Objective: To evaluate the impact of a fruit and vegetable subsidy program on short-term health outcomes of disadvantaged Aboriginal children.
Design, setting and participants: A before-and-after study involving clinical assessments, health record audits and blood testing of all children aged 0–17 years (n = 167) from 55 participating families at baseline and after 12 months at three Aboriginal community-controlled health services in New South Wales. All assessments were completed between December 2008 and September 2010.
Intervention: A weekly box of subsidised fruit and vegetables linked to preventive health services and nutrition promotion at an Aboriginal Medical Service.
Main outcome measures: Change in episodes of illness, health service and emergency department attendances, antibiotic prescriptions and anthropometry.
Results: There was a significant decrease in oral antibiotics prescribed (− 0.5 prescriptions/year; 95% CI, − 0.8 to − 0.2) during 12 months of participation in the program compared with the 12 months before the program. The proportion of children classified as overweight or obese at baseline was 28.3% (38/134) and the proportion in each weight category did not change (P = 0.721) after 12 months. A small but significant increase in mean haemoglobin level (3.1 g/L; 95% CI, 1.4–4.8 g/L) was shown, although the proportion with iron deficiency (baseline, 41%; follow-up, 37%; P = 0.440) and anaemia (baseline, 8%; follow-up, 5%; P = 0.453) did not change significantly.
Conclusion: This fruit and vegetable subsidy program was associated with improvements in some indicators of short-term health status among disadvantaged Aboriginal children. A controlled trial is warranted to investigate the sustainability and feasibility of healthy food subsidy programs in Australia.
- 1. Marmot M, Friel S, Bell R, et al; Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008; 372: 1661-1669.
- 2. World Health Organization. Fruit and vegetables for health. Report of a joint FAO/WHO workshop, 1-3 September 2004, Kobe, Japan. Geneva: World Health Organization and Food and Agriculture Organization, 2005. http://www.who.int/entity/dietphysicalactivity/publications/fruit_vegetables_report.pdf (accessed Jun 2013).
- 3. Drewnowski A, Darmon N. Food choices and diet costs: an economic analysis. J Nutr 2005; 135: 900-904.
- 4. Black AP, Vally H, Morris P, et al. Nutritional impacts of a fruit and vegetable subsidy programme for disadvantaged Australian Aborigi-nal children. Br J Nutr 2013; Jun 7: 1-9. [Epub ahead of print.]
- 5. Calder PC, Jackson AA. Undernutrition, infection and immune function. Nutr Res Rev 2000; 13: 3-29.
- 6. Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007; 335: 194.
- 7. Gwynn JD, Flood VM, D’Este CA, et al. Poor food and nutrient intake among Indigenous and non-Indigenous rural Australian children. BMC Pediatr 2012; 12: 12.
- 8. Rowley KG, Su Q, Cincotta M, et al. Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community. Am J Clin Nutr 2001; 74: 442-448.
- 9. Lee AJ, Bailey AP, Yarmirr D, et al. Survival tucker: improved diet and health indicators in an aboriginal community. Aust J Public Health 1994; 18: 277-285.
- 10. Kanyini Vascular Collaboration [website]. Sydney: The George Institute for Global Health; 2012. http://www.kvc.org.au (accessed Jul 2012).
- 11. Lehmann D, Arumugaswamy A, Elsbury D, et al. The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations. Paediatr Perinat Epidemiol 2008; 22: 60-71.
- 12. Ni Mhurchu C, Blakely T, Jiang Y, et al. Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. Am J Clin Nutr 2010; 91: 736-747.
- 13. Ball K, McNaughton SA, Mhurchu CN, et al. Supermarket Healthy Eating for Life (SHELf): protocol of a randomised controlled trial promoting healthy food and beverage consumption through price reduction and skill-building strategies. BMC Public Health 2011; 11: 715.
- 14. Vos T, Carter R, Barendregt J, et al; ACE-Prevention Team. Assessing cost-effectiveness in prevention (ACE–Prevention): final report. Brisbane and Melbourne: University of Queensland and Deakin University, 2010. http://www.lowitja.org.au/assessing-cost-effectiveness-prevention-ace%E2%80% 93prevention-final-report (accessed Jun 2013).
- 15. Rush D, Leighton J, Sloan NL, et al. The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. VI. Study of infants and children. Am J Clin Nutr 1988; 48 (2 Suppl): 484-511.
- 16. Rush D, Sloan NL, Leighton J, et al. The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. V. Longitudinal study of pregnant women. Am J Clin Nutr 1988; 48 (2 Suppl): 439-483.
- 17. Rush D, Alvir JM, Kenny DA, et al. The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. III. Historical study of pregnancy outcomes. Am J Clin Nutr 1988; 48 (2 Suppl): 412-428.
- 18. Metcoff J, Costiloe P, Crosby WM, et al. Effect of food supplementation (WIC) during pregnancy on birth weight. Am J Clin Nutr 1985; 41: 933-947.
- 19. Hoynes HW, Page ME, Stevens AH. Is a WIC start a better start? Evaluating WIC’s impact on infant health using program introduction. NBER Working Paper No.15589. Cambridge, MA: National Bureau of Economic Research, 2009. http://www.nber.org/papers/w15589 (accessed Jun 2013).
- 20. D’Souza L, Renfrew M, McCormick F, et al. Food-support programmes for low-income and socially disadvantaged childbearing women in developed countries. Systematic review of the evidence. London: National Institute for Health and Clinical Excellence, 2006. http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/p105.jsp (accessed Jun 2013).
- 21. Joyce T, Racine A, Yunzal-Butler C. Reassessing the WIC effect: evidence from the Pregnancy Nutrition Surveillance System. J Policy Anal Manage 2008; 27: 277-303.
- 22. Foley W, Ward P, Carter P, et al. An ecological analysis of factors associated with food insecurity in South Australia, 2002-7. Public Health Nutr 2010; 13: 215-221.
- 23. Barnett AG, van der Pols JC, Dobson AJ. Regression to the mean: what it is and how to deal with it. Int J Epidemiol 2005; 34: 215-220.
- 24. Healthy Kids Eat Well, Get Active. Live Life Well @ School. Sydney: NSW Department of Health, NSW Department of Education and Communities and the Heart Foundation, 2012. http://www.healthykids.nsw.gov.au/campaigns-programs/live-life-well-@-school.aspx (accessed Jul 2012).
- 25. Healthy Kids Eat Well, Get Active. About Munch & Move. Sydney: NSW Department of Health, NSW Department of Education and Communities and the Heart Foundation, 2012. http://www. healthykids.nsw.gov.au/campaigns-programs/about-munch-move.aspx (accessed Jul 2012).
- 26. Ford ES, Zhao G, Tsai J, Li C. Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study. Am J Public Health 2011; 101: 1922-1929.
- 27. Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 2008; 5: e12.
- 28. United States Department of Agriculture Food and Nutrition Service. How the WIC helps. 2004. http://www.fns.usda.gov/wic/aboutwic/howwichelps.htm (accessed Jun 2013).
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.