Deprivation matters: understanding associations between neighbourhood deprivation, unhealthy food outlets, unhealthy dietary behaviours and child body size using structural equation modelling

Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study

This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.

Caries Severity, Decayed First Permanent Molars and Associated Factors in 6-7 Years Old Schoolchildren Living in Palermo (Southern Italy)

To date, there are very few epidemiologic studies on caries disease in 6-7 year old children living in Sicily (Southern Italy). The first permanent molar (FPM) is the most commonly affected tooth in this target population, and a one-unit increase in the number of decayed FPMs is predictive of caries in other teeth and in adulthood. The primary aim of this research is to estimate the prevalence of caries in 6-7 year old schoolchildren living in Palermo and, as a secondary aim, to estimate the prevalence of affected FPMs. It was designed as a cluster cross-sectional survey on 995 children from 16 schools, selected based on their geographical location, in one of the eight city districts. Caries data were recorded using the International Caries Detection and Assessment System for each tooth surface. The relation between socio-economic status, behavioural determinants, and clinical information and the number of teeth with initial caries (IC), moderate caries (MC), or extensive caries (SC) was analysed through the ordinal logistic regression. Among the 995 schoolchildren, 662 (66.5%) had at least one lesion and 742 (74.6%) had FPMs. Of the latter, 238 (32.0%) were affected by IC, 86 (11.6%) were affected by MC, and only 3 (0.4%) were affected by SC. During multivariable analysis, there was evidence of an increased risk of MC and SC related to the deprivation of the district in which the children lived and went to school, as well as to the protective role of parental education and employment. The same significant determinants were found for IC and MC FPMs. The study showed the important role of socio-economic determinants, unhealthy behaviours, and social deprivation related to the increased risk of moderate and extensive caries in 6-7 year old schoolchildren. Investigating this target population is very important, as early development of caries in FPMs may have serious consequences in the prognostics of oral health in an adult.

Neighborhood obesogenic environment and cardiometabolic risk in Brazilian children: The mediation role of the mother's body mass index

OBJECTIVE

We aimed to evaluate the association of neighborhood obesogenic and leptogenic environments with cardiometabolic risk clustering among Brazilian schoolchildren, mediated by child's ultra-processed food consumption and the mother's body mass index (BMI).

METHODS

A total of 367 children aged 8-9 years, enrolled in urban schools of Viçosa, Minas Gerais, Brazil, were evaluated. Waist circumference, insulin resistance, blood pressure, high-density lipoprotein-cholesterol, and triglycerides concentrations were measured. The child's ultra-processed food consumption assessment was performed by applying three 24-hour dietary recall. The mother's weight and height values were used to calculate the BMI. The neighborhood income, walkability index, predominantly ultra-processed food stores, public spaces for leisure, and/or physical activities, traffic accidents, crime, and green spaces densities were assessed in four hundred road network buffers around households. From neighborhood and cardiometabolic risk variables, four latent variables were obtained from confirmatory factor analysis: neighborhood "obesogenic", and "leptogenic" environments; "high cardiometabolic risk," and "low atherogenic risk". A structural equation model was used to test the direct and indirect associations between neighborhood environment and cardiometabolic risk clusters.

RESULTS

The neighborhood obesogenic environment had a significant total association (Standardized Coefficient = 0.172, p = .011) and was indirectly associated with the child's "high cardiometabolic risk" cluster, mediated by the mother's body mass index (Standardized Coefficient = 0.066, p = .049).

CONCLUSIONS

Our results reinforce the role of the urban environment on maternal obesity and child's cardiometabolic risk and provide evidence for public health policies aimed to prevent such conditions.

Adolescents’ School Travel and Unhealthy Snacking: Associations with School Transport Modes, Neighbourhood Deprivation, and Body Weight

Active transport to and/or from school (ATS), alone or combined with motorised transport, provides an opportunity to increase adolescents’ physical activity levels to prevent obesity. However, travel through and exposure to an unhealthy food environment en route to school may have unintended consequences, specifically unhealthy snacking. This study examined the association between adolescents’ unhealthy snack food/soft drink purchases/consumption during the journey to and from school and their school transport modes, neighbourhood deprivation, and body weight. Adolescents (n = 660, age: 15.3 ± 1.3 years, 51.7% female) from 11 schools in the Otago region, New Zealand, completed an online survey and anthropometry. Data were analysed using χ2 test and logistic regression. Overall, 36.7% of adolescents purchased/consumed unhealthy snack foods and 25.9% purchased/consumed soft drinks at least once during their weekly school trips. ATS and mixed transport users reported more frequent unhealthy snack food/soft drinks purchases/consumption on the way to school than motorised transport users. Neighbourhood deprivation, but not body weight, was positively associated with unhealthy snack food/soft drink purchases/consumption during the school journey. Our findings highlight the importance of considering not only travel mode shift but also the obesogenic environment and unhealthy food/drinks purchases/consumption during adolescents’ school journeys, particularly in lower socio-economic areas, to prevent obesity.

Community Co-Design of Regional Actions for Children's Nutritional Health Combining Indigenous Knowledge and Systems Thinking

Children's nutrition is highly influenced by community-level deprivation and socioeconomic inequalities and the health outcomes associated, such as childhood obesity, continue to widen. Systems Thinking using community-based system dynamics (CBSD) approaches can build community capacity, develop new knowledge and increase commitments to health improvement at the community level. We applied the formal structure and resources of a Group Model Building (GMB) approach, embedded within an Indigenous worldview to engage a high deprivation, high Indigenous population regional community in New Zealand to improve children's nutrition. Three GMB workshops were held and the youth and adult participants created two systems map of the drivers and feedback loops of poor nutrition in the community. Māori Indigenous knowledge (mātauranga) and approaches (tikanga) were prioritized to ensure cultural safety of participants and to encourage identification of interventions that take into account social and cultural environmental factors. While the adult-constructed map focused more on the influence of societal factors such as cost of housing, financial literacy in communities, and social security, the youth-constructed map placed more emphasis on individual-environment factors such as the influence of marketing by the fast-food industry and mental wellbeing. Ten prioritized community-proposed interventions such as increasing cultural connections in schools, are presented with the feasibility and likely impact for change of each intervention rated by community leaders. The combination of community-based system dynamics methods of group model building and a mātauranga Māori worldview is a novel Indigenous systems approach that engages participants and highlights cultural and family issues in the systems maps, acknowledging the ongoing impact of historical colonization in our communities.

Retail food outlets and metabolic syndrome: a systematic review of longitudinal studies

CONTEXT

The community food environment covers the type, quantity, density, location, and access to retail food outlets, and its influence on eating behavior, obesity, and metabolic syndrome has been investigated.

OBJECTIVE

To evaluate the evidence on longitudinal associations between objectively measured retail food outlets and metabolic syndrome components in children, adolescents, and adults.

DATA EXTRACTION

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality and risk of bias were assessed with the Newcastle-Ottawa Scale.

DATA SOURCES

The Scopus, Embase, Web of Science, Scielo, PubMed, MEDLINE, and Lilacs databases were searched without any restriction on publication dates.

DATA ANALYSIS

Of the 18 longitudinal studies included, significant associations were reported in 9 between retail food outlets and metabolic syndrome components in adults (6 positive associations, 2 negative, and 1 both positive and negative), and in 3 studies of children and adolescents (2 negative associations and 1 both positive and negative). Six studies with adults found no association.

CONCLUSION

Limited evidence was found for longitudinal associations between retail food outlets and metabolic syndrome components. In future studies, researchers should consider the use of standardized retail food outlet measurements and accurate analysis to better understand the influence of the community food environment on metabolic syndrome.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no: CRD42020177137.

Adolescents' Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective

Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents' perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16-18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.

Associations between Neighborhood Deprivation Index, Parent Perceptions and Preschooler Lifestyle Behaviors

Parental perceptions and use of neighborhood facilities are important factors that are related to children’s dietary intake and physical activity. The aim of this study was to examine the association between neighborhood deprivation index, parents’ perceptions of their neighborhood environment, and healthy/unhealthy markers of child dietary intake, physical activity, and TV screen time. This cross-sectional study was conducted in Dublin, Ireland. The lifestyle behaviors among children and parental perceptions of their neighborhood environment were reported by the parents of 276 children aged 3–5 years by using parent-completed questionnaires. Deprivation index was assessed using the geographic information system (GIS). Data were analyzed using binary logistic regression, adjusting for socio-demographic confounders. In adjusted models, high deprivation index was associated with parental perception of the neighborhood as unsafe for walking and cycling due to crime (OR 1.59, 95% CI 1.04–2.43, p = 0.031) and children’s low engagement in structured physical activity (OR 0.35, 95% CI 0.17–0.72, p = 0.004). Parental perceptions of an unsafe neighborhood due to heavy traffic were negatively correlated with children’s active play (OR 0.73, 95% CI 0.55–0.95, p = 0.022). Children whose parents reported high satisfaction with the number of local sit-in and takeaway restaurants were 41% more likely to consume confectionary/sugar sweetened beverages (SSBs) weekly. In this age group, parents play an important role in children’s lifestyle behaviors; therefore, a better understanding of parents’ perceptions and their use of neighborhood facilities could contribute to creating a healthy environment for this age group.

Improving spatial data in health geographics: a practical approach for testing data to measure children's physical activity and food environments using Google Street View

Background

Geographic information systems (GIS) are often used to examine the association between both physical activity and nutrition environments, and children’s health. It is often assumed that geospatial datasets are accurate and complete. Furthermore, GIS datasets regularly lack metadata on the temporal specificity. Data is usually provided ‘as is’, and therefore may be unsuitable for retrospective or longitudinal studies of health outcomes. In this paper we outline a practical approach to both fill gaps in geospatial datasets, and to test their temporal validity. This approach is applied to both district council and open-source datasets in the Taranaki region of Aotearoa New Zealand.

Methods

We used the ‘streetview’ python script to download historic Google Street View (GSV) images taken between 2012 and 2016 across specific locations in the Taranaki region. Images were reviewed and relevant features were incorporated into GIS datasets.

Results

A total of 5166 coordinates with environmental features missing from council datasets were identified. The temporal validity of 402 (49%) environmental features was able to be confirmed from council dataset considered to be ‘complete’. A total of 664 (55%) food outlets were identified and temporally validated.

Conclusions

Our research indicates that geospatial datasets are not always complete or temporally valid. We have outlined an approach to test the sensitivity and specificity of GIS datasets using GSV images. A substantial number of features were identified, highlighting the limitations of many GIS datasets.

Investigating change in the food environment over 10 years in urban New Zealand: A longitudinal and nationwide geospatial study

BACKGROUND

While it is likely that changing food environments have contributed to the rise in obesity rates, very few studies have explored historical trends in the food environment with little, if any, consideration at a nationwide level. This longitudinal, nationwide, and geospatial study aims to examine change over time in proximity to food environments in all urban areas of New Zealand from 2005 to 2015.

METHOD

This study used high quality food outlet data by area-level deprivation within the three largest urban areas of Auckland, Christchurch and Wellington. We hypothesise that distance and travel time by car to supermarkets and fast-food outlets will have decreased over time with the most notable decreases in distance and time occuring in the most deprived areas of urban New Zealand. Change in major chain "fast-food" and "supermarket" outlets as identified by Territorial Authorities between 2005 and 2015 was analysed through the use of multilevel regression models.

RESULTS

Findings show a decrease in distance and time to both fast-food outlets and supermarkets. The biggest decrease in distance for supermarkets was seen in the most deprived areas.

CONCLUSION

Our findings contrast and add to previous evidence to demonstrate how changes in the food environment are not uniform, varying by area-level deprivation and by city with more equitable access to supermarkets occurring over time.

Growing fast food consumption and obesity in Asia: Challenges and implications

It is widely believed that better access to fast food (FF) outlets increases FF consumption and thus the risk of obesity; yet, thus far, there are limited results to support this conclusion in Asian countries. A recent study by Hall and his colleagues (in press) examined the cross-sectional relationship between FF restaurant density and the likelihood of being overweight or obese among 1388 female Filipino migrant workers living in Macao, China. It found that FF restaurant density within a 0.5-mile buffer zone around one's home was significantly associated with a 7% increase (95% CI: 1%-14%) in the odds of being overweight or obese in this population. Based on these findings, the authors suggested improving access to healthy foods as one of the means to fight the obesity epidemic. The current article examines literature 1) on the relationship between obesity, FF consumption, and access to FF outlets; 2) on different measures of access to FF outlets; 3) on potential confounders and effect modifiers such as neighborhood deprivation and transportation; and 4) on challenges and implications for researchers and policymakers. Considering the growing consumption of FF and obesity rates in many countries especially in developing countries, it is important to regulate the FF industry and help consumers improve their related knowledge and behaviors. We also recommend that government policies abate obesogenic environments and thus curb the obesity epidemic in the future.

Objective measurement of children's physical activity geographies: A systematic search and scoping review

This study aimed to systematically identify, map out, and describe geographical information systems (GIS)-based approaches that have been employed to measure children's neighborhood geographies for physical activity behaviors. Forty studies were included, most were conducted in the USA. Heterogeneity in GIS methods and measures was found. The majority of studies estimated children's environments using Euclidean or network buffers ranging from 100 m to 5 km. No singular approach to measuring children's physical activity geographies was identified as optimal. Geographic diversity in studies as well as increased use of measures of actual neighborhood exposure are needed. Improved consistency and transparency in reporting research methods is urgently required.

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Varied GIS measures of children's physical activity geographies were identified.

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Evidence was heterogeneous and predominantly from the USA.

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Most research used Euclidean or network buffers ranging from 100 m to 5 km.

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Larger buffer sizes (i.e., ≥800 m) performed better than smaller buffer sizes.

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No optimal approach to measuring children's activity geographies was determined.