Boyd A. Swinburn

Background: The nutritional health of tamariki (children) in Aotearoa New Zealand (NZ) is poor. Nourishing Hawke's Bay (NHB) began as an initiative to address this problem in low advantage regions of Hawke's Bay (HB) and evolved into the evaluation of Ka Ora. Ka Ako the free, healthy school lunch programme, and the scoping of wider improvements in the regional food ecosystem. Objective: The aim of this paper is to describe how NHB co-designed and evaluated food interventions incorporating systems thinking and mātauranga Māori (traditional knowledge), as lenses through which to view the initiative. Cognitive mapping interviews (n = 11) with community health and education leaders identified six key co-design principles or Pou (metaphorical posts) for NHB. Methods: Further systems methods, such as group model building and system dynamics modelling, and mātauranga Māori methods, such as wānanga (Māori learning forums), involved the community in food systems mapping and intervention co-design and prioritisation. Results: Three Pou, 'food security,' 'mātauranga Māori' and 'children's hauora' (wellbeing), set the research agenda for NHB. the other three Pou, 'work with community,' 'cohesion and integration' and 'start with schools,' determined the subsequent research processes. Along with standard population evaluation methods (including quantitative and qualitative assessments of changes in student health and wellbeing), a participatory Value for Investment (VFI) analysis assessed return on investment. Conclusions: Combining systems thinking and mātauranga Māori is a novel, participatory approach co-creating pathways to improved nutrition and food security for tamariki and holds promise for wider food system changes in regional NZ.

Alcohol advertising on television in China has the potential to target children and adolescents with harmful content. Understanding the extent of this advertising is critical for informing and improving current regulatory approaches. To measure the exposure of alcohol advertisements on television channels popular among children and adolescents in Beijing, China. This cross-sectional study of television advertisements used the 4 most popular television channels for viewers aged 3 to 18 years (2 children's channels and 2 general channels) in Beijing and accessed advertisements recorded from October 19, 2020, to January 17, 2021. Television advertisements were recorded during 4 randomly selected weekdays and 4 randomly selected weekend days (from 6:00 am to 11:59 pm). Data were analyzed from October 1, 2023, to December 31, 2024. Television alcohol advertisements, with food and nonalcoholic beverages (F&B) advertisements classified as not permitted in marketing to children included as comparison. Primary outcomes included frequency and distribution of alcohol advertisements, rate per channel-hour, and potential exposure during peak viewing times (PVT). Secondary outcomes included comparison with F&B advertisements classified as not permitted based on the World Health Organization Western Pacific Region Office Nutrient Profile Model integrated with the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) food classification system and analysis of 6 marketing strategies. Among 13 864 total advertisements included in the analysis, 5368 were food advertisements. Among the food advertisements, 321 (6.0%; 95% CI, 5.4%-6.7%) were alcohol advertisements and 2001 (37.3%; 95% CI, 36.0%-38.6%) were F&B advertisements classified as not permitted. On general channels, a mean (SD) of 1.1 (1.7) alcohol advertisements per channel-hour were identified, with significantly higher rates during PVT compared with non-PVT (2.0 [2.4] vs 0.7 [0.9] per channel-hour; P < .001). The highest rate occurred between 9:00 and 9:59 pm, with a mean (SD) of 3.7 (2.8) advertisements per channel-hour and an estimated mean (SD) of 14 303 014 (11 659 096) impressions among children and adolescents. All 321 alcohol advertisements (100%; 95% CI, 98.9%-100%) and 1997 F&B advertisements classified as not permitted (99.8%; 95% CI, 99.5%-99.9%) used at least 1 marketing strategy, predominantly brand benefit claims, which were used in 307 alcohol advertisements (95.6%; 95% CI, 92.8%-97.4%) and 1915 F&B advertisements classified as not permitted (95.7%; 95% CI, 94.7%-96.5%). In this cross-sectional study of television advertising, alcohol advertisements on general channels exceeded regulatory limits, especially during PVT. These findings suggest that current regulations allow exposure of children and adolescents to alcohol marketing and should be strengthened.

Background: Individuals impacted by adverse childhood experiences (ACEs) are at greater risk of developing obesity, however, few studies have prospectively measured ACEs and obesity during childhood. Associations with the adoption of obesogenic behaviours during childhood, which directly contribute to obesity are also understudied. Objective: To examine associations between individual and cumulative ACEs, obesity, and obesogenic behaviours during childhood. Methods: Data came from Growing Up in New Zealand. The study sample was restricted to those who provided obesity data at age 8 and one child per mother, resulting in an analytic sample of 4895 children. A newly developed ACEs index consisted of nine individual ACEs and cumulative ACEs scores (0, 1, 2, 3, 4+ ACEs), two obesity measures (BMI and waist circumference/height ratio), and eight obesogenic behaviours including unhealthy dietary behaviours, inadequate sleep duration, excessive screen time, and physical inactivity were included in the analyses. Results: ACEs were prevalent among this cohort of NZ children. By age eight, 87.1% of children experienced at least one ACE and 16% experienced at least 4 ACEs. Six individuals assessed ACEs showed significant associations with childhood obesity (AORs ranging from 1.22 to 1.44). A significant dose-response effect was observed where the experience of a higher number of ACEs was associated with greater risk for obesity (AORs increased from 1.78 for one ACE to 2.84 for 4+ ACEs). Further, a significant dose-response relationship was found between experiencing two or more ACEs and higher odds of adopting obesogenic behaviours (AORs ranging from 1.29 for physical inactivity to 3.16 for no regular breakfast consumption). Conclusions: ACEs exposure contributes to population-level burden of childhood obesity. Our findings highlight the importance of a holistic understanding of the determinants of obesity, reinforcing calls for ACEs prevention and necessitating incorporation of ACEs-informed services into obesity reduction initiatives.

This study conducted an exploratory content analysis of TV food advertisements on the top three most popular channels for Filipino children aged two to 17 during school and non-school days. Data were collected by manually recording of aired advertisements from 16 non-school days (July to September 2020) and 16 school days (January to April 2021). Descriptive and inferential statistical analyses were used to assess children's rates of exposure to food advertisements (mean ± SD of advertisements aired per channel per hour), the healthiness of promoted foods (as permitted (healthier) or not permitted (unhealthy) according to nutrient profiling models from the World Health Organization), and persuasive techniques used in food advertisements, including promotional characters and premium offers. The results show that the rates of exposure to food advertisements were higher during school days (14.6 ± 14.8) than on non-school days (11.9 ± 12.0) (p < 0.01). Both periods yield a similarly higher proportion of non-permitted food advertisements (e.g. 9.3 ± 9.7 ads/channel/hour for school days and 8.3 ± 8.5 ads/channel/hour for non-school days) than permitted ones. More non-permitted food advertisements during children's peak viewing times were observed than non-peak viewing times (e.g. 11.8 ± 10. vs. 8.3 ± 9.2 ads/channel/hour for school days). Non-permitted food advertisements employed persuasive techniques more frequently, accounting for 64-91% of all food ads during peak viewing times. Children are exposed to a large volume of television advertisements for foods that should not be permitted to be marketed to children based on authoritative nutrient criteria.

Objective: Food system sustainability is a broad goal, contributing to resilience, positive health, equity, cultural, environmental and economic outcomes. This study aims to understand the essential components on the journey towards "sustainable food systems" in New Zealand's, Hawke's Bay (HB) region. Methods: Seventeen qualitative semi-structured interviews were conducted to identify barriers, facilitators and potential interventions for improving a sustainable food system. Cognitive mapping (CM) was utilised, generating causal links between themes to answer the question: "What would it take to enhance the HB region to sustain a resilient food ecosystem to supply local people with local food?" Results: Three key themes were revealed: community engagement, the establishment of a local distribution system and fostering trust between growers and consumers. Community engagement was the most critical factor, highlighting the need for partnerships with local Iwi (tribe) and hapū (subtribe), support for local and community-based business models, economic sustainability and whakapapa of kai (genealogy of food) education. Establishing a local distribution system was identified as crucial to enhance the efficiency of food distribution and ensure repurposing of surplus food. Fostering trust between growers and consumers is needed to achieve this goal. Conclusions: These findings underscore the role of community-centric solutions in cultivating a sustainable food system. Rooted in the specific needs and aspirations of the community, the results offer valuable insights into the development of a sustainable food system in HB. Through leveraging cognitive mapping, this study provides a novel framework for enhancing community engagement and establishing a local distribution system.