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ABSTRACT:This paper estimates the incidence (all ages) of spinal cord neurological impairment (SCI; traumatic and non traumatic) in New Zealand and describes pre-SCI characteristics and early post-SCI outcomes for participants (16-64 years) in this longitudinal study. Demographic and clinical data on all people admitted to New Zealand's two spinal units (mid-2007 to mid-2009 )were included for the estimate of incidence. Participants in this longitudinal study were asked at first interview about pre-SCI socio-demographic, health and behavioural characteristics, and about post-SCI symptoms, general health status (EQ-5D) and disability (WHODAS 12-item). Age-adjusted incidence rates (95% CI) for European,Maori, Pacific and 'Other' ethnicities were 29 (24-34), 46 (30-64), 70 (40-100) and 16 (9-22) per million, respectively. Interviews with 118 (73%) participants (16-64 years), occurred 6.5 months post-SCI. Most reported bother with symptoms, and problems with health status and disability. Compared with Europeans, the incidence of SCI is high among Maori and particularly high among Pacific people. Six months after SCI, proximate to discharge from the spinal units, considerable symptomatic, general health and disability burden was borne by people with SCI. [ABSTRACT FROM AUTHOR]

The article focuses on the perception of New Zealand smokers on tobacco endgame as of November 2013. New Zealand has a goal of achieving a smoke-free society by year 2025. It notes that this goal reflects the country's endgame solutions to tobacco smoking. In response, tobacco companies created an endgame strategies as contrary to individual freedoms and choice. An interview which shows the strong support of the 2025 smoke-free goal is detailed.

Aim To examine the prevalence of smoker support for a ban on cigarette sales in 10 years time and increased regulation of the tobacco industry and to investigate the independent associations of support for these measures. Methods The authors surveyed opinions among adult smokers in two survey waves (N¼1376 and N¼923) from the New Zealand arm of the International Tobacco Control Policy Evaluation Survey during 2007e2009. The authors report prevalence of support stratified by age, gender and ethnicity. The authors carried out multivariate analyses to identify significant associations among potential determinants (demographics, socioeconomic status, mental health and smoking-related beliefs and behaviours) of support. Results Most New Zealand smokers supported greater regulation of the tobacco industry (65%) and more government action on tobacco (59%). Around half (46%) supported banning sales of cigarettes in 10 years time, provided effective nicotine substitutes were available. In a fully adjusted model, significant associations with support for greater tobacco company regulation included Maori ethnicity, experience of financial stress and greater awareness about the harms of smoking. Significant associations with support for a ban on tobacco sales in 10 years time included increasing area-based deprivation level, increasing intention to quit and greater concern about the health effects of smoking. Conclusions The findings suggest that most smokers will support stronger government action to control the tobacco industry and that many support radical ‘endgame’ approaches. Greater support among Maori, more deprived and possibly Pacific smokers, is an important finding, which could inform the design and implementation of new policies given the very high smoking prevalence among these groups and hence high priority for targeted tobacco control interventions. Perceived difficulties in gaining public support should not impede the introduction of rigorous tobacco control measures needed to achieve a tobacco-free New Zealand. [ABSTRACT FROM AUTHOR]

Background: There appears to be considerable variation between different national jurisdictions and between different sectors of public policy in the use of evidence and particularly the use of randomised controlled trials (RCTs) to evaluate non-healthcare sector programmes. Methods: As part of a wider study attempting to identify RCTs of public policy sector programmes and the reasons for variation between countries and sectors in their use, we carried out a pilot study which interviewed 10 policy makers and researchers in six countries to elicit views on barriers to and facilitators of the use of RCTs for social programmes. Results: While in common with earlier studies, those interviewed expressed a need for unambiguous findings, timely results and significant effect sizes, users could, in fact, be ambivalent about robust methods and robust answers about what works, does not work or makes no difference, particularly where investment or a policy announcement was planned. Different national and policy sector cultures varied in their use of and support for RCTs. Conclusions: In order to maximise the use of robust evaluations of public programmes across the world it would be useful to examine, systematically, cross-national and cross-sectoral variations in the use of different methods including RCTs and barriers to and facilitators of their use. Sound research methods, whatever their scientific value, are no guarantee that findings will be useful or used. 'Stories' have been shown to influence policy; those advocating the use of RCTs may need to provide convincing narratives to avoid repetition about their value. [ABSTRACT FROM AUTHOR]

Background Tobacco companies have opposed the removal of tobacco retail displays, arguing this would compromise retailers' safety, increase retail crime, reduce retailers' income, impose additional costs and be inconvenient. These arguments have successfully delayed policy development in several jurisdictions. Methods In-depth interviews conducted with New Zealand retailers who had voluntarily removed tobacco from open display in their stores. Results Retailers who had removed tobacco displays did so primarily to reduce their security risk and found their stores had become less vulnerable to retail crime. They did not find removing displays costly or inconvenient nor had this decision significantly reduced their revenue. Conclusions Removing in-store tobacco displays may increase rather than decrease store safety. Our findings reveal that retailers' experiences differed in many ways from tobacco companies' predictions and suggest that industry arguments against display removal lack objective support and are self-serving. [ABSTRACT FROM AUTHOR]

Background Tobacco industry documents illustrate how packaging promotes smoking experimentation and reinforces existing smokersbehaviour. Plain packaging reduces the perceived attractiveness of smoking and creates an opportunity to introduce larger pictorial warnings that could promote cessation-linked behaviours. However, little is known about the effects such a combined policy measure would have on smokers' behaviour. Methods A 3 (warning size) *4 (branding level) plus control (completely plain pack) best-worst experiment was conducted via face-to-face interviews with 292 young adult smokers from a New Zealand provincial city. The Juster Scale was also used to estimate cessation-linked behaviours among participants. Results Of the 13 options tested, respondents were significantly less likely to choose those featuring fewer branding elements or larger health warnings. Options that featured more branding elements were still preferred even when they also featured a 50% health warning, but were significantly less likely to be chosen when they featured a 75% warning. Comparison of a control pack representing the status quo (branded with 30% front of pack warning) and a plain pack (with a 75% warning) revealed the latter would be significantly more likely to elicit cessation-related behaviours. Conclusions Plain packs that feature large graphic health warnings are significantly more likely to promote cessation among young adult smokers than fully or partially branded packs. The findings support the introduction of plain packaging and suggest use of unbranded package space to feature larger health warnings would further promote cessation. [ABSTRACT FROM AUTHOR]

Background Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons. Methods In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory. Results 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age- related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age- specific testing, with some favouring whole- of- career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns-- remediate, restrict or retire--and emphasised the need for co- ordinated and timely responses. Conclusion Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self- awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age. [ABSTRACT FROM AUTHOR]

Background Despite the investment in exploring patient-centred alternatives to medical malpractice in New Zealand (NZ), the UK and the USA, patients' experiences with these processes are not well understood. We sought to explore factors that facilitate and impede reconciliation following patient safety incidents and identify recommendations for strengthening institutionled alternatives to malpractice litigation. Methods We conducted semistructured interviews with 62 patients injured by healthcare in NZ, administrators of 12 public hospitals, 5 lawyers specialising in Accident Compensation Corporation (ACC) claims and 3 ACC staff. NZ was chosen as the research site because it has replaced medical malpractice litigation with a no-fault scheme. Thematic analysis was used to identify key themes from interview transcripts. Results Interview responses converged on five elements of the reconciliation process that were important: (1) ask, rather than assume, what patients and families need from the process and recognise that, for many patients, being heard is important and should occur early in the reconciliation process; (2) support timely, sincere, culturally appropriate and meaningful apologies, avoiding forced or tokenistic quasi-apologies; (3) choose words that promote reconciliation; (4) include the people who patients want involved in the reconciliation discussion, including practitioners involved in the harm event; and (5) engage the support of lawyers and patient relations staff as appropriate. Discussion Policymakers and healthcare institutions are keenly interested in non-litigation approaches to resolving malpractice incidents. Interviewing participants involved in patient safety incident reconciliation processes suggests that healthcare institutions should not view apology as a substitute for other remedial actions; use flexible guidelines that distil best-practice principles, ensuring that steps are not missed, while not prescribing a 'one size fits all' communication approach. [ABSTRACT FROM AUTHOR]

Background Reduction of the availability of tobacco has been proposed as a means of reducing and denormalising tobacco use. Some retailers have stopped selling tobacco. Therefore, we investigated how willing New Zealand convenience store owners were to stop selling tobacco or sell nicotine replacement therapy. Promotion of their stores was offered as an incentive to stop selling tobacco. Methods We asked convenience store owners in the Auckland metropolitan region of New Zealand to choose one of three actions. The first was to stop selling tobacco for a short period of time; the second was to restrict the hours that they sold tobacco; the third was to display and sell nicotine replacement therapy. All participating retailers completed a short interview about selling tobacco. We also surveyed customers about nicotine replacement and cessation. Results One-third of eligible retailers agreed to participate. Most who participated (93%) were unwilling to stop or restrict tobacco sales and 2 (7%) had already stopped selling tobacco. Tobacco was perceived as a key product for their businesses. Very few customers who purchased cigarettes noticed nicotine replacement therapy or obtained it from convenience stores. Conclusions Substantially reducing the availability of tobacco in communities is likely to require legislative approaches, underpinned by sustained community pressure and support for convenience store owners who are willing to change their business model. [ABSTRACT FROM AUTHOR]

Objectives: The aims are to: (1) Determine the cumulative incidence of self-reported subsequent injury (of any anatomical site or injury type) occurring between 3 months and 12 months after a sentinel injury among participants in the Prospective Outcomes of Injury Study in New Zealand and (2) Examine the preinjury and injury-related predictors of subsequent injury. Methods: Prospective Outcomes of Injury Study participants (n=2282) were interviewed 3 months, 5 months and 12 months after a sentinel injury event. Data were collected about a range of preinjury and injury-related factors at the 3-month interview and about subsequent injury at the 5-month and 12-month interviews. Poisson regression modelling was used to determine the preinjury and injury-related predictors of subsequent injury. Results: Between the 3-month and 12 month interviews 28% of the participants reported at least one subsequent injury. Subsequent injury was 34% more likely among participants with a prior injury affecting them at the time of the sentinel injury compared with participants without a prior injury affecting them, and more likely among non-workers (31% more likely) and trade/manual workers (32% more likely) compared with professionals. Participants whose sentinel injury was due to assault were 43% more likely to report a subsequent injury compared with those whose sentinel injury was accidental. A subsequent injury was 23% less likely if the sentinel injury was a lower extremity fracture compared with other injuries, and 21% less likely if the sentinel injury event involved hospitalisation. Conclusions: Among general injury populations it may be possible to identify people at increased risk for subsequent injury. [ABSTRACT FROM AUTHOR]

Objective To identify factors associated with non-participation at the 12-month and 24-month follow-up phases of a prospective cohort study of injury outcomes. Methods Associations between non-participation at follow-up phases and a range of sociodemographic, injury, health, outcome and administrative factors were examined. Results An individual's non-participation at 12 months did not necessarily mean non-participation at 24 months. Sociodemographic factors were the most salient for non-participation, regardless of the number of follow-up phases or specific phase considered. Conclusions Retention rates in prospective cohort studies of injury outcome may be improved by follow-up of everyone irrespective of previous non-participation, focusing resources to retain men, young adults, indigenous people and those living with people other than family members, and by ensuring that multiple alternative participant contacts are obtained. There is sufficient evidence to be concerned about potential bias given that several of the factors we, and others, have identified as associated with non-participation are also associated with various functional and disability outcomes following injury. This suggests detailed investigations are warranted into the effect non-participation may be having on the estimates for various outcomes. [ABSTRACT FROM AUTHOR]

Background Although social smoking has increased among young adults, it remains a poorly understood behaviour. The authors explored how young adult social smokers viewed and defined smoking and the strategies they used to reconcile their conflicting smoker and nonsmoker identities. The authors also examined alcohol's role in facilitating social smoking and investigated measures that would decouple drinking and smoking. Methods The authors conducted 13 in-depth interviews with young adult social smokers aged between 19 and 25 years and used thematic analysis to interpret the transcripts. Results The authors identified four key themes: the demarcation strategies social smokers used to avoid classifying themselves as smokers, social smoking as a tactic that ameliorates the risk of alienation, alcohol as a catalyst of social smoking and the difficulty participants experienced in reconciling their identity as non-smokers who smoke. Conclusions Although social smokers regret smoking, their retrospective remorse was insufficient to promote behaviour change, and environmental modifications appear more likely to promote smoke-free behaviours among social smokers. Participants strongly supported extending the smoke-free areas outside bars, a measure that would help decouple their alcohol-fuelled behaviours from the identity to which they aspire. [ABSTRACT FROM AUTHOR]

Background New Zealand offers a unique opportunity for cost-of-injury research due to its comprehensive, no-fault injury compensation insurance scheme, which is managed by the government-controlled Accident Compensation Corporation (ACC).Objectives To estimate the costs of injury in New Zealand with respect to ACC's spending for entitlement claimants (ie, people with injuries requiring more that 'treatment only'), as well as injured individuals' out-of pocket-personal spending and non-pecuniary costs in terms of effects on health-related quality of life (HRQoL).Methods A prospective cohort study of people injured between June 2007 and May 2009 was followed for12 months after injury. ACC's spending for each participant (n = 2215) was estimated from ACC data.Out-of-pocket personal spending and quality-adjusted life years (QALYs) lost were estimated based on interviews conducted at 3, 5 and 12 months post injury.Results For the cohort studied, most of the reported financial costs of injury were met by ACC. ACC spending was higher for individuals with more severe injuries and ones admitted to hospital. There was no difference in mean personal spending between people who were hospitalised or not, or between those with minor or moderate injuries, although individuals with more severe injuries reported higher personal spending.Conclusions Overall, the ACC appears to be performing well supporting injured people financially. Nonetheless, people with more severe injuries incur substantial out-of pocket-expenses. Costs are higher for hospitalised and more severe injuries, but non-hospitalised and less severe cases can still incur substantial costs. The HRQoL effects of injured naturally, borne by injured individualsthemselvesdare relatively large on average. [ABSTRACT FROM AUTHOR]

Background Evidence for a cross-sectional relationship between income and health is strong but is probably biased by substantial confounding. Longitudinal data with repeated income and health measures on the same individuals can be analysed to control completely for time-invariant confounding, giving a more accurate estimate of the impact of short-term changes in income on health. Methods 4 years of annual data (2002--2005) from the New Zealand longitudinal Survey of Family, Income and Employment were used to investigate the relationship between annual household income and self-rated health (SRH) using a fixed-effects ordinal logistic regression model. Possible effect modification of the income--SRH relationship by poverty and baseline health was tested with interactions. Results An increase in income of $10 000 over the past year increased the odds of reporting better SRH by 1% (OR 1.01, 95% CI 1.00 to 1.02). Poor baseline health significantly modified the association between income and SRH. A $10 000 increase in income increased the odds of better SRH by 10% for those with two or more chronic conditions. Poverty or deprivation did not modify the income--health association. Conclusions The overall small, positive, but statistically non-significant, income--health effect size is consistent with similar analyses from other longitudinal studies. Despite the overwhelming consensus that income matters for health over the medium and long-term, evidence free of time-invariant confounding for the short-run association remains elusive. However, measurement error in income and health has probably biased estimates towards the null. [ABSTRACT FROM AUTHOR]

The Prospective Outcomes of Injury Study aims to identify predictors of disability following injury. Participants were selected from the entitlement claims register of New Zealand's no-fault compensation insurer, the Accident Compensation Corporation, and followed up by interview for 2 years. This report describes changes to intended Prospective Outcomes of Injury Study methods and key characteristics of the cohort, with an emphasis on general health and disability before injury and soon afterwards. There were 2856 injured participants in the first interview, which occurred 3.2 months (median) after injury. The recruitment period was extended to enable inclusion of sufficient Mori participants. At the first interview, most participants were experiencing worse health status and increased disability compared to before injury, despite less than one-third reporting admission to hospital because of their injury. Analysis of outcome predictors related to post-injury function, disability and return-to-work soon after injury and 1 year later is now under way. [ABSTRACT FROM AUTHOR]

Background: Few studies document the health burden attributable to intimate partner violence (IPV) at the population level. Objectives: To document injuries resulting from IPV and women's use of healthcare for treatment of IPV injuries using the New Zealand Violence Against Women Study. Methods: A cross-sectional household survey was conducted using a population-based cluster sampling scheme. In total, 2855 women aged 18--64 years were interviewed about their experience of IPV, injuries resulting from violence, and their use of healthcare services. Results: Of the 956 women who had experienced physical and/or sexual IPV in their lifetime, half were injured at least once as a result of the violence. The most common injuries were abrasions and bruises; followed by cuts, punctures, bites; and injuries to the eye or ear. Many women reported that they needed healthcare for treatment of IPV injuries, yet most (86%) did not receive healthcare on all occasions it was needed. Half of ever-injured women who received treatment told a healthcare provider the reason for their injury. Among those who did not disclose, shame was the most frequent reason for not telling, followed by fear of further violence. Conclusions: This population-based study documents the injury-burden created by IPV, to individuals, healthcare systems, and the population. Implications include supporting healthcare providers to respond to victims of violence and the need for prevention strategies at the population level. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tobacco retail displays promote smoking experimentation among youth; however, little is known about their effect on smokers making a quit attempt. Calls to ban tobacco retail displays would be strengthened if this measure would deter initiation and support cessation. METHODS: Semistructured in-depth interviews were conducted with 20 individuals, from two New Zealand provincial cities, who had attempted to quit smoking in the last 6 months. RESULTS: Tobacco products had high visibility, and elicited emotional and physical reactions that created on-going temptation, complicated cessation attempts and stimulated impulse purchases. Participants strongly supported banning tobacco retail displays primarily because they thought this would reduce youth initiation, promote greater consistency with smoke-free promotions and assist those attempting to quit. CONCLUSIONS: The effects of tobacco retail displays on smokers making a cessation attempt are explored. The findings are consistent with experimental and survey research, and expand a growing evidence base that supports government-mandated bans on tobacco retail displays. [ABSTRACT FROM AUTHOR]