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BACKGROUND: Improving social circumstances (eg, an increase in income, finding a job or moving into a good neighbourhood) may reduce tobacco use, but robust evidence on the effects of such improvements is scarce. Accordingly we investigated the link between changing social circumstances and changing tobacco smoking using repeated measures data. METHODS: 15 000 adults with at least two observations over three waves (each 2 years apart) of a panel study had data on smoking status, family, labour force, income and deprivation (both neighbourhood and individual). Fixed effects regression modelling was used. FINDINGS: The odds of smoking increased 1.42-fold (95% CI 1.16 to 1.74) for a one log-unit increase in personal income among 15-24-year-olds, but there was no association of increased smoking with an increase in income among 25+ year olds. Moving out of a family nucleus, increasing neighbourhood deprivation (eg, 1.83-fold (95% CI 1.18 to 2.83) increased odds of smoking for moving from least to most deprived quintile of neighbourhoods), increasing personal deprivation and moving into employment were all associated with increased odds of smoking. The number of cigarettes smoked a day changed little with changing social circumstances. INTERPRETATION: Worsening social circumstances over the short run are generally associated with higher smoking risk. However, there were counter examples: for instance, decreasing personal income among young people was associated with decreased odds of smoking, a finding consistent with income elasticity of demand (the less one's income, the less one can consume). This paper suggests that improving social circumstances is not always pro-health over the short run; a more nuanced approach to the social determinants of health is required. [ABSTRACT FROM AUTHOR]

Objectives This paper aims to examine ethnic differences in financial barriers to access to prescriptionmedication in New Zealand. Methods Data from SoFIE-Health (wave 3), which is an add-on to the Statistics New Zealand-led longitudinal Survey of Family, Income and Employment (SoFIE) (N¼18 320), were analysed using logistic regression, adjusting for demographic, socioeconomic, health behaviour and health variables. Financial barriers to access to prescription items were measured by the following question: 'In the past 12 months, have there been any times when a doctor gave you a prescription, but you didn't collect one or more of these items because you could not afford the cost?'. Results The odds of deferring buying a prescription at least once during the preceding 12 months because they could not afford the cost of the prescription were greater for Maori and Pacific people than for NZ Europeans (OR 2.98, 95% CI 2.56 to 3.47 vs OR 3.52, 95% CI 2.85 to 4.35). Adjusting for potential confounders attenuated the ORs to 1.31 (95% CI 1.08 to 1.58) for Maori people and to 2.17 (95% CI 1.68 to 2.81) for Pacific people. Deferring buying medications because of cost was also associated with increased odds of poor self-reported health status, high/very high psychological stress and the presence of two or more comorbid conditions. Conclusion Ethnicity plays a critical role in facilitating or impeding access to primary health care. This suggests that policy measures to further reduce financial barriers to buying medication may improve access to care for everyone including Maori and Pacific people and may have positive health implications. [ABSTRACT FROM AUTHOR]

Background and aims Adolescents represent the next generation and have the greatest amount to gain from the tobacco endgame. They will provide the future momentum to achieve the tobacco endgame, thus it is important that their views on interventions are monitored. We examined support among 14-15-year-old New Zealanders for tobacco endgame goals and measures, and trends in this support from 2009 to 2012. Methods This study used data from an annual survey of over 25 000 Year 10 students (14-15 year olds) undertaken by Action on Smoking and Health New Zealand. We assessed support for five tobacco control goals and measures: living in a smoke-free country; having fewer tobacco retail outlets; not selling tobacco in 10 years' time; implementing outdoor smoking bans; and raising the price of tobacco. Results Support for living in a smoke-free country was 59%, while support for a ban on all tobacco sales in 10 years' time was 57% in the most recent survey year. Most respondents supported each of the tobacco control measures and gave strongest support to having fewer places where tobacco could be sold (71% in 2012). Support for the other two tobacco control measures in the most recent year ranged from 59% to 64% and had increased over time, in most cases significantly. Support was strongest among non-smokers and declined as participants' smoking frequency increased. Conclusions Young people support New Zealand's smoke-free goal and interventions that could help achieve it; this evidence should galvanise policy action, which remains out of step with public opinion. [ABSTRACT FROM AUTHOR]

Background Evidence that exposure to tobacco 'powerwalls' increases young people's susceptibility to smoking has led many countries to require the removal of these displays. Despite this important step, tobacco remains widely available and policy action appears to have stalled. Methods We conducted an online survey of 364 smokers and 402 non-smokers aged 18 years and above, who were sampled from a commercial internet panel in January 2013. Results Six months after the removal of all tobacco products from open display in New Zealand retail outlets, strong support for the new law exists. Although daily smokers were less supportive than other groups, smokers intending to quit within the next 6 months were more likely than not to believe the law would facilitate quitting. Irrespective of their smoking status, respondents supported not selling tobacco products within 500 m of a school, and requiring tobacco retailers to sell nicotine replacement therapy products. Conclusions Public support for more progressive 'endgame' retail measures could catalyse policy action which, in turn, could offer greater protection to young people and accelerate declines in smoking prevalence. Mandatory tobacco-free retail zones around schools, and requiring stores selling tobacco to stock cessation products received strong support, even among daily smokers; both measures would reduce youth exposure to tobacco while providing smokers with better access to cessation aids. [ABSTRACT FROM AUTHOR]

Background In New Zealand, the burden of childhood obesity is greatest in M_aori and Pacific children. Methods In 687 infants from an internet-based birth cohort in New Zealand, we investigated ethnic differences in early life risk factors for later obesity, the degree to which these were explained by sociodemographic factors, and the extent to which ethnic differences in weight at age 3 months were explained by measured risk factors. Results The risk of having an obese mother was double in M_aori and Pacific infants compared with NZ European infants (prevalence 24% and 14%, respectively; OR 2.23, 95% CI 1.23 to 4.04). M_aori and Pacific infants had higher weights in the first week of life and at 3 months (mean difference 0.19 kg, 95% CI 0.01 to 0.38), and their mothers had higher scores on a ‘snacks' dietary pattern and lower scores on ‘healthy' and ‘sweet' dietary patterns. These inequalities were not explained by maternal education, maternal age or areabased deprivation. No ethnic differences were observed for maternal pre-pregnancy physical activity, hypertension or diabetes in pregnancy, exclusive breastfeeding or early introduction of solid foods. Ethnic inequalities in infant weight at 3 months were not explained by sociodemographic variables, maternal pre-pregnancy body mass index or dietary pattern scores or by other measured risk factors. Conclusions This study shows excess prevalence of early life risk factors for obesity in M_aori and Pacific infants in New Zealand and suggests an urgent need for early interventions for these groups. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the present work were to (a) develop a relatively simple single-observer method for data collection on cigarette butt discarding; and (b) quantify cigarette butt discarding behaviour in city streets. Methods: A method was developed, piloted and refined (with interobserver assessment). Cigarette butt discarding was systematically observed by a single data collector while walking a continuous circuit of busy downtown streets in a capital city (Wellington, New Zealand). Results: The final method appeared feasible in this setting and seemed efficient (at 5.5 discarding events observed per hour). A clear majority (76.7%; 95% CI 70.8 to 82.0%) of the 219 smokers observed littered their cigarette butts. Butt littering was more common for those who did not extinguish their cigarette (94.4% vs 4.5%, p=0.003). Butt littering was more common in the evening versus lunchtime periods of observation (85.8% vs 68.1%, p=0.002, logistic regression analysis). Overall, most smokers (73.5%) did not extinguish their butts and some placed lit butts in bins (constituting a risk of bin fires). The context for this littering was a high density of rubbish bins on this circuit with a mean of 3.5 bins being in view and with a bin every 24 m on average. Conclusions: Butt littering behaviour appears to be the norm among smokers in this urban setting, even though rubbish bins were ubiquitous. One solution is stronger enforcement of littering laws. Nevertheless, in a society with a national smokefree goal (by year 2025 for New Zealand), it would probably be more logical and cost effective to move to smokefree policies for major city streets, which are used in a number of jurisdictions internationally. [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]

Background Few cohort studies of the health effects of urban air pollution have been published. There is evidence, most consistently in studies with individual measurement of social factors, that more deprived populations are particularly sensitive to air pollution effects. Methods Records from the 1996 New Zealand census were anonymously and probabilistically linked to mortality data, creating a cohort study of the New Zealand population followed up for 3 years. There were 1.06 million adults living in urban areas for which data were available on all covariates. Estimates of exposure to air pollution (measured as particulate matter with an aerodynamic diameter less than 10 &mgr;m, PM10) were available for census area units from a previous land use regression study. Logistic regression analyses were conducted to investigate associations between causespecific mortality rates and average exposure to PM10 in urban areas, with control for confounding by age, sex, ethnicity, social deprivation, income, education, smoking history and ambient temperature. Results The odds of all-cause mortality in adults (aged 30e74 years at census) increased by 7% per 10 μg/m3 increase in average PM10 exposure (95% CI 3% to 10%) and 20% per 10 μg/m3 among Maori, but with wide CI (7% to 33%). Associations were stronger for respiratory and lung cancer deaths Conclusions An association of PM10 with mortality is reported in a country with relatively low levels of air pollution. The major limitation of the study is the probable misclassification of PM10 exposure. On balance, this means the strength of association was probably underestimated. The apparently greater association among Maori might be due to different levels of co-morbidity. INSETS: What is already known on this subject;What this study adds. [ABSTRACT FROM AUTHOR]

Background: New Zealand is a temperate country with substantial excess winter mortality. We investigated whether this excess winter mortality varies with social factors.Methods: Records from New Zealand censuses in 1981,1986, 1991, 1996 and 2001 were each anonymously and probabilistically linked to 3 years of subsequent mortality data creating five cohort studies of the New Zealand adult population (age 30-74 years at census) each with3 years' follow-up. Logistic regression analysis was used to model the risk of dying in winter compared to summer with winter deaths classified '1' and summer deaths '0'.There were 75 138 eligible mortality records with complete data on social variables recorded for 58 683(78%).Results: Adjusting for age, sex, census year, ethnicity and tenure, those in the lowest tertile of income were at increased risk of winter death compared to those in the highest tertile: OR 1.13 (95% CI 1.08 to 1.19). Compared to home owners, people living in rented accomadation were at greater risk of winter death: OR 1.05 (95% CI1.01 to 1.10). Urban dwellers were also at significantlyincreased risk. The strongest associations were seen for infectious diseases.Conclusions: There was an increased risk of dying in winter for most New Zealanders, but more so among low-income people, those living in rented accommodation and those living in cities. Exact casual mechanisms are not known but possibly include correlated poorer health status, low indoor temperatures and household crowding. [ABSTRACT FROM AUTHOR]

Background: Previous research shows associations of geographical density of alcohol outlets with a range of alcohol-related harms. Socioeconomic conditions that are associated with both outlet density and alcohol-related outcomes may confound many studies. We examined the association of outlet density with both consumption and harm throughout New Zealand while controlling for indicators of area deprivation and individual socioeconomic status (SES). Methods: Individual alcohol consumption and drinking consequences were measured in a 2007 national survey of 18--70 year olds (n=1925). All alcohol outlets in New Zealand were geocoded. Outlet density was the number of outlets of each type (off-licences (stores that sell alcoholic beverages for consumption elsewhere), bars, clubs, restaurants) within 1 km of a person's home. We modelled the association of outlet density with total consumption, binge drinking, risky drinking (above New Zealand guidelines) and two measures of effects ('harms' and 'troubles' due to drinking) in the previous year. Logistic regression and zero-inflated Poisson models were used, adjusting for sex, educational level, a deprivation index (NZDep06) and a rurality index. Results: No statistically significant association was seen between outlet density and either average alcohol consumption or risky drinking. Density of off-licences was positively associated with binge drinking, and density of all types of outlet was associated with alcohol-related harm scores, before and after adjustment for SES. Associations of off-licences and clubs with trouble scores were no longer statistically significant in the adjusted analysis. Conclusions: The positive associations seen between alcohol outlet density and both individual level binge drinking and alcohol-related problems appear to be independent of individual and neighbourhood SES. Reducing density of alcohol outlets may reduce alcohol-related harm among those who live nearby. [ABSTRACT FROM AUTHOR]