title: Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach.
abstract: To identify barriers to fruit and vegetable intake for Indigenous Australian children and quantify factors related to these barriers, to help understand why children do not meet recommendations for fruit and vegetable intake.
  
  
  
  We examined factors related to carer-reported barriers using multilevel Poisson models (robust variance); a key informant focus group guided our interpretation of findings.
  
  
  
  Eleven diverse sites across Australia.
  
  
  
  Australian Indigenous children and their carers (N 1230) participating in the Longitudinal Study of Indigenous Children.
  
  
  
  Almost half (45 %; n 555/1230) of carers reported barriers to their children's fruit and vegetable intake. Dislike of fruit and vegetables was the most common barrier, reported by 32·9 % of carers; however, we identified few factors associated with dislike. Carers were more than ten times less likely to report barriers to accessing fruit and vegetables if they lived large cities v. very remote areas. Within urban and inner regional areas, child and carer well-being, financial security, suitable housing and community cohesion promoted access to fruit and vegetables.
  
  
  
  In this national Indigenous Australian sample, almost half of carers faced barriers to providing their children with a healthy diet. Both remote/outer regional carers and disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables for their children. Where vegetables were accessible, children's dislike was a substantial barrier. Nutrition promotion must address the broader family, community, environmental and cultural contexts that impact nutrition, and should draw on the strengths of Indigenous families and communities.
authors.affiliation: 1National Centre for Epidemiology and Population Health,Research School of Population Health,The Australian National University,62 Mills Road,Acton,ACT 2601,Australia.
authors.forename: Katherine Ann
authors.initials: KA
authors.lastname: Thurber
authors.affiliation: 1National Centre for Epidemiology and Population Health,Research School of Population Health,The Australian National University,62 Mills Road,Acton,ACT 2601,Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Banwell
authors.affiliation: 2Statistical Consulting Unit,The Australian National University,Acton,ACT,Australia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Neeman
authors.affiliation: 3National Drug & Alcohol Research Centre,University of New South Wales,Randwick,NSW,Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Dobbins
authors.affiliation: 4RegNet School of Regulation and Global Governance,The Australian National University,Acton,ACT,Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Pescud
authors.affiliation: 1National Centre for Epidemiology and Population Health,Research School of Population Health,The Australian National University,62 Mills Road,Acton,ACT 2601,Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Lovett
authors.affiliation: 1National Centre for Epidemiology and Population Health,Research School of Population Health,The Australian National University,62 Mills Road,Acton,ACT 2601,Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Banks
mesh_terms: D001315:Australia; D002648:Child; D000067576:Child Health; D002675:Child, Preschool; D002755:Choice Behavior; D004032:Diet / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D005518:Food Preferences; D005638:Fruit; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012931:Social Environment; D011795:Surveys and Questionnaires; D014675:Vegetables; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords:  food and nutrition; Child health; Diet; Health behaviour; Holistic health