Perceptions of New Zealand nutrition labels by Maori, Pacific and low-income shoppers.

BACKGROUND: In New Zealand the burden of nutrition-related disease is greatest among Maori, Pacific and low-income peoples. Nutrition labels have the potential to promote healthy food choices and eating behaviours. To date, there has been a noticeable lack of research among indigenous peoples, ethnic minorities and low-income populations regarding their perceptions, use and understanding of nutrition labels. Our aim was to evaluate perceptions of New Zealand nutrition labels by Maori, Pacific and low-income peoples and to explore improvements or alternatives to current labelling systems. METHODS: Maori, Samoan and Tongan researchers recruited participants who were regular food shoppers. Six focus groups were conducted which involved 158 people in total: one Maori group, one Samoan, one Tongan, and three low-income groups. RESULTS: Maori, Pacific and low-income New Zealanders rarely use nutrition labels to assist them with their food purchases for a number of reasons, including lack of time to read labels, lack of understanding, shopping habits and relative absence of simple nutrition labels on the low-cost foods they purchase. CONCLUSIONS: Current New Zealand nutrition labels are not meeting the needs of those who need them most. Possible improvements include targeted social marketing and education campaigns, increasing the number of low-cost foods with voluntary nutrition labels, a reduction in the price of 'healthy' food, and consideration of an alternative mandatory nutrition labelling system that uses simple imagery like traffic lights.

Strategies to promote healthier food purchases: a pilot supermarket intervention study.

OBJECTIVE: To pilot the design and methodology for a large randomised controlled trial (RCT) of two interventions to promote healthier food purchasing: culturally appropriate nutrition education and price discounts. DESIGN: A 12-week, single-blind, pilot RCT. Effects on food purchases were measured using individualised electronic shopping data ('Shop 'N Go' system). Partial data were also collected on food expenditure at other (non-supermarket) retail outlets. SETTING: A supermarket in Wellington, New Zealand. PARTICIPANTS: Eligible customers were those who were the main household shoppers, shopped mainly at the participating store, and were registered to use the Shop 'N Go system. Ninety-seven supermarket customers (72% women; age 40 +/- 9.6 years, mean +/- standard deviation) were randomised to one of four intervention groups: price discounts, nutrition education, a combination of price discounts and nutrition education, or control (no intervention). RESULTS: There was a 98% follow-up rate of participants, with 85% of all reported supermarket purchases being captured via the electronic data collection system. The pilot did, however, demonstrate difficulty recruiting Maori, Pacific and low-income shoppers using the electronic register and mail-out. CONCLUSIONS: This pilot study showed that electronic sales data capture is a viable way to measure effects of study interventions on food purchases in supermarkets, and points to the feasibility of conducting a large-scale RCT to evaluate the effectiveness of price discounts and nutrition education. Recruitment strategies will, however, need to be modified for the main trial in order to ensure inclusion of all ethnic and socio-economic groups.

No association of neighbourhood volunteerism with mortality in New Zealand: a national multilevel cohort study.

BACKGROUND: The association of social capital with health and mortality is contentious, and empirical findings are inconsistent. This study tests the association of neighbourhood-level volunteerism with mortality. METHODS: Cohort study of 1996 New Zealand census respondents aged 25-74 years (4.75 million person years) using multilevel Poisson regression analyses. Neighbourhood (average population 2,034) measures included indices of social capital (volunteering activities for all census respondents) and deprivation. RESULTS: Adjusting for just age and marital status, the mortality rate ratios for people living in the quintile of neighbourhoods with the lowest compared with highest volunteerism were 1.16 (95% confidence interval 1.08-1.24) and 1.09 (1.01-1.18), for males and females, respectively. Adjusting for potential individual-level and neighbourhood-level socioeconomic confounders reduced the rate ratios to 0.94 (0.88-1.01) and 0.92 (0.85-1.01), respectively. There was no significant association with any cause of death, including suicide [rate ratios 0.89 (0.64-1.22) and 0.57 (0.31-1.05), respectively]. Restricting the analyses to only those census respondents living at their census night address for five or more years, and therefore 'exposed' to that level of volunteerism for a longer period, did not substantially alter findings. CONCLUSIONS: This study, one of the largest multilevel studies yet, found no statistically significant independent association of a structural measure of neighbourhood social capital with mortality-including suicide. Assuming social features of neighbourhoods are important determinants of health, future research should examine other features (e.g. social fragmentation) and other outcomes (e.g. behaviour).

Effectiveness of monetary incentives in modifying dietary behavior:a review of randomized, controlled trials.

To review research evidence on the effectiveness of monetary incentives in modifying dietary behavior, we conducted a systematic review of randomized, controlled trials (RCTs) identified from electronic bibliographic databases and reference lists of retrieved relevant articles. Studies eligible for inclusion met the following criteria: RCT comparing a form of monetary incentive with a comparative intervention or control; incentives were a central component of the study intervention and their effect was able to be disaggregated from other intervention components; study participants were community-based; and outcome variables included anthropometric or dietary assessment measures. Data were extracted on study populations, setting, interventions, outcome variables, trial duration, and follow-up. Appraisal of trial methodological quality was undertaken based on comparability of baseline characteristics, randomization method, allocation concealment, blinding, follow-up, and use of intention-to-treat analysis. Four RCTs were identified as meeting the inclusion criteria. All four trials demonstrated a positive effect of monetary incentives on food purchases, food consumption, or weight loss. However, the trials had some methodological limitations including small sample sizes and short durations. In addition, no studies to date have assessed effects according to socioeconomic or ethnic group or measured the cost-effectiveness of such schemes. Monetary incentives are a promising strategy to modify dietary behavior, but more research is needed to address the gaps in evidence. In particular, larger, long-term RCTs are needed with population groups at high risk of nutrition-related diseases.