Improving low fruit and vegetable intake in children: Findings from a system dynamics, community group model building study.

Many children globally do not meet government guidelines for daily fruit and vegetable intake, and in New Zealand, adherence to the vegetable intake recommendation is declining. This study aimed to identify systemic barriers to children meeting fruit and vegetable (FV) guidelines and generate sustainable actions within a local community to improve children's FV intake. A qualitative system dynamics method of community group model building was used. The research team partnered with Healthy Families Waitakere, a Ministry of Health funded prevention initiative, to recruit 17 participants (including students, parents, teachers, community leaders, local retailers and health promoters) from a low-income, ethnically-diverse community in West Auckland, New Zealand. Three group model building workshops were held during which a systems map was created and used to identify actions by considering causal pathways and reinforcing loops in the system. Barriers to children's FV intake identified by participants were the saturation of fast-food outlets in the community and ubiquitous marketing of these products, the high cost of fresh produce compared to fast food, and parents having little time for food preparation plus declining cooking skills and knowledge. Several actions to improve children's FV intake by improving the local food environment were identified, which will be co-designed further and tested by a collaborative group involving community leaders. This project highlights the effectiveness of group model building for engaging a local community in systems change to improve child nutrition, and supplies a blueprint for future qualitative system dynamics research.

Food swamps by area socioeconomic deprivation in New Zealand: a national study.

OBJECTIVES: A nationwide spatial analysis of community retail food environments in relation to area socioeconomic deprivation was conducted in New Zealand. METHODS: Addresses from about 20,000 registered food outlets were retrieved from all 66 Councils. Outlets were classified, geocoded and (spatially) validated. The analysis included 4087 convenience, 4316 fast food/takeaway and 1271 supermarket and fruit/vegetable outlets and excluded outlets not considered 'healthy' or 'unhealthy'. The population-weighted density of different outlet types in Census areas and the proximity to different outlet types from Meshblock centres were calculated and associations with area socioeconomic deprivation assessed. Spatial scan statistics was used to identify food swamp areas with a significantly higher relative density of unhealthy outlets than other areas. RESULTS: A significantly positive association was observed between area deprivation and density of all retailers. A significantly negative association was observed between area deprivation and proximity to all retailers. Nationwide, 722 Census areas were identified as food swamps. CONCLUSIONS: Access to food retailers is significantly higher in more deprived areas than in less deprived areas. Restricting unhealthy outlets in areas with a high relative density of those outlets is recommended.

Obesogenic Retail Food Environments Around New Zealand Schools: A National Study.

INTRODUCTION: This is the first nationwide spatial analysis of retail food environments around more and less socioeconomically deprived schools in New Zealand. METHODS: Addresses from all food outlets were retrieved from 66 City and District Councils in 2014. All fast food, takeaway, and convenience outlets (FFTCs) were geocoded and (spatially) validated in 2015. Density and proximity of FFTCs around/from all schools were stratified by urban/rural area and quintile of school socioeconomic deprivation. RESULTS: About 68.5% urban and 14.0% rural schools had a convenience store within 800 m; 62.0% urban and 9.5% rural schools had a fast food or takeaway outlet within 800 m. Median road distance to the closest convenience store from urban schools was significantly higher for the least (617 m) versus the most deprived (521 m) schools (p<0.001); the opposite was found for rural schools. Median FFTC density was 2.4 (0.8-4.8) per km(2) and maximum density was 85 per km(2) within 800 m of urban schools. Median density of convenience stores around the least deprived urban schools was significantly lower than around the most deprived schools (p<0.01). CONCLUSIONS: Access to unhealthy foods through FFTCs within walking distance from urban schools is substantial in New Zealand, and greater for the most versus the least deprived schools. Health promoters should work with retailers to explore feasible actions to reduce children's exposure to unhealthy foods before and after school, and provisions to allow Councils to restrict new FFTCs in school neighborhoods could be included in the Local Government Act.