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Objective: Māori, the Indigenous population of Aotearoa New Zealand, face a substantial burden of nutrition-related diseases, especially obesity and type 2 diabetes. Weight loss, through dietary change, is a central component of obesity and diabetes prevention and management; however, most approaches have not been designed with or evaluated specifically for Māori. The aim of this study was to review literature on the enablers and barriers to dietary change, for Māori., Design: Relevant literature published from January 2000 to May 2024 was identified by searches in Medline (Ovid), Embase (Ovid), Scopus, Indigenous health (informit), CINAHL (EBSCO), Web of Science and NZResearch. Studies included Māori and reflected enablers and barriers to dietary change for individuals/whānau (families). Data identifying the aims, methods, interventions, location, population studied and identified enablers and barriers to dietary change and responsiveness to Māori were extracted. Enablers and barriers to dietary change were mapped to a New Zealand Indigenous health framework, the Meihana model., Setting: Settings included studies based in Aotearoa New Zealand, where participants were free living and able to determine their dietary intake., Participants: Studies included at least 30 % Māori participants., Results: Twenty-two of the seventy-seven identified records met the inclusion criteria. Records included a diverse range of research approaches., Conclusions: Using a relevant Indigenous model, this study highlights that multiple and diverse enablers and barriers to dietary change exist for Māori and the critical importance of developing interventions, in close partnership with Indigenous communities, grounded in Indigenous understandings of health.

Aim: Acute alcohol use (AAU) can increase suicide risk. It is unknown if this effect differs by population sub-group in New Zealand, and what characteristics are associated with alcohol being coded as contributory to death, when AAU is identified. This study aimed to answer: 1) are the characteristics associated with suicide involving AAU different between females and males, and 2) among suicides that involved AAU, what factors are associated with alcohol being coded as a contributory factor?, Method: Secondary analysis was conducted of suicide data from 2007-2020, from the National Coronial Information System. Binomial regression models for females and males were used to estimate sex-specific differences in risk of suicide involving AAU. Poisson regression modelling was used to estimate the relative risk of alcohol being coded as contributory where AAU was identified., Results: Suicide was more likely to involve AAU among Māori females (adjusted risk ratio [ARR] 1.35, 95% confidence interval [CI] 1.08-1.68) and Pacific females (ARR 1.75, 95% CI 1.22-2.51), compared to European females. Compared to males who were employed, all other employment statuses had significantly lower risk of suicide that involved AAU. Those who died by hanging (ARR 0.75, 95% CI 0.62-0.92) or firearms (ARR 0.55, 95% CI 0.38-0.90) were less likely to have alcohol coded as contributory, compared to those who died by poisoning., Conclusion: Targeted public health interventions designed by and for specific demographic groups (particularly Māori and Pacific females) are needed, alongside universal interventions that address social and structural determinants. Data systems and coding must accurately reflect the association between AAU and suicide in New Zealand., Competing Interests: Nil., (© PMA.)

Introduction: On-demand delivery (<2 h from ordering) of alcohol is relatively new to New Zealand. We aimed to quantify the number of services available and the number of outlets available to purchase from within on-demand services. We then tested whether access differed by neighbourhood demographics., Methods: We identified six on-demand alcohol services and quantified access to these in Auckland, Wellington and Christchurch. Eighty-one addresses were sampled according to three variables: (i) density of physical alcohol outlet tertile; (ii) socio-economic deprivation tertile; and (iii) areas within the top 20th percentile of Māori within each city., Results: The median number of alcohol outlets to purchase from across all on-demand delivery services was five, though this was higher in Christchurch. For all three cities combined, and for Wellington, the number of outlets available on-demand was highest in areas with the highest density of physical outlets. However, the number of outlets available virtually was not associated with physical outlet density in Auckland or Christchurch. There were no significant differences in access observed for neighbourhood socio-economic deprivation., Discussion and Conclusions: On-demand delivery services are changing local alcohol environments, and may be increasing overall access to alcohol at a neighbourhood level. On-demand access patterns do not consistently reflect the physical alcohol environment. The current legislative and policy environment in New Zealand pre-dates the emergence of on-demand alcohol services. Local councils need to consider 'virtual' access as well as physical access when developing Local Alcohol Policies., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: While effective policies exist to reduce alcohol-related harm, political will to enact them is low in many jurisdictions. We aimed to identify key barriers and strategies for strengthening political priority for alcohol policy reform., Methods: A framework synthesis was conducted, incorporating relevant theory, key informant interviews (n = 37) and a scoping review. Thematic analysis informed the development of a framework for understanding and influencing political priority for alcohol policy., Results: Twelve barriers and 14 strategies were identified at multiple levels (global, national and local). Major barriers included neoliberal or free trade ideology, the globalised alcohol industry, limited advocate capacity and the normalisation of alcohol harms. Strategies fell into two categories: sector-specific and system change initiatives. Sector-specific strategies primarily focus on influencing policymakers and mobilising civil society. Examples include developing a clear, unified solution, coalition building and effective framing. System change initiatives target structural change to reduce the power imbalance between industry and civil society, such as restricting industry involvement in policymaking and securing sustainable funding for advocacy. A key example is establishing an international treaty, similar to the Framework Convention on Tobacco Control, to support domestic policymaking., Discussion and Conclusions: Our findings provide a framework for understanding and advancing political priority for alcohol policy. The framework highlights that progress can be achieved at various levels and through diverse groups of actors. The importance of upstream drivers of policymaking was a key finding, presenting challenges for time-poor advocates, but offering potential facilitation through effective global leadership., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction Delayed diagnosis of gut disease is a continuing problem, variously attributed to a range of patient, doctor, and health system factors. Gut disease often begins with indeterminate gut behaviours that are hard to classify. Aim This study aimed to investigate delayed diagnosis from the point of view of the patient, or prospective patient. How gut and gut disease was understood, what might prompt them to seek care, and their experiences of seeking care. Methods Using a qualitative design, we interviewed 44 people in New Zealand. Thirty-three had a diagnosis of gut disease, and 11 did not, though some of the patients in this latter group had symptoms. Results Some participants had a smooth trajectory from first noticing gut symptoms to diagnosis. However, a subgroup of 22 participants experienced long periods of troublesome gut behaviours without a diagnosis. For this subgroup of 22 participants, we found people struggled to work out what was normal, thus influencing when they sought health care. Once they sought health care, experiences of that care could be frustrating, and achieving a diagnosis protracted. Some who remained undiagnosed felt abandoned, though had developed strategies to self-manage. Discussion Indeterminate gut behaviours remain complex to deal with and it can difficult for both patients and doctors to assess when a symptom or group of symptoms need further investigation, watchful waiting or the use of other supportive strategies. Effectively communicating with healthcare staff can be a significant problem and there is currently a gap in support for patients in this regard.

Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes-the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts' proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities., (© The Author(s) 2023. Published by Oxford University Press.)

Indigenous mothers and birthing parents experience significant inequities during the perinatal period, with mental health distress causing adverse outcomes for mothers/birthing parents and their infants. Limited literature is available to inform our understanding of solutions to these issues, with research primarily focusing on inequities. Our aim was to conduct a systematic review of Indigenous approaches to treatment of perinatal mental health illness. Following the PRISMA guidelines for systematic literature reviews, an electronic search of CINAHL, Medline, PubMed, Embase, APA PsycInfo, OVID Nursing, Scopus, Web of Science, and Google Scholar databases was conducted in January and February 2022 and repeated in June 2022. Twenty-seven studies were included in the final review. A critical interpretive synthesis informed our approach to the systematic review. The work of (Yamane and Helm J Prev 43:167-190, 2022) was drawn upon to differentiate studies and place within a cultural continuum framework. Across the 27 studies, the majority of participants were healthcare workers and other staff. Mothers, birthing parents, and their families were represented in small numbers. Outcomes of interest included a reduction in symptoms, a reduction in high-risk behaviours, and parental engagement/attachment of mothers/birthing parents with their babies. Interventions infrequently reported significant reductions in mental health symptoms, and many included studies focused on qualitative assessments of intervention acceptability or utility. Many studies focused on describing approaches to perinatal mental health distress or considered the perspectives and priorities of families and healthcare workers. More research and evaluation of Indigenous interventions for perinatal mental health illness is required. Future research should be designed to privilege the voices, perspectives, and experiences of Indigenous mothers, birthing parents, and their families. Researchers should ensure that any future studies should arise from the priorities of the Indigenous population being studied and be Indigenous-led and designed., (© 2023. The Author(s).)

The increase in availability of online on-demand food and alcohol delivery services has changed the way unhealthy commodities are accessed and understood. We conducted a systematic scoping review of academic and grey literature to map the current knowledge of public health and regulatory/policy outcomes arising from on-demand food and alcohol delivery (defined as delivery within 2 h). We systematically searched three electronic databases and completed supplementary forward citation searches and Google Scholar searches. In total, we screened 761 records (de-duplicated) and synthesised findings from 40 studies by commodity types (on-demand food or alcohol) and outcome focus (outlet, consumer, environmental, labour). Outlet-focused outcomes were most common (n = 16 studies), followed by consumer (n = 11), environmental (n = 7), and labour-focused (n = 6) outcomes. Despite geographical and methodological diversity of studies, results indicate that on-demand delivery services market unhealthy and discretionary foods, with disadvantaged communities having reduced access to healthy commodities. Services that deliver alcohol on-demand can also subvert current alcohol access restrictions, particularly through poor age verification processes. Underpinning these public health impacts is the multi-layered nature of on-demand services and context of the COVID-19 pandemic, which creates ongoing complications as to how populations access food and alcohol. Changing access to unhealthy commodities is an emerging issue in public health. Our scoping review considers priority areas for future research to better inform policy decisions. Current regulation of food and alcohol may not appropriately cover emerging on-demand technologies, necessitating a review of policy., Competing Interests: None., (© 2023 The Authors.)

This study aimed to identify dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing. We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ, and performed descriptive analyses on food expenditures. Overall, total household food expenditure per capita increased by 0.38% annually over this period. Low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds and a greater reduction in expenditure on processed meat. There was increased expenditure over time on fruit and vegetables nuts and seeds, and healthy foods in Māori (Indigenous) households with little variations in non-Māori households. But there was little change in processed meat expenditure for Māori households and expenditure on less healthy foods also increased over time. Routinely collected HES data were useful and cost-effective for understanding trends in food expenditure patterns to inform public health interventions, in the absence of nutrition survey data. Potentially positive expenditure trends for Māori were identified, however, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial., (© 2022. The Author(s).)

Access to unhealthy commodities is a key factor determining consumption, and therefore influences the prevalence of non-communicable diseases. Recently, there has been an increase in the availability of food 'on-demand' via meal delivery apps (MDAs). However, the public health and equity impacts of this shift are not yet well understood. This study focused on three MDAs in New Zealand and aimed to answer (1) what is the health profile of the foods being offered on-demand, (2) how many food outlets are available and does this differ by physical access or neighbourhood demographics and (3) does the health profile of foods offered differ by physical access or neighbourhood demographics? A dataset was created by sampling a set of street addresses across a range of demographic variables, and recording the menu items and number of available outlets offered to each address. Machine learning was utilised to evaluate the healthiness of menu items, and we examined if healthiness and the number of available outlets varied by neighbourhood demographics. Over 75% of menu items offered by all MDAs were unhealthy and approximately 30% of all menu items across the three MDAs scored at the lowest level of healthiness. Statistically significant differences by demographics were identified in one of the three MDAs in this study, which suggested that the proportion of unhealthy foods offered was highest in areas with the greatest socioeconomic deprivation and those with a higher proportion of Māori population. Policy and regulatory approaches need to adapt to this novel mode of access to unhealthy foods, to mitigate public health consequences and the effects on population groups already more vulnerable to non-communicable diseases.

Aim: Child poverty is a wicked problem and a key determinant of health, but research on child poverty has relied largely on self-report methods and reports from parents or caregivers. In this study we aimed to assess aspects of child poverty using data collected by children using wearable cameras., Method: The Kids'Cam Project recruited 168 randomly selected children aged 11-13 from 16 randomly selected schools in the Wellington Region of Aotearoa New Zealand. Each child wore a wearable camera for four consecutive days, recording an image every seven seconds. We used negative binomial regression models to compare measures of household resources, harms, behaviours and built environment characteristics between children living in low socio-economic deprivation households (n=52) and children living in high socio-economic deprivation households (n=26)., Results: Compared with children living in conditions of low socio-economic deprivation, children living in conditions of high socio-economic deprivation captured significantly fewer types of fruit (RR=0.46), vegetables (RR=0.25), educational materials (RR = 0.49) and physical activity equipment (RR = 0.66) on camera. However, they lived in homes with more structural deficiencies (RR=4.50) and mould (no mould was observed in low socio-economic deprivation households). They were also less likely to live in households with fixed heating (RR=0.27) and home computers (RR=0.45), and more likely to consume non-core food outside home (RR=1.94)., Conclusions: The children in this study show that children in poverty face disadvantages across many aspects of their lives. Comprehensive policies are urgently needed to address the complex problem of child poverty., Competing Interests: Nil., (© PMA.)

Objective: To determine the geographical location and characteristics of on-demand delivery services operating in New Zealand., Methods: We systematically searched the web and application (app) stores for on-demand services offering rapid delivery of food, alcohol, cigarettes or vaping products in New Zealand and mapped their geographic location as of May 2021. Using desktop review, data on service characteristics were collected and stratified including: types of commodities available, promotion strategies, and the legal aspects of access to age-restricted items., Results: On-demand services for food, alcohol and nicotine products operate across urban and rural New Zealand. All services offered personal memberships and 97% used promotions. All services offering restricted items had an age verification process, however, only 87% had birth date entry and 73% had an 18+ message pop-up on website entry. Only 60% of services appeared to have number limits on restricted items., Conclusions: Much of New Zealand is serviced by on-demand delivery services., Implications for Public Health: The trend towards on-demand delivery services may increase unhealthy food, alcohol and nicotine-related harms and it undermines current government actions, e.g. the Smokefree 2025 goal. This research informs policy to reduce the future health burden., (© 2022 The Authors.)

Introduction: Telehealth is widely proposed to improve access and equity in provision of rehabilitation, including wheelchair assessment, yet the design requirements of telehealth wheelchair assessment that will be accepted and utilised at scale are unclear. Service design that addresses the existing inequities in outcomes for indigenous populations, such as Māori will be critical. The aim of this study was to examine the design requirements of a telehealth wheelchair assessment service from the perspectives of key stakeholders such as wheelchair users and their families, including indigenous (Māori) and health professionals including occupational therapist, and physiotherapist assessors and technicians., Methods: Within a wider mixed methods design, inductive thematic analysis was applied to focus group and interview data from 23 assessors (19 occupational therapists and four physiotherapist assessors, one of whom was Māori) and 19 wheelchair users (three of whom were Māori)., Results: Eight themes were discerned with the final three themes emphasising the experiences of particular concern to Māori: (1) At the mercy of the system; (2) The hurdle of technology; (3) More efficient for all; (4) Lost information and connection; (5) Rights and the right way forward; (6) Cultural safety; (7) Whanaungatanga (relationship building); and (8) Summative disadvantage for Tāngata whaikaha (Māori with disabilities). Themes reflected a recognition of risks and uncertainty associated with tele-delivered assessment. Conversely, advantages in access, equity, and professional competency were reimagined. Perspectives of Māori included both risks and advantages as perceived by Māori., Conclusion: Substantial dissatisfaction with current wheelchair assessment services among wheelchair users provides context to the impetus for a successful design of a telehealth assessment service. Training in conducting telehealth wheelchair assessment is essential incorporating culturally safe communication practices and support of wheelchair user autonomy while identifying solutions that achieve wheelchair user goals., (© 2022 Occupational Therapy Australia.)

Children's community nutrition environments are an important contributor to childhood obesity rates worldwide. This study aimed to measure the type of food outlets on children's journeys to or from school, children's food purchasing and consumption, and to determine differences by ethnicity and socioeconomic status. In this New Zealand study, we analysed photographic images of the journey to or from school from a sample of 147 children aged 11-13 years who wore an Autographer camera which recorded images every 7 s. A total of 444 journeys to or from school were included in the analysis. Camera images captured food outlets in 48% of journeys that had a component of active travel and 20% of journeys by vehicle. Children who used active travel modes had greater odds of exposure to unhealthy food outlets than children who used motorised modes; odds ratio 4.2 (95% CI 1.2-14.4). There were 82 instances of food purchases recorded, 84.1% of which were for discretionary foods. Of the 73 food and drink consumption occasions, 94.5% were for discretionary food or drink. Children on their journeys to or from school are frequently exposed to unhealthy food outlets. Policy interventions are recommended to limit the availability of unhealthy food outlets on school routes.

Background: Marketing promotes values of consumerism and overconsumption, and negatively affects children's wellbeing and psychological development. The threat marketing poses to planetary health is just being realised. However, little is known about children's exposure to marketing at an aggregate level. Using an objective method of wearable cameras, we aimed to determine the nature and extent of children's exposure to marketing., Methods: Kids'Cam was a cross-sectional study of children aged 11-13 years in New Zealand, from which we randomly selected a sample of 90 children. Children wore cameras from when they woke up until they went to sleep for four consecutive days (Thursday-Sunday) that captured images at an angle of 136° every 7 s for exposure to marketing. Marketing brands were categorised into three groups: core food and social marketing messages, harmful commodities (eg, non-core food, alcohol, and gambling), or other. Exposure rates by marketing medium, setting, and product category were calculated using negative binomial regression models., Findings: From June 21, 2014, to June 30, 2015, we recruited 168 children, and randomly selected data from 90 children for the present study. Children in this study were exposed to a mean of 554 brands per 10 h day (95% CI 491-625), nearly a brand a minute, through multiple mediums (predominantly brand labels [36% of exposures] and product packaging [22%]) and mostly in schools (43%) and at home (30%). Food and beverages (20% of exposures) were the dominant product category. The most pervasive marketing brands typically sold a range of products across more than one product category (eg, children were exposed to Nike on average 20 exposures per day). Children were exposed to more than twice as many harmful commodities (mean 76 per 10 h day [95% CI 55-105]) as core food and social marketing messages (32 [26-39]) per day., Interpretation: We found that children are repeatedly exposed to marketing through multiple mediums and across all settings, and our findings suggests that marketing privileges particular messages, for example, marketing of harmful commodities. Given the key role marketing plays in establishing and supporting consumption norms, and perpetuating the normalisation of overconsumption which contributes to environmental degradation, these findings suggest an urgent need to reduce marketing to promote planetary health., Funding: This research was funded by a University of Otago, Dean's Research Grant. The Kids'Cam study was funded by a Health Research Council of New Zealand Programme Grant (13/724)., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Aims: Lack of transport is a contributor to poor access to healthcare and missed appointments. This research aimed to understand the accessibility of primary care for patients using public transport in Ōtautahi Christchurch, and to describe spatial and social distribution., Methods: We measured access to primary care using geospatial analysis based on the time taken to reach the nearest general practice, the number of practices accessible within given time thresholds and the frequency of public transport services. Results are disaggregated by ethnicity, age, socioeconomic deprivation and car ownership., Results: The poorest levels of access were in areas with the least deprivation and a greater NZ European population. Children aged 5-14 had low levels of access. Only 58.4% of the population in the most deprived areas had access to high-frequency bus services., Conclusions: This study highlights connectivity gaps between public transport and primary healthcare for key groups known to have a greater dependence upon public transport and poorer health outcomes. From an equity perspective, it highlights the need for further investigation into transport and health solutions to improve access to primary care for lower socioeconomic groups., Competing Interests: The authors report studentship from University of Otago Transport Research Network during the conduct of the study.

Background: The United Nations Convention on the Rights of the Child confirms a child's right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food. We explored with key stakeholder's policy options to ensure the rights of indigenous children to healthy food, through a case study of the rights of tamariki., Methods: Interviews were conducted with 15 key stakeholders, with experience in research, development or delivery of policies to safeguard the rights of tamariki to healthy food. Iterative thematic analysis of the transcripts identified both deductive themes informed by Kaupapa Māori theory and literature on rights-based approaches and inductive themes from the interviews., Results: The analysis suggests that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children's rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making., Conclusions: The right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ.

Snacking is a common eating behaviour, but there is little objective data about children's snacking. We aimed to determine the frequency and context of children's snacking ( n = 158; mean age = 12.6 years) by ethnicity, gender, socioeconomic deprivation and body mass index (BMI) children. Participants wore wearable cameras that passively captured images of their surroundings every seven seconds. Images ( n = 739,162) were coded for snacking episodes, defined as eating occasions in between main meals. Contextual factors analysed included: snacking location, food source, timing, social contact and screen use. Rates of total, discretionary (not recommended for consumption) and healthful (recommended for consumption) snacking were calculated using negative binomial regression. On average, children consumed 8.2 (95%CI 7.4, 9.1) snacks per day, of which 5.2 (95%CI 4.6, 5.9) were discretionary foods/beverages. Children consumed more discretionary snacks than healthful snacks in each setting and at all times, including 15.0× more discretionary snacks in public spaces and 2.4× more discretionary snacks in schools. Most snacks (68.9%) were sourced from home. Girls consumed more total, discretionary and healthful snacks than boys, and Māori and Pacific consumed fewer healthful snacks than New Zealand (NZ) Europeans. Results show that children snack frequently, and that most snacking involves discretionary food items. Our findings suggest targeting home buying behaviour and environmental changes to support healthy snacking choices.

Introduction: Food environments shape food behaviours and are implicated in rising rates of obesity worldwide. Measurement of people's interactions with food stores is important to advance understanding of the associations between the food environment and in-store behaviour. This paper describes a new method, Food Store Environment Examination (FoodSee) to measure people's interaction with the food store environment in a feasibility study focused on convenience stores and children., Methods: One hundred and sixty-eight randomly selected children (aged 11-13 years) recruited from 16 randomly selected schools in Wellington, New Zealand, used wearable cameras for 4 days that recorded images every 7 s. The study was conducted from July 2014 to June 2015. All images of convenience stores and service stations, and a sample of images from supermarkets, were evaluated to determine the feasibility of assessing food availability and marketing. The outcomes of interest assessed were: food product availability, placement, packaging, branding, price promotion, purchases and consumption., Results: Thirty-seven children (22%) visited a convenience store or service station at least once during the study period. In total, there were 65 visits to 34 different stores. Seven hundred and nineteen images revealed the in-store environment. Of those, 86.1% were usable and able to be analysed for the outcomes of interest., Conclusions: The FoodSee methodology provides a promising new method to study people's interaction with the in-store food environment. The evidence generated will be valuable in understanding and improving the food store environment within which people shop, and will contribute to efforts to address obesity globally.

Increasing rates of childhood obesity worldwide has focused attention on the obesogenic food environment. This paper reports an analysis of children's interactions with food in convenience stores. Kids'Cam was a cross-sectional study conducted from July 2014 to June 2015 in New Zealand in which 168 randomly selected children aged 11-14 years old wore a wearable camera for a 4-day period. In this ancillary study, images from children who visited a convenience store were manually coded for food and drink availability. Twenty-two percent of children ( n = 37) visited convenience stores on 62 occasions during the 4-day data collection period. Noncore items dominated the food and drinks available to children at a rate of 8.3 to 1 (means were 300 noncore and 36 core, respectively). The food and drinks marketed in-store were overwhelmingly noncore and promoted using accessible placement, price offers, product packaging, and signage. Most of the 70 items purchased by children were noncore foods or drinks (94.6%), and all of the purchased food or drink subsequently consumed was noncore. This research highlights convenience stores as a key source of unhealthy food and drink for children, and policies are needed to reduce the role of convenience stores in the obesogenic food environment.

Aim: Researchers explored how food insecurity was experienced in Māori households and how this can affect hauora (well-being)., Methods: This Māori-centred research was conducted in New Zealand by Māori dietetic students with Māori supervision. Kaupapa Māori methodology guided the inductive thematic analysis of observational and discussion data (40+ hours per household) from four Māori households (18 individuals) that participated in a 3-month ethnographic-style investigation in 2011., Results: Four themes were identified. 'Overcoming socioeconomic hardship' was most clearly observed within the low-income whānau (family), however, all whānau had experienced food insecurity. This experience had short- and long-term impacts on well-being. Other themes identified strategies whānau developed to reduce the severity of food insecurity: sharing food, gardening food, and teaching food and nutrition skills. Selected text for themes revealed expressed Māori values and/or hauora influences. The values of manaakitanga (sharing food/hospitality), whānaungatanga (family relationships) and kaitiakitanga (caring for the environment) were observed and analysed deductively., Conclusions: All households had experienced income-related food insecurity, and its short- and long-term impacts on well-being were observed. Whānau had developed many strategies to reduce the severity of food insecurity, relying on support from extended whānau and the wider community, but households remained food insecure. Health and other professionals should advocate for social justice and policy solutions that change systems perpetuating social and health inequity. All households need sufficient income to afford basic needs including food. When basic needs are met, households and individuals can thrive and make meaningful contributions to society., (© 2018 Dietitians Association of Australia.)

Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me'akai (food) consumed by Tongan children in Ha'apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids'Cam Tonga project. Images were analysed to assess the participants' food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.

Issue: Lack of food security is one of the major nutrition issues facing Māori today. Loss of traditional kai (food) gathering places and practices following colonisation and urbanisation has impacted negatively on food security for Māori. This paper explores the role of Māori in enhancing Māori food security through revitalising traditional kai., Methods: A narrative literature review of peer reviewed and grey literature on revitalising traditional kai for Māori was conducted. The focus was on two areas: increasing the availability of traditional kai to Māori households (such as through replenishing fish stocks, and gardening projects) and increasing the financial means available to Māori households to purchase food (by economic development of traditional kai industries and employment creation)., Results: A range of activities to improve food security for Māori by revitalising traditional kai was identified in the literature. Māori are now significant players in New Zealand's fishing industry, and are developing their horticultural resources. Gardening initiatives have also grown considerably in Māori communities. Enabling factors included: the return of traditional kai resources by the Crown, and successful pursuit by Māori of the legal rights to develop them; development of Māori models of governance; government policy around Māori economic development and healthy eating; and Māori leadership on the issue. Barriers to revitalising traditional kai that remain to be addressed include: tensions between Government and Māori goals and models of resource management; economic pressures resulting in severely depleted fishing stocks; and pollution of marine and freshwater fish., Conclusion: Revitalising traditional kai has considerable potential to improve food security for Māori, both directly in terms of food supply and by providing income, and warrants policy and practical support. These findings have implications for other indigenous cultures who are struggling to be food secure., (© The Author(s) 2014.)

Atypical antipsychotic drugs, such as clozapine, show many differences in their actions as compared to typical antipsychotic drugs, such as haloperidol. In particular, the neuroanatomical substrates responsible for the superior therapeutic profile of clozapine are unknown. In order to identify regions of the CNS which are affected either differentially or in parallel by clozapine and haloperidol, we have used 2-deoxyglucose autoradiography to monitor local cerebral glucose utilisation (LCGU), in parallel with in situ hybridisation to monitor the expression of five immediate-early genes (c-fos, fos B, fra 1, fra 2 and zif 268). Clozapine (20 mg/kg i.p.) caused a reduction in LCGU in many areas of the psychosis-related corticolimbothalamic and Papez circuits, such as the anterior cingulate and retrosplenial cortices and the mammillary body. Haloperidol (1 mg/kg i.p.) showed less ability to modulate LCGU in these regions. Clozapine also increased immediate-early gene expression in these limbic circuits, although the pattern of induction was different for each gene, and also differed from the pattern of effects on LCGU. The only region which displayed similar effects with both antipsychotics was the anteroventral thalamus, with LCGU and c-fos mRNA expression being altered similarly by both drugs. This further supports the hypothesis of the thalamus being a common site of antipsychotic action. Since the Papez circuit has been implicated in emotive learning, and to be involved in mediating the negative symptoms associated with schizophrenia, the greater action of clozapine on regions within this circuit may also provide clues to the atypical antipsychotic's superior efficacy against negative symptoms. This is one of the first studies which provides a direct comparison of regional activity as assessed by LCGU and by a panel of IEGs. The results emphasise the necessity of monitoring a number of different parameters of regional activity in order to identity the neuroanatomical substrate for actions of a drug in the CNS.