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.

Inclusion of indigenous and ethnic minority populations in intervention trials: challenges and strategies in a New Zealand supermarket study.

BACKGROUND: The Supermarket Healthy Options Project (SHOP) is a large, randomised, controlled trial designed to evaluate the effect of tailored nutrition education and price discounts on supermarket food purchases. A key objective was to recruit approximately equal numbers of Maori, Pacific and non-Maori, non-Pacific shoppers. This paper describes the recruitment strategies used and evaluates their impact on recruitment of Maori, Pacific and non-Maori, non-Pacific trial participants. METHODS: Trial recruitment strategies included mailed invitations to an electronic register of supermarket customers; in-store targeted recruitment; and community-based recruitment. RESULTS: Of the 1103 total trial randomisations for whom ethnicity was known, 247 (22%) were Maori, 101 (9%) Pacific and 755 (68%) were non-Maori, non-Pacific shoppers. Mailed invitations produced the greatest proportion of randomisations (73% vs 7% in-store, and 20% from community recruitment). However, in-store and community recruitment were essential to boost Maori and Pacific samples. The cost of mailout (NZ$40 (14 pounds) per randomised participant) was considerably less than the cost of community and in-store recruitment (NZ$301 (105 pounds) per randomised participant). CONCLUSIONS: The findings demonstrate considerable challenges and cost in recruiting indigenous and minority ethnic participants into intervention trials. Researchers and funding organisations should allocate more resources to recruitment of indigenous and minority populations than to recruitment of majority populations. Community recruitment and networks appear to be better ways to recruit these populations than passive strategies like mailouts.

Induction of differential patterns of local cerebral glucose metabolism and immediate-early genes by acute clozapine and haloperidol.

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.