Moira Smith

Children's exposure to alcohol marketing within supermarkets: An objective analysis using GPS technology and wearable cameras

Background and aim Exposure to alcohol marketing within alcohol retailers has been associated with higher rates of childhood drinking, brand recognition, and marketing recall. This study aimed to objectively measure childrens everyday exposure to alcohol marketing within supermarkets. Method Children aged 11–13 (n = 167) each wore a wearable camera and GPS device for four consecutive days. Micro‐spatial analyses were used to examine exposures within supermarkets. Results In alcohol retailing supermarkets (n = 30), children encountered alcohol marketing on 85% of their visits (n = 78). Alcohol marketing was frequently near everyday goods (bread and milk) or entrance/exit. Conclusion Alcohol sales in supermarkets should be banned in order to protect children from alcohol marketing. HighlightsMicro‐spatial analyses were conducted using paired wearable camera and GPS data.Children are exposed to alcohol marketing on 85% of their visits to supermarkets.Existing legislation does not protect children from exposure to alcohol marketing.Micro‐spatial analyses provide insight into health exposures in smaller spatial units.

Consuming calories and creating cavities: beverages NZ children associate with sport.

Sugar-sweetened beverages (SSBs) are widely available, discounted and promoted, and despite recommendations to the contrary, frequently consumed by children. They provide few nutritional benefits, and their consumption is implicated in a number of poor health outcomes. This study examined the nature of the beverages that sport-playing New Zealand (NZ) children associate with sport. It assessed how well the beverages aligned with nutrition guidelines and relevant regulations, and their likely impacts on health. Eighty-two children (38 girls and 44 boys) aged 10-12 years were purposively selected from netball, rugby and football clubs in low and high socioeconomic neighbourhoods, in Wellington, New Zealand (NZ). Children photographed beverages they associated with sport. The beverages were then purchased and analysed in accordance with NZ nutrition guidelines, and relevant content and labelling regulations, by: package and serving size; energy, sugar, sodium and caffeine content; pH; and advisory statements. The beverages the children associated with sport overwhelmingly had characteristics which do not support children in adhering to NZ nutrition guidelines. Implementing public health mechanisms, such as healthy food and beverage policies, widely promoting water as the beverage of choice in sport, and implementing healthy eating and drinking campaigns in sports clubs, would assist children who play organised sport to select beverages that are in keeping with childrens nutrition guidelines. As part of a comprehensive public health approach they would also reduce the substantial, unnecessary and potentially harmful contribution sugar-sweetened beverages make to their diet.

Using SenseCam to capture children's exposure to food marketing: a feasibility study

Childrens exposure to food marketing across multiple everyday settings has not yet been objectively documented. This study aimed to assess the feasibility of using automated camera devices to record childrens exposure to food marketing across a variety of settings. A sample of six children (aged 12) wore the ViconRevue 3MP device for a period of two days, following which they attended a focus group to ascertain their experiences of using the device. Automated camera devices may be effective tools for documenting the extent of food marketing in a number of childrens settings. However, for this technology to be considered feasible, operational issues with the SenseCam device and the analysis of image data must be resolved.

Sun Protection Among New Zealand Primary School Children

Schools are an important setting for raising skin cancer prevention awareness and encouraging sun protection. We assessed the clothes worn and shade used by 1,278 children in eight schools in the Wellington region of New Zealand. These children were photographed for the Kids’Cam project between September 2014 and March 2015 during school lunch breaks. Children’s mean clothing coverage (expressed as a percentage of body area covered) was calculated. Data on school sun-safety policies were obtained via telephone. Mean total body clothing coverage was 70.3% (95% confidence interval = 66.3%, 73.8%). Body regions with the lowest mean coverage were the head (15.4% coverage), neck (36.1% coverage), lower arms (46.1% coverage), hands (5.3% coverage), and calves (30.1% coverage). Children from schools with hats as part of the school uniform were significantly more likely to wear a hat (52.2%) than children from schools without a school hat (2.7%). Most children (78.4%) were not under the cover of shade. Our findings suggest that New Zealand children are not sufficiently protected from the sun at school. Schools should consider comprehensive approaches to improve sun protection, such as the provision of school hats, sun-protective uniforms, and the construction of effective shade.

Measuring Blue Space Visibility and ‘Blue Recreation’ in the Everyday Lives of Children in a Capital City

Blue spaces (water bodies) may promote positive mental and physical health through opportunities for relaxation, recreation, and social connections. However, we know little about the nature and extent of everyday exposure to blue spaces, particularly in settings outside the home or among children, nor whether exposure varies by individual or household characteristics. Wearable cameras offer a novel, reliable method for blue space exposure measurement. In this study, we used images from cameras worn over two days by 166 children in Wellington, New Zealand, and conducted content and blue space quantification analysis on each image (n = 749,389). Blue space was identified in 24,721 images (3.6%), with a total of 23 blue recreation events. Visual exposure and participation in blue recreation did not differ by ethnicity, weight status, household deprivation, or residential proximity to the coastline. Significant differences in both visual exposure to blue space and participation in blue recreation were observed, whereby children from the most deprived schools had significantly higher rates of blue space exposure than children from low deprivation schools. Schools may be important settings to promote equitable blue space exposures. Childhood exposures to blue space may not follow the expected income inequality trends observed among adults.

Understanding differences in access to water fountains and sugar-sweetened beverages in children׳s environments: A pilot study in high and low deprivation neighbourhoods

Access to water fountains and sugar-sweetened beverages (SSBs) in children׳s environments may impact on child obesity and may vary with neighbourhood deprivation. Our pilot analyses of access to water fountains and SSBs in Wellington, New Zealand revealed that water fountain access was high in school environments and low in recreational environments. There were also differences in water fountain and SSB access points by neighbourhood deprivation. The methods piloted in this study could be translated in a larger study, more capable of detecting significant differences in access and allowing for more sophisticated analyses. Such future studies may provide important evidence for the improvement of children׳s health and well-being.

Clothing Protection from UVR: A New Method for Assessment

Clothing modifies ultraviolet radiation (UVR) exposure from the sun and has an impact on skin cancer risk and the endogenous synthesis of vitamin D. There is no standardized method available for assessing body surface area (BSA) covered by clothing, which limits generalizability between study findings. We calculated the body cover provided by 38 clothing items using diagrams of BSA, adjusting the values to account for differences in BSA by age. Diagrams displaying each clothing item were developed and incorporated into a coverage assessment procedure (CAP). Five assessors used the CAP and Lund & Browder chart, an existing method for estimating BSA, to calculate the clothing coverage of an image sample of 100 schoolchildren. Values of clothing coverage, inter‐rater reliability and assessment time were compared between CAP and Lund & Browder methods. Both methods had excellent inter‐rater reliability (>0.90) and returned comparable results, although the CAP method was significantly faster in determining a persons clothing coverage. On balance, the CAP method appears to be a feasible method for calculating clothing coverage. Its use could improve comparability between sun‐safety studies and aid in quantifying the health effects of UVR exposure.

Quantifying the Nature and Extent of Children’s Real-time Exposure to Alcohol Marketing in Their Everyday Lives Using Wearable Cameras: Children’s Exposure via a Range of Media in a Range of Key Places

Aims Childrens exposure to alcohol marketing is typically measured using self-report data, television viewing data or street marketing audits, which are subject to bias and often do not provide quantifiable measures of daily exposure. This article describes an innovative methodology to capture the world in which children live using wearable cameras. Short summary Children wearing wearable cameras were exposed 4.5 times per day to alcohol marketing in multiple places and via a range of marketing media. The results reinforce calls for legislative restrictions and a global response to alcohol marketing in order to protect children and reduce alcohol-related harm. Methods Children aged 11-13 years (n = 167) wore cameras that automatically captured images approximately every 7 s for a 4-day period between June 2014 and July 2015. Content analysis of images (n = 700,000) was manually undertaken to assess childrens exposure to alcohol marketing. Results On average, children were exposed to alcohol marketing 4.5 (95% CI: 3.3, 6.0) times per day, excluding within off-licence retailers, on screens and product packaging. Children were exposed at home (47%), on-licence alcohol retailers (19%), off-licence shop fronts (16%) and sporting venues (12%), and via sports sponsorship (31%) and shop front signage (31%) and merchandise (25%). The highest exposure rates were found among Māori (5.4 times higher than New Zealand European) and Pacific (3.0 times higher than New Zealand European), and boys (2.0 times higher than girls). Conclusions These findings highlight the urgent need to implement strict legislative restrictions on all forms of alcohol marketing to fulfil the World Health Organization Global Alcohol Strategy.

Children's home and school neighbourhood exposure to alcohol marketing: Using wearable camera and GPS data to directly examine the link between retailer availability and visual exposure to marketing

Background and aim: Neighbourhood alcohol availability has been associated with alcohol consumption by children, despite children rarely acquiring alcohol from retailers. This study explores one potential reason for this finding, by evaluating the relationships between neighbourhood alcohol availability and childrens actual exposure to alcohol marketing. Method: Wearable cameras and GPS devices were worn by 167 children (aged 11–13 y) over a four‐day period. Image and GPS data were linked and compared to known alcohol availability data. Results: Off‐licence retailer availability and ethnicity were positively associated with childrens exposure to marketing in both residential and school neighbourhoods. Conclusion: Neighbourhood off‐licence alcohol retailers are associated with increased childhood exposure to alcohol marketing. HighlightsExamines the relationship between alcohol availability and exposure to alcohol marketing.Uses combined image and GPS data to provide objective estimates of childrens real‐time exposure.Off‐licence retailers were positively associated with childrens exposure to alcohol marketing.Māori children experienced high rates of neighbourhood exposure to alcohol marketing.

Housing as a Determinant of Tongan Children’s Health: Innovative Methodology Using Wearable Cameras

Housing is a significant determinant of health, particularly in developing countries such as Tonga. Currently, very little is known about the quality of the housing in Tonga, as is the case with many developing countries, nor about the interaction between children and the home environment. This study aimed to identify the nature and extent of health risk factors and behaviours in Tongan houses from a child’s perspective. An innovative methodology was used, Kids’Cam Tonga. Seventy-two Class 6 children (10 to 13-year-olds) were randomly selected from 12 randomly selected schools in Tongatapu, the main island. Each participating child wore a wearable camera on lanyards around their neck. The device automatically took wide-angled, 136° images of the child’s perspective every seven seconds. The children were instructed to wear the camera all day from Friday morning to Sunday evening, inclusive. The analysis showed that the majority of Tongan children in the study live in houses that have structural deficiencies and hazards, including water damage (42%), mould (36%), and electrical (89%) and burn risk factors (28%). The findings suggest that improvements to the housing stock may reduce the associated health burden and increase buildings’ resilience to natural hazards. A collaborative approach between communities, community leaders, government and non-governmental organisations (NGOs) is urgently needed. This research methodology may be of value to other developing countries.