups, which fosters creativity and networking.
• All projects return analysed data back to the ORIGINS platform increasing the richness of the data.

ORIGINS has been able to work collaboratively with many researchers resulting in:
• 4014 participants recruited in multiple projects.
• Connections with > 60 local, national, and international collaborators.
• 14 PhD students, and 29 Masters, Honours, Doctor of Medicine, and Undergraduate students.
• >250 presentations at conferences, seminars and symposiums.
• >60 publications.

ORIGINS has contributed to research translation through:
• Identification of biomarkers to prevent respiratory disease development.
• Enabling AI systems for improving cognition and reducing the impact of neurodevelopmental disorders.
• Identification of autism markers for early intervention.

ORIGINS provides a platform for researchers to collaborate, and leverage on existing and new data to improve research output and guide policy planning. Data is currently being used to contribute to the development of guidelines around: screen usage, food allergens, outdoor play, dietary intake and weight trajectory.

Since 2002 the Health and Wellbeing Surveillance System (HWSS) has collected information on a range of health and wellbeing topics using survey methods. Each year a random selection of residents from Western Australia (WA) are asked a series of questions on chronic health conditions, risk factors, health service utilisation, and mental health. The collected information is weighted and used to produce prevalence estimates for health topics annually and over time. This allows WA Health to monitor trends in public health. Despite recent increases in sample size, modernisation of sample frames and the introduction of online data collection, the representativeness, stability and reliability of prevalence estimates have declined. We determined the design and post-stratification weighting method was insufficient in addressing non-response bias. An alternative weighting method needed to be identified and tested to maintain the ability of the HWSS to accurately monitor public health trends into the future.

In raked weighting, weights are created and iteratively adjusted so that the proportions of certain demographic characteristics in the respondent sample are equal to the proportions found in the population. Raked weighting also avoids the creation of very large weights which can introduce instability into prevalence estimates. We tested raked weighting as an alternative to design and post-stratification weighting for HWSS collected data over time. ABS Census population totals for the year prior to data collection were used and proportions were calculated in 5 yearly blocks for age, sex, geographic location, country of birth, marital status, educational attainment, and employment status. We compared demographic alignment, summary statistics of weights, and prevalence estimates for each year. We also examined the need for adjustment for differences between online and telephone respondents.

Raked weighting produced smaller weights with better demographic alignment, and improved representativeness, reliability, and stability of the prevalence estimates when compared with design and post stratification weighting. Mode adjustment was not required. We have re-weighted all HWSS data collected since 2002 using raked weighting. Other population health surveys undergoing modernisation of survey data collection methods should consider raked weighting to allow the preservation of trends and a reduction in differences by mode.

Context and aim: Iron deficiency is the largest factor contributing to anaemia in all paediatric age-groups and is associated with a number of conditions which include developmental and adverse neurocognitive outcomes, sleep disorders, periodic limb movement disorder, ENT disorders, increased anxiety levels, depression and problematic behaviours associated with inattentiveness and social interactions.

Methods and analysis/research findings: The ORIGINS Project is a longitudinal pregnancy and birth cohort. The active sample comprises n =3,448 women and 3,806 children who were recruited antenatally and at birth and are now being followed up at regular timepoints throughout childhood. Blood samples are taken during clinic appointments from children aged 1, 3 and 5-years. Unexpectedly, high rates of iron deficiency were observed among ORIGINS children at 1 and 3-year visits. Specifically, 38% of 1 year olds (229/609), 54% of 3 year olds (358/658) and 41% of 5 year olds (137/333) had very low ferritin levels (<20μg/L).

Translational outcomes: Upon detection of the high prevalence of low iron and in order to increase blood-draw compliance during clinic appointments, The ORIGINS Project started offering families feedback on ferritin and full blood counts, with paediatric advice for iron supplementation and GP follow-up, if iron deficiency was detected. Coeliac serology is also conducted on children meeting the low iron threshold (<20μg/L) with a referral to a gastroenterologist if needed. Provision of these results has been well received by families.

Future actions: Research is now being conducted within the ORIGINS cohort to investigate the associations of iron deficiency with health, developmental, behavioural and sleep issues, and quality of life in childhood. The study will also evaluate the acceptability and efficiency of iron supplementation in 1-5-year-old children diagnosed with iron deficiency, including barriers and enablers to parents using supplementation. This study will provide important information on whether routine iron screening and monitoring should be recommended for young children. Additionally, the parent-focused approach will ensure that any recommendations for supplementation will have a high success rate.