A Snapshot of Kiwi Kids’ Environment · A Snapshot of Kiwi Kids’ Environment Project Authors:...

4thYearMBChBPublicHealthProject2014

ThroughtheLookingGlass:

ASnapshotofKiwiKids’Environment

ProjectAuthors:JordanAitcheson,KylieAllison,MohammedAlsinan,JordanBaldwin,

AbigailBoyer,Aterea-JamesBrown,NinaChambers,PhilipDabrowski,CharlotteDuley,

MichaelFleete,BridgetGilmour,HenryGribben,HelenaHalley,DanielHermann,Dylan

Hohepa,SophieKyrke-Smith,AnwenMaddock,SunnivaJones

Abstract

Children’swellbeingisanimportantfacetoftoday’ssociety,giventhatchildrenrepresentthefuture

ofourcommunity.Despitethis,NZhaspoorrecordswithregardtochildren’shealth.Thisstudy

addresses,firstly,whetherchildrenlivinginNewZealandgrowupinahealthyenvironmentand,

secondly,whetherusingdigitalcameratechnologyisafeasiblemethodofobservingthis

environment.NewZealandEuropean,MaoriandPasifikachildrenworeportablecamerasaround

theirnecksforfourdays;thecamerasautomaticallytookphotographseverytenseconds.We

analysedtheresulting106,688imagesforexposurestoalcohol,tobaccoproducts,andinfluenceson

screentime,self-image,methodsoftransportandthedinnerenvironment.Wefoundthat,onthe

whole,theparticipants’environmentcontainedmanypotentiallyhealth-modifyingexposures.

Elevenoutoftwelveparticipantswereexposedtoalcoholinvariousforms.Onlytwoparticipants

wereexposedtotobaccouse.Averagescreentimewasbelowtheinternationalrecommended

average.Therewasawidevarietyofexposurestoself-imageinfluences.Therewasobservedtobea

widevarietyoftransportmethodssharedbetweenthedifferentethnicities.Dinnerenvironmentwas

alsoanalysedanditwasshownthattherewereavarietyofsettingsinwhichfamiliesatetheirmeals.

Wealsofoundthatdigitalcameratechnologywasaneffectivetoolforobservingthe

afforementionedexposuresandwouldbeusefulinfuture,morecomprehensivestudies.Potential

limitationsincludedsocialdesirabilitybias,selectionbiasandmisseddata.Thecamerashave

widespreadpotentialforfutureapplicationstoresearch.

1.Introduction

SupportinggoodhealthamongourchildrenshouldbeanimportantgoalforNewZealanders.

Unfortunately,NewZealand’schildrecordcomparedtoothernationsiswoeful.TheOrganisationfor

EconomicCo-OperationandDevelopment(OECD)recentlyrankedNewZealandtwenty-ninthoutof

thirtyforchildhoodhealthandsafety(OECD,2009).ThisreportalsofoundthatNewZealandwas:

● 21stforinfantmortality;

● 20thforthepercentageofchildrenlivinginpoorhouses;

● had14timestheaverageOECDrateofrheumaticfever;

● hadratesofwhoopingcoughandpneumoniafivetotentimesgreaterthantheUnited

KingdomandUnitedStates.

Additionally,NewZealandhasahighrateofchildinjury(Chalmers&Pless,2001)aswellashigh

ratesofchildabuseandchildneglect(Adamson,Brown,Micklewright,Schnepf,&Wright,2003).

NewZealandgovernmentspendingisbelowtheOECDaverageforallchildhoodagegroups,while

NewZealandhasthehighestratesofyouthsuicideintheOECD(OECD,2009).

Oneofthemajorfactorsinfluencingchildren’shealthistheirenvironment.A‘healthy’physicaland

socialenvironmentisrecognisedasadeterminantofhealth;achild’senvironmentalsoprovides

safety,opportunitiesforsocialintegration,andtheabilitytopredictand/orcontrolaspectsofthat

environment.An‘unhealthy’environmentthreatenssafetyandunderminesthecreationofsocial

ties(Taylor&Repetti.,1997).Forexample,afavourablesocialenvironmentwaspositivelyassociated

withseveralmeasuresofphysicalactivityandthatphysicalactivitywasnegativelyassociatedwith

obesityinchildren(Franzini,etal.,2009).

Theadventofautomatedcameratechnologyhasprovidedresearcherswithanovelmethodof

objectivelyrecordingasubject’senvironment.Theautomateddigitalrecordingofone’sday-to-day

activitiesusingacamera,or“lifelogging”(Sellen,Aitken,Hodges,Rother,&Wood,2007)followed

Microsoft’sdevelopmenttheSenseCamin1999(Microsoft,2013);asmalldigitalcamerathatcanbe

wornonalanyardaroundtheneckthatautomaticallytakestwotothreedigitalpicturesevery

minute.Thedevicerespondstobuilt-insensorsortoauser-programmabletimer.TheSenseCam

wasoriginallyusedinhealthresearchtoaidinrehabilitationofpatientswithcognitiveimpairment

(Pauly-TakacsK,2011)andmemorylossafteracquiredbraininjury(BrindleyR,2011).

Theuseofwearablecameratechnologyhasrecentlybecomeapopularresearchtooltoobjectively

measurelife-stylebehavioursandthecontextinwhichtheyoccur.Thisisespeciallyrelevantas

lifestylebehavioursareincreasinglyassociatedwithmortalityfromnon-communicablediseases,yet

therelationshipsbetweenlifestylebehavioursandhealthoutcomesareusuallybasedonself-

reporteddata.Automatedcamerasinresearchpotentiallyreducetherecallbiasassociatedwith

self-reporting.

Ourstudyusesautomatedcamerastoqualitativelyevaluatetheenvironmentof13childrenof

varyingethnicitiesanddecilesintheWellingtonregion.OurdatawasobtainedfromtheKids'Cam

study,aprojectleadbyAssociateProfessorLouiseSignalattheUniversityofOtago,Wellington.

2.Aims&Objectives

Thisstudyaimedtoaddresstworesearchquestions:

1) DoNewZealandchildrengrowupinanenvironmentthatsupportstheirhealthandwell-

being?

2) Whatpublichealthissuescanbeobservedusingautomatedcameras?

Weuseddatafromautomatedcamerasandglobalpositioningsystemstoprovideanobjective

evaluationoftheenvironmentsof15Wellingtonchildren.Comparisonoftheseenvironmental

influencestodemographicdataallowedustodetermineaspectsthatmaycontributeto,ordetract

from,theirhealthandwellbeing.Theareasofinterestaredefinedas:

● Exposuretoalcohol

● Exposuretosmoking

● Timespendengagedwithascreen(e.g.computer,cellphone,videogamuse)

● Perceptionofthehumanform

● Transporttoandfromschool

● DinnerEnvironment

3.LiteratureReview

Wereviewedtheliteratureforcurrentopinionontheeffectofthoseaspectsofchildren’s

environmentthathadthepotentialtoaffecttheirhealthandwellbeing.

Alcohol

Excessive alcohol consumption and alcohol misuse is a major preventable cause of death and

hospitalization in New Zealand (Alcohol Advisory Council of New Zealand, 2005). The burden of

alcohol misuse affects individuals and the people in their environment, including infants and

children. Exposure to unhealthy parental behaviours, including alcohol use, smoking and

overfeeding,wasfoundtohavenegativeimpactsonchildren’shealth(Bell,McNaughton,&Salmon,

2009), including physical and behavioural issues. Bijur et al. (1992) examined the association

between children’s health and parental drinking in American children by specifically looking at

seriousinjuriesthatresultinhospitalization.Theyconcludedthatchildrenofmotherscategorisedas

problem drinkers were 2.1 times more likely to be involved in serious injury in comparison to

childrenofnon-drinkers.Theriskofseriousinjurytochildrenincreasesto2.7whenbothparentsare

problemdrinkers(Bijur,Kurzon,Overpeck,&Scheidt,1992).

Parentalalcoholusealsonegatively impactschildren’sbehaviour.Thechildrenofproblemdrinkers

frequentlysufferfromlessparentalcontacttimeandadysfunctionalfamilystructurecomparedto

childrenfromhouseholdswithoutaproblem-drinkingparent(SnowJones,Miller,&Salkever.,1999).

Parentalattitudesanddrinkinghabitsalsoplayapart in theirchild’sattitudetowardsalcoholuse.

Greaterparentaldisapprovalof alcohol is associatedwith less involvementwith friendsandpeers

whousealcohol,lesspeerinfluencetousealcohol,greaterself-efficacyforavoidingalcoholuseand

lower subsequent alcohol-use-related problems (Nash, McQueen, & Bray, 2005). Furthermore,

parentswho established clear alcohol-specific rules lowered the likelihood of their child drinking,

regardless of the child’s age. However, this effect seems to diminish if the child has already

establishedadrinkingpattern(VanDerVorst,Engels,Dekovic,Meeus,&Vermulst,2007).

Smoking

Tobaccouseisoneofthelargestpublichealthconcernsworldwide.Morethanfivemilliondeaths

areattributedtodirecttobaccousewhilemorethan600,000aretheresultofbeingexposedto

second-handsmoking(WHO).InNewZealand,morethan650,000peoplecurrentlysmokeona

regularbasis;therateamongyouthsaged15-17fellto6%in2011/2012(NZMinistryofHealth,

2012).

Childrenwhoseparentssmokehaveanincreasedriskofhavingnightcoughs,snoring,andearly

respiratoryinfectionscomparedtootherchildren(Forastiére,GiuseppeM.Corbo,Pistelli,Nera

Agabiti,Ciappi,&Perucci.,1992)andparentalsmokingisdirectlyassociatedwithsignificant

childhoodmorbidity(Aligne&Stoddard,1997).AstudybyWeitzmanetal(1992)foundalink

betweenchildhoodbehaviouralproblemsandmaternalcigarettesmokinginadose-response

relationship(Weitzman,Gortmaker,&Sobol,1992).

Childhoodandadolescentsmokingisamultifactorialphenomenonthatisinfluencedbylocaland

socialfactors.Parentalorhouseholdmemberssmokingstatusisacrucialfactorindeterminingthe

smokingbehaviourinchildren(Pustetal,2007).Otherfactorsinfluencingchildhoodandadolescent

smokingincludesocioeconomicstatusandthehighestlevelofschoolingattained.Tobacco

consumptionisassociatedwithlowersocioeconomicstrataandlowlevelofschooling(Pust,

Mohnen,&Schneider,2008).InNewZealand,peoplelivinginsocioeconomicallydeprivedareasare

2.5timesaslikelytosmokeaspeopleintheleastdeprivedsocioeconomicareas(NZMinistryof

Health,2012).

Thetobaccoindustryspendsbillionsofdollarsinpromotingtobaccosmokingusingvariousmedia

includingnewspapers,magazinesandTV.Exposuretotheseadvertisementshasbeenfoundto

increasethelikelihoodfortobaccouseamongstchildren(DiFranza,Wellman,Sargent,Weitzman,

Hipple,&Winickoff,2006).Luckily,however,anti-tobaccoadvertisingcampaignsandwarningsdo

reducethenumberofchildrenwhobeginsmokingandincreasethenumberofsmokerswhoquit

(WHO).InNewZealand,however,notobaccoadvertisinghasbeenallowedfollowingthe

introductionoftheSmoke-freeEnvironmentsAct,1990.

ScreenTime

Highscreentime(television,video,computerandelectronicgameuse)isdefinedas≥2hoursper

dayandveryhighscreentimeas≥4hoursperdayandtheAmericanAcademyofPaediatrics

recommendationsnotmorethan2hoursofscreentimeperdayinschool-agechildren.Despitethis,

BiddleshowedScottishadolescentswatched,onaveragejustbelow2hoursoftelevisionon

weekdaysand2.5hoursonweekenddays,withapproximately25%ofchildrenwatchingmorethan

4hoursperdayonweekends(Biddle,Gorely,Marshall,&Cameron.,2009).InAmericascreentimeis

higherstill.Andersonfoundthat65%of4-11yearoldsspend,onaverage,morethan2hoursperday

usingcomputersortelevision(Anderson,Economos,&Must,2008).84%ofCanadianyouth(10-

16yrs)havemorethan2hoursoftelevisionandcomputerscreentimeperday,withanaveragetotal

screentimeofmorethan4hoursperday(Mark,Boyce,&Janssen,2006).Mostadolescentswatch

between2and2.5hoursoftelevisionperday,withaccesstoacomputerorvideogamesincreasing

screentimeby30to45minutes;thesepatternsaresimilaracrossEuropeandNorthAmerica

(Marshall,Gorely,&Biddle,2006).Furthermore,themostdeprivedareathighestriskofhighscreen

time.Havingalowerparentalincome,beingasingleparent,havinglowereducationalattainment

andalowersocio-economicstatusareallcorrelatedwithhigherscreentime(Salmon,Tremblay,

Marshall,&Hume,2011).

Highscreentimehasbeenassociatedwithincreasedriskofbeingoverweight,obeseandpre-

diabetic.Hillreviewedthegrowingagreementthattheenvironment,notbiology,isdrivingan

obesityepidemic;anincreaseintimespentonsedentaryactivitiessuchaswatchingtelevision,

surfingtheWeb,andplayingvideogameswasimplicated(Hill,Wyatt,Reed,&Peters,2003).Mark

andJanssen(2008)foundadose-responserelationshipbetweenscreentimeandthemetabolic

syndromein1803Canadianadolescents.Theprevalenceofthemetabolicsyndromewas3.7%inthe

youthwhohad≤1hourofscreentimeperday,increasinglinearlyto8.4%inthe≥5hoursperday

group(Mark,Boyce,&Janssen,2006).

Highscreen-basedmediausehasalsobeencorrelatedwithphysicalaggression,cigarettesmoking

andalcoholuseinCanadianandAmericanyouth(Iannotti,Kogan,Janssen,&Boyce,2009).Theonly

positivehealthoutcomethathasbeenlinkedtohighscreentimeisimprovedqualityofpeer

relationships(Iannotti,Kogan,Janssen,&Boyce,2009).Ithasbeensuggestedthattheeffectsofhigh

screentimearesimplyduetolowphysicalactivity.Timespentbehindascreenistimenotspent

beingactive,howevertheadverseeffectsremaintrueevenaftercontrollingforlowactivitylevels,

whichsuggestsscreentimeisanindependentriskfactorforpoorerhealthoutcomesinadolescence

(Mark2008;Ianotti2009).

Factorsassociatedwithhighscreentimeincludeperceivedlackofneighbourhoodsafety,livingin

urbanareasandparentalattitudestoscreenuseeg.allowingTVatmealtimes;TV’sinchildren’s

bedrooms(Salmon,Tremblay,Marshall,&Hume,2011).Interventionstoreducetelevisiontime

havehadvaryingsuccess.Ashighscreenuseisabehaviouralhabit,successfulinterventionsare

likelytorequireexternalregulatorsofscreenuse,removalofenvironmentalpromptsandlongterm

follow-up(Salmon,Tremblay,Marshall,&Hume,2011).Themosteffectiveinterventionshavehigh

levelsofparentalinvolvementanduseelectronicmonitoringofscreenuseorclinic-based

counselling.Interventionsaremosteffectiveonchildrenwhoarealreadyoverweightorobeseat

baseline(Schmidt,etal.,2012).Currentresearchonscreentimeinadolescentsreliesonself-reports

orparent-reportsofuse,introducingthepossibilityofbiasorinaccuraciesindata.Thereisan

opportunityformoreobjectivemeasuresofbehaviourtobetterassesschildren’sactualscreenuse.

PerceptionoftheHumanForm

Theoriesofbodyimagesuggestthatbodydissatisfactionresultsfromunrealisticsocietalbeauty

ideals;onemethodoftransmittingtheseidealsisthroughmassmedia(Hargreaves&Tiggemann,

2004).Hargreavesetal.studiedtheeffectofexposuretoimagesofidealisedbeautyinthemediaon

adolescentgirlsandboy’sbodyimage.Bodyimagewasassessedbeforeandafterviewing

commercials.Theyfoundanincreaseinbodyimagedissatisfactionamonggirlsbutnotamongboys

(Hargreaves&Tiggemann,2004).Ontelevisionprogrammes,therangeofacceptablebodytypes

portrayedforwomenwasfoundtobenarrowerthanformen,withobesewomenthesinglegroup

mostlikelytobethetargetofjokes(Smolak,2003).Smolak’sresearchsuggeststhatupto40%of

lateelementaryschoolgirlsexperiencebodydissatisfaction,andthatgirlsseemtobemoredirectly

andextensivelyaffectedbymediaimagesthanboys(Smolak,2003).Inaddition,manymoregirls’

magazinesfocusonappearance,andgirlsaremorelikelytoreadmagazines(Smolak,2003).

Incomparison,Cohaneetal.(2001)reviewedtheliteratureregardingbodyimageamongboys.The

reviewfoundthatalthoughgirlsfrequentlywantedtobethinner,boyfrequentlywantedtobe

bigger(Cohane&Pope.,2001).However,boysdisplayedlessdissatisfactionwiththeirbodies

comparedtogirls.

TransportToandFromSchool

Activetransporttoschoolisanimportantfactorusedtoincreasetheamountofphysicalactivityof

youngchildren(Faulkner).InFaulkner’ssystematicreviewtheeffectsofactivetransportonbody

weightwereinvestigatedincurrentliterature.Theobjectiveofthisstudywastoassesswhether

therewasarelationshipbetweenmodeoftraveltoschoolandobjectivemeasuresoflevelsof

activityinchildren.Elevenofthethirteenstudiesobservedthatchildrenwhohadactivetransport

toschool,weremorephysicallyactivethanthosewhousedmotorisedtransport.Theaccelerometer

wasmostcommonlyusedtoassesslevelsofphysicalactivity.Ofnote,thisinvestigationfoundthat

therewasoftenalackofdetailintheincludedstudiesofhowparticipantswherewereclassifiedas

beingactiveorpassiveschoolcommuters,whereparticipantsweregenerallyasked“theirusual

methodoftransport,to/fromschool”.

InMerom’sstudy,researchersusedatelephoneinterviewtoasktheparentsofschoolchildrenin

NSWtheirmethodoftransporttoschool.Optionsincludedwalk,cycle,andtravelbycarorpublic

transport.Parentswerealsorequiredtoestimatethetimespenttravelling.Overalllessthanhalfthe

childrenwere“activecommuters”.Ofthosewhowerefoundtobeactivecommutertheaverage

journeywasfoundtobeshort,onaverage4-7minutes.

DinnerEnvironment

Non-communicablediseaseslikeobesityanddiabetesimpactthehealthandwellbeingofchildrenin

NewZealand.Thesediseaseshavemodifiableriskfactorsthatincludedietaryintake.Childrenwhose

familieswatchTVduringmealtimeeatfewerfruitandvegetablesandmoretakeawayandsnack

foods(Coon2001).Eatingfrequentlyatfastfoodrestaurantsareassociatedwithhighenergyintake

andinverselyassociatedwitheatingfruit,vegetablesandmilkinadolescents(French2001).A

systematicreviewexaminedthefamilyandsocialfactorsthatinfluencechildren’seatingpatterns

anddietquality(Heather2005).Theysuggestedthattopromotehealthyeatingpatternsinchildren

itisnecessarytotargetfamiliesandschoolstoo.

AutomatedCameraUseinChildren’sHealthResearch

Automatedcamerashavebeenusedtorecordenergyintakeinpreviousresearch.Theimages

generatedbySenseCamenhancetheaccuracyofself-reporteddietarypatterns,withself-reported

energyintakebyincreasingby12.5%comparedwith24hourrecallalone(Gemming2013).When

combinedwithfooddiaryreporting,theSenseCamalsoincreasestheaccuracyoftotalenergyintake

estimatesbysubjects(O’Loughlin2013).

Untilrecently,automatedcameratechnologyhasbeenprimarilyinadult-focusedresearchregarding

healthbehaviourssuchassedentarytransporttowork.Researchofthisnaturehasbeenusefulto

thosedesigningactivetransportationinterventions(KellyP.,Doherty,Berry,Hodges,Alan,&Foster,

2011).Theuseofcamerasinchildrenhasbeenusedtoassessthefeasibilityofchildren’sexposureto

foodmarketingandsedentarybehaviour(Barr,Signal,Jenkin,&Smith.,2013).

Automatedcamerashavebeenusedasanaidinresearchclassifyingsedentarybehaviourinfree-

livingsettings(Kerr,etal.,2013).Thisstudyhighlightedtheadvantagesofwearablecamerasover

accelerometersinprovidingtypeandcontextinformationaboutsedentarybehaviour,as-wellas

identifyingerrorsinself-reportedinformationabouttraveltimes.Physicalactivitycanbeassociated

withimportanthealthoutcomesinchildren(KellyP.,Doherty,Berry,Hodges,Alan,&Foster,2011).

Automatedcamerashavealsobeenusedinchildrentoevaluatefeasibilityofmeasuringtravelto

school,whereprevioustothismeasurementwasbasedaroundself-reportedjourneytime,whichis

subjecttohumanerror(KellyP.,Doherty,Berry,Hodges,Alan,&Foster,2011).

Todatetherehasbeennouseofwearablecamerastoassesstheexposureofotheraspectsof

environmenttochildren;anovelareaforresearchdevelopment.

LimitationsandChallenges

Theuseofautomatedcamerasinlife-logging,especiallyintheanalysisoftheeverydayactivitiesof

thewearer,createsachallengingamountofworkforresearchers.Therearelargevolumesofvisual

imageswithsignificantamountsofrepetitivedata.Manualcodingofdataistimeconsumingand

canintroducecodingerrors(Kerr,etal.,2013).Barretal(2013)usedonlyasmallsampleof

participantsandhighlightedthatmanualcodingonalargescalemaynotbefeasible.Thisisanarea

thatneedstobeaddressedinfurtherstudies.

EthicalConsiderations

Thereareanumberofethicalissuesidentifiedintheliteratureregardingautomatedcamerasasan

investigatingtoolintohealthbehaviours(Kelly,etal.,2013).Thelargevolumesofimagedatacreate

confidentialityandsecurityissues;datamustbestoredsecurelywithpasswordprotectedsoftware

toavoidbecomingpublic(Kelly,etal.,2013).Theuseoftheimagesmustbeinaccordancewiththe

studyaimsandinformedconsentmustbeobtainedfromtheparticipants.However,confidentiality

oftheparticipantandthirdpartiesmaynotalwaysbepossible,andinformedconsentmaynotbe

abletobesuppliedbyindividualsthattheparticipantcomesintocontactwith,whohavetheirimage

captured.Somecameras,includingMicrosoft’sSenseCam,containaprivacyfunctionwhichhalts

imagecaptureforasettimeperiod(Kelly,etal.,2013).Despitethesefeatures,participantsmustbe

allowedaccesstothephotossotheycanscreenforunwantedimages,e.g.,iftheyforgottheywere

wearingthecamerainaprivatesetting.Thisshouldoccurpriortohandingthedatatoresearches

(Kelly,etal.,2013).

4.Methods

LiteratureReview

WeperformedaliteraturesearchusingMedline,INNZandGoogleScholarduringtheperiod

September30thtoOctober21st,2014.Theprojectsupervisorsprovidedadditionalliteratureand

publishedmaterial.Searchtermsincluded:

● childANDenvironmentANDhealth

● alcoholANDchildrenANDenvironment

● alcoholANDchildrenANDhealth

● smokingANDchildrenANDhealth

● bodyANDimageANDchildren

● childrenANDfoodANDmeals

● screenANDuseANDchildren

EthicsApproval

ThisstudyreceivedethicsapprovalfromtheUniversityofOtagoHumanEthicsCommittee(RefNo.

13/220).Protocol for themanagementofprivacyandsafety issueswasput inplaceaspartof the

widerKids'Camstudy.Thisprotocol includedensuring theprovisionof informationtoparticipants,

requiring informed consent from participants, their parents and the participating school; the

developmentofprotocolsfordatacollectionanddatahandlingtoprotecttheprivacy,confidentiality

andanonymityofparticipantsandthirdpartiescapturedintheimages(Barr,Signal,Jenkin,&Smith.,

UsingSenseCamtoCaptureChildren’sExposuretoFoodMarketing:AFeasibilityStudy,2013).

Participants

VolunteerYear8studentswererecruitedfrom24schoolsacrossWellingtontotakepartinthelarger

Kids'Cam study,with 214 students selected in total. For this study, 15 students (aged 12-13)who

gathereddata inAugust2014wereselectedfromthe214 inthewiderstudy.Afterdatareview, it

wasfoundthatthreeoftheparticipantshadlessthanfivehoursofdatafromthefourdaysofdata

collection,andthesethreeweresubsequentlyremovedfromthestudypopulation.

The participating schools were sorted into three categories based on theMinistry of Education’s

decilerankings.Deciles1-3wereclassifiedaslow,4-7asmediumand8-10ashigh.Oneschoolwas

randomlychosenfromeachcategory;fivestudentswerethenrandomlyselectedfromeachschool,

stratified by ethnicity. The 12 participants with full data sets included four high decile Māori

students, fivemedium decile NZ European students and three low decile Pasifika students. There

were four boys and eight girls. The majority of the students had low NZiDep scores (i.e. less

deprived),with10havinganNZiDep scoreof1or2 andonehavinga scoreof3.Oneparticipant

from the high decile school had the highest possible NZiDep score of 5 (i.e. most deprived).

Demographicinformationforthe12studentsisdisplayedinTable1.

InclusionandExclusionCriteria

Theinclusioncriteriarequiredachild’sexpressionofinterestinparticipatinginthestudy,provision

ofwritten consent, and commitment to attendance ofmultiple sessions at school. These sessions

wereeitherduringclasstime,duringlunchtimesorbeforeorafterschool.Theprovisionofwritten

parentalconsenttoparticipateandtorecordimagesinthehomeenvironmentwasalsopartofthe

inclusioncriteria.Childrenwereonlyincludediftheyhadcollectedmorethanfivehoursofdataover

thefourdays.

A lack of desire to participate by either the parent or child, or a refusal of parental consent,

comprisedthemainexclusioncriteria.Childrenwhowereunabletoeithercollectdataorcopewith

therequirementsofthestudy,duetodisabilityorcircumstance,werealsoexcluded.

Table1:Baselinecharacteristics

Student Schooldecile Gender Dateofbirth Ethnicity-selected Ethnicities-selfidentified NZiDep

1 7 F 16/06/02 NZE NZE 1

2 7 M 24/04/02 NZE NZE 2

3 7 M 09/05/02 NZE NZE 1

4 7 M 21/01/02 NZE NZE 1

5 7 F 23/12/01 NZE NZE 2

6 9 F 08/04/02 Maori Maori,Samoan,Chinese 5

7 9 F 30/09/01 Maori NZE,Maori 1

8 9 M 28/11/01 Maori NZE,Maori 1

9 9 F 18/06/01 Maori NZE,Maori,Dutch 1

10 2 F 17/09/01 Pacific Tokelauan 3

11 2 F 13/05/01 Pacific Tokelauan 2

12 2 F 02/01/02 Pacific Samoan,CookIslandMaori 2

Student Smokingathome

Smokinginotherplacesregularlyvisited

Height(m)

Weight(kg) BMI

BMI–ageandsexadjustedpercentile

BMI–convertedto

adultequivalent

Ageatdatacollection(years)

1 No No 1.57 35.2 14.21 1st(underweight) 17 12.2

2 No No 1.61 46.0 17.75 45th 23 12.3

3 No No 1.42 31.1 15.51 9th 18.5 12.3

4 No No 1.59 39.3 15.58 8th 18.5 12.6

5 No No 1.59 50.3 19.90 67th 23 12.6

6 Yes No 1.59 66.0 25.98 95th(obese) 30 12.4

7 No No 1.62 53.9 20.51 71st 23 12.9

8 No No 1.55 37.1 15.54 6th 18.5 12.7

9 Yes No 1.64 48.0 17.89 36th 18.5 13.2

10 Yes Yes 1.54 54.6 23.02 87th(overweight) 25 12.9

11 Yes Yes 1.60 50.4 19.76 61st 23 13.3

12 Yes No 1.62 46.9 17.87 41st 18.5 12.6

NoteonBMI:Children’sBMIsmustbecomparedwithotherchildrenofthesameageandsex.Theycaneitherbeconverted

toanadultequivalentBMI(Cole&Lobstein,2012)ortheappropriateadjustmentscanbemadetofindhowacertainchild

comparestoothersofthesameageandsex(i.e.tofindwhatpercentiletheyarein).Childrenlessthanthe5thpercentile

areunderweight,inthe5thtolessthanthe85thpercentileareofahealthyweight,inthe85thtolessthanthe95th

percentileareoverweightandinthe95thpercentileoraboveareobese(CDC)

DataCollection

BriefingSession

Abriefingsessionwasheldwithallstudyparticipantstodiscusstheethical,legalandpracticalissues

associatedwithusingthevariousrecordingdevices;tofamiliariseparticipantswiththedevices;and

todiscusswhattheywouldbeaskedtododuringdatacollection.

TheKids'Camprojectwasexplainedtotheparticipantsandtheywereinstructedtowearacamera

andGPSrecorderfor4days,includingtwoweekdaysandtwoweekenddays.Participantsweretold

thattheycanremovethedevicesatanytimeforanyreason,andtheywereencouragedtoremove

theminsituationswhereothersmaybeuncomfortablewiththeirpresence.Additionally,theywere

told to remove the camera before entering: changing rooms (school, club, and swimming pool);

toilet or shower facilities; or in any other situation or location inwhich people could be partially

clothed or would feel uncomfortable being photographed, for example in healthcare facilities.

Participants were asked to either activate the privacy setting on the camera when using the

bathroomorchanging,ortoturnoffandremovethedevice.Theywerealsoadvisedtoremovethe

camera if entering retail outlets where signage advises that photography is not permitted. The

participantswereadvisedtoremovethecamerasinanycaseswheredamagemightoccur,i.e.heavy

rainorvigorousphysicalactivity.

Participants were briefed on how to handle any attention they may receive while wearing the

camera.Ifchallengedbythirdparties,participantswereadvisedtoexplainthattheyareparticipating

inastudybeingconductedbyresearchersfromtheUniversityofOtago,Wellington;thattheproject

aims todocument theirenvironmentand that theyarewearingacamera thatautomatically takes

picturescontinuallythroughouttheday.Furthermore,theywereadvisedtostatethattheyarenot

intentionallytakingphotographsofspecificpeopleorplaces.Asanalternative,theywereprovided

with informationcards tohandout if challengedby thirdpartieswhilewearing thecamera. They

werealsoencouragedtotellthirdpartiestocontacttheKids'Camresearchteamusingthecontact

details given on the information card if they required additional information or had further

questions.

ReviewSession

On the firstweekday following the participants’ four-day data collection period, the deviceswere

collectedandthedatawasdownloadedontoa laptopcomputerusingpurpose-designedsoftware.

The participants were then able to review their images and (in private) remove any sensitive or

personal photographs. Participants were also asked questions to determine the extent of their

usageofthecameraandGPS.

Asatokenofappreciation,schoolswereprovidedwithbookvouchersandaletterofthanksatthe

endofdatacollectioninlieuoftheirtimeandassistanceinrecruitingandprovidingfacilitiesfordata

collection.Participantsreceivedacertificateandvouchertothankthemfortheirparticipationand

time.

DataAnalysis

Followingdatacollection,theimagesfromthe12participantsweredownloadedontoashareddrive

andwerereviewedmanuallytoidentifyandcodeanyexposurestothepre-definedcontributorsto

healthandwell-being.Thisinvolvedtwocodersviewingeachphotoanddecidingifitfellintothe

pre-determinedcodingcategory.

Alcohol

Everyphotocontainingalcohol,imagesofalcoholoradvertisingofalcoholwasclassifiedas:

● Drinking(others)

● Drinking(self)

● Bottlesorboxes

● Alcoholadvertisingorretail

● Recycling

● Legalsignage

● Art

Apre-codedschedulewasusedtorecorddataonthetypeofexposureandthedateitoccurred.We

didnotincludeimagesofalcoholseenoncomputerorTVscreens,asthephotoqualitywasnot

sufficienttoaccuratelyseewhatwasonscreensviewedbyparticipants.Ifthesameexposure(e.g.to

thesamebottle)occurredmultipletimes,itwasonlycountedasoneexposureperday.

Smoking

Allphotoscontainingsmoking,imagesofsmoking,orsmokefreesignswereclassifiedaseither:

● Cigarettesmoking

● Cigarettepackets

● Ashtrays

● Smokefreesigns

Apre-codedschedulewasusedtorecorddataonthetypeofexposureandthedateitoccurred.

ImagesseenoncomputerorTVscreenswerenotincluded.Ifthesameexposureoccurredmultiple

times,itwasonlycountedasoneexposureperday.

ScreenTime

Imageswereincludedifan‘on’screencouldbeseen,thattheparticipantwaspresumablylookingat.

Thisincludedpartialscreenswiththeparticipantsittinginfrontofit,butdidnotincludescreensthat

someoneelsewas in frontof, forexample,aparentusingthecomputer.Variations inscreentype

werealsorecorded.Thesevariationswere:

● Computer

● Television

● Phone

● Mobiledevice(tablets,iPads,Nintendos)

● Multiplescreens(morethanoneactivescreenviewed)

Datawascompiledforeachparticipantandanalysedtodeterminetimeofexposureinhours.This

analysisassumedthateachimagerepresented10secondsofscreentime.Timeofexposurewas

thenaveragedoverthetwelveparticipantsfordaily,totalanddevice-specificscreentimevalues.

PerceptionoftheHumanForm

Allpicturesthatportrayedthehumanformwereidentifiedandclassifiedonapre-codedschedule

whichincludedthefollowingcategories:

• MagazineandNewspaperAdvertisements

• BillboardAdvertisement

• BeautyProductsorObjects

• ClothingBrands

• TelevisionProgrammesandInternetVideos

• VideoGames

• SocialMedia

• Posters

• Books

• DVDandBookCovers

• FoodPackaging

Datawaslabelledwithcategory,time,date,andspecificsrelatedtothecategory(e.g.locationof

exposure,gender,approximateage,descriptionofthepersonseen).Exposureswerecountedasa

singleevent,ratherthancountingthenumberofphotoscontainingtheexposure.Ifthesame

exposureoccurredonaseparateoccasionitwascountedagainasaseparateevent.Aseparate

occasionwasdefinedasoccurringafterthechildhadlefttheexposureforadifferentactivityand

thencameback,excludingbreaksforfoodathomeandbathroombreaks.

TransportToandFromSchool

Tripstoandfromschoolwereclassifiedbymodeoftransport:

● Car

● Walking

● Scooter

● Bus

● Acombinationoftransportmodes

Tripstoschoolwerecountedseparatelyfromtripsfromschool.

DinnerEnvironment

Allphotosweresearchedforevidenceofamaineveningmealeatenbetweenthehoursof5-9pm

only.Thesearchwasstoppedoncethemealhadbeenidentified.Nosnacksordessertsnotedwithin

thistimeperiodwererecorded.Mealswereseparatedintofourmaincategories:

• Home-cookedmeals

• Ready-mademeals(onlyneededheatingbeforeconsumption)

• Takeaways

• Restaurantmeals

Allmealswerealsoexaminedtoidentifywhethertheycontainedvegetables(excludingpotatoesand

pizzatoppings).

Mealswerealsocategorizeddependingonwherethemealtookplace.Thecategorieswere:

• Mealeatenatfamilydiningtable

• Mealeateninfrontoftelevision

• Mealeatenoutsideofhome

• Other

SpatialAnalysis

TheGIS(geographic informationsystem)softwareArcGIS10.2.2wasusedtocreateamapforeach

participant.TheGPScoordinateswereuploadedandconvertedtoaGPXfile.Amapwascreatedfor

eachparticipantwithalloftheGPSdatatheycollectedduringthe4daystudyperiodusingArcMap.

Theparticipant’smovementswereplottedonthemapfortheperiodswhentheyhadtheGPSon.

The ‘Community’ base map was added and the map was zoomed to a level where all of the

participant’sdatapointscouldbeobservedononemap.Finally,themapwasexportedasa.jpegfile

(FigureA1-12).

5.Results

Exposuretoalcohol

11outof12participantswereexposedtoalcoholinsomewayduringthe4daysofthestudy.This

includedexposuretodrinking,bottles,advertisingandlegalsignage.Themostcommonexposure

wastobottlesinthehousehold,whichtenoutoftwelveparticipantswitnessed.Themostcommon

typeofexposuretobottleswaswine,butwealsosawbeerbottles,aswellasbottlesofvodkaand

otherspirits.Bottleswereoftenseenonthekitchenbenchandinthefridge(Images1-4).Allofthe

participantsofEuropeanethnicitywereexposedtobottlesintheirhomes.Incontrast,only3ofthe

Maoriparticipants(75%)and2ofthePacificparticipants(67%)wereexposed.

Otherexamplesofalcoholbottlesthatwereseenwerealcoholstorageinthehome(image5),bottle

collectionsinthegarage(image6)andbottlesseeninrecyclingbinsinthestreet(image7).

Image1.Exposuretobeerbottleonkitchenbench07/08/14

Image2.Exposuretovodkabottleonkitchenbench08/08/14

Image3.Exposuretowinebottleinfridge10/10/14 Image4.Exposuretowinebottlesonbenchandinfridge08/08/14

Image7.Participantcarryingalcoholbottlestorecyclingbin10/08/14

Sevenofthetwelveparticipantswereexposedtosomeformofalcoholadvertisingorretail.This

includedpaperadvertsing(image8),thealcoholsectioninsupermarkets(image9)andliquorstores

(image10)..

Image8.Exposuretoalcoholadvertisinginflyer16/08/14

Image5.Exposuretowinestorageinthehome07/08/14

Image6.Exposuretoalcoholbottlecollectioningarage15/08/14

Image9.Exposuretoalcoholretailinsupermarket10/08/14

Image10.Exposuretoliquorstore10/08/14

Therewasrelativelylittleexposuretolegalsignage,withonlytwoofthetwelveparticipantsbeing

exposedtosignsrelatingtothepermissibilityofalcoholconsumption(image11).

Image11.Exposuretoliquorbansignage16/08/14

Fourparticipantswitnessedalcoholbeingconsumedaroundthem,whichineverycasewasdueto

parentsandotheradultsdrinkingwineorbeerinthecontextofafamilydinner(images12and13).

Onlyoneparticipantwasseentobedrinkingwhatwaspresumablywinehimself,duringwhat

appearedtobeaShabbatdinner(images14and15).

Image13.Exposuretoadultdrinkingalcoholatdinnertable07/08/14

Image12.Exposuretoadultsdrinkingalcoholatdinnertable09/08/14

Images14&15.ParticipantdrinkingalcoholatShabbatdinner08/08/14

AllofthefourparticipantswhowereexposedtoactualdrinkingwereofNewZealandEuropean

ethnicityandwereeither1or2ontheNZiDepindex.Outofthetenparticipantswhowereexposed

tobottles,fivewereNewZealandEuropean,threewereMāoriandtwowerePacific.

EuropeanandPacificparticipantsweremorelikelytobeexposedtoanykindofalcohol(bottles,

drinking,advertisingorsignage)onaweekdaythanaweekend.Europeanparticipantswereexposed

toalcoholon100%ofweekdaysand80%ofweekenddays.Pacificparticipantswereexposedto

alcoholon67%ofweekdaysand50%ofweekenddays.Incontrast,Maoriparticipantswereexposed

toalcoholmorefrequentlyonweekenddays(63%)thanweekdays(38%).

Smoking

Onlytwoparticipantswereexposedtoanytypeofsmokingorcigarettepackaging.Thefirst

participantwitnessedanadult(presumablyaparent)withanunlitcigaretteinhermouthbothinand

outsidethehouse(images1and2).Therewasalsoevidenceofwhatappearedtobeanashtrayin

herhouse(image3).Thesecondparticipanthadexposuretoapacketofroll-your-owntobacco

(image4)andwitnessedanadultrollingacigarette(images5and6).Bothoftheseparticipantswere

ofPacificethnicity.Forbothoftheparticipants,theexposureoccurredontheweekendandthe

personsmokingwassomeoneknowntothechild.

Images1&2.Exposuretoparentsmoking16/08/14

Image3.Exposuretoashtray16/08/14 Image4.Exposuretocigarettepackaging17/08/14

Images5&6.Exposuretocigarettepackageandadultrollingacigarette17/08/14

Fourparticipantswereexposedtosmokefreesignsinpublicbuildings(image7),andoneotherchild

ownedseveral“auahikore”(smokefree)drinkbottles(image8).Alloftheseparticipantswereeither

MāoriorPacificethnicity.

ScreenTime

Overall,wefoundthattheparticipantswereexposedto7.3hoursofscreentimeoverthefourdays.

Eachdaytheywereexposedto,onaverage,1.8hoursofscreentime.Themaximumamountof

screentimeforaparticipantinonedaywas7.1hours;theminimumscreentimewas0hours.

Overall,participantswereexposedtoscreensonadailybasis.

Participantssawscreensinavarietyofsettings,whichweremainlywithintheirhomeenvironment.

Participantsalsoviewedscreensatvariouspointsthroughouttheday,thepatternsincluded;

watchingascreenastheypreparedforschool,usingscreensforhomeworkdirectlyafterschoolas

wellasaregularexposuretoscreensinthelateafternoonspriortothecamerasbeingturnedoff.

Image8.Exposuretosmokefreedrinkbottle21/08/14

Image7:Exposuretosmokefreesign17/08/14

45%

35%

7%

6%7%

ScreenType

computer

tv

phone

mobiledevice

muluplescreens

Screentypesincluded:computer,TV,phone,mobiledeviceandmultiplescreens.Thescreentypes

seenvariedbetweenthedifferentethinicities.NZEuropeanparticipantswereexposedto3.4screen

typesonaverage,whilstMaoriandPacificparticipantssaw2.7screentypes.

Table1Screentimedataset

Computer

Onaverage,participantswereexposedto0.81hoursofcomputertimeeachday,withamaximum

dailyexposureof6hoursforoneparticipant.Personalcomputersandlaptopswereusedfora

varietyofpurposesincluding:gaming,socialmedia,homework,music,googlingandmovies.

Computer TV Phone Mobiledevice Multiplescreens TotalScreens

Averagetotaltime 3.25 2.55 0.51 0.48 0.50 7.29Averagedailytime 0.81 0.64 0.13 0.14 0.12 1.8Maximumdailytime 6.04 5.8 0.69 1.68 2.14 7.13

Minimumdailytime 0 0 0 0 0 0

Image2.Exposuretoacomputerscreenwhilstgamingoneevening21/08/14

Image1.Exposuretocomputerscreenwhilsteatingbreakfast10/08/14

MobileDevice

Onaverage,participantswereexposedto0.14hoursofscreentimeonmobiledevices,witha

maximumdailyexposureof1.68hoursforoneparticipant.Mobiledevicesweredefinedaspersonal

computingdevices,whichincluded:tabletsi-padsandNintendo.Thesedeviceswereusedfora

varietyofpurposes.Outsidethehouse,theywerecommonlyusedoncarrides.

MultipleScreens

Onaverage,participantswereexposedto0.12hoursofmultiplescreenseachday,withamaximum

dailyexposureof2.14hoursforoneparticipant.Themostcommonscenarioformultiplescreens

wasusingatabletorphone,whilsttheTVwasoninthebackground.

Image4.ExposuretoaNintendo-mobiledevice8/8/14Image3.Exposuretoatablet/mobiledevice7/8/14

Image6.Exposuretoatabletandtelevision21/8/14Image5.Exposuretoaphoneandlaptopscreen10/8/14

Phone

Onaverage,participantswereexposedto0.13hoursofmobilephonetimeeachday,witha

maximumdailyexposureof0.51hoursforoneparticipant.Phoneswereusedforavarietyof

purposes,including:communication,gaming,socialmedia,photographyandwebsearching.

TV

Onaverage,participantswereexposedto0.64hoursofTVtimeeachday,withamaximumdaily

exposureof5.8hoursforoneparticipant.TVwaswatchedbeforeschool,afterschool,andinthe

weekend.Somefamiliesatedinnerinfrontofthetelevision,whilstothersatebreakfastinfrontofit.

TheTVwasplayinginthebackgroundformostoftheeveninginsomehouseholds.

Image8.Exposuretoaphonescreen48/8/14Image7.Exposuretoaphonescreenforcommunication9/8/14

Image10.ExposuretoTVscreenwhilsteatingdinner7/8/14Image9.ExposuretoTVscreenwhilstgaming9/8/14

PerceptionofHumanForm

Thereweremultipledifferentexposurestoportrayalsofthehumanform.Itistheseexposuresthat

maycontributetowhatisseenasthe‘social-norm’andhaveapotentialinfluenceovertheself-

imagerelatedbehavioursoftheseparticipants.Repetitionofexposuresillustratingsocialstatus,

physiqueandappearancemaycreateaperceivedideaofwhata‘normal’personis.

MagazinesandNewspaperAdvertisements

Magazines/newspaperadvertisementswereseenatthesupermarket,dairiesorintheparticipants’s

ownhomes.Inthesupermarketsanddairiesitwasonlythecoversofmagazinesseen;inthe

participants’shomesitwascoversaswellasarticles,andnewspaperadvertisements.Morethanhalf

oftheparticipants(7/12)hadatleastonephotographcontainingamagazine.Manyofthemagazine

covershadAmericanandBritishcelebritiesonthem.Thesepotentialexposurescontributetowhat

beingsuccessfulandfamousmaylooklike,orwhatyouneedtolookliketobefamousand

successful.

Image1:magazinestandatsupermarket10/08(left),Image2:celebrityphotographedinmagazinearticle,atchild’shome21/08(right)

PublicBillboards/Posters

Billboardadvertisementswerephotographedatleastoncebyjustunderhalfoftheparticipants

(5/12).Threequartersofthesewereseenontheweekend,andofthosetakenonaweekday,there

werenoexposuresonthejourneytoandfromschool.Onethirdofthephotographsweretakenby

oneparticipantonatripintoWellingtonCBD;theyweretheonlyparticipanttogointoWellington

CBDwhilstwearingacamera.

Billboardsincludedclothingadvertisements,radiostationadvertisements,electionvotingpromotion

andsportsplayers/athletes.Anumberofparticipantssawpostersofathletesatsportsarenas.These

athleteswereallslimandtoned,wearingshortortightsportsuniforms.Theseimagesmayportray

whatanathletelookslike,orwhatyouwilllooklikeifyouplaysport.Theclothingadvertisements

seenwereofyoung,attractive,slimmodelswiththeirfriends.Thismayportraywhattypesofpeople

weartheclothesadvertisedorwhatyouwilllooklikeifyouweartheclothes.Thevotingposter

photographedhadthreeyoungadultswithdifferinggendersandethnicities.Alloftheseexamples

havethepotentialtocontributetowhata‘normal’personlookslike.

Image2:Maleclothingbillboardportrayingthreemuscularyoungmalesonthebeach09/08(left),promotionalvotingposterfeaturingthreeethnicallydiverseyoungadults09/08(right)

BeautyProductsandObjects

Onlyoneparticipantdidnothaveaphotographcontainingabeautyproductorobject.Three

quartersofthephotographsrecordedhadmirrorsinthem,eitherinbedrooms,bathroomsorliving

areas.Theotherphotographswereofbeautyproducts(includinghairstraighteners,facewash,

make-up,hairspray,nailpolish,deodorant),andexercisemachinesinthehome.

Inthebeautyaisleinthesupermarket,allofthephotographedpackaginghadattractivePakeha

womenwithlonghairandperfectlymade-upfaces.Thiscreatestheidealofwhatpeopledo,or

shouldlooklike,andsendsthemessagetousetheproducttoachievethis.Mostofthebeauty

productsseenattheparticipants’shouseswereinthebathroomaroundthesinkoronthe

participants’sdressers–bothmostlywithinviewwhenlookinginthemirror.Locationaroundthe

mirrormayshowthereflectionof‘enhancing’or‘bettering’thehumanformthroughtheuseof

productsandthatitisaneverydayandnormaloccurrence.

200200216/0812pm

Images3(clockwisefromtopleft):participantholdinga

hairstraightenerandstandinginfrontofamirror24/08,

participantlookinginmirrorholdinganunspecified

beautyproduct16/08,beautyaisleinsupermarket

showinghairdyepackagingwithyoungattractive

femalesonboxes07/08

BrandedClothing

Allbutoneoftheparticipantshadaphotographofbrandedclothinginatleastoneoftheir

photographs.Threequartersoftheparticipantshadaphotograph/sofbrandedclothingwhich

includedbrandedshoesorabrandedbackpackonotherparticipantsontheirwaytoandfrom

school(5/5NZEuropean1/3Pacific3/4Maori).

ManyparticipantswereseentobewearingbrightlycolouredNikesneakersorConverseShoes,and

havingNikeorAdidasschoolbags.Thismaybeanexampleoftheperceptionofa‘social-norm’

directlyinfluencingaparticipant’sbehaviour.Wenoticedthatthetrendofshoebrandwasreflected

withingroups,andifoneparticipanthadapairofNikesneakers,manyoftheotherswouldtoo.

AnotherrecurringfashionwenoticedwasKathmandu/Macpacpufferjackets,anumberof

photographsshowedgirlswearingtheseinside(atMcDonalds).Thismayshowthatwearingthe

pufferjacketisnotonlyforwarmth,butalsoasfashion.

Image4:5girlsphotographedonthewaytoschoolwearingbrightcolouredNikeshoes07/08(left),girlwithNikebackpackandNikeshoes08/08(right)

TelevisionProgrammesandInternetVideos

Onlyoneparticipantdidnothaveaphotographofatelevisionprogramme,movieoraninternet

video.Almostthreequartersoftheparticipantsphotographedtelevisionprogrammesthatfeatured

teenagersofthesamegender.WhilewatchingTVprogrammes,therewerelimitedadvertisements

seen,withnoadvertisementsshowinghumanformphotographed.

Almosthalfoftheparticipantshadphotographsonlyshowingatelevisionshow,whiletheothers

hadamixtureoftelevisionprogrammes,moviesandinternetvideos.GirlsinAmericantelevision

programmesweredressedmaturelyfortheirageandwearingmake-up,jewelleryandtightfitting

clothing.Somephotographsshowedparticipantswearingplaingreyschooluniforms(e.g.Summer

HeightsHigh).Newspresenterswerephotographedwell-presentedandinsensibleclothing,butonly

onequarteroftheparticipantshadoneormorephotographofthe6pmnews.

Theparticipantsshoweddifferencesandpreferenceforthevideostheywatchedontheinternet.

Somechosetowatchmainlymusicvideosshowingscantilycladwomenwithsmallwaistsandlarge

hips/bottoms.AnotherchildshowedapreferenceforanAsianRealityprogrammeandonechild

watchedasetofmade-upteenagerssingingonmultipleoccasions.Thismayalsobeanexampleof

self-imagebehaviours,astheimagesofhumanformwereself-chosen.

Image5:Womanfeaturedinaninternetvideowithasmallwaist,andlargebreastsandbottom07/08(left),heavilymade-upblondeyoungfemaleonanAmericantelevisionprogram07/08(right)

Video/Computergames

Onethirdoftheparticipants(3maleand1female)hadphotographsofvideogameswithhuman

charactersatleastonce.Allofthemaleparticipantshadoneormorephotographofamasculine

characterorviolenceinthevideogame,whilethegirlwasplayingaKimKardashianfashiongame.

The‘masculine’characterswerelarge,muscularandcarriedweapons.TheKimKardashianfashion

gameportraysaslim,verycurved(smallwaist,largebreasts,largehipsandbottom)womanona

fashionrunway.Similartotheinternetvideos,thesegamesarealsoself-chosenexposuresto

masculineandfemininestereotypes,butmaycontributetotheperceptionofnormalhumanform.

Image6:computergamewithmalecharacterholdingweapons09/08(right),animatedpictureofKimKardashianportrayedwithvoluminoushair,asmallwaistandlargebreastandhips21/08

SocialMedia

Overhalfoftheparticipantshadphotographscontainingaformofsocialmedia.Fromtheseallbut

oneweregirls.Theidentifiablesocialmediasphotographedincluded:Facebook,Twitter,Snapchat,

InstagramandSkype.FacebookandInstagramshowedatrendofyoungadultsofsimilarageand

genderastheparticipantsposinginphotographs.

Oneparticipanthadmultiplephotographswhichshowedhertakingpicturesofherself.Shealsohad

photographsthatshowedhereditingthese‘selfies’withdifferentfilters.

Image7(clockwisefromtopleft):editinga‘selfie’imagewithfiltersonamobiledevice14/08,Facebookshowingyounggirlposing10/08,Instagramfeaturingslimblondemodel22/08

Posters

Overhalfoftheparticipantshadaphotographofaposterononeofthewallsintheirhouse.Halfof

theparticipantshadoneormorephotographofaposterintheirbedroom;theothershadposters

photographedinotherregionsinthehouse.Postersincludedthoseofsportsplayers,singers(e.g.

OneDirection),andmoviecharacters(e.g.TheHobbit).

Theplacementandchoiceofpostermayreflectwhatthechildaspirestobeorlooklike.The

placementofthepostersissignificanttotheregularityofexposure.

Books

Onethirdoftheparticipantshadatleastonephotographholdingabook.Allbutoneofthe

participantsphotographedwithabookwereholdinganovelinatleastonephoto,theother

Image9:holdingaHarryPotternovel09/08(left),holdingTheGuinnessBookofWorldRecords09/08(right)

Image8:Multipleposterswithmalefootballplayersonthewallofachild’sbedroom10/08(left),multipleOneDirectionpostersonthewallofachild’sbedroom09/08(right)

participanthadthebookontheirmobilephone.Wewereabletoidentifythenoveltitlesinhalfof

theparticipants:anumberoftheHarryPotterSeriesandTheSubtleKnife.

Covers(Game,Book,DVD)

OnethirdoftheparticipantshadatleastonephotographofaDVD,bookorgamecoverthathada

humanorhumancharacteronthefront.Thesephotographsweresplitbetweenhome,thelibrary

andbook/electronicshops.Likewiththecomputer/videogames,themalecharactersweregenerally

muscularandholdingweapons.OtherDVDcovershadexamplesofattractivecouplesand

celebrities.

FoodPackaging

Only2participantshadaphotographwiththehumanformonfoodpackaging.Bothofthesewere

oncerealboxesandatthechild’shome.ThesewereaNutri-Grainboxwithamaleskieronitandthe

otherwasaWeetbixboxwiththeAllBlacksonit.

Image11:takingthecontentsoutofaNutrigrainbox,pictureofamaleskieronfront07/08

Image10:childholdingavideogamewithmalecharacterholdingaweaponinanelectronicshop09/08

SchoolTransport

Wegathereddatafor37tripstoandfromschool,outofthe48possibletripsover2weekdaysfor

the12participants.Tripswereclassifiedbymodeoftransportascar,walking,scooter,bus,ora

combination.Wedidnotseeanybicycleuseorotherformsoftransport.

Themostcommontypeoftransportwascar(image3),whichaloneaccountedfor15trips.When

tripsthatinvolvedtravellingbycarforpartofjourneywerealsoincluded,thenumberoftrips

totalled21outof37(57%).Walkingaccountedfor8tripsalone(image2),andtravellingbyscooter

for4trips(image1).Participantstravelledbybuson4trips(image4),with2oftheseincombination

withwalkingand2incombinationwithusingascooter.

Usingacombinationofmodesoftransportinasingletripwasrelativelycommon.Therewereatotal

of10combinedtrips,forexample,therewere5tripswhichinvolvedbothwalkinganddrivingbycar.

Pacificparticipantswereonlyseenwalking(37.5%oftrips)orgoingbycartoschool(62.5%).NZ

Europeanparticipantsweredrivenatleastpartofthewaytoschoolon37.5%oftrips.Maori

participantsweredrivenon76.9%oftrips,buthalfofthesewereincombinationwithwalking.

Europeanparticipantshadthemostvariationinmodeoftransportoverall,withparticipants

observedusingwalking,cars,bussesandscooters.Incontrast,MaoriandPacificparticipantsboth

onlywalkedortravelledbycar.

Onethingthatwenoticedwasthatmanyoftheparticipantswhowalkedortravelledbyscooterto

schooldidsowithagroupoffriends.Itwouldbedifficulttoaccuratelycollectdataonhow

frequentlythisoccursandthesizeofthegroupsbecauseitishardtotelliftheotherparticipants

seeninthephotosareactuallytravellingwiththechildornot.

CarTransport

21ofthe37individualrecordedjourneysofallparticipantsusedacaratleastpartofthetime.Maori

participantsweremostlikelytotravelbycartoorfromschool,with10/13or76.9%oftripsusinga

caratleastpartoftheway.62.5%(5/8)ofthejourneysmadebyPacificparticipantsalsousedacar

astransport.Only6/16or37.5%oftheindividualjourneysundertakenbyNZEuropeanparticipants

involvedtravellingbycarforallorpartofthejourney.

Onlyoneparticipantoutofthetwelvewentbothtoschoolandbackbycaronbothoftheschool

daysthattheywereobservedandthatchildwasofPacificethnicity.

Walking

15outof37(40.5%)oftheindividualjourneysinvolvedtheparticipantswalkingallorpartoftheway

toorfromschool.Maoriparticipantsweremostlikelytousethismethodoftransport,with61.5%

(8/13)tripsinvolvingwalkingatleastpartoftheway.Thisalsoaccountedfor37.5%(3/8)ofall

PacificIslanderparticipants’sjourneys,andonly25%(4/16)oftheNZEuropeanparticipants’s

journeys.

Scooter

NZEuropeanparticipantswereontheonlyparticipantsobservedtravellingtoschoolbyscooter,

with7/16journeysundertakenthisway.4outofthe5NZEuropeanparticipantsusedascooterat

somepoint.NoneofthefourMaoriorthreePacificparticipantswereseentobeusingscootersat

all.

0

2

4

6

8

10

12

14

16

Totalnum

bero

ftrip

s

Totalnumberoftripsbyethnicity

Maori

Pacific

European

Figure3:Exampleofdriving

Image2.ExampleofwalkingtoschoolImage1.Exampleofusingascootertogettoschool

Image3.Exampleofdrivingtoschool Image4.Exampleofcatchingthebustoschool

DinnerAnalysis

Aim

Toidentifywhateachchildatefortheirmaineveningmealandwherethatmealwaseaten.

Methods

Allphotosweresearchedforevidenceofamaineveningmealeatenbetweenthehoursof5-9pm

only.Thesearchwasstoppedoncethemealhadbeenidentified.Nosnacksordessertsnotedwithin

thistimeperiodwererecorded.Mealswereseparatedbyfourmaincategories:

• Home-cookedmeals

• Ready-mademeals(onlyneededheatingbeforeconsumption)

• Takeaways

• Restaurantmeals

Allmealswerealsoexaminedtoidentifywhethertheycontainedvegetables(excludingpotatoesand

pizzatoppings).

Mealswerealsocategorizeddependingonwherethemealtookplace.Thecategorieswere:

• Mealeatenatfamilydiningtable

• Mealeateninfrontoftelevision

• Mealeatenoutsideofhome

• Other

Results

Werecordedwhateachofthetwelveparticipantsatefordinneroverthefourdaysofthestudy.We

wereabletorecord32mealsoutofapossible48.Mealsthatwereunabletoberecordedwere

mostlyduetotheparticipantsturningoffthecameraduringthehoursthatwesearched,from5-

9pm,butontwooccasionsachilddidnotappeartoeatdinnerduringthesehours.Twoofthemeals

thatwererecordedwereunidentifiablefoodstuffsduetopoorcameraquality.

Outoftheentire30mealswhereitwaspossibletoidentifywhatthechildwaseating,16meals

(53%)werehomecooked.Ofthese,14meals(87.5%)includedsomesortofidentifiablevegetable.

(figure1).11dinnersoutofthe30(36.7%)consistedofeithertakeaways(includingpizza,Chinese

meals,fish‘n’chips)or“ready-made”storeboughtfoodsuchaspiesorcordonbleu.3mealswere

eatenoutinrestaurantswithfamilymembers(twoItalianrestaurantsandoneIndianrestaurant).

OnemealwaseatenataMcDonalds(figure2).

Wealsorecordedwheretheparticipantatewheneatingathome.Ofthe28mealsthatwereeaten

attheparticipant’shouse,19ofthese(67%)wereeatensittingaroundthediningtablewiththe

family.Theremainder(32%)wereeateninfrontoftheTVwithsiblingsorotheradults

Wealsoanalysedtheparticipants’sdatabyethnicity.Werecorded13mealsfromtheNZEuropean

participants,8mealsfromtheMaoriparticipantsand11mealsfromthePacificparticipants.

However,ofthe11mealseatenbyPacificparticipants,only9containedidentifiablefoodstuffs.

Nineofthe13mealseatenbyNZEuropeanparticipants(69.2%)and5ofthe8mealseatenby

Maoriparticipants(62.5%)werehomecooked.Allofthesemealsincludedsomesortofidentifiable

vegetable.Incontrast,only2ofthe9identifiablemeals(22.2%)eatenbyPacificparticipantswere

homecooked,neitherofwhichcontainedanyvegetables.Duringthefourdayperiod,Pacific

participantsdidnotappeartoeatvegetables(excludingpotatoesandpizzatoppings)atthedinner

timemeal.Pacificparticipantsweremuchmorelikelytoeateithertakeawaysorready-mademeals

(suchaspies),with6ofthe9meals(67%)consistingoftakeaways,ready-mademealsorMcDonalds.

Only2meals(15.4%)fromtwoseparateNZEuropeanparticipantsconsistedoftakeaways(pizzain

bothinstances).Threemeals(37.5%)fromtheMaoriparticipantsconsistedoftakeaways(fishnchips

ontwooccasions).NoneoftheNZEuropeanorMaoriparticipantswereobservedtobeeatingready-

mademealsfordinner.

TwomealsfromtwoseparateNZEuropeanparticipantsand1mealfromaPacificchildwerespent

eatingoutatrestaurants(non-fastfoodoutlets)withtheirfamilies.Maoriparticipantsdidnoteat

dinneroutsideofthehomeduringthefourdays.

BothNZEuropeanandMaoriparticipantsweremorelikelytoeatdinneratthediningtablewith

familythanPacificparticipants.Tenofthe11meals(91%)eatenathomebyNZEuropean

participantswerecarriedoutaroundthefamilydiningtable.Sevenoutofthe8mealseatenby

Maoriparticipantswerealsoheldatthediningtable.However,only2ofthe9mealseatenathome

bythePacificparticipantswereatthediningtable.Onbothoccasionsthemealconsistedof

takeawaysbroughthomebyanadult(Figure3).The7remainingmealsfromthePacificparticipants

wereeateninfrontoftheTV(Figure4).

Images1-4(inclockwiseorder):home-cookedmealwithvegetables,McDonald’sfordinner,fish’n’chips,‘ready-made’mealeateninfrontofthetelevision

Breakdownofwhattheparticipantsatefordinner(%)

0

10

20

30

40

50

60

70

80

Home-cookedmeal Takeawaysor"ready-made"meals

dinnerinrestaurant

%ofa

llmeals

Contentofmeal

NZEuropean

Māori

Pacific

Feasibility

TheAutographerappearstobeaneffectivetoolforrecordingimagesofparticipants’sfood

consumption,andwouldbeausefulvehicletouseinfuturestudiesexploringeatingenvironments.

Thecameraisabletocapturemostofthefoodthatthechildiseatingandbeingexposed.The

Autographeralsocapturesotheraspectsoffoodandeatingbehaviourincluding;whoiseatingwith

0

10

20

30

40

50

60

70

80

90

Mealincludedvegetables(excludingpotatoesandpizzatoppings)

%ofa

llmeals

Inclusionofvegetablesinmeal

NZEuropean

Māori

Pacific

0

10

20

30

40

50

60

70

80

90

100

Mealeatenatdiningtablewithfamily

Mealeateninfrontoftelevision

%ofa

llmeals

Wherethemealwaseaten

NZEuropean

Māori

Pacific

theparticipant,howoftentheparticipanteats,thetypeoffoodthatisstoredinthehouseandhow

oftentheparticipantvisitsthesupermarket.

Themainlimitationisthatitisnotalwayspossibletoidentifywhattheparticipantiseating,either

duetopoorcameraqualityor,morecommonly,poorangleofthecamera.Itisalsodifficulttosee

whatisbeingeatenoutofbowls,forexample,ortoseewhattheparticipantiseatingiftheyare

lyingonthefloororsofa.

Anotherpotentiallimitationisthelikelihoodoftheparticipantturningthecameraoffduringmeal

times,eitherontheirownvolition(duetoshameattheirowndiet,forexample)orattherequestof

thepeoplewhoareeatingaroundthem.

6.Discussion

Thiswasasmallscalequalitativestudy,wheretheprimaryaimwastodetermineaspectsof

children’senvironmentswhichmodifytheirhealthandwell-being.Secondarilyweaimedtoexplore

thevalueofautomatedcamerasasresearchtools.

Alcohol

Thisstudyfoundthat11outof12participantswereexposedtoalcoholinsomewayduringthe4

daysofthestudy.Wholealcoholbottlesinthehouseholdwerethemostcommontypeofexposure,

witnessedbytenofthetwelveparticipants.Thisfindingsuggeststhattheparticipantswereroutinely

exposedtoevidenceofalcoholconsumptionintheirhomeenvironment.Bottlesofbeer,wine,

vodkaandotherspiritswereallobservedindicatingthattheparticipantswereexposedtoavariety

ofdifferentalcoholicbeverages.

Futurestudiesonalargerscalecouldfeasiblyexaminewholealcoholbottlesquantitatively.With

respecttothoseparticipantswhowerenotexposedtowholealcoholbottlesintheirhousehold,we

areunabletotellfromthedatawhetherthiswastrulybecausetherewasnoalcohol.Itispossible

thatthisabsenceisduetostorageofalcoholinawaythatmeanttheseparticipantswerenot

exposedtoitduringthefourdaysofthestudy.

Fouroftheparticipantswitnessedalcoholbeingconsumedaroundthem,whichineverycasewas

duetoparentsandotheradultsdrinkingwineorbeerinthecontextofafamilydinner.Considering

thefrequencywithwhichtheparticipantswereexposedtowholealcoholbottleswithintheir

householdenvironment,thisrepresentsanotablysmallerexposurethanthatseeninalcohol

consumption.AllfouroftheparticipantswhowereexposedtoactualdrinkingwereofNewZealand

Europeanethnicityandwereeither1or2ontheNZiDepindex.Thissuggeststhattheparticipantsof

highersocioeconomicstatusmayhavebeenmorelikelytobeexposedtodrinkinginafamilydinner

setting.Withintheframeworkofalargerstudyitmaybepossibletofurtherexplorethesocial

contextsurroundingalcoholconsumptiontowhichchildrenareexposed.

Consideringtheadversehealthoutcomesassociatedwithexcessalcoholconsumptionandthe

prevalenceofthesewithinNewZealand,qualitativedataonchildhoodexposuretoparentaldrinking

areofpotentialsignificance.Ithasbeendemonstratedthatexposuretounhealthyparental

behavioursincludingalcoholmisuseandsmokinghavenegativeimpactsonchildren’shealth.Our

studyhasshownthattheparticipantswereverylikelytobeexposedtoevidenceofalcohol

consumptionbutlesslikelytowitnessactualconsumption.Ourstudyislimitedinthecontextof

unhealthydrinkingbehavioursbytendenciestohavethecameraturnedoffduringweekend

eveningsandthepossibilitythatstudyparticipantswerelesslikelytoexhibitalcoholmisuse.

Wefoundexposuretoalcoholadvertisingorretailtobeatamoderatelevel,withsevenofthe

twelveparticipantsexposed.Incontrasttherewasrelativelylittleexposuretolegalsignage,with

onlytwoofthetwelveparticipantsexposedtosignsrelatingtothepermissibilityofalcohol

consumption.Thereisareasonablediscrepancyherebetweenchildren’sexposureto

advertisementsencouragingconsumptionofalcoholandsignageadvocatingitsresponsibleuse.

Ourstudyindicatesthattheparticipantsgrowupinanenvironmentwherealcoholusemeetsvery

littledisapproval.Thisissignificantconsideringthatgreaterparentaldisapprovalofalcoholis

associatedwithlowernumbersofchildren’salcohol-use-relatedproblems.Whilewearelimitedin

thissensebyfewdataonexposuretoparentaldrinkingbehaviour,ourfindingthatmostparticipants

wereexposedtoevidenceofalcoholconsumptionintheformofwholealcoholbottlessuggeststhat

alcoholconsumptionisfairlynormalised.

Thecamerasprovidedanoriginalmethodtoexplorethewaysinwhichchildrenwereexposedto

alcohol.Wefoundthecameraswereparticularlygoodatpickinguponbackgroundorsubliminal

exposures,includingitemssuchaswholealcoholbottlesandadvertisements.Theywerelessadept

atprovidinginformationondrinkingbehaviour.Wholealcoholbottleexposurecouldpotentiallybe

furtherexploredusingquantitativestudies.OurfindingsalsobuildontheworkofKerretalin

suggestingthatautomatedcamerasofferanadvantageinprovidingcontextualinformation

unavailablethroughothermethods.

Smoking

Wefoundthatonlytwoparticipantswereexposedtoanytypeofsmoking.Bothoftheseparticipants

wereofPacificethnicity.Inbothinstancestheexposuresweretoadultshandlingcigarettesbutnot

smokingthem.Theabsenceofexposuretoactualsmokingsuggeststheparticipantswererarely

exposedtotheactofsmoking.Fourparticipantswereexposedtosmoke-freesignsinpublic

buildings;allofthesewereofeitherMāoriorPacificethnicity.

Accordingtothedemographicdataoftheparticipants,6liveinhouseholdswherethereisasmoker

athome.However,weonlysawtwoexamplesofexposuretosmoking.Therecouldbeanumberof

reasonswhywedidnotseeexamplesofsmokingintheothersmokinghouseholds,includingparents

onlysmokingawayfromtheparticipantsandparentspreferringnottosmokewhentheyknewthere

wasacameraaround.Thefour-daydatacollectionperiodmayalsonothavebeenlongenough.Itis

alsolikelythatthecamerasmayhavemissedachanceexposuretosmoking,suchasifthe

participantwasridingordrivingpastsomeonesmokingonthestreet.

NewZealandremainsburdenedwithasignificantamountofdiseaserelatedtodirectandsecond

handsmokingexposure.Giventhelinksbetweenparentalsmokingandchildren’srespiratory

problems,breathingdifficultiesandmorbidityitispositivetonotetheverylowlevelofchildren’s

exposuretosmokingthatourstudyfound.Itshouldbenotedthatthisobservationislimitedbythe

potentialforadultstohavemodifiedtheirbehaviourgiventhepresenceofthecameras.Ourstudy

indicatesthattheparticipant’senvironmentsincludedsmokefreesignageandthatthisisan

exposuretheyreceivedregularly.Thisisbeneficialgiventheprovenefficacyofthese

advertisements.Consideringthegreaterlikelihoodfortobaccoconsumptioninpeoplelivingin

socioeconomicallydeprivedareasthereissomeconsolationinourfindingthattheparticipantsin

theseareastendedtobethemostexposedtosmokefreeadvertisements.

Thecamerascapturedverylittleexposuretosmokinginthisstudy.Therewereinstancesofexposure

tociggarettesbeingpreparedandexposuretoantismokingadvertisements.Thecamerastendedto

belessadeptatcollectinginformationonbehaviouralexposures.Thiswasespeciallytrueof

smoking.Itisdifficulttoclaimwhetherthisisbecausechildrentrulyareminimallyexposedto

smokingorwhetheranelementofbiasispresent.Adultsmayhavealteredtheirexposureduetothe

presenceofthecameras,leadingtoanunderrepresentationofstigmatisedbehavioursuchas

smoking.

PerceptionofHumanForm

Ourstudyfoundthattheparticipantsweresubjectedtoawidevarietyofexposureswhichhavean

influenceonperceptionofthehumanform.Theseportrayalsofsocialnormsmayhavecontributed

toarangeofself-imagerelatedbehaviours.Exposuretomagazines/newspaperadvertisementswas

atamoderatelevel,withsevenofthetwelveparticipantsexposed.Manyofthesemagazines

portrayedBritishandAmericancelebritiesandpotentiallyestablishanarchetypicalsenseofsuccess

andfame.Fiveofthetwelveparticipantswereexposedtobillboardadvertisementsonarangeof

subjects.Severaloftheseinstancesinvolvedgirlsencounteringpostersofathleteswhichpotentially

demonstrateanidealisedathletichumanform.

Allbutoneparticipantwereexposedtoabeautyproductatsomepointinthestudy.Onlybottlesor

containersforsuchproductswerecodedasbeautyproducts.Bynotcodingtheseproductswhen

encounteredwhile‘inuse’,i.e.womenwearingnailpolish,weaimedtoeliminategenderbias.Of

thesephotos,75%alsocontainedmirrors.Locationaroundthemirrormayshowthereflectionof

‘enhancing’or‘bettering’thehumanformthroughtheuseofproductsandthatitisaneverydayand

normaloccurrence.Thisindicatesthattheparticipantsarebeingraisedinanenvironmentthat

containsmanyproductsgearedtoimproveone’sself-image.Inthebeautyaisleinthesupermarket,

allofthephotographedpackaginghadattractivePakehawomenwithlonghairandperfectlymade-

upfaces.Thismayhavesuggestedtotheparticipantsanidealofwhatshouldlooklike,aswellas

suggestingthisproductshouldbeusedtoachievethisimage.

Allbutoneoftheparticipantswereexposedtobrandedclothingatleastonce.Manyparticipants

wereseentobewearingbrightlycolouredNikesneakersorConverseShoes,andhavingNikeor

Adidasschoolbags.Thismaybeanexampleoftheperceptionofa‘social-norm’directlyinfluencinga

child’sbehaviour.Wenoticedthatthetrendofshoebrandwasreflectedwithingroups,andifone

childhadapairofNikesneakers,manyoftheotherswouldtoo.

Allbutoneoftheparticipantswereexposedtotelevision,moviesoraninternetvideo.Ofthese,

eightparticipantswatchedtelevisionprogrammesfeaturingteenagersofthesamegender.This

suggeststhattheparticipantswerecommonlyexposedtotelevisionparadigmsofteenageimage.

GirlsinAmericantelevisionprogrammesweredressedmaturelyfortheirageandwearingmake-up,

jewelleryandtightfittingclothing.Onlyalimitednumberofadvertisementswereseen,noneof

whichwererelatedtothehumanform.Fourofthetwelveparticipntswereexposedtovideogames

withhumancharacters,threeofwhichweremaleandwereplayinggamesinvolvingviolenceand

masculinecharacters.Theonegirlwasplayingafashiongamewhichportraysaslim,verycurved

(smallwaist,largebreasts,largehipsandbottom)womanonafashionrunway.

Overhalfoftheparticipantshadphotographscontainingsomeformofsocialmedia,sixofwhom

werefemale.TheseexposuresincludedFacebook,Twitter,Snapchat,InstagramandSkypeuse.

Socialmediauseunanimouslyinvolvedexposuretoimagesofchildrenofsimilarageandgender.A

moderatenumberoftheparticipants(8/12)wereexposedtoposters.Thesepostersincludeda

varietyofsportsplayers,singersandmoviecharacters.Theplacementandchoiceofpostermay

reflectwhatthechildaspirestobeorlooklike.Theplacementofthepostersissignificanttothe

regularityofexposure.

Intotalourstudyhasfoundthattheparticipantswerehighlyexposedtomediawhichhadthe

potentialtoinfluencetheirconceptofsocialnormsrelatingtothehumanform.Theseexposures

wereoftendispersedthroughouttheirenvironment.Acrosstherangeofexposurescertainbody

typestendedtorecur.Thissuggeststhattheparticipantsmayhavebeenexposedtoarelatively

narrowsetofvariationsofthehumanform.Inconcordancewiththisitispossiblethattheyexhibit

behaviourwhichstrivestoemulatethewindowinwhichthisvariationfalls.

ConsideringthestudybyHargreavesetalanditsfindingthatbodydissatisfactionincreaseswith

exposuretocommercialsrelatingtobody-imageamongadolescentgirls,theparticipantsmaywell

begrowingupinanenvironmentrifewithsuchexposures.Theliteraturesuggeststhatmediaimages

haveproventoinfluencegirls’satisfactionwiththeirappearance.Ourstudyindicatesthe

participantsmayberoutinelysubjectedtoalargevarietyofsuchexposuresandthereforeitisquite

possiblethattheygrowupinanenvironmentwheretheybecomeincreasinglydissatisfiedwiththe

waytheylook.

ThisphenomenonismorepronouncedforgirlsthanforboysasdescribedbyCohaneetal(2001).

Whileboysdisplayedlessdissatisfaction,theyoftenexhibitedadesiretolookbiggerandmore

muscular.Ourfindingsshowseveralexamplesofthesearchetypestendtoreappearinproducts

pitchedatyoungboyssuchasthevideogamesandposters.Thisindicatesboysmaybesubjecttoa

separatesphereofsocialnormswithimpactsfurtherresearchcouldfeasiblyexplore.

Wefoundthecameraswereparticularlygoodatpickinguponsubliminalexposuressuchasthe

advertisementsandproductswhichinfluenceself-image.Allofthesearepredominantlyvisualby

natureandgaveusapictureoftheenvironmenttheseparticipantswereexposedto.Giventherich

arrayofinformationcapturedbythecamerasitishighlyfeasibletousetheseforfurtherresearchon

alargerscalebothqualitativelyandquantitativelyexploringtheseexposures.

ScreenTime

Participantsinthisstudyspentanaverageof1.8hoursperdayoutsideofschoolhourswatchingan

activescreen.Therangeinscreentimeexposurewasfrom0-7.13hoursperday.Themajorityofthe

screentimewasspentonthecomputerorwatchingtelevision,withthesescreensaccountingfor

45%and35%oftotalscreentimerespectively.Mobiledevices,phonesandsituationswhere

multipleactivescreenswerepresentmadeuptheremainderofrecordedscreentime.

TheAmericanAcademyofPaediatricsrecommendsthatschoolagechildrenareexposedtonomore

than2hoursofscreentimeperday(Committee2003).Sedentaryactivitieslikescreentimeare

associatedwithanincreasedriskofbeingoverweight,obeseandpre-diabetic(Hilletal2003).

Althoughtheaveragescreentimeforparticipantsinthisstudywasbelowtherecommendedlimit,

someparticipantsspentmorethan2hoursperdayinfrontofscreenswithonechildhavingatotal

of7.13hoursofscreentimeinoneday.Thissuggeststhatsomeoftheparticipantsdonotgrowup

inanenvironmentthatsupportstheirhealthandwellbeingduetohighscreentime.

TheKidsCam™photographsallowedresearcherstoobservewhatscreenswerebeingusedforand

thecontextinwhichtheywereused.Computersandlaptopswereusedforgaming,viewingsocial

media,homework,playingmusic,searchingtheinternetandwatchingmovies.Portablecomputing

devicesdefinedas‘mobiledevices’inthisstudywereoftenusedwhiletheparticipantswereinthe

car.MultiplescreenexposurecommonlyoccurredwhentheTVplayedinthebackgroundwhilethe

participantusedaportablecomputingdeviceorphone.Somepicturesshowedfamilieseating

breakfastordinnerwhilewatchingthetelevision.

Theuseofautomatedcamerasisanovelwaytoinvestigatescreentimeinchildren.Previous

methodsuseself-reportedscreentime,accelerometers(Anderson2008)andecologicalmomentary

assessment(Biddle2009).Thephotographsgeneratedbyautomatedcamerasproviderichdata

aboutthepurposeandcontextofthescreentime,whichallowsformorecomprehensiveanalysisof

sedentarybehaviour.

TransportTo/FromSchool

Outof46tripstoandfromschool16(%wouldbebetter)werebycaralone,12bywalkingalone,8

byscooterandtheremainingtripsincludedacombinationoftransportmethods.Drivinginthecar

eitherincombinationwithanothermodeoraloneaccountedfor37.5%ofschooltransporttripsin

NewZealandEuropeanparticipants,50%inPacificparticipantsand66.6%inMāoriparticipants.New

ZealandEuropeanparticipantstravelledtoschoolbyscootermorefrequentlythanMāoriorPacific

children.

Levelsofphysicalactivityarehigherinchildrenwhouseactivetransporttoschool(Faulkner2009).

Theuseofpassivetransportmethodscouldbecontributingtothegrowingoverweightandobesity

ratesinNewZealand.AstudyinAustraliashowedthatoveralllessthanhalfofchildrenwere‘active

commuters’,whichissimilartotoourfindinginthisstudy(Merom2006).

Theautomatedcameraprovidedanaccurateandsimplewaytocategorisetransporttoschoolin

NewZealandchildren.Althoughnotmeasuredinthisstudy,thecamerascouldbeusedtoprovidean

objectivemeasurejourneyduration.

Previousresearchershavealsousedautomatedcamerastocategorisetransportmethodsand

measurejourneyduration(Kelly2011).Kellyetalfoundthattheautomatedcamerasprovideda

moreaccuratemeasureofjourneydurationthanself-reportedjourneytimes.Researchusingself-

reportedtransportmethodsnotedalackofdetailbecausetheyaskedforthe‘usualmethod’of

transport(Faulkner2009).

Dinnerenvironment

Ofthe30mealsrecorded53%werehomecookedand36.7%weretakeawaysor‘ready-made’food.

Giventhatfrequentfastfoodeatingisassociatedwithhighenergyintakeinadolescents(Coon

2001),thisresultisconcerningforthewellbeingoftheparticipants.Ofthe28mealseatenathome

67%wereeatenaroundthediningtablewiththefamilyand32%wereeateninfrontofthe

television.Participantswhosefamilieswatchtelevisionduringmealtimesaremorelikelytohavea

dietcontaininghighenergyandlowfruitandvegetables(French2001).

Oftherecordedmeals69.2%eatenbyNewZealandEuropeanparticipantswerehomecookedand

62.5%eatenbyMāoriparticipantswerehomecooked,allofwhichcontainedvegetables.Incontrast,

22.2%ofmealseatenbyPacificIslandparticipantswerehomecooked,noneofwhichcontained

vegetables.91%ofmealseatenathomebyNewZealandEuropeanparticipantswereeatenaround

thediningtable,87.5%forMāoriparticipantsand22.2%forPacificIslandparticipants.Giventhat

thefamilyeatingenviromenthasaninfluenceonchildren’sdietquality(Heather2005),theseresults

areconcerningforthehealthandwellbeingofthePacificparticipantsinthisstudy.

Strengths

Themajorstrengthsofourstudylieintheuseoftheautomatedcamerasasresearchtools.Often

qualitativestudiesconsideringexposuressimilartothosewehaveinvestigatedrelyonself-reporting

andthusarelimitedbyrecallbias.The10secondphotographintervalallowedforanobjective

measurementofexposures,eliminatingrecallbiasencounteredinpreviousresearch.Byemployinga

qualitativeapproachweareabletoexploreamuchgreaterrangeofexposuresandcollectsubtler

informationwhichenablesustocontextualisetheexperienceofgrowingupinamodernNew

Zealandenvironment.Thequalitativenatureofthestudyisperfectlysuitedtoundertakethe

preliminaryinvestigationgivinganoverviewofthefeasibilityofautomatedcamerasinresearch.The

regularityandclarityofphotographstakenbytheautomatedcameramademealidentification

simple.Thepicturesprovidedrichdataaboutthechildrenseatingenvironment,allowingthe

locationofthemeal,whothemealiseatenwithandvegetablecontenttoberecorded.

Additionallybylimitingthenumberofpeopleanalysingthephotostotwoperexposurecategoryour

studyaidedtheconformityofthecodingprocessandminimisedtheeffectsofmisclassificationbias.

Limitations

Thisstudyhadanumberoflimitationswhichcouldbeovercomebyconductingalarger,funded

study,includingthesamplesizeandtimeperiodsavailableforcollectionofdata.Ourstudyrestson

theassumptionthattheparticipantsactuallynoticedorobservedtheexposuresthatwehave

observedinthephotographstakenbytheautomatedcameras.Anumberoftheparticipantshad

datamissingfromweekendevenings,whichmaybethetimewherealcoholandsmokingexposure

wouldbemostlikelytooccur.Inconjunctionwiththiswearelimitedbythelikelihoodthat

participantsmayturnoffthecamerasiftheyweredoingorseeingsomethingtheyknewwasillegal

orfrownedupon.

Thegreatestlimitationfacedbythisstudywasthepotentialforstudyparticipantsandtheirfamilies

toaltertheirbehaviouraroundthecamera.Thismaybeconnectedwithanelementofselection

bias.Inthiscase,studyparticipantsaremorelikelytobethosewhoarehappytobefilmed,which

couldbebecausetheydonotexhibitstigmatisedbehavioursuchassmoking.Thismayhaveledtoan

underrepresentationofsuchbehaviour.

Wewerenotabletoanalyseexposuretosmokingontelevisionorcomputers,becauseitwastoo

difficulttomakeoutwhatwasonthescreen.Thisalsomeantwecouldnotseeiftheywereexposed

toanti-smokingtelevisionadvertisements.Insomephotographsthecamerawascoveredorpointing

attheroof.Thismayhaveledtoanunderestimationofscreentimebecausethesephotographs

werenotcountedinthecodingsystem.Screentimeatschoolwasnotcountedinthisstudy,which

mayhaveledtoanunderestimationofscreentime.

Wewerealsounabletocaptureactivitiesthattheparticipantswerelikelyveryawareofbutdidnot

witness,suchastheparentsgoingoutsidetosmoke,orhearingadultpartiesaftertheyhadgoneto

bed.Alsothephotographsdidnotenableresearcherstorecordwhetherparticipantsweretravelling

aloneorinagroup.Participantswouldturntheircamerasofftogotothetoilet,howeverthismay

haveledtounderestimationofexposuretobeautyproductsandmirrorsinthebathroom.

Anotherpotentiallimitationisthelikelihoodoftheparticipantturningthecameraoffduringmeal

times,eitherontheirownvolition(duetoembarrassmentregardingtheirowndiet,forexample)or

attherequestofthepeoplewhoareeatingaroundthem.

Otherlimitationsofusingthecamerastoanalysethisdataincludedifficultieswithphotoqualityin

definitivelyascertainingthetypesoffood,beverages,advertisements,signageetc.Thecoding

processitselfwasalsopronetoerrorinthisfashion.Thisisespeciallytrueconsideringthelarge

amountoftimenecessarytoconductmanualcodingofthedata.

7.Conclusions

Ourstudyhasfoundthattheparticipantsareraisedinenvironmentsrepletewithhealthmodifying

exposures.Theseincludedahighlikelihoodtobeexposedtoalcohol,especiallyevidenceofits

consumptionintheformofwholealcoholbottles.Smokingexposurewasconsiderablylowerwith

exposuretoanti-smokingadvertisementsreachingtheareaswheretheyaremostneeded.The

participantswereheavilyexposedtoself-imagerelatedinfluences,severalofwhichhavebeen

demonstratedtocontributetogirls’dissatisfactionwiththeirappearance.Thisstudysuggeststhat

theparticipantsgrowupinanenvironmentwithalevelofscreentimethatsupportstheirhealthand

wellbeing.However,someparticipantsareatriskofdiseasesassociatedwithsedentarybehaviour

duetoahighlevelofscreentime.Someparticipantsusedactivetransporttogettoschool,which

supportstheirwellbeing.However,thereisanethnicdisparityintransportmethods,withMaoriand

Pacificparticipantshavingusedmoresedentarytransporttypesmorefrequently.Theproportionof

takeawaymealsconsumedandmealseateninfrontofthetelevisionamongparticipantsinthis

studymayreflectnegativelyontheenvironmentthattheygrowupin.Theeffectsofthis

environmentshowinequities,withPacificparticipantshavingbeenexposedmoreoftenthanNew

ZealandEuropeanandMāoriparticipantstoaneatingenvionmentthatdoesn’tsupporttheirhealth

andwellbeing.Automatedcamerasappearfeasibleastoolstoinvestigateawidevarietyofpublic

healthissues.Thisisparticularlytrueofstatic,backgroundexposuressuchasadvertisements.

Futurequalitativestudiescouldexaminetheattitudessurroundingchildren’sexposuretoalcohol.

Bothparentsandchildrenmaybeabletoprovidesomecommentaryontheplaceofalcoholwithin

NewZealandsociety.Ourstudysuggeststhattheuseofautomatedcamerascouldbeofusein

furtherresearchaimedatassessingexposuretoadvertisingofalcohol,tobaccoandfoodin

environmentsbeyondthehome.

Inconjunctionwiththeuseofautomatedcamerasfurtherstudiescouldpotentiallyexploremore

qualitativeaspectsofchildren’sattitudesregardingsocialnorms.Ourstudyhashighlightedthe

aptitudeofthesecamerasforresearchinvolvingassessmentofbackgroundexposures.Influenceson

children’sperceptionofsocialnormstendtoliewithinthisset.Futureresearchcouldalso

investigatetheeffectsofexposuretothesesocialnormsinbothboysandgirls.

FurtherresearchcouldfocusonfindingoutwhysomeNewZealandchildrenarespendingmorethan

therecommended2hoursperdayinfrontofascreen.Parentalattitudesandneighbourhoodsafety

havebeenshowntoinfluencescreentime(Salmon2011).Thesefactorscouldbeexploredwithinthe

environmentofchildreninWellington.Healthpolicycouldfocusonincreasingawarenessofthe

harmfuleffectsofscreentimeonchildren’swellbeing.

TheautomatedcameracouldbeusedtocalculatejourneydurationinNewZealandchildren.The

GPSdevicestheycarriedcouldbeusedtocalculatejourneydistance.Thecameracouldbeusedto

exploretheethnicdifferenceobservedintravelmethods,whichmayhavebeenduetoschool

journeydistanceorotherfactors.Thisresearchsuggeststhatsedentarybehaviourmaybe

contributingtothegrowingrateofoverweightandobesityinNewZealand,andlendsitselfto

evidenceforthedevelopmentofpolicytoencouragefamiliestouseactiveschooltransport

methods.

Theautomatedcameracouldbeusedtorecordmoreeatingbehaviourslikehowoftenthechild

eats,thetypeoffoodthatisstoredinthehouseandhowoftenthechildvisitsthesupermarket.Itis

feasiblethatthecamerascouldbeusedtocomprehensivelydescribetheeatingenvironmentof

childreninNewZealand,andcorrelatethistotheindividualchild’shealthandwellbeing.This

researchindicatesthattheeatingenvironmentofPacificchildreninparticularcouldbeaddressedto

improvetheirhealthandwellbeing.

Automatedcamerasaredemonstrablygoodatproducingdataonadvertisingorotherpassiveor

subliminaltypeexposures.Howevertheyarelessadeptatcapturingactiveorbehavioural

exposures.Itispossiblethatthisisduetoapropensityforpeopletoaltertheirbehaviouraroundthe

camera,orbedisinclinedtoparticipateinthestudy,leadingtoalikelyunderrepresentationof

stigmatisedbehaviourssuchassmoking.Manyoftheexposureswehaveexaminedincludingwhole

alcoholbottles,advertisementsandbeautyproductslendthemselvestofuturestudiesonalarger

scalewhichcouldfeasiblyinvestigatetheseaspectsquantitatively.

Acknowledgements

WewouldliketoacknowledgethehelpandsupportreceivedfromoursupervisorsLouiseSignaland

RichardJaine.WealsoreceivedvaluableassistancefromMoiraSmithandMichelleBarr.

Wewouldliketoacknowledgetheworkandexperiencesofthe15childrenonwhichthisstudyis

based.

WewouldliketoalsothanktheKids’CamteamattheUniversityofOtagoandtheNationalInstitute

ofHealthInnovationatAucklandUniversityandKids’CamfunderstheHealthResearchCouncil.

AspecialthankstoallthestaffintheDepartmentofPublicHealth,UniversityofOtago,Wellington.

Appendix

Figure1A.MapofGPSdatacollectedbystudent1on7-10thAugust2014












References

Adamson,P.,Brown,G.,Micklewright,J.,Schnepf,S.V.,&Wright,A.(2003).Aleaguetableofchildmaltreatmentdeathsinrichnations.UnitedNationsInternationalChildrensEmergencyFund:InnocentiResearchCentre.

AlcoholAdvisoryCouncilofNewZealand.(2005).Theburdenofdeath,diseaseanddisabilityduetoalcoholinNewZealand.Welllington:ALAC.

Aligne,C.A.,&Stoddard,J.J.(1997).Tobaccoandchildren:aneconomicevaluationofthemedicaleffectsofparentalsmoking.Archivesofpediatrics&adolescentmedicine,151(7),648-653.

Anderson,S.E.,Economos,C.D.,&Must,A.(2008).ActiveplayandscreentimeinUSchildrenaged4to11yearsinrelationtosociodemographicandweightstatuscharacteristics:anationallyrepresentativecross-sectionalanalysis.BMCPublichealth,8(1),366.

Barr,M.,Signal,L.,Jenkin,G.,&Smith.,M.(2013).UsingSenseCamtoCaptureChildren’sExposuretoFoodMarketing:AFeasibilityStudy.ACM,50-51.

Bell,K.,McNaughton,D.,&Salmon,A.(2009).Medicine,MoralityandMothering:PublicHealthDiscoursesonFoetalAlcoholExposure,SmokingAroundChildrenandChildhoodOvernutrition.CriticalPublicHealth,19(2),155-170.

Biddle,S.J.,Gorely,T.,Marshall,S.J.,&Cameron.,a.N.(2009).Theprevalenceofsedentarybehaviorandphysicalactivityinleisuretime:astudyofScottishadolescentsusingecologicalmomentaryassessment.Preventivemedicine,48(2),151-155.

Bijur,P.E.,Kurzon,M.,Overpeck,M.D.,&Scheidt,P.C.(1992).Parentalalcoholuse,problemdrinking,andchildren'sinjuries.JAMA,267.23,3166-3171.

BrindleyR,B.A.(2011).ExplorationofuseofSenseCamtosupportautobiographicalmemoryretrievalwithinacognitivebehaviouraltherapeuticinterventionfollowingacquiredbraininjury..Memory,745-757.

CDC.(n.d.).BMIPercentileCalculatorforChildandTeen.RetrievedOctober19,2014,fromhttp://nccd.cdc.gov/dnpabmi/Calculator.aspx

Chalmers,D.,&Pless,B.(2001).UNICEF'schildinjuryleaguetables:abagofmixedmessages.InjuryPrevention,81-82.

Cohane,G.H.,&Pope.,H.G.(2001).Bodyimageinboys:Areviewoftheliterature.InternationalJournalofEatingDisorders,29.4,373-379.

Cole,T.J.,&Lobstein,T.(2012).Extendedinternational(IOTF)bodymassindexcut-offsforthinness,overweightandobesity.PediatricObesity,7(4),284-294.

CoonKA,GoldbergJ,RogersBL,TuckerK.Relationshipsbetweenuseoftelevisionduringmealsandchildren’sfoodconsumptionpatterns.Paediatrics.2001.

Davis,A.,&Jones,L.J.(1996).Childrenintheurbanenvironment:anissueforthenewpublichealthagenda.Health&Place,2.2,107-113.

DiFranza,J.R.,Wellman,R.J.,Sargent,J.D.,Weitzman,M.,Hipple,B.J.,&Winickoff,J.P.(2006).Tobaccopromotionandtheinitiationoftobaccouse:assessingtheevidenceforcausality.Pediatrics,e1237-e1248.

Doherty,A.R.,Hodges,S.E.,King,A.C.,Smeaton,A.F.,Berry,E.,Moulin,C.J.,etal.(2013).Wearablecamerasinhealth:Thestateoftheartandfuturepossibilities.AmJPrevMed,44(3):,320–323.

Forastiére,F.,GiuseppeM.Corbo,P.M.,Pistelli,R.,NeraAgabiti,G.B.,Ciappi,G.,&Perucci.,C.A.(1992).Effectsofenvironmentandpassivesmokingontherespiratoryhealthofchildren.Internationaljournalofepidemiology,21(1),66-73.

Franzini,L.,Elliott,M.N.,Cuccaro,P.,Schuster,M.,Gilliland,J.,Grunbaum,J.A.,etal.(2009).Influencesofphysicalandsocialneighborhoodenvironmentsonchildren'sphysicalactivityandobesity.AmericanJournalofPublicHealth,271.

FrenchSA,StoryM,Neumark-SztainerD,FulkersonJA,HannanP.Fastfoodrestaurantuseamongadolescents:associationswithnutrientintake,foodchoicesandbehavioralandpsychosocialvariables.IntJObesMetabDisord.2001.1823-33.

GemmingL,ADoherty,PKelly,JUtter&CNiMhurchu.FeasibilityofaSenseCam-assisted24hrecalltoreduceunder-reportingofenergyintake.EuropeanJournalofClinicalNutrition.2013.67;1095-1099

Hargreaves,D.A.,&Tiggemann,M.(2004).Idealizedmediaimagesandadolescentbodyimage:"Comparing"boysandgirls.BodyImage,351-361.

HeatherP,NicklasT.Areviewoffamilyandsocialdeterminantsofchildren’seatingpatternsanddietquality.JournaloftheAmericanCollegeofNutrition.2005

Hill,J.O.,Wyatt,H.R.,Reed,G.W.,&Peters,J.C.(2003).ObesityandtheEnvironment:Wheredowegofromhere?Science,299.5608,853-855.

Iannotti,R.J.,Kogan,M.D.,Janssen,I.,&Boyce,W.F.(2009).Patternsofadolescentphysicalactivity,screen-basedmediause,andpositiveandnegativehealthindicatorsintheUSandCanada.JournalofAdolescentHealth,44(5),493-499.

Kelly,P.,Doherty,A.R.,Hamilton,A.,Matthews,A.,Batterham,A.M.,Nelson,M.,etal.(Nov2012).EvaluatingthefeasibilityofmeasuringtraveltoschoolusingawearableCamera.AmJPrevMed,43(5):,546–550.

Kelly,P.,Doherty,A.,Berry,E.,Hodges,S.,A.M.,&Foster,C.(2011).Canweusedigitallife-logimagestoinvestigateactiveandsedentarytravelbehaviour?Resultsfromapilotstudy.InternationalJournalofBehavioralNutritionandPhysicalActivity,8:44.

Kelly,P.,Marshall,S.J.,Badland,H.,Kerr,J.,Oliver,M.,Doherty,A.R.,etal.(2013).AnEthicalFrameworkforAutomated,WearableCamerasinHealthBehaviorResearch.AmericanJournalofPreventiveMedicine,44(3),314–319.

Kerr,J.,Marshall,S.J.,Godbole,S.,Chen,J.,Legge,A.,Doherty,A.R.,etal.(2013).UsingtheSenseCamtoimproveclassificationsofsedentarybehaviourinFree-livingsettings.AmJPrevMed,44(3),290–296.

Mark,A.E.,Boyce,W.F.,&Janssen,I.(2006).Televisionviewing,computeruseandtotalscreentimeinCanadianyouth.Paediatrics&childhealth,11(9),595.

Marshall,S.J.,Gorely,T.,&Biddle,S.J.(2006).Adescriptiveepidemiologyofscreen-basedmediauseinyouth:Areviewandcritique.JournalofAdolescence,29,333-349.

Microsoft.(2013).SenseCamOverview.RetrievedOctober8,2014,fromMicrosoftResearch:http://research.microsoft.com/en-us/um/cambridge/projects/sensecam/

Nash,S.G.,McQueen,A.,&Bray,J.H.(2005).Pathwaystoadolescentalcoholuse:Familyenvironment,peerinfluence,andparentalexpectations.JournalofAdolescentHealth,37.1,19-28.

NZMinistryofHealth.(2012).TheHealthofNewZealandAdults2011/12.Wellington:NZMOH.

NZMOJ.(n.d.).UnitedNationsConventionontheRightsoftheChild.RetrievedOctober8,2014,fromwww.justice.govt.nz:http://www.justice.govt.nz/policy/constitutional-law-and-human-rights/human-rights/international-human-rights-instruments/international-human-rights-instruments-1/united-nations-convention-on-the-rights-of-the-child

OECD.(2009).DoingBetterforChildren.

O’LoughlinG,CullenSJ,McGoldricketcetc.Usingawearablecameratoincreaseaccuracyofdietaryanalysis.AmericanJournalofPreventativeMedicine.2013.44(3);297-301

Pauly-TakacsK,M.C.(2011).SenseCamasarehabilitationtoolinachildwithanterogradeamnesia..Memory,705-712.

PriceCohen,C.,&Naimark,H.(1991).UnitedNationsConventionontheRightsoftheChild:IndividualRightsConceptsandTheirSignificanceforSocialScientists.AmericanPsychologist,46(1),p60-65.

Pust,S.,Mohnen,S.M.,&Schneider,S.(2008).Individualandsocialenvironmentinfluencesonsmokinginchildrenandadolescents.Publichealth,122(12),1324-1330.

Salmon,J.,Tremblay,M.S.,Marshall,S.J.,&Hume,C.(2011).Healthrisks,correlates,andinterventionstoreducesedentarybehaviorinyoungpeople.Americanjournalofpreventivemedicine,41(2),197-206.

Schmidt,M.E.,Haines,J.,O'Brien,A.,McDonald,J.,Price,S.,Sherry,B.,etal.(2012).SystematicReviewofEffectiveStrategiesforReducingScreenTimeAmongYoungChildren.Obesity,20(7),1338-1354.

Sellen,A.J.,Aitken,M.,Hodges,S.,Rother,C.,&Wood,K.(2007).Dolife-loggingtechnologiessupportmemoryforthepast?:anexperimentalstudyusingsensecam.ProceedingsoftheSIGCHIconferenceonHumanfactorsincomputingsystems,81-90.

Smolak,L.(2003).Bodyimageinchildrenandadolescents:Wheredowegofromhere?BodyImage,1.1,15-28.

SnowJones,A.,Miller,D.J.,&Salkever.,D.S.(1999).Parentaluseofalcoholandchildren'sbehaviouralhealth:ahouseholdproductionanalysis.HealthEconomics,8.8,661-683.

Taylor,S.E.,&Repetti.,R.L.(1997).HEALTHPSYCHOLOGY:Whatisanunhealthyenvironmentandhowdoesitgetundertheskin?Annu.Rev.Psychol.,48,411-47.

UN.(1989,November20).ConventionontheRightsoftheChild.RetrievedOctober8,2014,fromUNDocuments:http://www.un-documents.net/crc.htm

VanDerVorst,H.,Engels,R.C.,Dekovic,M.,Meeus,W.,&Vermulst,A.A.(2007).Alcohol-specificrules,personalityandadolescents'alcoholuse:alongitudinalperson-environmentstudy.Addiction,1064-1075.

Wan,P.,&Smeaton.,A.F.(n.d.).UsingvisuallifelogstoautomaticallycharacterizeeverydayActivities.

Weitzman,M.,Gortmaker,S.,&Sobol,A.(1992).Maternalsmokingandbehaviorproblemsofchildren.Pediatrics,90(3),342-349.

WorldHealthOrganisation.(2012).Population-basedapproachestochildhoodobesityprevention.Geneva,Switzerland:WorldHealthOrganization.

Date post:	11-Jul-2020
Category:	Documents
Upload:	others
View:	5 times
Download:	0 times