Health-related Attitudes, Perceptions and Practices of Young people: A Comparative Observational Case Study between a school in New Zealand and Tonga

Abstract

ntroduction Non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and cancers are the leading cause of ill-health globally. They contribute significantly to social inequities. The burden of NCD risk and incidence, and associated socio-economic impacts are disproportionately high in low- and middle-income countries (LMIC), and communities experiencing social and economic deprivation in high-income countries. Evidence from the field of research known as Developmental Origins of Health and Disease demonstrates strong associations between early-life environmental influences (including before birth) and later life NCD risk. This has highlighted the inter-generational nature of NCD risk, and the importance of adolescence as a life phase where the establishment of health-promoting behaviours may influence the future health of the individual and their potential future offspring. Exploring factors influencing adolescent food choices could usefully inform NCD prevention strategies targeting this life phase. Setting Tonga is an example of a Pacific LMIC burdened with high levels of adult overweight, obesity (90%/67%), and associated NCDs. In New Zealand, communities experiencing social and economic deprivation have similarly high levels of overweight/obesity and NCDs. Many of these communities have significant Pacific populations. Participants and Aim This study compared the dietary attitudes and practices of Year 9 students (13 to 14 years-ofage) in a school in Nuku'alofa, Tonga, and a school in a low-income setting in Auckland, New Zealand. Assessment of the built-food environment surrounding each school enabled examination of the influence of this on adolescent food-related practices. Methods A mixed methods approach was developed using the Kakala and Talanga frameworks. This employed a self-reflective questionnaire (n = 100 Auckland; n = 81 Nuku'alofa); focus groups (n = 28 Auckland); and spatial mapping of food-stores in the environment surrounding each school. Findings Students in both settings reported positive attitudes towards the importance of food, but poor dietary practices. Purchasing lunch from food-stores on-site and in the surrounding area was common for students in both locations. Five key influences on dietary practices were identified via focus groups in Auckland: agency; influential people; individual preferences; accessibility; advertising. Significant differences were observed in the density of food-stores surrounding the two schools (n = 52 Auckland, n = 150 Nuku'alofa). Poor quality foods dominated the foodstores surrounding both schools. Conclusion This evidence offers participating schools a snapshot of current influences on adolescent dietary practices that could inform learning programmes designed by teachers to support young people to examine and explore these issues. It offers schools a protocol that could be repeated to enable tracking of these issues over time.