Neighbourhoods for Healthy Kids: A Child-centred Investigation Into the Role of the Built Environment on Child Body Size

Abstract

A summary for this thesis is in the form of a short, fun, online video. To view please visit https://www.youtube.com/watch?v=FXXlVeEQ_IE Or put “Neighbouhoods for healthy kids” into the search box on YouTube.

Background: Neighbourhood built environments can promote or hinder health-promoting behaviours such as physical activity and dietary behaviours in children. The aim of this thesis was to contribute to a greater understanding of possible associations between physical activity and nutrition built environments and child body size. Child-centred methodologies and triangulation of multiple data sources may yield in-depth understanding of the relationships between these variables.

Methods: Cross-sectional data from children (aged 8 – 13 years) and primary and intermediate schools participating in the Neighbourhoods for Active Kids Study in Auckland New Zealand were used. Google Street View was used to map outdoor advertising around schools. Objective measures of the built environment were derived using Geographic Information Systems. Children’s neighbourhood destinations, perceptions and preferences were captured using public participation geographic information systems (PPGIS). Children’s physical activity was assessed using 7-day accelerometery and children answered an online survey on their dietary behaviours. Children’s height, weight, and waist circumference were objectively measured by trained researchers. Knowledge translation efforts were employed throughout the research process.

Analysis: Structural equation modelling was used to assess associations between the built environment and physical activity and dietary behaviours and waist to height ratio (WtHR). The Kids-PoND framework for children’s neighbourhood use and preferences was developed using content analysis from the PPGIS, based on the theory of affordances.

Results: 1102 children from 19 schools participated in this body of work. Google Street View shows promise for assessing obesogenic advertising in children’s neighbourhoods. No association was found between the neighbourhood built environment and WtHR. A statistically significant inverse relationship between a positive physical activity built environment and a poor nutrition built environment was found. Children from neighbourhoods of high deprivation were more likely to have greater WtHRs. Children mentioned spending time with friends and purchasing and consuming unhealthy food as important activities in neighbourhood destinations.

Conclusions: Neighbourhood built environments are associated with health-promoting behaviours in children. Quantitative modelling found no relationship between the neighbourhood built environment and children’s WtHR. However, the significant, inverse relationship between a positive physical activity-promoting environment and a poor nutrition environment, in combination with children’s use and perceptions of neighbourhood destinations, has important implications for public health and urban planning. There is evidence that inequalities exist particularly for poorer nutrition environments in areas of high deprivation. Findings may indicate that promoting better physical activity built environments in the absence of concurrent restriction of poor nutrition environments may intensify health inequalities. Multi-level approaches, including environmental policies and practices to promote positive health behaviours in children may have a substantial positive impact on body size outcomes and help to reduce health inequalities. Research opportunities exist to build upon this body of work and further investigate the role of food purchasing behaviour in children’s neighbourhoods and the role of social relationships on dietary behaviours.

NOTE: Chapters 4-6 inclusive, Appendices are embargoed until 21 March 2022