Julie Brimblecombe

• Associate Professor Public Health Nutrition at Monash University (Australia)

Background Maternal and early childhood nutrition is foundational in setting the course for lifetime metabolic and disease outcomes. Food security influences the achievement of optimal diets; however, little is known about how traditional food intake may influence this dynamic for Aboriginal and Torres Strait Islander people living in remote commun...

Background Health-promoting strategies targeting the food retail environment can influence consumer purchasing behaviour. Most strategies require the healthiness of available food and beverages to be determined. Healthiness classification systems exist; however, no system is linked to remote food retail point-of-sale systems. The objective of this...

The World Health Organization recommends countries adopt policies that encourage the creation of healthier food retail. In Australia, some organisations have created enforceable regulation for healthier food retail in settings under their contractual control. While progressive for public health, little evidence exists on the characteristics of indi...

Food insecurity disproportionately impacts Indigenous peoples, leading to significant health disparities. Indigenous peoples globally share a deep and interconnected relationship to their lands, waterways and seas that ensures optimum health, and cultural, spiritual, social and emotional wellbeing. However, food security definitions and assessment...

Background Contracts can be an effective lever to implement and manage health-enabling food retail environments. However, guidance for the effective use of contracts in food retail settings is limited. The use of contracts to create healthy food vending environments is one area where policy attention has been focussed in high income countries. We a...

A form of food retail regulation called the Stores Licensing Scheme was introduced by the Australian Government in 2007–2022 to ensure food security in remote Indigenous communities of the Northern Territory. We examined evaluations of this Scheme implemented under the Northern Territory National Emergency Response and Stronger Futures Northern Ter...

Background Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated ‘audit and feedback’ with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community stor...

Aboriginal Peoples in the Northern Territory (NT) of Australia have customary connections to seafood for cultural practices, nourishment, livelihoods, and social connections which have been linked to health and wellbeing outcomes. Global and national entities have called for health and self-determination principles to be considered across all publi...

Indonesia is home to the greatest area of mangroves globally, which provide an essential source of livelihoods and food for millions of people. Despite this, there is a gap in the empirical evidence on the role mangroves play as a food system and the diversity of species they provide. This study aimed to examine mangroves as a gendered food system...

Reporting key dietary indicators from sales data can help us guide store decision makers in developing effective store policy to support healthier customer purchases. We aimed to develop a web-based reporting tool of key dietary indicators from sales data to support health-promoting policy and practice in stores in geographically remote Aboriginal...

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregive...

Objective Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review...

Background Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail. Methods We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into f...

Background Food retailers can be reluctant to initiate healthy food retail activities in the face of a complex set of interrelated drivers that impact the retail environment. The Systems Thinking Approach for Retail Transformation (START) is a determinants framework created using qualitative systems modelling to guide healthy food retail interventi...

This study explored the local food environment of Hong Kong and Singapore using a qualitative case study approach to inform future upstream public health nutrition policies. Food outlets that provide food to be eaten in the home were mapped in selected areas of high and low socioeconomic status (SES) of Hong Kong and Singapore. Food outlet density...

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand...

Introduction Co-creation of healthy food retail comprises the systematic collaboration between retailers, academics and other stakeholders to improve the healthiness of food retail environments. Research into the co-creation of healthy food retail is in its early stages. Knowledge of the roles and motivations of stakeholders in intervention design,...

Objective: This article aims to examine the framing of the issue of food security in very remote Aboriginal and Torres Strait Islander communities in print media and press releases during the beginning of the COVID-19 pandemic in 2020. Methods: Newspaper articles were identified following a systematic search of the Factiva database, and press re...

Objective: This article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet. Methods: Convergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisation...

Objective: To synthesize peer-reviewed literature that utilize co-creation principles in healthy food retail initiatives. Methods: Systematic review of six databases from inception to September 2021. Screening and quality assessment were carried out by two authors independently. Studies were included if they were conducted in food retail stores,...

This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to...

Background: Private regulation, such as contracts, can be an effective lever to implement and manage health-enabling food retail environments. However, guidance for the effective use of contracts in food retail settings is limited. The use of contracts to create healthy food vending environments is one area where policy attention has been focussed....

Background Adoption of health-enabling food retail interventions in food retail will require effective implementation strategies. To inform this, we applied an implementation framework to a novel real-world food retail intervention, the Healthy Stores 2020 strategy, to identify factors salient to intervention implementation from the perspective of...

Despite long histories of traditional food security, Indigenous peoples globally are disproportionately exposed to food insecurity. Addressing this imbalance must be a partnership led by Indigenous peoples in accordance with the UN Declaration of the Rights of Indigenous Peoples. We report the co-design process and resulting design of a food securi...

The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess (1) the Thumbs system’s alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying ‘...

Collaboration between community members, researchers, and policy makers drives efforts to solve complex health problems such as obesity, alcohol misuse, and type 2 diabetes. Community participation is essential to ensure the optimal design, implementation and evaluation of resulting initiatives. The terms ‘co-creation’, ‘co-design’ and ‘co-producti...

There are complex ethical issues about appropriate roles, responsibilities and methodologies for non-Indigenous people researching Indigenous Peoples and contexts. As a research methodology, critical discourse analysis (CDA) may expose colonial power and inequities through an examination of language and discourse. This study examined, via a scoping...

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet‐related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective o...

Among smallholders, gender relations shape how agricultural products are produced and how foods are acquired and consumed, which impacts food security and nutrition. In Timor-Leste, most rural households own multiple livestock species, yet intake of animal-source foods (ASF) is low and malnutrition high. This study explores how gender relations inf...

Objectives Culturally safe health care services contribute to improved health outcomes for Aboriginal and Torres Strait Islander Peoples in Australia. Yet there has been no comprehensive systematic review of the literature on what constitutes culturally safe health care practice. This gap in knowledge contributes to ongoing challenges providing cul...

Objective This scoping review sought to describe the policy actions that urban local governments globally have implemented to facilitate healthy and environmentally sustainable diet-related practices. Design Five databases were searched to identify publications which cited policies being implemented by local governments within the 199 signatory ci...

Issue addressed: The B.strong Program was an Indigenous health worker brief intervention (BI) training program delivered in Queensland from 2017-2020. This study examines the organisational factors of participating Indigenous primary health care (PHC) services that impacted on B.strong's uptake and implementation in those services. Methods: Semi...

Learning through work is a common feature of preparing health professionals for practice. Current understandings of work-integrated learning or a ‘work-based placement’, focus on students being consumers of experiences rather than providing a reciprocal benefit to the organisation in which they are placed. More nuanced understanding of the ways tha...

Background Evidence on child feeding practice is often based on the perspectives and experiences of parents and less that of health practitioners. In this study, we explored child feeding practice in Aboriginal communities in northern Australia from both the parents and health practitioners’ perspectives with the aim of informing nutrition improvem...

Women’s empowerment is essential to improve nutrition in low and middle-income countries. We investigated the empowerment of women in agriculture in association with household production and the dietary diversity of children 12–59 months old and their mothers in Timor-Leste. Using the Abbreviated Women’s Empowerment in Agriculture Index (A-WEAI) we...

Providing simple information that identifies healthier/less healthy products at the point‐of‐sale has been increasingly recognized as a potential strategy for improving population diet. This review evaluated the effect on healthiness of food purchasing/intake of interventions that identify specific products as healthier/less healthy at the point‐of...

Issue addressed Brief interventions (BIs) in primary health care (PHC) settings can be effective in addressing behavioural risk factors of chronic conditions. However, the impact of the characteristics of BI training programs on the uptake of the program and implementation of BIs in Indigenous PHC settings is not fully understood. The B.strong Prog...

This paper describes the applicability of the Consolidated Framework for Implementation Research (CFIR) to the qualitative evaluation of the implementation of the Queensland Aboriginal and Torres Strait Islander Brief Intervention Training Program, the B.strong Program. Interviews were conducted with 20 B.strong Program trainees and four health ser...

Prior to the 2020 outbreak of COVID-19, 70% of Australians’ food purchases were from supermarkets. Rural communities experience challenges accessing healthy food, which drives health inequalities. This study explores the impact of COVID-19 on food supply and purchasing behaviour in a rural supermarket. Group model building workshops explored food s...

Issue addressed Anaemia persists as a public health issue in many Aboriginal communities despite having standard practice guidelines. This case study reveals how Barunga Aboriginal Community in the Northern Territory, Australia, implemented an Anaemia Program (1998‐2016) which contributed to low anaemia prevalence in children aged under five years....

Background To determine the prevalence of enteric infections in Aboriginal children aged 0–2 years using conventional and molecular diagnostic techniques and to explore associations between the presence of pathogens and child growth. Methods Cross-sectional analysis of Aboriginal children ( n = 62) residing in a remote community in Northern Austra...

Objective High quality diets, characterized by nutrient-rich foods, are one of the foundations for health and well-being. Indicators of diet quality, antioxidants, are associated with protection against cardio-metabolic diseases. This study explores relationships between plasma antioxidants and cardio-metabolic risk among Aboriginal people in Austr...

The traditional diets of Indigenous Peoples globally have undergone major transition due to settler colonization. This systematic review aims to provide a perspective of traditional food intake of Indigenous populations in high-income countries with a history of settler colonization. For inclusion, studies reported the primary outcome of interest:...

A new form of conditional welfare through income management is being trialled in Australia, dubbed the “Cashless Debit Card”. It aims to reduce gambling, alcohol and illegal drug use to address social pathologies related to crime and welfare. Routinely collected data from government were used to assess if the targeted reductions arose. Store sales...

Background: The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contr...

Australia's largest university, Monash, is a complex food system, with >70 000 students, 17000 staff, 50 food outlets, a supermarket and >100 vending machines. Analysis of this food system in 2016 identified poor availability of healthy food and prompted the university to implement a local healthy eating framework, the Victorian Government's Health...

Background How food is promoted in food retail settings impacts population diet. Foods high in sugar, fat and/or salt are promoted by retailers to attract impulse purchases. To combat the high burden of chronic disease and associated conditions confronting society we examined the impact of restricted retail merchandising (promotion and visibility)...

This study aimed to pilot the feasibility, acceptability and effectiveness of three co-developed healthy food and beverage pricing interventions in a community retail setting. Aquatic and recreation centres in Victoria, Australia were recruited to co-develop and pilot pricing interventions within their onsite cafés, for 15 weeks from January 2019....

Objective To rigorously develop a tool which enables rapid yet comprehensive appraisal of the consumer food retail environment and provision of real-time feedback to store managers and owners, based on the ‘4Ps’ principles of marketing. Design Multi-stage iterative approach including (1) Systematic literature review; (2) Stakeholder consultation;...

Improving the dietary quality of women and children is essential to reduce all forms of malnutrition. In this study, we assessed seasonal child and maternal dietary diversity and consumption of animal‐source foods (ASF), using 1,236 observations from combined data collected among 167 mother–child dyads in rural Timor‐Leste. We used generalized line...

Objective: To explore for whom and under what circumstances nutrition-education cooking interventions affect nutrition outcomes in adults. Methods: A realist synthesis was undertaken. The CINAHL, Ovid Medline, Scopus, and Web of Science databases were searched for literature published between 1980 and 2019, using the terms "cook" and "interventi...

Background: Scarce literature comprehensively captures the transition to solid foods for children in remote Aboriginal Australian communities, a population expected to be especially vulnerable to nutritional inadequacy for largely socio-economic reasons. This study describes the dietary intake of children aged 6-36 months in a remote Aboriginal co...

The Aboriginal and Torres Strait Islander Health Curriculum Framework (2014) identifies the need for Australian higher education providers to develop health professional students’ cultural capabilities. This study investigated whether integrating the Framework’s learning outcomes into undergraduate nutrition curricula changed higher education stude...

Background: Due to the lack of resources in remote Aboriginal communities within the Northern Territory of Australia, Aboriginal people requiring chronic maintenance hemodialysis often must relocate from their home communities to Darwin city permanently to receive ongoing care. This phenomenon can cause distressing isolation from important traditi...

This paper reviews the literature on evaluations of brief intervention training programs for health professionals which address one or more lifestyle factors of chronic disease to identify factors impacting on development and implementation of programs. A search was conducted of the literature evaluating brief intervention training programs from 20...

Objective To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians. Methods We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30–74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRIS...

Introduction: This study sought to determine change in chronic condition risk factors in a remote Indigenous community following a 3-year period of community-led health promotion initiatives. Methods: Data were compared between two cross-sectional surveys of Indigenous Australian community residents before and after health promotion activities,...

BACKGROUND Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates evaluation of product (availability, range)...

Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability a...

Objective: To create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. Methods: This paper applied qualitative and quantitative methods to evaluate a co-designed multi-strategy health promotion initiative, implemented...

Large changes to food retail settings are required to improve population diet. However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strateg...

Retailers have the capacity to improve the food and beverage environment by making healthier options more affordable and attractive for their consumers. The perspectives of retailers on feasible and acceptable pricing strategies are not known. The aim of this study was to understand retailers' perceptions of factors that are relevant to feasible an...

Objective To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people. Study design Systematic review of peer-reviewed literature. Data sources MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Lib...

Although extensive literature on parent feeding practices among the general Australian population exists, Australian Indigenous populations are generally overlooked. A systematic scoping review was carried out to map any source of literature showing Indigenous parent feeding practices in Australia in the context of what is known about parent feedin...

Poor diet including inadequate fruit and vegetable consumption is a major contributor to the global burden of disease. Aboriginal and Torres Strait Islander Australians experience a disproportionate level of preventable chronic disease and successful strategies to support Aboriginal and Torres Strait Islander people living in remote areas to consum...

Aboriginal and Torres Strait Islander people living in remote communities in Australia experience a disproportionate burden of diet-related chronic disease. This occurs in an environment where the cost of store-purchased food is high and cash incomes are low, factors that affect both food insecurity and health outcomes. Aboriginal and Torres Strait...

Evidence on Aboriginal and Torres Strait Islander peoples’ food security experiences and coping strategies used when food insecurity occurs is limited. Such evidence is important to inform policies that can reduce the consequences of food insecurity. This study investigated factors perceived by Aboriginal and Torres Strait Islander families with yo...

Objective The public health nutrition workforce has been reported to be underprepared for practice. The present study aimed to test the ability of an unfolding case study approach to support the public health nutrition workforce for the workplace, with a focus on improved access to nutritious food. Design Two unfolding case studies were trialled w...

BACKGROUND Discretionary food and beverages (products high in high in saturated fat, added sugars and salt) are detrimental to a healthy diet. Nevertheless, they provide 42% of total energy and account for 53% of food and beverage expenditure for remote living Aboriginal and Torres Strait Islander Australians, contributing to the excessive burden o...

Background: Discretionary food and beverages (products high in saturated fat, added sugars, and salt) are detrimental to a healthy diet. Nevertheless, they provide 42% of total energy and account for 53% of food and beverage expenditure for remote living Aboriginal and Torres Strait Islander Australians, contributing to the excessive burden of chr...

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artific...

Indigenous input data used to model DALYs and costs averted. (PDF)

We conducted a longitudinal dietary intervention study to assess the impact of a store-based intervention on mediators and moderators and consequent dietary behaviour in Indigenous communities in remote Australia. We assessed dietary intake of fruit, vegetable, water and sweetened soft drink, mediators and moderators among 148, eighty-five and seve...

The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6–24 months, living in a Remote Aboriginal Community (RAC), derived...

Background: The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional i...

Objective: We compared self-reported dietary intake from the very remote sample of the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (VR-NATSINPAS; n=1,363) to one year of food and beverage purchases from 20 very remote Indigenous Australian communities (servicing ∼8,500 individuals). Methods: Differences...

Objective: To provide an overview of published research on the dietary intake of Aboriginal and Torres Strait Islander peoples. Methods: Peer-reviewed literature from 1990 to October 2016 was searched to identify studies that measured the dietary intake of Australian Aboriginal and Torres Strait Islander populations. Study quality was assessed u...

BACKGROUND The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional int...

Background: Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia. Method: A longitudinal...

Objective: To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia. Methods: Availability was assessed through repeated semi-structured interviews and consumption via a survey. Quantitative data were described and qualitative data classified. Re...