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Deprivation matters: understanding associations between neighbourhood deprivation, unhealthy food outlets, unhealthy dietary behaviours and child body size using structural equation modelling
  1. Victoria Egli1,
  2. Matthew Hobbs2,
  3. Jordan Carlson3,
  4. Niamh Donnellan1,
  5. Lisa Mackay4,
  6. Daniel Exeter5,
  7. Karen Villanueva6,
  8. Caryn Zinn4,
  9. Melody Smith1
  1. 1 School of Nursing, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
  2. 2 GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand
  3. 3 Center for Children’s Healthy Lifestyles & Nutrition, Children’s Mercy, Kansas City, Missouri, USA
  4. 4 School of Sport and Recreation, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
  5. 5 Epidemiology and Biostatistics, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
  6. 6 Centre for Urban Research, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
  1. Correspondence to Dr Victoria Egli, School of Nursing, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand; v.egli{at}


Background Children residing in neighbourhoods of high deprivation are more likely to have poorer health, including excess body size. While the availability of unhealthy food outlets are increasingly considered important for excess child body size, less is known about how neighbourhood deprivation, unhealthy food outlets and unhealthy dietary behaviours are interlinked.

Methods This study involves children aged 8–13 years (n=1029) and resided in Auckland, New Zealand. Unhealthy dietary behaviours (frequency of consumption of unhealthy snacks and drinks) and food purchasing behaviour on the route to and from school were self-reported. Height and waist circumference were measured to calculate waist-to-height ratio (WtHR). Geographic Information Systems mapped neighbourhood deprivation and unhealthy food outlets within individual, child-specific neighbourhood buffer boundaries (800 m around the home and school). Associations between neighbourhood deprivation (calculated using the New Zealand Index of Deprivation 2013), unhealthy food outlets, unhealthy dietary behaviours and WtHR were investigated using structural equation modelling in Mplus V.8.0. Age, sex and ethnicity were included as covariates, and clustering was accounted for at the school level.

Results Structural equation models showed that unhealthy food outlets were unrelated to unhealthy dietary behaviours (estimate 0.029, p=0.416) and excess body size (estimate −0.038, p=0.400). However, greater neighbourhood deprivation and poorer dietary behaviours (estimate −0.134, p=0.001) were associated with greater WtHR (estimate 0.169, p<0.001).

Conclusion Excess child body size is associated with neighbourhood deprivation and unhealthy dietary behaviours but not unhealthy outlet density or location of these outlets near home and school.

  • deprivation
  • child health
  • nutrition

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  • Correction notice The images for figure 1 and figure 3 were published the wrong way around. This has been corrected in the current version online. However, the print version is incorrect.

  • Twitter Victoria Egli @EgliVictoria and Matthew Hobbs @hobbs_PA

  • Contributors VE, MS, LM, CZ and KV contributed to the initial study design. VE, LM and ND contributed to preliminary data analysis and VE, JC, DE, MS and MH contributed to the modelling. All authors contributed to the manuscript and approved the final version prior to submission.

  • Funding This study was supported by a Health Research Council of New Zealand grant (grant number 14/436). MS is supported by a Health Research Council of New Zealand Sir Charles Hercus Research Fellowship (grant number 17/013).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval to conduct the study was provided by the host institution ethics committees (AUT Ethics Committee 14/263, 3 September 2014; Massey University Human Ethics Committee, 3 September 2014; University of Auckland Human Participant Ethnics Committee, 9 September 2014).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. We do not have permission from the participants to share this data in whole or in part.

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