Comparison of ten policy options to equitably reduce children's exposure to unhealthy food marketing.

OBJECTIVE: Reducing children's exposure to unhealthy food marketing is crucial to combat childhood obesity. We aimed to estimate the reduction of children's exposure to food marketing under different policy scenarios and assess exposure differences by socio-economic status. DESIGN: Data on children's exposure to unhealthy food marketing were compiled from a previous cross-sectional study in which children (n 168) wore wearable cameras and Global Positioning System (GPS) units for 4 consecutive days. For each exposure, we identified the setting, the marketing medium and food/beverage product category. We analysed the percentage reduction in food marketing exposure for ten policy scenarios and by socio-economic deprivation: (1) no product packaging, (2) no merchandise marketing, (3) no sugary drink marketing, (4) no confectionary marketing in schools, (5) no sugary drink marketing in schools, (6) no marketing in public spaces, (7) no marketing within 400 m of schools, (8) no marketing within 400 m of recreation venues, (9) no marketing within 400 m of bus stops and (10) no marketing within 400 m of major roads. SETTING: Wellington region of New Zealand. PARTICIPANTS: 168 children aged 11-14 years. RESULTS: Exposure to food marketing varied by setting, marketing medium and product category. Among the ten policy scenarios, the largest reductions were for plain packaging (60·3 %), no sugary drink marketing (28·8 %) and no marketing in public spaces (22·2 %). There were no differences by socio-economic deprivation. CONCLUSIONS: The results suggest that plain packaging would result in the greatest decrease in children's exposure to food marketing. However, given that children are regularly exposed to unhealthy food marketing in multiple settings through a range of marketing mediums, comprehensive bans are needed to protect children's health.

Generating political priority for alcohol policy reform: A framework to guide advocacy and research.

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.

Diabetes Cam: An Objective Methodology to Study Diabetes Self-Management.

INTRODUCTION: The prevalence of Type 2 Diabetes Mellitus (T2DM) is rapidly increasing throughout the world. T2DM is primarily a self-managed disease yet clinical studies indicate that a large proportion of adults with T2DM struggle to self-manage their diabetes. This puts them at high risk of developing diabetes-related complications. This study presents Diabetes Cam, a new methodology to objectively study T2DM self-management and identify its barriers and facilitators. METHODS: Thirty adults with diabetes of i-taukei descent from the 4 medical divisions throughout Fiji wore a camera for 4 days that automatically recorded images every 7 seconds. They also participated in in-depth photo-elicitation interviews to explore their experiences and perceptions of T2DM self-management. Data was collected between October 2021 and May 2022, and the analysis was done in August 2023. RESULTS: Approximately 11,500 images per participant were generated providing rich data. The method is ethical, legal, and acceptable for adults with T2DM, their families, and the wider community. The images can be readily coded for food availability and consumption, physical activity, transportation, medication use, and foot care. Photo-elicitation enabled further information on what was occurring within the images and about participants' perspectives on diabetes self-management. CONCLUSIONS: The Diabetes Cam methodology enabled automated, objective observation of participants' T2DM self-management and their perspectives on self-management. It provides unique insights into diabetes self-management and ways to improve diabetes self-management. It provides valuable data to develop strategies to enhance diabetes self-management for people living with diabetes, their families, the wider community, health professionals, and policymakers.

Watching the watchers: assessing the nature and extent of children's screen time using wearable cameras.

AIM: Children's screen use has increased rapidly in recent years, yet little is known about this use in real-time due to reliance on self-report or proxy data sources. Screens provide benefits such as educational content and social connection, but also pose health risks including obesity, depression, poor sleep and poor cognitive performance. In this cross-sectional observational study, we aimed to determine the nature and extent of children's after-school screen time using wearable cameras. METHOD: Children aged 11-13 years took part in the New Zealand Kids'Cam project in 2014/2015. Each child wore a camera that passively captured images of their surroundings every 7 seconds. Images from 108 children were manually coded. RESULTS: Children spent over a third of their time on screens, including over half their time after 8pm. Television accounted for the highest proportion of screen time (42.4%), followed by computers (32.0%), mobile devices (13.0%) and tablets (12.6%). Approximately 10% of children's screen time involved multiple screen use. CONCLUSION: Guidelines are needed to promote healthy screen time behaviour among children. Further research is also needed to monitor the impact of screens on children's wellbeing, including any socio-demographic differences, and to identify innovations to protect children from harm in the online space.

Determinants of Future Physical Activity Participation in New Zealand Adolescents across Sociodemographic Groups: A Descriptive Study.

This cross-sectional study aimed to explore various determinants of future physical activity (PA) participation in adolescents across sociodemographic groups. Sociodemographic characteristics (age, gender, ethnicity, deprivation status, physical disability status) were assessed in a national sample (n = 6906) of adolescents (12-17 years old) between 2017 and 2020 in New Zealand. The determinants of future PA participation chosen for analysis included current indicators of PA participation (i.e., total time, number of types, number of settings). We also examined widely recognised modifiable intrapersonal (i.e., physical literacy) and interpersonal (i.e., social support) determinants of current and future PA behaviour, along with indicators of PA availability issues. Older adolescents scored worse across all determinants of future PA than younger adolescents, with a key transition point appearing at 14-15 years of age. Maori and Pacific ethnicities scored best across each determinant category on average, with Asian populations scoring the worst. Gender diverse adolescents scored substantially worse than male and female adolescents across every determinant. Physically disabled adolescents scored worse than non-disabled across all determinants. Adolescents from medium and high deprivation neighbourhoods scored similarly across most determinants of future PA participation and both tended to score worse than people from low deprivation neighbourhoods. A particular focus on the improvement of future PA determinants is warranted within adolescents who are older, Asian, gender diverse, physically disabled, and from medium to high deprivation neighbourhoods. Future investigation should prioritise the longitudinal tracking of PA behaviours over time and develop interventions that affect multiple future PA determinants across a range of sociodemographic backgrounds.

Objective Assessment of the Nature and Extent of Children's Internet-Based World: Protocol for the Kids Online Aotearoa Study.

BACKGROUND: Children under 18 years of age account for approximately 1 in 3 internet users worldwide. Largely unregulated, the internet-based world is evolving rapidly and becoming increasingly intrusive. There is a dearth of objective research globally on children's real-time experiences of the internet-based world. OBJECTIVE: This paper reports an objective methodology to study the nature and extent of children's internet-based world, their engagement with it, and how this impacts their health and well-being. METHODS: A total of 180 year 8 students from 12 schools will be recruited into the study within the Wellington region of Aotearoa, New Zealand. Children use Zoom video teleconferencing software to record real-time, screen-shared internet-based content, for 4 consecutive days. Data on demographics, health and well-being, and attitudes and perceived behaviors in relation to the internet-based world are collected. Phone screen-time balances are retrieved. Data collection commenced in June 2021 and is anticipated to be completed in 2023. RESULTS: Recordings show children exploring diverse web-based settings and content, including personalized content curated by algorithms on platforms such as TikTok, YouTube, and Instagram. Preliminary analysis shows that the data can be used to study a wide range of topics. Behavioral Observation Research Interaction Software is being used to manually code recordings. Artificial Intelligence techniques are also being applied, including hashtag extraction, optical character recognition, as well as object, pattern, speech, and lyric recognition. CONCLUSIONS: This novel methodology reveals the unique internet-based experiences of children. It is underpinned by a commitment to ensuring that their rights are protected. It seeks to provide concrete evidence on internet usage in this group and to facilitate appropriate political and societal action to effectively regulate the internet-based world to prevent harm to children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39017.

Children's perspectives on the wicked problem of child poverty in Aotearoa New Zealand: a wearable camera study.

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.

The distribution of harmful product marketing in public outdoor spaces and the effectiveness of marketing bans.

Children's exposure to the marketing of harmful products in public outdoor spaces may influence their consumption of those products and affect health into adulthood. This study aimed to: i) examine the spatial distribution of children's exposure to three types of marketing-related 'harms' (alcohol, unhealthy food, and gambling) in outdoor spaces in the Wellington region, New Zealand/Aotearoa; ii) compare differences in the distribution of harms by socioeconomic deprivation; and iii) estimate the effectiveness of different policies that ban such marketing. Data were from 122 children aged 11-13y who wore wearable cameras and GPS devices for four consecutive days from July 2014 to June 2015. Images were analysed to identify harmful product marketing exposures in public outdoor spaces. Eight policy scenarios were examined to identify the effectiveness of marketing bans, for all children and by socioeconomic deprivation. Children's ratio of harmful marketing was higher for children from high deprivation households and was also found to cluster, with hots spots observed around city centers. The effectiveness of marketing bans depended on the target setting and ban area, with banning 400 m around bus stops leading to the largest reduction. Effectiveness varied also by type of harm and socioeconomic deprivation. For example, banning alcohol marketing in residential areas was estimated to have a larger effect on exposure reduction for children from high deprivation households. Our findings suggest that alcohol, unhealthy food and gambling marketing often cluster outdoors and that targeted bans of such marketing would likely improve child health and, for some banning scenarios, promote equity.

Children's Community Nutrition Environment, Food and Drink Purchases and Consumption on Journeys between Home and School: A Wearable Camera Study.

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.

The association of social and food preparation location context with the quality of meals and snacks consumed by young adults: findings from the MYMeals wearable camera study.

PURPOSE: This study examined the association of social contexts and food preparation location with the quality of meals and snacks (predominately from the five food groups (FFG) versus discretionary foods) in a sample of young Australian adults (18-30 years old) using wearable camera technology. METHODS: A sub-sample from the cross-sectional MYMeals study wore a wearable camera that captured images every 30 s for three consecutive days. Eating episodes from 133 participants (55% female) were classified across 4 domains: food quality (observed proportion of FFG and discretionary items), preparation location, social interaction, and screen use. Socio-economic status (SES) was assigned using residential postcode and gender self-reported. Associations of contexts and demographic factors with food quality stratified by meal type were determined using mixed binary logistic regression models. RESULTS: Of the 1840 eating episodes identified, 1775 were included in analysis (n = 8 preparation location and n = 57 food components that could not be identified were excluded). Food prepared at home was more likely to be from the FFG at lunch (OR = 4.8 95% CI 2.7-8.6), dinner (OR = 14.8 95% CI 7.6-28.6), and snacks (OR = 3.2 95% CI 2.2-4.8). Participants from higher SES areas were more likely to consume breakfasts (OR = 3.2 95% CI 1.4-7.4) and lunches (OR = 1.9 95% CI 1.0-3.7) predominately from the FFG. Females were more likely to consume lunches (OR = 2.0 95% CI 1.1-3.8) that was largely from the FFG. Social interaction and screen use were not associated with meal or snack quality. CONCLUSION: Wearable cameras have verified the importance of addressing meals and snacks prepared outside of home as an important contributor of discretionary food.

What can Aotearoa New Zealand learn from the Australian Sunsmart Story? A qualitative study.

OBJECTIVE: To explore the views of stakeholders in Australia concerning skin cancer primary prevention and identify successful strategies used that may be translatable to other jurisdictions. METHODS: In-depth stakeholder interviews with experts engaged in skin cancer prevention advocacy and action in Australia. RESULTS: A number of important facilitators were identified including: the use of good scientific evidence (including economic), strong leadership, legislation and strategic documents, engaging the media particularly with the use of personal stories and garnering public support. A number of barriers were also identified including: a lack of funding (particularly nationally), variation by state, apathy and the long latency of skin cancer. CONCLUSIONS: Advocates identified a number of key strategies that were used to gain momentum in achieving Australia's comprehensive Sunsmart program. These included: strong leadership, legislation including that banning solaria and workplace health and safety legislation, a critical mass of key advocates from a range of disciplines including clinicians and patients, and the advantageous use of media to drive change. IMPLICATIONS FOR PUBLIC HEALTH: Australia demonstrates what can be achieved when skin cancer prevention is taken seriously. The challenge for other nations is to apply the lessons learnt in Australia to our own jurisdictions.

An objective assessment of children's exposure to brand marketing in New Zealand (Kids'Cam): a cross-sectional study.

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).

Generating political priority for skin cancer primary prevention: A case study from Aotearoa New Zealand.

ISSUES ADDRESSED: Skin cancer is highly prevalent but preventable, yet little research has been done on the challenges in generating political priority for skin cancer prevention. This qualitative study aimed to identify the political challenges to, facilitators of, and strategies to strengthen skin cancer prevention. The focus was on the case of Aotearoa New Zealand (NZ): a country with high skin cancer rates, but limited investment in primary prevention. METHODS: Data sources included 18 national key informant interviews and documentary analysis. Data were analysed inductively for emerging themes and framed using a conceptual framework of political priority. RESULTS: Challenges to advocates for skin cancer primary prevention include limited resources and competing priorities. Political-level challenges include a lack of quick results compared with other initiatives vying for political attention, lack of negative externalities and, in NZ, misalignment with health system priorities. Challenges in the evidence base include the perceived conflict of sun protection with Vitamin D and physical activity, the lack of data on the financial burden of skin cancer and relatively low temperatures in NZ. Facilitators include strong policy community cohesion and issue framing, and weak opposition. Promising strategies to strengthen skin cancer prevention in NZ could include network building, using framing that resonates with policy makers and addressing key knowledge gaps in NZ, such as the financial burden of skin cancer. CONCLUSION: Advocacy for skin cancer prevention faces challenges due to advocates' limited resources, political challenges such as lack of quick results and gaps in evidence. Nonetheless, the initiative encounters little opposition and can be framed in ways that resonate with policy makers. SO WHAT?: Skin cancer is highly preventable, but advocates for prevention initiatives have struggled to gain political traction. This study identifies several strategies that could help raise the political profile for skin cancer prevention.

Food, nutrition and cancer: perspectives and experiences of New Zealand cancer survivors.

AIM: This research sought to understand and describe cancer survivors' perspectives and post-diagnosis experiences of food and nutrition, with a particular focus on barriers to healthy eating, health equity, and Maori and Pacific perspectives. METHOD: Data were collected using semi-structured interviews with cancer survivors from three different ethnic groups (Maori, Pacific Peoples, and New Zealand European). Thematic analysis was undertaken to identify both similar and contrasting experiences and perspectives in relation to topics of interest. Data analysis also sought to identify any trends indicating differences between ethnic groups. RESULTS: Limited awareness of the role nutrition has in cancer recovery or prevention, combined with little or no access to nutrition advice/support, meant that healthy dietary change was not a focus for some cancer survivors in this study, whereas others invested considerable time and money accessing nutrition information and support outside of cancer care services. Financial limitations (eg, cost of healthy food and low income) and lack of practical support were also important barriers to post-diagnosis healthy eating. CONCLUSION: There is a need for more widely available cancer-specific nutrition advice and support in New Zealand. Interventions to address financial barriers and increase access to cancer-related nutrition advice and support have the potential to improve cancer outcomes and reduce inequities in cancer outcomes.

Life during lockdown: a qualitative study of low-income New Zealanders' experience during the COVID-19 pandemic.

AIM: This research explores the experience of low-income New Zealanders during the COVID-19 pandemic lockdown and their advice to the Government about addressing future pandemics. New Zealand had a rapid and effective lockdown that meant the virtual elimination of community transmission. METHOD: Twenty-seven semi-structured interviews were undertaken with low-income people in June-July 2020 immediately after lockdown was lifted. RESULTS: Life during lockdown was challenging for study participants. They were fearful of the virus and experienced mental distress and isolation. Most participants felt safe at home and reported coping financially while still experiencing financial stress. Participants were resourceful and resilient. They coped with lockdown by using technology, self-help techniques and support from others. New Zealand's welfare state ensured participants had access to health services and welfare payments, but there were challenges. Welfare payments did not fully meet participants' needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government's response and advised the Government to take the same approach in the future. This is a particularly reassuring finding from some of the most vulnerable New Zealanders. CONCLUSIONS: An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful lockdown for the low-income people in this study. Research of the experience of low-income people during pandemics is critical to ensuring inequities in pandemic impact are mitigated.

Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App.

Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18-30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.

Progress in the Pacific on sugar-sweetened beverage taxes: a systematic review of policy changes from 2000 to 2019.

OBJECTIVE: To systematically characterise sugar-sweetened beverage (SSB) tax policy changes in Pacific Island countries and territories (PICTs) from 2000 to 2019. METHODS: Medline, Google Scholar, Pacific Islands Legal Information Institute database, Factiva and news and government websites were systematically searched up to October 2019. Information was extracted on the date and SSB tax level change, tax type, included beverages, and earmarking; and checked for consistency with local experts. RESULTS: Three-quarters of PICTs had an SSB tax (n=16/21) and 11 of these were excise taxes that included both imported and locally produced beverages. The level of tax was over 20% in 14 jurisdictions. SSB tax was increased by more than 20 percentage points in eight PICTs. Most taxes were ad valorem or volumetric, three were earmarked and only two taxes targeted sugar-sweetened fruit juices. The majority of countries (14/21) had different tax rates for imported and locally produced beverages. CONCLUSIONS: More than three-quarters of PICTs have SSB taxes. More than one-third increased these taxes since 2000 at an amount that is expected to reduce soft drink consumption. Implications for public health: Despite high-quality tax design elements in some PICTs, SSB control policies could generally be strengthened to improve health benefits, e.g. by targeting all SSBs and earmarking revenue for health.

Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki Maori to healthy food.

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 (Maori 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 Maori 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 Maori 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 Maori 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.

Equity of expenditure changes associated with a sweetened-beverage tax in Tonga: repeated cross-sectional household surveys.

BACKGROUND: The aim of this study was to examine changes in beverage expenditure patterns before and after a T$0.50/L sweetened-beverage (SB) excise was introduced in Tonga in 2013, by household income, household age composition and island of residence. METHODS: Two cross-sectional surveys involved households being randomly sampled (the Household Income and Expenditure Surveys in 2009 (n = 1982) and 2015/16 (n = 1800)). Changes in soft drink (taxed), bottled water, and milk (both untaxed) expenditure were examined namely: (i) prevalence of households purchasing the beverage; (ii) average expenditure per person (inflation-adjusted); (iii) expenditure as a proportion of household food budget; and (iv) expenditure per person as a proportion of equivalised income. RESULTS: The pattern found was of decreases in all soft drink expenditure outcomes and these appeared to be greater in low-income than high-income households for purchasing prevalence (- 30% and - 25% respectively, t-test p = 0.98), per-capita expenditure (- 37% and - 34%, p = 0.20) and food budget share (- 27% and - 7%, p = 0.65), but not income share (- 6% and - 32%, p = 0.71). The large expenditure increases in bottled water appeared to be greater in low-income than high-income households for purchasing prevalence (355 and 172%, p = 0.32) and food budget share (665 and 468%, p = 0.09), but greater in high-income households for per-capita expenditure (121 and 373%, p < 0.01) and income share (83 and 397%, p = 0.50). CONCLUSIONS: The sweetened-beverage tax was associated with reduced soft drink purchasing and increased bottled water expenditure. Low-income households appeared to have slightly greater declines in soft drink expenditure.