Prime Minister for a day: children's views on junk food marketing and what to do about it.

AIMS: This study explored children's awareness of and engagement with food marketing, and their views on action to address it. METHODS: A purposeful sample of 33 children (11-13 years) from the Wellington region of New Zealand were interviewed. RESULTS: Children were knowledgeable about food marketing, although most were not aware of the extent to which they were exposed. Children did not distinguish 'marketing to children' from other marketing. According to the children, they were frequently exposed to food marketing, and persuaded, against their better judgement, to purchase food they knew to be harmful to their health. As many children recognised the unhealthy nature of the food marketed to them, they agreed they would take action to reduce junk food marketing if they were Prime Minister for a day. Interventions included making food marketing honest, providing nutrition information, removing billboards and increasing the promotion of healthy food. CONCLUSIONS: These findings suggest children's exposure to junk food marketing may cause them physical, mental and moral harm, in direct contradiction of the New Zealand self-regulatory code for marketing. The children's views align with the World Health Assembly's recent decision to endorse initiatives to end childhood obesity, including restricting marketing of unhealthy foods.

Competing teammates: food in New Zealand sports settings.

Despite the global popularity of sport, we know surprisingly little about food in sports settings. This two-phased study analysed the foods available in New Zealand sports settings. Phase one included a systematic literature review and 18 interviews with key informants from national and regional sporting organizations. Phase two involved 37 key informant interviews with stakeholders from two exemplar sports, rugby and netball and direct observations at netball and rugby venues. This study found most foods and beverages at New Zealand sports events were energy-dense and nutrient-poor. Caterers' control over food provision, socio-cultural attitudes which view unhealthy foods as normal, and a dominant profit motive, appear to be the key factors influencing the food environment in sports settings. Food environments in sport settings provide frequent opportunities to purchase and consume energy-dense, nutrient-poor foods. The research shows we have competing players in the sports context-unhealthy food and healthy physical activity. Achieving sustainable healthy change in sports settings will be challenging when the prevailing attitude normalizes the unhealthy environment. Nutrition policies in sports clubs are urgently needed to increase the availability of healthy food. This requires support from health agencies and leadership from national sports organizations. Given the international nature of the food industry and sport, these findings from New Zealand may assist other countries to better understand the nature of food in sport and adopt appropriate interventions to reduce the obesogenic environment that is sport.

Process, pitfalls and profits: lessons from interviewing New Zealand policy-makers.

Little has been written about interviewing policy-makers in health promotion and public health research. This article explores the process, pitfalls and profits of semi-structured interviews with policy-makers in 10 research projects conducted in New Zealand. Key members of each research team were surveyed about their research and findings verified against research publications. Key aspects of the process of policy-maker interviews include gaining ethical approval, navigating gatekeepers, using personal contacts and multiple research dissemination methods. Pitfalls of interviewing policy-makers include interviewers not having enough knowledge of the topic so efforts were made to use knowledgeable researchers or up-skill others. Interviews provide access to specialist knowledge of the policy process which cannot be obtained by other methods. While this study was conducted in one jurisdiction, it has implications for other countries. Effective policy-maker interviews in health promotion policy research could contribute to improvements in the quality of data collected and uptake of research by policy-makers.

Appetite for health-related food taxes: New Zealand stakeholder views.

There is increasing discussion globally of the value of health-related food taxes and subsidies to address obesity and noncommunicable diseases. In order for such policies to be successful it is important to understand the positions of key stakeholders. This research investigated New Zealand (NZ) stakeholders' views on the feasibility and acceptability of selected health-related food taxes and subsidies over the next 5 to 10 years. Twenty semi-structured interviews were undertaken by telephone from November 2014 to May 2015. The purposive sample of key stakeholders included politicians, bureaucrats, public health experts, food industry leaders and consumer representatives. Prior to interviews participants were sent summary information on the estimated impacts of a range of health-related food taxes and subsidies on dietary intake and mortality. According to key stakeholders there appears to be little appetite for taxes on foods high in saturated fat or salt in NZ. Stakeholders largely agreed that a tax on sugar-sweetened beverages (SSBs) and a subsidy on fruit and vegetables were both feasible and likely acceptable. There was strong support for starting with a SSBs tax, possibly framed around protecting children and dental health. Addressing obesity and noncommunicable diseases is a multidimensional challenge. A tax on SSBs and a subsidy on fruit and vegetables, possibly in tandem, could be part of the solution in NZ. There is growing interest in, and evidence for, health-related taxes and subsidies internationally. Given the critical role of stakeholder support for such policies similar research on stakeholders' views may assist the implementation of health-related food taxes and subsidies in other jurisdictions.

Kids'Cam: An Objective Methodology to Study the World in Which Children Live.

INTRODUCTION: This paper reports on a new methodology to objectively study the world in which children live. The primary research study (Kids'Cam Food Marketing) illustrates the method; numerous ancillary studies include exploration of children's exposure to alcohol, smoking, "blue" space and gambling, and their use of "green" space, transport, and sun protection. METHODS: One hundred sixty-eight randomly selected children (aged 11-13 years) recruited from 16 randomly selected schools in Wellington, New Zealand used wearable cameras and GPS units for 4 days, recording imagery every 7 seconds and longitude/latitude locations every 5 seconds. Data were collected from July 2014 to June 2015. Analysis commenced in 2015 and is ongoing. Bespoke software was used to manually code images for variables of interest including setting, marketing media, and product category to produce variables for statistical analysis. GPS data were extracted and cleaned in ArcGIS, version 10.3 for exposure spatial analysis. RESULTS: Approximately 1.4 million images and 2.2 million GPS coordinates were generated (most were usable) from many settings including the difficult to measure aspects of exposures in the home, at school, and during leisure time. The method is ethical, legal, and acceptable to children and the wider community. CONCLUSIONS: This methodology enabled objective analysis of the world in which children live. The main arm examined the frequency and nature of children's exposure to food and beverage marketing and provided data on difficult to measure settings. The methodology will likely generate robust evidence facilitating more effective policymaking to address numerous public health concerns.

Tackling 'wicked' health promotion problems: a New Zealand case study.

This paper reports on a complex environmental approach to addressing 'wicked' health promotion problems devised to inform policy for enhancing food security and physical activity among Maori, Pacific and low-income people in New Zealand. This multi-phase research utilized literature reviews, focus groups, stakeholder workshops and key informant interviews. Participants included members of affected communities, policy-makers and academics. Results suggest that food security and physical activity 'emerge' from complex systems. Key areas for intervention include availability of money within households; the cost of food; improvements in urban design and culturally specific physical activity programmes. Seventeen prioritized intervention areas were explored in-depth and recommendations for action identified. These include healthy food subsidies, increasing the statutory minimum wage rate and enhancing open space and connectivity in communities. This approach has moved away from seeking individual solutions to complex social problems. In doing so, it has enabled the mapping of the relevant systems and the identification of a range of interventions while taking account of the views of affected communities and the concerns of policy-makers. The complex environmental approach used in this research provides a method to identify how to intervene in complex systems that may be relevant to other 'wicked' health promotion problems.