Using Google Earth to Assess Shade for Sun Protection in Urban Recreation Spaces: Methods and Results.

Shade in public spaces can lower the risk of and sun burning and skin cancer. However, existing methods of auditing shade require travel between sites, and sunny weather conditions. This study aimed to evaluate the feasibility of free computer software-Google Earth-for assessing shade in urban open spaces. A shade projection method was developed that uses Google Earth street view and aerial images to estimate shade at solar noon on the summer solstice, irrespective of the date of image capture. Three researchers used the method to separately estimate shade cover over pre-defined activity areas in a sample of 45 New Zealand urban open spaces, including 24 playgrounds, 12 beaches and 9 outdoor pools. Outcome measures included method accuracy (assessed by comparison with a subsample of field observations of 10 of the settings) and inter-rater reliability. Of the 164 activity areas identified in the 45 settings, most (83%) had no shade cover. The method identified most activity areas in playgrounds (85%) and beaches (93%) and was accurate for assessing shade over these areas (predictive values of 100%). Only 8% of activity areas at outdoor pools were identified, due to a lack of street view images. Reliability for shade cover estimates was excellent (intraclass correlation coefficient of 0.97, 95% CI 0.97-0.98). Google Earth appears to be a reasonably accurate and reliable and shade audit tool for playgrounds and beaches. The findings are relevant for programmes focused on supporting the development of healthy urban open spaces.

Children's everyday exposure to food marketing: an objective analysis using wearable cameras.

BACKGROUND: Over the past three decades the global prevalence of childhood overweight and obesity has increased by 47%. Marketing of energy-dense nutrient-poor foods and beverages contributes to this worldwide increase. Previous research on food marketing to children largely uses self-report, reporting by parents, or third-party observation of children's environments, with the focus mostly on single settings and/or media. This paper reports on innovative research, Kids'Cam, in which children wore cameras to examine the frequency and nature of everyday exposure to food marketing across multiple media and settings. METHODS: Kids'Cam was a cross-sectional study of 168 children (mean age 12.6 years, SD = 0.5) in Wellington, New Zealand. Each child wore a wearable camera on four consecutive days, capturing images automatically every seven seconds. Images were manually coded as either recommended (core) or not recommended (non-core) to be marketed to children by setting, marketing medium, and product category. Images in convenience stores and supermarkets were excluded as marketing examples were considered too numerous to count. RESULTS: On average, children were exposed to non-core food marketing 27.3 times a day (95% CI 24.8, 30.1) across all settings. This was more than twice their average exposure to core food marketing (12.3 per day, 95% CI 8.7, 17.4). Most non-core exposures occurred at home (33%), in public spaces (30%) and at school (19%). Food packaging was the predominant marketing medium (74% and 64% for core and non-core foods) followed by signs (21% and 28% for core and non-core). Sugary drinks, fast food, confectionary and snack foods were the most commonly encountered non-core foods marketed. Rates were calculated using Poisson regression. CONCLUSIONS: Children in this study were frequently exposed, across multiple settings, to marketing of non-core foods not recommended to be marketed to children. The study provides further evidence of the need for urgent action to reduce children's exposure to marketing of unhealthy foods, and suggests the settings and media in which to act. Such action is necessary if the Commission on Ending Childhood Obesity's vision is to be achieved.

Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review.

BACKGROUND: Comorbidity is very common among patients with cancer. Multidisciplinary team meetings (MDTs) are increasingly the context within which cancer treatment decisions are made internationally. Little is known about how comorbidity is considered, or impacts decisions, in MDTs. METHODS: A systematic literature review was conducted to evaluate previous evidence on consideration, and impact, of comorbidity in cancer MDT treatment decision making. Twenty-one original studies were included. RESULTS: Lack of information on comorbidity in MDTs impedes the ability of MDT members to make treatment recommendations, and for those recommendations to be implemented among patients with comorbidity. Where treatment is different from that recommended due to comorbidity, it is more conservative, despite evidence that such treatment may be tolerated and effective. MDT members are likely to be unaware of the extent to which issues such as comorbidity are ignored. CONCLUSIONS: MDTs should systematically consider treatment of patients with comorbidity. Further research is needed to assist clinicians to undertake MDT decision making that appropriately addresses comorbidity. If this were to occur, it would likely contribute to improved outcomes for cancer patients with comorbidities.

Availability and marketing of food and beverages to children through sports settings: a systematic review.

OBJECTIVE: The current systematic review aimed to identify and critically appraise research on food environments in sports settings, including research into the types of food and beverages available, the extent and impact of food and beverage sponsorship and marketing, and views about food environments among key stakeholders. DESIGN: A systematic review. Fourteen English-language studies (two were papers describing different facets of the same study), published between 1985 and 2011, were identified from searches of electronic databases and bibliographies of primary studies. SETTING: Most studies originated from Australia (n 10), with the remaining studies originating in the UK (n 1), New Zealand (n 1), the USA (n 1) and Canada (n 1). Data were collected from observations in stadia, websites and televised sports events, through in-depth interviews, focus groups and surveys with sports club members, parents and quick serve restaurant managers. RESULTS: Literature exploring food environments in sports settings was limited and had some important methodological limitations. No studies comprehensively described foods available at clubs or stadia, and only one explored the association between food and beverage sponsorship and club incomes. Club policies focused on the impact of health promotion funding rather than the impact of sponsorship or food availability in sports settings. CONCLUSIONS: Further research, including comprehensive studies of the food environment in sports settings, is required to document the availability, sponsorship and marketing of food and beverages at national, regional and club levels and to estimate how sports settings may influence children's diets.

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

BACKGROUND AND AIM: Neighbourhood alcohol availability has been associated with alcohol consumption by children, despite children rarely acquiring alcohol from retailers. This study explores one potential reason for this finding, by evaluating the relationships between neighbourhood alcohol availability and children's actual exposure to alcohol marketing. METHOD: Wearable cameras and GPS devices were worn by 167 children (aged 11-13 y) over a four-day period. Image and GPS data were linked and compared to known alcohol availability data. RESULTS: Off-licence retailer availability and ethnicity were positively associated with children's exposure to marketing in both residential and school neighbourhoods. CONCLUSION: Neighbourhood off-licence alcohol retailers are associated with increased childhood exposure to alcohol marketing.

Children's and parents' opinions on the sport-related food environment: a systematic review.

Sport is a key setting for interventions to address child obesity given its obesogenic nature. Understanding children's and parents' opinions on the sport-related food environment is critical in developing effective programmes and policies to improve children's health. This systematic review synthesizes quantitative and qualitative research examining children's and parents' opinions on the sport-related food environment. During July 2016, a range of electronic databases of academic and grey literature were searched. Thirty-two publications (11 including children, 17 parents and 4 both) were included for review. The publications were assessed using the Analysis Grid for Environments Linked to Obesity framework to categorize the sport-related food environment into the physical, sociocultural, economic and political environments. The literature available investigating children's and parents' opinions of the sport-related food environment suggests that many children and parents consider the environment neither conducive to nor supportive of children's healthy food behaviours or wider health and well-being. Both groups would likely support actions to change and improve it. This systematic review found that original research specifically investigating children's and parents' perspectives on almost all aspects of the sport-related food environment is limited. Thus, there is scope for further investigation into this important part of children's food environments.

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

BACKGROUND AND AIM: Exposure to alcohol marketing within alcohol retailers has been associated with higher rates of childhood drinking, brand recognition, and marketing recall. This study aimed to objectively measure children's everyday exposure to alcohol marketing within supermarkets. METHOD: Children aged 11-13 (n = 167) each wore a wearable camera and GPS device for four consecutive days. Micro-spatial analyses were used to examine exposures within supermarkets. RESULTS: In alcohol retailing supermarkets (n = 30), children encountered alcohol marketing on 85% of their visits (n = 78). Alcohol marketing was frequently near everyday goods (bread and milk) or entrance/exit. CONCLUSION: Alcohol sales in supermarkets should be banned in order to protect children from alcohol marketing.

Kids in space: Measuring children's residential neighborhoods and other destinations using activity space GPS and wearable camera data.

INTRODUCTION: Defining the boundary of children's 'neighborhoods' has important implications for understanding the contextual influences on child health. Additionally, insight into activities that occur outside people's neighborhoods may indicate exposures that place-based studies cannot detect. This study aimed to 1) extend current neighborhood research, using data from wearable cameras and GPS devices that were worn over several days in an urban setting; 2) define the boundary of children's neighborhoods by using leisure time activity space data; and 3) determine the destinations visited by children in their leisure time, outside their neighborhoods. METHOD: One hundred and fourteen children (mean age 12y) from Wellington, New Zealand wore wearable cameras and GPS recorders. Residential Euclidean buffers at incremental distances were paired with GPS data (thereby identifying time spent in different places) to explore alternative definitions of neighborhood boundaries. Children's neighborhood boundary was at 500 m. A newly developed software application was used to identify 'destinations' visited outside the neighborhood by specifying space-time parameters. Image data from wearable cameras were used to determine the type of destination. RESULTS: Children spent over half of their leisure time within 500 m of their homes. Children left their neighborhood predominantly to visit school (for leisure purposes), other residential locations (e.g. to visit friends) and food retail outlets (e.g. convenience stores, fast food outlets). Children spent more time at food retail outlets than at structured sport and in outdoor recreation locations combined. CONCLUSION: Person-centered neighborhood definitions may serve to better represent children's everyday experiences and neighborhood exposures than previous methods based on place-based measures. As schools and other residential locations (friends and family) are important destinations outside the neighborhood, such destinations should be taken into account. The combination of image data and activity space GPS data provides a more robust approach to understanding children's neighborhoods and activity spaces.

A case study of health goals in New Zealand.

OBJECTIVE: This paper outlines the New Zealand experience in using health goals and examines its strengths and weaknesses from an 'insiders's' perspective. METHOD: This paper reports on a review of the New Zealand health goals framework conducted in 1996-97. The review centred on a discussion paper, written submissions on it, and consultation meetings with the public, the public health sector and relevant government agencies. RESULTS: It is argued that the framework usefully shaped public health activity in New Zealand and should be retained with a focus on strengthening public health action. Health goals have been developed in New Zealand at a time of considerable change in the health sector. Although this change has been disruptive, it has also provided benefits such as the emergence of new providers. The strengths of the New Zealand framework have included: its inclusiveness, the consultation that occurred in developing it, and the monitoring and reporting system. Ongoing challenges, such as reorienting the health sector and developing a formal intersectoral strategy, are also identified. CONCLUSION: The paper concludes that the current health goals framework has the potential to frame future public health action in New Zealand, but that the increasing mainstreaming of the public health function poses some risk. IMPLICATIONS: The insight provided by the New Zealand case on the implementation of a health goals framework may assist public health planners in other jurisdictions.

A systematic review of persuasive marketing techniques to promote food to children on television.

The ubiquitous marketing of energy-dense, nutrient-poor food and beverages is a key modifiable influence on childhood dietary patterns and obesity. Much of the research on television food advertising is focused on identifying and quantifying unhealthy food marketing with comparatively few studies examining persuasive marketing techniques to promote unhealthy food to children. This review identifies the most frequently documented persuasive marketing techniques to promote food to children via television. A systematic search of eight online databases using key search terms identified 267 unique articles. Thirty-eight articles met the inclusion criteria. A narrative synthesis of the reviewed studies revealed the most commonly reported persuasive techniques used on television to promote food to children. These were the use of premium offers, promotional characters, nutrition and health-related claims, the theme of taste, and the emotional appeal of fun. Identifying and documenting these commonly reported persuasive marketing techniques to promote food to children on television is critical for the monitoring and evaluation of advertising codes and industry pledges and the development of further regulation in this area. This has a strong potential to curbing the international obesity epidemic besieging children throughout the world.

Framing obesity: the framing contest between industry and public health at the New Zealand inquiry into obesity.

Drawing on submissions to the 2006-2007 New Zealand Inquiry into Obesity and Type 2 Diabetes, this article outlines how the food and marketing industries (industry) and the public health sector framed the issue of obesity. The analysis revealed that industry framed obesity as a consequence of poor lifestyle choices attributed largely to knowledge, cultural or other character deficits. Industry argued that lack of physical activity rather than increased food consumption was the dominant cause of obesity. In contrast, public health groups positioned obesity as a normal response to an obesogenic environment, characterized by the ubiquitous marketing and availability of low-cost, energy-dense/nutrient-poor foods. For public health groups, increased consumption of energy-dense/nutrient-poor foods was positioned as the dominant cause of obesity. Many public health submitters also suggested that social inequalities contributed to obesity. Industry emphasized education as the key solution to obesity, while public health groups argued for regulation of the activities of the food and marketing industries, and policies to address wider determinants of health and social inequalities. Identifying and documenting these frames, by making transparent the interests of the frame's sponsors, contributes to greater understanding of the wider policy context around obesity and provides useful information for public health advocacy.