Int J Health Geogr. 2025 Nov 3;24(1):32. doi: 10.1186/s12942-025-00409-7.
ABSTRACT
BACKGROUND: We describe the development of a comprehensive proof-of-concept index of environmental exposures for children based on evidence-informed connections to health behaviours- the Healthy Environments Index for Children (HEIC) — with two sub-indices relating to the food environment (HEIC-FE) and physical activity environment (HEIC-PA) in Taranaki, New Zealand. Associations between this theory-informed index and health outcomes in a cohort of children and adolescents identified with overweight or obesity and enrolled in a community-based healthy lifestyle programme and randomised controlled trial were examined.
METHODS: The HIEC was developed using Geographic Information Systems (GIS) and 15 variables selected from a series of systematic literature reviews identifying environmental factors associated with childhood obesity. Activity spaces around each participant’s residential address, and the route to their nearest school were created and used to estimate environmental exposure. Health data from the Whānau Pakari randomised controlled trial (n = 179 at baseline, 121 at 12-months, 95 at 24-months) was integrated to test associations between HEIC and health outcomes. Statistical analyses included spearman rank correlations, multinomial linear regression, and geographically weighted regression.
RESULTS: Higher HEIC scores (indicating health-promoting environments) tended to be clustered within the cities and towns, while rural areas had low HEIC scores. Strong and consistent associations were not identified between HEIC indices and health outcomes in our study population. However, higher HEIC food environments were associated with increased water intake and decreased sweet drink intake at 24-months.
CONCLUSIONS: The theory-informed HEIC and its two subindices may be useful tools for policy and practice aiming at improving child health outcomes. However, they require validation in larger studies in other areas of New Zealand.
PMID:41184879 | DOI:10.1186/s12942-025-00409-7
