Despite women's awareness that drinking alcohol in pregnancy can lead to lifelong disabilities in a child, it appears that an awareness alone does not discourage some pregnant women from drinking. To explore influences on pregnant women's choices around alcohol use, we conducted interviews and group discussions with 14 Indigenous Australian and 14 non-Indigenous pregnant women attending antenatal care in a range of socioeconomic settings. Inductive content analysis identified five main influences on pregnant women's alcohol use: the level and detail of women's understanding of harm; women's information sources on alcohol use in pregnancy; how this information influenced their choices; how women conceptualised their pregnancy; and whether the social and cultural environment supported abstinence. Results provide insight into how Indigenous Australian and non-Indigenous pregnant women understand and conceptualise the harms from drinking alcohol when making drinking choices, including how their social and cultural environments impact their ability to abstain. Strategies for behaviour change need to: correct misinformation about supposed 'safe' timing, quantity and types of alcohol; develop a more accurate perception of Fetal Alcohol Spectrum Disorder; reframe messages about harm to messages about optimising the child's health and cognitive outcomes; and develop a holistic approach encompassing women's social and cultural context.

BackgroundAustralian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional’s perceptions of models of care and related quality improvement activities since the implementation of the Partnership.MethodsChanges to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A ‘systems assessment tool’ was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology.ResultsKey improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes.ConclusionsThe Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.

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 young children to influence household food security, and coping strategies used, in an urban setting. A qualitative research inductive approach was used. Data were collected through an iterative process of inquiry through initial interviews with 30 primary care-givers, followed by in-depth interviews with six participants to further explore emerging themes. Major topics explored were: influencing factors, food insecurity experiences, impact on food selection, and coping strategies. Food affordability relating to income and living expenses was a major barrier to a healthy diet with large household bills impacting food choice and meal quality. Access to family support was the main reported coping strategy. Food insecurity is experienced by Aboriginal and Torres Strait Islander families, it is largely intermittent occurring especially when large household bills are due for payment. Family support provides an essential safety net and the implications of this are important to consider in public policy to address food insecurity.

Although health initiatives promote increased physical activity in children, the physiologic outcomes have not been well characterized. This investigation examined the effects of programmed aerobic exercise on protein metabolism in children (n = 7; mean +/- SEM: 9.14 +/- 0.46 y old; weight, 32.1 +/- 1.6 kg; height, 138 +/- 2.5 cm; and body mass index, 16.21 +/- 0.36 kg/m(2) ) using (15)N-glycine methodology. Boys (n = 5) and girls (n = 2) walked (5 d/wk, 3.2-6.4 km/d) for 6 wk. Criterion measures taken at baseline (Pre) and after the exercise program (Post) included anthropometric data, dietary assessment, nitrogen balance, nitrogen flux (Q), protein synthesis (PS), protein breakdown (PB) and net protein balance [(Net) = PS - PB]. After the walking program, there were no significant changes in body weight, fat-free mass or percentage of body fat, whereas height increased (P < 0.01). Energy and protein intakes were constant throughout the study. Nitrogen balance was significantly more positive Post than Pre (P < 0.05). There was a significant decrease in Q (P < 0.0001) with corresponding decreases in PS (P < 0.001) and PB (P < 0.01). These data provide the first evidence that programmed aerobic exercise alters whole-body protein utilization in healthy, nonobese children. Longitudinal studies are required to further examine changes in protein metabolism associated with increased physical activity in this population. In addition, findings suggest a need to evaluate nutrient requirements for healthy, physically active boys and girls.

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